WSR 10-05-068

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed February 12, 2010, 12:14 p.m. , effective February 13, 2010 ]


Effective Date of Rule: February 13, 2010.

Purpose: Amending WAC 388-106-0125 If I am age twenty-one or older, how does CARE use criteria to place me in a classification group for in-home care?, and adopting new WAC 388-106-0126 If I am under age twenty-one, how does CARE use criteria to place me in a classification group for in-home care?

These emergency rules continue rules filed as WSR 09-21-074. The department is revising WAC 388-106-0125 to amend the in-home classifications to allow for the reduction of in-home base hours for each of the seventeen classification groups. The department is adopting new WAC to comply with a United States District Court order to exclude children and youth under the age of twenty-one from the rules.

Citation of Existing Rules Affected by this Order: Amending WAC 388-106-0125.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

Other Authority: Washington state 2009-11 budget (ESHB 1244).

Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule; and that in order to implement the requirements or reductions in appropriations enacted in any budget for fiscal years 2009, 2010, or 2011, which necessitates the need for the immediate adoption, amendment, or repeal of a rule, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the fiscal needs or requirements of the agency.

Reasons for this Finding: The Washington state 2009-11 operating budget (ESHB 1244) directs the department to reduce the number of in-home hours authorized. The hours awarded for in-home long-term care for each of the seventeen CARE classification groups are reduced by a certain percentage. As instructed by the legislature, classification groups with greater care needs receive a smaller percentage reduction than classification groups with lesser care needs.

The United States District Court in Tacoma issued an order stating "that the Department will not apply the emergency rules contained in WSR 09-14-046 to the Medicaid in-home personal care services provided to children and youth under the age of 21." These emergency rules continue rules filed as WSR 09-21-074 while the department proceeds with the permanent rule-making process.

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 1, Amended 1, 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 1, Amended 1, Repealed 0.

Date Adopted: February 9, 2010.

Don Goldsby, Manager

Rules and Policies Assistance Unit

4113.4
AMENDATORY SECTION(Amending WSR 08-10-022, filed 4/25/08, effective 5/26/08)

WAC 388-106-0125   If I am age twenty-one or older, how does CARE use criteria to place me in a classification group for in-home care?   CARE uses the criteria of cognitive performance score as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behavior and behavior point score as determined under WAC 388-106-0100, ADLS as determined under WAC 388-106-0105, and exceptional care as determined under WAC 388-106-0110 to place you into one of the following seventeen in-home groups. 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 base hours to lowest qualifying base hours.

(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 with ((420)) 416 base hours if you have an ADL score of 26-28; or

(b) Group E Medium with ((350)) 346 base hours if you have an ADL score of 22-25.

(2) If you meet the criteria for clinical complexity and have cognitive performance score of 4-6 or you have cognitive performance score of 5-6, 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 with ((280)) 277 base hours if you have an ADL score of 25-28; or

(b) Group D Medium-High with ((240)) 234 base hours if you have an ADL score of 18-24; or

(c) Group D Medium with ((190)) 185 base hours if you have an ADL score of 13-17; or

(d) Group D Low with ((145)) 138 base hours 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 with ((200)) 194 base hours if you have an ADL score of 25-28; or

(b) Group C Medium-High with ((180)) 174 base hours if you have an ADL score of 18-24; or

(c) Group C Medium with ((140)) 132 base hours if you have an ADL score of 9-17; or

(d) Group C Low with ((95)) 87 base hours 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 with ((155)) 147 base hours if you have an ADL score of 15-28; or

(b) Group B Medium with ((90)) 82 base hours if you have an ADL score of 5-14; or

(c) Group B Low with ((52)) 47 base hours if you have an ADL score of 0-4; or

(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 with ((155)) 147 base hours if you have a behavior point score 12 or greater; or

(b) Group B Medium-High with ((110)) 101 base hours if you have a behavior point score greater than 6; or

(c) Group B Medium with ((90)) 82 base hours if you have a behavior point score greater than 4; or

(d) Group B Low with ((52)) 47 base hours if you have a behavior point score greater than 1.

(6) If you are not clinically complex and your CPS score is less than 5 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 with ((78)) 71 base hours if you have an ADL score of 10-28; or

(b) Group A Medium with ((62)) 56 base hours if you have an ADL score of 5-9; or

(c) Group A Low with ((29)) 26 base hours if you have an ADL score of 0-4.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 2007 c 522. 08-10-022, 388-106-0125, filed 4/25/08, effective 5/26/08. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0125, filed 5/17/05, effective 6/17/05.]


NEW SECTION
WAC 388-106-0126   If I am under age twenty-one, how does CARE use criteria to place me in a classification group for in-home care?   CARE uses the criteria of cognitive performance score as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behavior and behavior point score as determined under WAC 388-106-0100, ADLS as determined under WAC 388-106-0105, and exceptional care as determined under WAC 388-106-0110 to place you into one of the following seventeen in-home groups. 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 base hours to lowest qualifying base hours.

(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 with 420 base hours if you have an ADL score of 26-28; or

(b) Group E Medium with 350 base hours if you have an ADL score of 22-25.

(2) If you meet the criteria for clinical complexity and have cognitive performance score of 4-6 or you have cognitive performance score of 5-6, 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 with 280 base hours if you have an ADL score of 25-28; or

(b) Group D Medium-High with 240 base hours if you have an ADL score of 18-24; or

(c) Group D Medium with 190 base hours if you have an ADL score of 13-17; or

(d) Group D Low with 145 base hours 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 with 200 base hours if you have an ADL score of 25-28; or

(b) Group C Medium-High with 180 base hours if you have an ADL score of 18-24; or

(c) Group C Medium with 140 base hours if you have an ADL score of 9-17; or

(d) Group C Low with 95 base hours 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 with 155 base hours if you have an ADL score of 15-28; or

(b) Group B Medium with 90 base hours if you have an ADL score of 5-14; or

(c) Group B Low with 52 base hours if you have an ADL score of 0-4; or

(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 with 155 base hours if you have a behavior point score 12 or greater; or

(b) Group B Medium-High with 110 base hours if you have a behavior point score greater than 6; or

(c) Group B Medium with 90 base hours if you have a behavior point score greater than 4; or

(d) Group B Low with 52 base hours if you have a behavior point score greater than 1.

(6) If you are not clinically complex and your CPS score is less than 5 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 with 78 base hours if you have an ADL score of 10-28; or

(b) Group A Medium with 62 base hours if you have an ADL score of 5-9; or

(c) Group A Low with 29 base hours if you have an ADL score of 0-4.

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Washington State Code Reviser's Office