WSR 10-22-065

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed October 29, 2010, 2:29 p.m. , effective November 1, 2010 ]


     Effective Date of Rule: November 1, 2010.

     Purpose: Amending rules in chapters 388-71 and 388-106 WAC to implement Governor's Executive Order 10-04 to reduce current year spending by 6.287%. The law creates three classifications of personal care services. Participants will be eligible for either agency managed personal care services or participant managed personal care services based upon their assessed cognitive and decision making abilities. Eligible participants may also choose residential personal care services. The department may authorize exceptions based on the client's health and safety. These rules will not affect the amount, duration, or scope of the personal care services benefit to which the client may be entitled.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-71-0500, 388-71-0540, 388-71-0546, 388-106-0010, 388-106-0020, 388-106-0055, 388-106-0600, 388-106-1300, 388-106-1303, and 388-106-1445.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

     Other Authority: Governor's Executive Order 10-04.

     Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.

     Reasons for this Finding: State law authorizes and directs the governor to implement across-the-board reductions of allotments of appropriations to avoid a projected cash deficit. Governor's Executive Order 10-04 reduces current year spending by 6.287%, and the department is proposing these amendments to stay within the reduced appropriation.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.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 2, Amended 10, 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 2, Amended 10, Repealed 0.

     Date Adopted: October 27, 2010.

Katherine I. Vasquez

Rules Coordinator

4246.2
AMENDATORY SECTION(Amending WSR 05-11-082, filed 5/17/05, effective 6/17/05)

WAC 388-71-0500   What is the purpose of WAC 388-71-0500 through (([388-71-05952] [388-71-05909])) 388-71-05909?   A client/legal representative may choose an individual provider or a home care agency provider based upon criteria set forth in WAC 388-106-0042 and 388-106-0043. The intent of WAC 388-71-0500 through (([388-71-05952] [388-71-05909])) 388-71-05909 is to describe the:

     (1) Qualifications of an individual provider, as defined in WAC 388-106-0010;

     (2) Qualifications of a home care agency provider, as defined in WAC 388-106-0010 and chapter 246-336 WAC;

     (3) Conditions under which the department or the area agency on aging (AAA) will pay for the services of an individual provider or a home care agency provider;

     (4) Training requirements for an individual provider and home care agency provider.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-71-0500, filed 5/17/05, effective 6/17/05. Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0500, filed 10/21/02, effective 11/21/02. Statutory Authority: Chapter 74.39A RCW and 2000 c 121. 02-10-117, § 388-71-0500, filed 4/30/02, effective 5/31/02. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0500, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0500, filed 1/13/00, effective 2/13/00.]


AMENDATORY SECTION(Amending WSR 10-06-112, filed 3/3/10, effective 4/3/10)

WAC 388-71-0540   When will the department((, AAA,)) or the department's designee deny payment for services of an individual provider or home care agency provider?   The department((, AAA,)) or the department's designee will deny payment for the services of an individual provider or a home care agency provider ((if the services are provided by an employee of the home care agency who is related by blood, marriage, adoption, or registered domestic partnership to the client.

     The department, AAA, or department designee will deny payment for the services of an individual provider or home care agency provider)) who:

     (1) Is the client's spouse, per 42 C.F.R. 441.360(g), except in the case of an individual provider for a chore services client. Note: For chore spousal providers, the department pays a rate not to exceed the amount of a one-person standard for a continuing general assistance grant, per WAC 388-478-0030;

     (2) Is the natural/step/adoptive parent of a minor client aged seventeen or younger receiving services under medicaid personal care;

     (3) Is a foster parent providing personal care to a child residing in their licensed foster home;

     (4) Has been convicted of a disqualifying crime, under RCW 43.43.830 and 43.43.842 or of a crime relating to drugs as defined in RCW 43.43.830;

     (5) Has abused, neglected, abandoned, or exploited a minor or vulnerable adult, as defined in chapter 74.34 RCW;

     (6) Has had a license, certification, or a contract for the care of children or vulnerable adults denied, suspended, revoked, or terminated for noncompliance with state and/or federal regulations;

     (7) Does not successfully complete the training requirements within the time limits required in WAC 388-71-05665 through 388-71-05865;

     (8) Is already meeting the client's needs on an informal basis, and the client's assessment or reassessment does not identify any unmet need; ((and/or))

     (9) Is terminated by the client (in the case of an individual provider) or by the home care agency (in the case of an agency provider(())); and/or

     (10) Is not a qualified provider of a service the client is eligible to receive.

     In addition, the department, AAA, or department designee may deny payment to or terminate the contract of an individual provider as provided under WAC 388-71-0546, 388-71-0551, and 388-71-0556.

[Statutory Authority: RCW 74.08.090, 74.09.520, 2009 c 571, and Washington state 2009-11 budget, section 206(17). 10-06-112, § 388-71-0540, filed 3/3/10, effective 4/3/10. Statutory Authority: RCW 74.08.090, 74.09.520. 07-24-026, § 388-71-0540, filed 11/28/07, effective 1/1/08. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-71-0540, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-71-0540, filed 5/17/05, effective 6/17/05. Statutory Authority: Chapter 74.39A RCW and 2000 c 121. 02-10-117, § 388-71-0540, filed 4/30/02, effective 5/31/02. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0540, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0540, filed 1/13/00, effective 2/13/00.]


AMENDATORY SECTION(Amending WSR 06-05-022, filed 2/6/06, effective 3/9/06)

WAC 388-71-0546   When can the department((, AAA,)) or ((managed care entity)) the department's designee reject the client's choice of an individual provider?   The department((, AAA,)) or ((managed care entity)) the department's designee may reject a client's request to have a family member or other person serve as his or her individual provider if the case manager has a reasonable, good faith belief that the person will be unable to appropriately meet the client's needs. Examples of circumstances indicating an inability to meet the client's needs could include, without limitation:

     (1) Evidence of alcohol or drug abuse;

     (2) A reported history of domestic violence, no-contact orders, or criminal conduct (whether or not the conduct is disqualifying under RCW 43.43.830 and 43.43.842;

     (3) A report from the client's health care provider or other knowledgeable person that the requested provider lacks the ability or willingness to provide adequate care;

     (4) Other employment or responsibilities that prevent or interfere with the provision of required services;

     (5) Excessive commuting distance that would make it impractical to provide services as they are needed and outlined in the client's service plan.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-71-0546, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0546, filed 5/4/01, effective 6/4/01.]


AMENDATORY SECTION(Amending WSR 10-08-074, filed 4/6/10, effective 5/7/10)

WAC 388-106-0010   What definitions apply to this chapter?   "Ability to make self understood" means how you make yourself understood to those closest to you; express or communicate requests, needs, opinions, urgent problems and social conversations, whether in speech, writing, sign language, symbols, or a combination of these including use of a communication board or keyboard:

     (a) Understood: You express ideas clearly;

     (b) Usually understood: You have difficulty finding the right words or finishing thoughts, resulting in delayed responses, or you require some prompting to make self understood;

     (c) Sometimes understood: You have limited ability, but are able to express concrete requests regarding at least basic needs (e.g. food, drink, sleep, toilet);

     (d) Rarely/never understood. At best, understanding is limited to caregiver's interpretation of client specific sounds or body language (e.g. indicated presence of pain or need to toilet.)

     "Activities of daily living (ADL)" means the following:

     (a) Bathing: How you take a full-body bath/shower, sponge bath, and transfer in/out of tub/shower.

     (b) Bed mobility: How you move to and from a lying position, turn side to side, and position your body while in bed, in a recliner, or other type of furniture.

     (c) Body care: How you perform with passive range of motion, applications of dressings and ointments or lotions to the body and pedicure to trim toenails and apply lotion to feet. In adult family homes, contracted assisted living, enhanced adult residential care, and enhanced adult residential care-specialized dementia care facilities, dressing changes using clean technique and topical ointments must be performed by a licensed nurse or through nurse delegation in accordance with chapter 246-840 WAC. Body care excludes:

     (i) Foot care if you are diabetic or have poor circulation; or

     (ii) Changing bandages or dressings when sterile procedures are required.

     (d) Dressing: How you put on, fasten, and take off all items of clothing, including donning/removing prosthesis.

     (e) Eating: How you eat and drink, regardless of skill. Eating includes any method of receiving nutrition, e.g., by mouth, tube or through a vein.

     (f) Locomotion in room and immediate living environment: How you move between locations in your room and immediate living environment. If you are in a wheelchair, locomotion includes how self-sufficient you are once in your wheelchair.

     (g) Locomotion outside of immediate living environment including outdoors: How you move to and return from more distant areas. If you are living in a boarding home or nursing facility (NF), this includes areas set aside for dining, activities, etc. If you are living in your own home or in an adult family home, locomotion outside immediate living environment including outdoors, includes how you move to and return from a patio or porch, backyard, to the mailbox, to see the next-door neighbor, etc.

     (h) Walk in room, hallway and rest of immediate living environment: How you walk between locations in your room and immediate living environment.

     (i) Medication management: Describes the amount of assistance, if any, required to receive medications, over the counter preparations or herbal supplements.

     (j) Toilet use: How you use the toilet room, commode, bedpan, or urinal, transfer on/off toilet, cleanse, change pad, manage ostomy or catheter, and adjust clothes.

     (k) Transfer: How you move between surfaces, i.e., to/from bed, chair, wheelchair, standing position. Transfer does not include how you move to/from the bath, toilet, or vehicle.

     (l) Personal hygiene: How you maintain personal hygiene, including combing hair, brushing teeth, shaving, applying makeup, washing/drying face, hands (including nail care), and perineum (menses care). Personal hygiene does not include hygiene in baths and showers.

     "Aged person" means a person sixty-five years of age or older.

     "Agency managed personal care services", per WAC 388-106-0043, means in-home personal care services and performance of the employer functions such as recruitment, scheduling, supervision, and monitoring of personal care workers for clients who, based upon criteria in a CARE assessment, may need assistance with employer functions.

     "Agency provider" means a licensed home care agency or a licensed home health agency having a contract to provide long-term care personal care services to you in your own home.

     "Application" means a written request for medical assistance or long-term care services submitted to the department by the applicant, the applicant's authorized representative, or, if the applicant is incompetent or incapacitated, someone acting responsibly for the applicant. The applicant must submit the request on a form prescribed by the department.

     "Assessment details" means a summary of information that the department entered into the CARE assessment describing your needs.

     "Assessment or reassessment" means an inventory and evaluation of abilities and needs based on an in-person interview in your own home or your place of residence, using CARE.

     "Assistance available" means the amount of informal support available if the need is partially met. The department determines the amount of the assistance available using one of four categories:

     (a) Less than one-fourth of the time;

     (b) One-fourth to one-half of the time;

     (c) Over one-half of the time to three-fourths of the time; or

     (d) Over three-fourths but not all of the time.

     "Assistance with body care" means you need assistance with:

     (a) Application of ointment or lotions;

     (b) Trimming of toenails;

     (c) Dry bandage changes; or

     (d) Passive range of motion treatment.

     "Assistance with medication management" means you need assistance managing your medications. You are scored as:

     (a) Independent if you remember to take medications as prescribed and manage your medications without assistance.

     (b) Assistance required if you need assistance from a nonlicensed provider to facilitate your self-administration of a prescribed, over the counter, or herbal medication, as defined in chapter 246-888 WAC. Assistance required includes reminding or coaching you, handing you the medication container, opening the container, using an enabler to assist you in getting the medication into your mouth, alteration of a medication for self-administration, and placing the medication in your hand. This does not include assistance with intravenous or injectable medications. You must be aware that you are taking medications.

     (c) Self-directed medication assistance/administration if you are a person with a functional disability who is capable of and who chooses to self-direct your medication assistance/administration.

     (d) Must be administered if you must have medications placed in your mouth or applied or instilled to your skin or mucus membrane. Administration must either be performed by a licensed professional or delegated by a registered nurse to a qualified caregiver (per chapter 246-840 WAC). Intravenous or injectable medications may never be delegated. Administration may also be performed by a family member or unpaid caregiver if facility licensing regulations allow.

     "Authorization" means an official approval of a departmental action, for example, a determination of client eligibility for service or payment for a client's long-term care services.

     "Blind person" means a person determined blind as described under WAC 388-511-1105 by the division of disability determination services of the medical assistance administration.

     "Categorically needy" means the status of a person who is eligible for medical care under Title XIX of the Social Security Act. See WAC 388-475-0100 and chapter 388-513 WAC.

     "Client" means an applicant for service or a person currently receiving services from the department.

     "Current" means a behavior occurred within seven days of the CARE assessment date, including the day of the assessment. Behaviors that the department designates as current must include information about:

     (a) Whether the behavior is easily altered or not easily altered; and

     (b) The frequency of the behavior.

     "Decision making" means your ability and actual performance in making everyday decisions about tasks or activities of daily living. The department determines whether you are:

     (a) Independent: Decisions about your daily routine are consistent and organized; reflecting your lifestyle, choices, culture, and values.

     (b) Modified independence/difficulty in new situations: You have an organized daily routine, are able to make decisions in familiar situations, but experience some difficulty in decision making when faced with new tasks or situations.

     (c) Moderately impaired/poor decisions; unaware of consequences: Your decisions are poor and you require reminders, cues and supervision in planning, organizing and correcting daily routines. You attempt to make decisions, although poorly.

     (d) Severely impaired/no or few decisions: Decision making is severely impaired; you never/rarely make decisions.

     "Department" means the state department of social and health services, aging and disability services administration or its designee.

     "Designee" means area agency on aging.

     "Difficulty" means how difficult it is or would be for you to perform an instrumental activity of daily living (IADL). This is assessed as:

     (a) No difficulty in performing the activity;

     (b) Some difficulty in performing the activity (e.g., you need some help, are very slow, or fatigue easily); or

     (c) Great difficulty in performing the activity (e.g., little or no involvement in the activity is possible).

     "Disabling condition" means you have a medical condition which prevents you from self performance of personal care tasks without assistance.

     "Estate recovery" means the department's process of recouping the cost of medicaid and long-term care benefit payments from the estate of the deceased client. See chapter 388-527 WAC.

     "Home health agency" means a licensed:

     (a) Agency or organization certified under medicare to provide comprehensive health care on a part-time or intermittent basis to a patient in the patient's place of residence and reimbursed through the use of the client's medical identification card; or

     (b) Home health agency, certified or not certified under medicare, contracted and authorized to provide:

     (i) Private duty nursing; or

     (ii) Skilled nursing services under an approved medicaid waiver program.

     "Income" means income as defined under WAC 388-500-0005.

     "Individual provider" means a person employed by you to provide personal care services in your own home. See WAC 388-71-0500 through 388-71-05909.

     "Disability" is described under WAC 388-511-1105.

     "Informal support" means a person or resource that is available to provide assistance without home and community program funding. The person or resource providing the informal support must be age 18 or older.

     "Institution" means medical facilities, nursing facilities, and institutions for the mentally retarded. It does not include correctional institutions. See medical institutions in WAC 388-500-0005.

     "Instrumental activities of daily living (IADL)" means routine activities performed around the home or in the community and includes the following:

     (a) Meal preparation: How meals are prepared (e.g., planning meals, cooking, assembling ingredients, setting out food, utensils, and cleaning up after meals). NOTE: The department will not authorize this IADL to plan meals or clean up after meals. You must need assistance with actual meal preparation.

     (b) Ordinary housework: How ordinary work around the house is performed (e.g., doing dishes, dusting, making bed, tidying up, laundry).

     (c) Essential shopping: How shopping is completed to meet your health and nutritional needs (e.g., selecting items). Shopping is limited to brief, occasional trips in the local area to shop for food, medical necessities and household items required specifically for your health, maintenance or well-being. This includes shopping with or for you.

     (d) Wood supply: How wood is supplied (e.g., splitting, stacking, or carrying wood) when you use wood as the sole source of fuel for heating and/or cooking.

     (e) Travel to medical services: How you travel by vehicle to a physician's office or clinic in the local area to obtain medical diagnosis or treatment-includes driving vehicle yourself, traveling as a passenger in a car, bus, or taxi.

     (f) Managing finances: How bills are paid, checkbook is balanced, household expenses are managed. The department cannot pay for any assistance with managing finances.

     (g) Telephone use: How telephone calls are made or received (with assistive devices such as large numbers on telephone, amplification as needed).

     "Long-term care services" means the services administered directly or through contract by the aging and disability services administration and identified in WAC 388-106-0015.

     "Medicaid" is defined under WAC 388-500-0005.

     "Medically necessary" is defined under WAC 388-500-0005.

     "Medically needy (MN)" means the status of a person who is eligible for a federally matched medical program under Title XIX of the Social Security Act, who, but for income above the categorically needy level, would be eligible as categorically needy. Effective January 1, 1996, an AFDC-related adult is not eligible for MN.

     "New Freedom consumer directed services (NFCDS)" means a mix of services and supports to meet needs identified in your assessment and identified in a New Freedom spending plan, within the limits of the individual budget, that provide you with flexibility to plan, select, and direct the purchase of goods and services to meet identified needs. Participants have a meaningful leadership role in:

     (a) The design, delivery and evaluation of services and supports;

     (b) Exercising control of decisions and resources, making their own decisions about health and well being;

     (c) Determining how to meet their own needs;

     (d) Determining how and by whom these needs should be met; and

     (e) Monitoring the quality of services received.

     "New Freedom consumer directed services (NFCDS) participant" means a participant who is an applicant for or currently receiving services under the NFCDS waiver.

     "New Freedom spending plan (NFSP)" means the plan developed by you, as a New Freedom participant, within the limits of an individual budget, that details your choices to purchase specific NFCDS and provides required federal medicaid documentation.

     "Own home" means your present or intended place of residence:

     (a) In a building that you rent and the rental is not contingent upon the purchase of personal care services as defined in this section;

     (b) In a building that you own;

     (c) In a relative's established residence; or

     (d) In the home of another where rent is not charged and residence is not contingent upon the purchase of personal care services as defined in this section.

     "Participant managed personal care services", per WAC 388-106-0042, means in-home personal care services for clients who, based upon criteria in a CARE assessment, are able to manage employer functions, or who have an alternate plan in place to assist with employer functions. Clients have employer authority, including hiring, firing, scheduling, and supervision of the care provider(s).

     "Past" means the behavior occurred from eight days to five years of the assessment date. For behaviors indicated as past, the department determines whether the behavior is addressed with current interventions or whether no interventions are in place.

     "Personal aide" is defined in RCW 74.39.007.

     "Personal care services" means physical or verbal assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL) due to your functional limitations. Assistance is evaluated with the use of assistive devices. Personal care services are based upon eligibility for three distinct service options: participant managed personal care services, agency managed personal care services, and residential personal care services (see definitions).

     "Physician" is defined under WAC 388-500-0005.

     "Plan of care" means assessment details and service summary generated by CARE.

     "Provider or provider of service" means an institution, agency, or person:

     (a) Having a signed department contract to provide long-term care client services; and

     (b) Qualified and eligible to receive department payment.

     "Reasonable cost" means a cost for a service or item that is consistent with the market standards for comparable services or items.

     "Representative" means a person who you have chosen, or has been appointed by a court, whose primary duty is to act on your behalf to direct your service budget to meet your identified health, safety, and welfare needs.

     "Residential facility" means a licensed adult family home under department contract or licensed boarding home under department contract to provide assisted living, adult residential care or enhanced adult residential care.

     "Residential personal care services" means clients may choose to receive personal care services provided by a licensed and contracted adult family home or boarding home.

     "Self performance for ADLs" means what you actually did in the last seven days before the assessment, not what you might be capable of doing. Coding is based on the level of performance that occurred three or more times in the seven-day period and does not include support provided as defined in WAC 388-106-0010. Your self performance level is scored as:

     (a) Independent if you received no help or oversight, or if you needed help or oversight only once or twice;

     (b) Supervision if you received oversight (monitoring or standby), encouragement, or cueing three or more times;

     (c) Limited assistance if you were highly involved in the activity and given physical help in guided maneuvering of limbs or other nonweight bearing assistance on three or more occasions. For bathing, limited assistance means physical help is limited to transfer only;

     (d) Extensive assistance if you performed part of the activity, but on three or more occasions, you needed weight bearing support or you received full performance of the activity during part, but not all, of the activity. For bathing, extensive assistance means you needed physical help with part of the activity (other than transfer);

     (e) Total dependence if you received full caregiver performance of the activity and all subtasks during the entire seven-day period from others. Total dependence means complete nonparticipation by you in all aspects of the ADL; or

     (f) Activity did not occur if you or others did not perform an ADL over the last seven days before your assessment. The activity may not have occurred because:

     (i) You were not able (e.g., walking, if paralyzed);

     (ii) No provider was available to assist; or

     (iii) You declined assistance with the task.

     "Self performance for IADLs" means what you actually did in the last thirty days before the assessment, not what you might be capable of doing. Coding is based on the level of performance that occurred three or more times in the thirty-day period. Your self performance is scored as:

     (a) Independent if you received no help, set-up help, or supervision;

     (b) Set-up help/arrangements only if on some occasions you did your own set-up/arrangement and at other times you received help from another person;

     (c) Limited assistance if on some occasions you did not need any assistance but at other times in the last thirty days you required some assistance;

     (d) Extensive assistance if you were involved in performing the activity, but required cueing/supervision or partial assistance at all times;

     (e) Total dependence if you needed the activity fully performed by others; or

     (f) Activity did not occur if you or others did not perform the activity in the last thirty days before the assessment.

     "Service summary" is CARE information which includes: Contacts (e.g. emergency contact), services the client is eligible for, number of hours or residential rates, personal care needs, the list of formal and informal providers and what tasks they will provide, a provider schedule, referral needs/information, and dates and agreement to the services.

     "SSI-related" is defined under WAC 388-475-0050.

     "Status" means the amount of informal support available. The department determines whether the ADL or IADL is:

     (a) Met, which means the ADL or IADL will be fully provided by an informal support;

     (b) Unmet, which means an informal support will not be available to provide assistance with the identified ADL or IADL;

     (c) Partially met, which means an informal support will be available to provide some assistance, but not all, with the identified ADL or IADL; or

     (d) Client declines, which means you do not want assistance with the task.

     "Supplemental Security Income (SSI)" means the federal program as described under WAC 388-500-0005.

     "Support provided" means the highest level of support provided (to you) by others in the last seven days before the assessment, even if that level of support occurred only once.

     (a) No set-up or physical help provided by others;

     (b) Set-up help only provided, which is the type of help characterized by providing you with articles, devices, or preparation necessary for greater self performance of the activity. (For example, set-up help includes but is not limited to giving or holding out an item or cutting food);

     (c) One-person physical assist provided;

     (d) Two- or more person physical assist provided; or

     (e) Activity did not occur during entire seven-day period.

     "You/your" means the client.

[Statutory Authority: RCW 74.08.090 and 74.09.520. 10-08-074, § 388-106-0010, filed 4/6/10, effective 5/7/10. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.030. 06-16-035, § 388-106-0010, 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, § 388-106-0010, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0010, filed 5/17/05, effective 6/17/05.]


AMENDATORY SECTION(Amending WSR 08-05-026, filed 2/12/08, effective 3/14/08)

WAC 388-106-0020   Under the MPC, COPES, MNRW, MNIW, and chore programs, what services are not covered?   The following types of services are not covered under MPC, COPES, MNRW, MNIW, and chore:

     (1) Child care.

     (2) Individual providers must not provide:

     (a) Sterile procedures unless the provider is a family member or the client self directs the procedure;

     (b) Administration of medications or other tasks requiring a licensed health professional unless these tasks are provided through nurse delegation, self-directed care, or the provider is a family member.

     (3) Agency providers, including family members who provide care while working as an agency provider, must not provide:

     (a) Sterile procedures;

     (b) Self-directed care;

     (c) Administration of medications or other tasks requiring a licensed health care professional unless these tasks are provided through nurse delegation.

     (4) Services provided over the telephone.

     (5) Services to assist other household members not eligible for services.

     (6) Development of social, behavioral, recreational, communication, or other types of community living skills.

     (7) Nursing care.

     (8) Pet care.

     (9) Assistance with managing finances.

     (10) Respite.

     (11) Yard care.

     (12) Agency managed personal care services, unless, based on a CARE assessment, you are determined to be eligible for such services based on the criteria set forth in WAC 388-106-0043.

[Statutory Authority: RCW 74.08.090, 74.09.520. 08-05-026, § 388-106-0020, filed 2/12/08, effective 3/14/08; 05-11-082, § 388-106-0020, filed 5/17/05, effective 6/17/05.]


NEW SECTION
WAC 388-106-0042   When am I eligible to receive participant managed personal care services from an individual provider?   You are eligible to receive participant managed personal care services when you:

     (1) Are assessed using the CARE tool and have unmet needs for personal care;

     (2) Are found financially and functionally eligible for services; and

     (3) Are able to manage employer functions, or your assessment demonstrates a need for assistance with employer functions and alternative monitoring is in place.

[]


NEW SECTION
WAC 388-106-0043   When am I eligible to receive agency managed personal care services from a home care agency?   You are eligible to receive agency managed personal care services when you meet the criteria outlined in WAC 388-106-0042 (1) and (2) and:

     (1) You meet the following criteria based on your CARE assessment:

     (a) You have a cognitive performance score of two or more as defined in WAC 388-106-0090; and

     (b) Decision making is coded as "poor decisions/unaware of consequences" or "no/few decisions".

     (2) You may also be eligible to use a contracted home care agency for your in-home plan of care for a maximum of sixty days when you are actively seeking, but have been unable to obtain an individual provider.

[]


AMENDATORY SECTION(Amending WSR 06-16-035, filed 7/25/06, effective 8/25/06)

WAC 388-106-0055   What is the purpose of an assessment?   The purpose of an assessment is to:

     (1) Determine eligibility for long-term care programs;

     (2) Identify your strengths, limitations, and preferences;

     (3) Evaluate your living situation and environment;

     (4) Evaluate your physical health, functional and cognitive abilities, including your ability to perform employer functions based on the criteria set forth in WAC 388-106-0042 and 388-106-0043;

     (5) Determine availability of informal supports and other nondepartment paid resources;

     (6) Determine need for intervention;

     (7) Determine need for case management activities;

     (8) Determine your classification group that will set your payment rate for residential care or number of hours of in-home care;

     (9) Determine need for referrals; ((and))

     (10) Develop a plan of care, as defined in WAC 388-106-0010((.)); and

     (11) Determine whether you are eligible for participant managed personal care services or agency managed personal care services based on the criteria set forth in WAC 388-106-0042 and 388-106-0043, if you are receiving, or may receive, services in your own home.

     (12) In the case of New Freedom consumer directed services, the purpose of an assessment is to determine functional eligibility and for the participant to develop the New Freedom spending plan, as defined in WAC 388-106-0010.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.030. 06-16-035, § 388-106-0055, filed 7/25/06, effective 8/25/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0055, filed 5/17/05, effective 6/17/05.]


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

WAC 388-106-0600   What services may I receive under chore?   You may receive personal care services in your own home and, as applicable, assistance with personal care tasks while you are out of the home accessing community resources or working. The personal care services you receive are those you are determined to be eligible pursuant to WAC 388-106-0042 or 388-106-0043.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0600, filed 5/17/05, effective 6/17/05.]


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

WAC 388-106-1300   What rights do I have as a client of the department?   As a client of the department, you have a right to:

     (1) Be treated with dignity, respect and without discrimination;

     (2) Not be abused, neglected, financially exploited, abandoned;

     (3) Have your property treated with respect;

     (4) Not answer questions, turn down services, and not accept case management services you do not want to receive. However, it may not be possible for the department to offer some services if you do not give enough information;

     (5) Be told about all services you can receive and make choices about services you want or don't want;

     (6) Have information about you kept private within the limits of the laws and DSHS regulations;

     (7) Be told in writing of agency decisions and receive a copy of your care plan;

     (8) Make a complaint without fear of harm;

     (9) Not be forced to answer questions or do something you don't want to;

     (10) Talk with your social service worker's supervisor if you and your social service worker do not agree;

     (11) Request a fair hearing;

     (12) Have interpreter services provided to you free of charge if you cannot speak or understand English well;

     (13) Take part in and have your wishes included in planning your care;

     (14) Choose, fire, or change a qualified personal care service provider ((you want)) that provides the type of services for which you are determined to be eligible pursuant to WAC 388-106-0042 and 388-106-0043; and

     (15) Receive results of the background check for any individual provider you choose.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-1300, filed 5/17/05, effective 6/17/05.]


AMENDATORY SECTION(Amending WSR 10-06-112, filed 3/3/10, effective 4/3/10)

WAC 388-106-1303   What responsibilities do I have as a client of the department?   As a client of the department, you have a responsibility to:

     (1) Give us enough information to assess your needs;

     (2) Let the social services worker into your home so that your needs can be assessed;

     (3) Follow your care plan;

     (4) Not act in a way that puts anyone in danger;

     (5) Provide a safe work place;

     (6) Tell your social services worker if there is a change in:

     (a) Your medical condition;

     (b) The help you get from family or other agencies;

     (c) Where you live; or

     (d) Your financial situation.

     (7) Tell your social services worker if someone else makes medical or financial decision for you;

     (8) Choose a qualified personal care services provider that provides the type of services for which you are determined to be eligible pursuant to WAC 388-106-0042 and 388-106-0043;

     (9) Inform the department and your home care agency if an employee assigned by the home care agency is related to you by blood, marriage, adoption, or registered domestic partnership.

     (10) Keep provider background checks private;

     (11) Tell your social services worker if you are having problems with your provider; and

     (12) Choose your own health care. Tell your social services worker when you do not do what your doctor says.

[Statutory Authority: RCW 74.08.090, 74.09.520, 2009 c 571, and Washington state 2009-11 budget, section 206(17). 10-06-112, § 388-106-1303, filed 3/3/10, effective 4/3/10. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-106-1303, filed 2/6/06, effective 3/9/06.]


AMENDATORY SECTION(Amending WSR 10-08-074, filed 4/6/10, effective 5/7/10)

WAC 388-106-1445   How is the amount of the individual budget determined?   The department will calculate your individual budget amount after you are assigned a classification resulting from completion of the comprehensive assessment reporting and evaluation tool, CARE. The calculation will be based on:

     (((a))) (1) The hourly wage as determined by the collective bargaining agreement for individual provider personal care paid by the department multiplied by the number of hours generated by the assessment, multiplied by a factor of .95, plus an amount equal to the average per participant expenditures for nonpersonal care supports purchased in the COPES waiver. The average will be recalculated in July of each year.

     (((b))) (2) If ((you)) the participant is determined to be eligible for agency managed personal care services and selects a home care agency, an adjustment will be made for each hour of personal care identified in the NFSP for an amount equal to the difference between the published individual provider rate and home care agency rate.

[Statutory Authority: RCW 74.08.090 and 74.09.520. 10-08-074, § 388-106-1445, filed 4/6/10, effective 5/7/10. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.030. 06-16-035, § 388-106-1445, filed 7/25/06, effective 8/25/06.]

© Washington State Code Reviser's Office