EMERGENCY RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Effective Date of Rule: Immediately.
Purpose: The department is amending WAC 388-106-0125 and
388-106-0130 to adjust in-home hours based on individualized
CARE assessments related to:
• An elimination of the increase associated with incontinence and/or specialized diet for clients with informal support; and
• An increase that gives back some of the hours reduced
July 1, 2009, to all in-home clients.
Citation of Existing Rules Affected by this Order: Amending WAC 388-106-0125 and 388-106-0130.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.
Other Authority: Washington state 2009-2011 supplemental operating budget (ESSB 6444).
Under RCW 34.05.350 the agency for good cause finds 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: These adjustments are necessary to address the state's revenue shortfall as outlined in the 2009-2011 supplemental operating budget (ESSB 6444). This CR-103E continues emergency rules filed as WSR 10-14-055 while the department completes adoption of permanent rules. A CR-101 was filed as WSR 10-14-056, and the department is currently in the process of filing a CR-102 Proposed rule making.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 2, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.
Date Adopted: October 26, 2010.
Katherine I. Vasquez
Rules Coordinator
-4216.1(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 ((416)) 420 base hours if you have
an ADL score of 26-28; or
(b) Group E Medium with ((346)) 349 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 ((277)) 279 base hours if you have
an ADL score of 25-28; or
(b) Group D Medium-High with ((234)) 236 base hours if
you have an ADL score of 18-24; or
(c) Group D Medium with ((185)) 187 base hours if you
have an ADL score of 13-17; or
(d) Group D Low with ((138)) 139 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 ((194)) 196 base hours if you have
an ADL score of 25-28; or
(b) Group C Medium-High with ((174)) 176 base hours if
you have an ADL score of 18-24; or
(c) Group C Medium with ((132)) 133 base hours if you
have an ADL score of 9-17; or
(d) Group C Low with ((87)) 88 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 ((147)) 149 base hours if you have
an ADL score of 15-28; or
(b) Group B Medium with ((82)) 83 base hours if you have
an ADL score of 5-14; or
(c) Group B Low with ((47)) 48 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 ((147)) 149 base hours if you have
a behavior point score 12 or greater; or
(b) Group B Medium-High with ((101)) 102 base hours if
you have a behavior point score greater than 6; or
(c) Group B Medium with ((82)) 83 base hours if you have
a behavior point score greater than 4; or
(d) Group B Low with ((47)) 48 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 ((71)) 72 base hours if you have an
ADL score of 10-28; or
(b) Group A Medium with ((56)) 57 base hours if you have
an ADL score of 5-9; or
(c) Group A Low with ((26)) 27 base hours if you have an
ADL score of 0-4.
[Statutory Authority: RCW 74.08.090, 74.09.520, 2009 c 564 § 206(5). 10-11-050, § 388-106-0125, filed 5/12/10, effective 6/12/10. 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.]
(2) The department will deduct from the base hours to account for informal supports, as defined in WAC 388-106-0010, or other paid services that meet some of an individual's need for personal care services, including adult day health, as follows:
(a) The CARE tool determines the adjustment for informal
supports by determining the amount of assistance available to
meet your needs, assigns it a numeric percentage, and reduces
the base hours assigned to the classification group by the
numeric percentage. The department has assigned the following
numeric values for the amount of assistance available for each
ADL and IADL:
| Meds | Self Performance | Status | Assistance Available | Value Percentage |
| Self administration of medications | Rules for all codes apply except independent is not counted | Unmet | N/A | 1 |
| Met | N/A | 0 | ||
| Decline | N/A | 0 | ||
| Partially met | <1/4 time | .9 | ||
| 1/4 to 1/2 time | .7 | |||
| 1/2 to 3/4 time | .5 | |||
| >3/4 time | .3 | |||
| Unscheduled ADLs | Self Performance | Status | Assistance Available | Value Percentage |
| Bed mobility, transfer, walk in room, eating, toilet use | Rules apply for all codes except:
Did not occur/client not able and
Did not occur/no provider = 1; Did not occur/client declined and independent are not counted. |
Unmet | N/A | 1 |
| Met | N/A | 0 | ||
| Decline | N/A | 0 | ||
| Partially met | <1/4 time | .9 | ||
| 1/4 to 1/2 time | .7 | |||
| 1/2 to 3/4 time | .5 | |||
| >3/4 time | .3 | |||
| Scheduled ADLs | Self Performance | Status | Assistance Available | Value Percentage |
| Dressing, personal hygiene, bathing |
Rules apply for all codes except:
Did not occur/client not able and
Did not occur/no provider = 1; Did not occur/client declined and independent are not counted. |
Unmet | N/A | 1 |
| Met | N/A | 0 | ||
| Decline | N/A | 0 | ||
| Partially met | <1/4 time | .75 | ||
| 1/4 to 1/2 time | .55 | |||
| 1/2 to 3/4 time | .35 | |||
| >3/4 time | .15 | |||
| IADLs | Self Performance | Status | Assistance Available | Value Percentage |
| Meal preparation, Ordinary housework, Essential shopping |
Rules for all codes apply except independent is not counted. | Unmet | N/A | 1 |
| Met | N/A | 0 | ||
| Decline | N/A | 0 | ||
| Partially met | <1/4 time | .3 | ||
| 1/4 to 1/2 time | .2 | |||
| 1/2 to 3/4 time | .1 | |||
| >3/4 time | .05 | |||
| IADLs | Self Performance | Status | Assistance Available | Value Percentage |
| Travel to medical | Rules for all codes apply except independent is not counted. | Unmet | N/A | 1 |
| Met | N/A | 0 | ||
| Decline | N/A | 0 | ||
| Partially met | <1/4 time | .9 | ||
| 1/4 to 1/2 time | .7 | |||
| 1/2 to 3/4 time | .5 | |||
| >3/4 time | .3 | |||
| Key: > means greater than < means less than |
||||
(3) Also, the department will adjust in-home base hours when:
(a) There is more than one client receiving ADSA-paid personal care services living in the same household, the status under subsection (2)(a) of this section must be met or partially met for the following IADLs:
(i) Meal preparation;
(ii) Housekeeping;
(iii) Shopping; and
(iv) Wood supply.
(b) You are under the age of eighteen, your assessment will be coded according to age guidelines codified in WAC 388-106-0213.
(4) ((In addition to any determination of unmet need in
(2)(a) when you are not affected by (3) above, the department
will score the status for meal preparation as unmet when you
adhere to at least one of the following special diets:
(a) ADA (diabetes);
(b) Autism diet;
(c) Calorie reduction;
(d) Low sodium;
(e) Mechanically altered;
(f) Planned weight change program;
(g) Renal diet; or
(h) Needs to receive nutrition through tube feeding or receives greater than twenty-five percent of calories through tube or parenteral feeding.
(5) In addition to any determination of unmet need in (2)(a) when you are not affected by (3) above, the department will score the status for housework as unmet when you are incontinent of bladder or bowel, documented as:
(a) Incontinent all or most of the time;
(b) Frequently incontinent; or
(c) Occasionally incontinent.
(6))) After deductions are made to your base hours, as described in subsections (2) and (3), the department may add on hours based on your living environment:
| Condition | Status | Assistance Available | Add On Hours |
| Offsite laundry facilities, which means the client does not have facilities in own home and the caregiver is not available to perform any other personal or household tasks while laundry is done. | N/A | N/A | 8 |
| Client is >45 minutes from essential services (which means he/she lives more than 45 minutes one-way from a full-service market). | Unmet | N/A | 5 |
| Met | N/A | 0 | |
| Partially met | <1/4 time | 5 | |
| between 1/4 to 1/2 time | 4 | ||
| between 1/2 to 3/4 time | 2 | ||
| >3/4 time | 2 | ||
| Wood supply used as sole source of heat. | Unmet | N/A | 8 |
| Met | N/A | 0 | |
| Declines | N/A | 0 | |
| Partially met | <1/4 time | 8 | |
| between 1/4 to 1/2 time | 6 | ||
| between 1/2 to 3/4 time | 4 | ||
| >3/4 time | 2 |
(((8))) (6) The result of actions under subsections (2),
(3), and (4)((, (5) and (6))) is the maximum number of hours
that can be used to develop your plan of care. The department
must take into account cost effectiveness, client health and
safety, and program limits in determining how hours can be
used to meet your identified needs. In the case of New
Freedom consumer directed services (NFCDS), a New Freedom
spending plan (NFSP) is developed in place of a plan of care.
(((9))) (7) You and your case manager will work to
determine what services you choose to receive if you are
eligible. The hours may be used to authorize:
(a) Personal care services from a home care agency provider and/or an individual provider.
(b) Home delivered meals (i.e. a half hour from the available hours for each meal authorized).
(c) Adult day care (i.e. a half hour from the available hours for each hour of day care authorized).
(d) A home health aide if you are eligible per WAC 388-106-0300 or 388-106-0500.
(e) A private duty nurse (PDN) if you are eligible per WAC 388-71-0910 and 388-71-0915 or WAC 388-551-3000 (i.e. one hour from the available hours for each hour of PDN authorized).
(f) The purchase of New Freedom consumer directed services (NFCDS).
[Statutory Authority: RCW 74.08.090, 74.09.520. 08-23-011, § 388-106-0130, filed 11/6/08, effective 12/7/08; 08-03-111, § 388-106-0130, filed 1/22/08, effective 2/22/08. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.030. 06-16-035, § 388-106-0130, filed 7/25/06, effective 8/25/06. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-106-0130, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0130, filed 5/17/05, effective 6/17/05.]