WSR 10-22-123

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed November 3, 2010, 11:15 a.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 10-14-056.

     Title of Rule and Other Identifying Information: Chapter 388-106 WAC, Long-term care services.

     Hearing Location(s): Office Building 2, Auditorium, DSHS Headquarters, 1115 Washington, Olympia, WA 98504 (public parking at 11th and Jefferson. A map is available at http://www1.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html, or by calling (360) 664-6094), on December 7, 2010, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than December 8, 2010.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 1115 Washington Street S.E., Olympia, WA 98504, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on December 7, 2010.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by November 23, 2010, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: 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.


     Amendments are necessary to implement the 2009-2011 supplemental budget, ESSB 6444.

     Reasons Supporting Proposal: See above.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

     Statute Being Implemented: ESSB 6444.

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: Department of social and health services, governmental.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Geri-Lyn McNeil, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2353.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The preparation of a small business economic impact statement is not required, as no new costs will be imposed on small businesses or nonprofits as a result of this rule amendment.

     A cost-benefit analysis is not required under RCW 34.05.328. Rules are exempt, per RCW 34.05.328 (5)(b)(vii), relating only to client medical or financial eligibility.

November 1, 2010.

Katherine I. Vasquez

Rules Coordinator

4216.1
AMENDATORY SECTION(Amending WSR 10-11-050, filed 5/12/10, effective 6/12/10)

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 ((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.]


AMENDATORY SECTION(Amending WSR 08-23-011, filed 11/6/08, effective 12/7/08)

WAC 388-106-0130   How does the department determine the number of hours I may receive for in-home care?   (1) The department assigns a base number of hours to each classification group as described in WAC 388-106-0125.

     (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 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

     (b) To determine the amount of reduction for informal support, the value percentages are totaled and divided by the number of qualifying ADLs and IADLs needs. The result is value A. Value A is then subtracted from one. This is value B. Value B is divided by three. This is value C. Value A and Value C are summed. This is value D. Value D is multiplied by the "base hours" assigned to your classification group and the result is the number of in-home hours reduced for informal supports.

     (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

     (((7))) (5) In the case of New Freedom consumer directed services (NFCDS), the department determines hours as described in WAC 388-106-1445.

     (((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.]

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