WSR 08-19-102

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed September 17, 2008, 6:39 a.m. , effective October 18, 2008 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: The department is amending chapter 388-106 WAC, Long-term care services, to phase in a 17 level CARE assessment payment system effective July 1, 2008, as directed by ESHB 2687 (Washington state supplemental operating budget).

Prior to July 1, 2008, the department assigned a home and community residential client to one of 12 CARE classifications. The development of the 17 CARE classifications for home and community residential clients allows the department to tie payment more closely to acuity. Each of the 17 levels of CARE classifications is assigned a payment rate.

Citation of Existing Rules Affected by this Order: Amending WAC 388-106-0080, 388-106-0110, and 388-106-0115.

Statutory Authority for Adoption: ESHB 2687, chapter 329, Laws of 2008.

Adopted under notice filed as WSR 08-14-121 on July 1, 2008.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 3, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.

Date Adopted: September 11, 2008.

Stephanie E. Schiller

Rules Coordinator

4001.2
AMENDATORY SECTION(Amending WSR 05-11-082, filed 5/17/05, effective 6/17/05)

WAC 388-106-0080   How is the amount of long-term care services I can receive in my own home or in a residential facility determined?   The amount of long-term care services you can receive in your own home or in a residential facility is determined through a classification system. ((Twelve)) Seventeen classifications apply to clients served in residential and in-home settings. ((Two additional exceptional care groups apply to clients served in in-home settings.)) The department has assigned each classification a residential facility daily rate or a base number of hours you can receive in your own home.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0080, filed 5/17/05, effective 6/17/05.]


AMENDATORY SECTION(Amending WSR 08-10-022, filed 4/25/08, effective 5/26/08)

WAC 388-106-0110   How does the CARE tool evaluate me for the exceptional care classification of ((in-home care)) the E Group?   CARE places you in the exceptional care E Group classifications ((for the in-home setting)) when the following criteria are met in either diagram 1 or 2:


Diagram 1
You have an ADL score of greater than or equal to 22.
AND
You need a Turning/repositioning program.
AND
You ((require)) need at least one of the following:

▪ External catheter;

▪ Intermittent catheter;

▪ Indwelling catheter care;

▪ Bowel program;

▪ Ostomy care; or

▪ Total in Self Performance for Toilet Use.

AND
You need one of the following services provided by an individual provider, agency provider, a private duty nurse, or through self-directed care when in the in home setting, or provided by AFH/boarding home staff, facility RN/LPN, facility staff or private duty nursing when living in a residential setting:

▪ Active range of motion (AROM); or

▪ Passive range of motion (PROM).


Diagram 2
You have an ADL score of greater than or equal to 22.
AND
You need a Turning/repositioning program.
AND
You need one of the following services provided by an individual provider, agency provider, a private duty nurse, or through self-directed care when in the in home setting, or provided by AFH/boarding home staff, facility RN/LPN, facility staff or private duty nursing when living in a residential setting:

▪ Active range of motion (AROM); or

▪ Passive range of motion (PROM).

AND
All of the following apply:

▪ You require IV nutrition support or tube feeding;

▪ Your total calories received per IV or tube was greater than 50%; and

▪ Your fluid intake by IV or tube is greater than 2 cups per day.

AND
You need assistance with one of the following, provided by an individual provider, agency provider, a private duty nurse, or through self-directed care when in the in home setting or provided by AFH/boarding home staff, facility RN/LPN, facility staff, a private duty nurse or nurse delegation when living in a residential setting:

▪ Dialysis; or

▪ Ventilator/respirator.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 2007 c 522. 08-10-022, 388-106-0110, filed 4/25/08, effective 5/26/08. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0110, filed 5/17/05, effective 6/17/05.]


AMENDATORY SECTION(Amending WSR 05-11-082, filed 5/17/05, effective 6/17/05)

WAC 388-106-0115   How does CARE use ((the)) criteria ((of cognitive performance as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behaviors as determined under WAC 388-106-0100, and ADLs as determined under WAC 388-106-0105)) to place me in a classification group for residential facilities?   The CARE tool uses the criteria of cognitive performance as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behaviors as determined under WAC 388-106-0100, ((and)) ADLs as determined under WAC 388-106-0105 and exceptional care under WAC 388-106-0110 to place you into one of the following ((twelve)) seventeen residential classification groups:


((Classification)) ((ADL Score)) ((Group))
((Group D

Cognitive performance score = 4-6

and

Clinically complex = yes

and

Mood/behavior = yes or no))

((ADL Score 18-28)) ((D High (12)))
((ADL Score 13-17)) ((D Med (11)))
((ADL Score 2-12)) ((D Low (10)))
((Group C

Cognitive performance score = 0-3

and

Clinically complex = yes

and

Mood/behavior = yes or no))

((ADL Score 18-28)) ((C High (9)))
((ADL Score 9-17)) ((C Med (8)))
((ADL Score 2-8)) ((C Low (7)))
((Group B

Mood & behavior = Yes

and

Clinically complex = no

and

Cognitive performance score = 0-6))

((ADL Score 15-28)) ((B High (6)))
((ADL Score 5-14)) ((B Med (5)))
((ADL Score 0-4)) ((B Low (4)))
((Group A

Mood & behavior = No

and

Clinically complex = No

and

Cognitive performance score = 0-6))

((ADL Score 10-28)) ((A High (3)))
((ADL Score 5-9)) ((A Med (2)))
((ADL Score 0-4)) ((A Low (1)))

CARE classification is determined first by meeting criteria to be placed into a group, then you are further classified based on ADL score or behavior point score into a classification sub-group following a classification path of highest possible group to lowest qualifying group.

(1) If you meet the criteria for exceptional care, then CARE will place you in Group E. CARE then further classifies you into:

(a) Group E High if you have an ADL score of 26-28; or

(b) Group E Medium if you have an ADL score of 22-25.

(2) If you meet the criteria for clinical complexity and have a cognitive performance score of 4-6 then you are classified in Group D regardless of your mood and behavior qualification or behavior points. CARE then further classifies you into:

(a) Group D High if you have an ADL score of 25-28; or

(b) Group D Medium-High if you have an ADL score of 18-24; or

(c) Group D Medium if you have an ADL score of 13-17; or

(d) Group D Low if you have an ADL score of 2-12.

(3) If you meet the criteria for clinical complexity and have a CPS score of less than 4, then you are classified in Group C regardless of your mood and behavior qualification or behavior points. CARE then further classifies you into:

(a) Group C High if you have an ADL score of 25-28; or

(b) Group C Medium-High if you have an ADL score of 18-24; or

(c) Group C Medium if you have an ADL score of 9-17; or

(d) Group C Low if you have an ADL score of 2-8.

(4) If you meet the criteria for mood and behavior qualification and do not meet the classification for C, D, or E groups, then you are classified into Group B. CARE further classifies you into:

(a) Group B High if you have an ADL score of 15-28; or

(b) Group B Medium if you have an ADL score of 5-14; or

(c) Group B Low if you have an ADL score of 0-4.

(5) If you meet the criteria for behavior points and have a CPS score of greater than 2 and your ADL score is greater than 1, and do not meet the classification for C, D, or E groups, then you are classified in Group B. CARE further classifies you into:

(a) Group B High if you have a behavior point score 12 or greater; or

(b) Group B Medium-High if you have a behavior point score greater than 6; or

(c) Group B Medium if you have a behavior point score greater than 4; or

(d) Group B Low if you have a behavior point score greater than 1.

(6) If you are not clinically complex and you do not qualify under either mood and behavior criteria, then you are classified in Group A. CARE further classifies you into:

(a) Group A High if you have an ADL score of 10-28; or

(b) Group A Medium if you have an ADL score of 5-9; or

(c) Group A Low if you have an ADL score of 0-4.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0115, filed 5/17/05, effective 6/17/05.]

Washington State Code Reviser's Office