PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Effective Date of Rule: Thirty-one days after filing.
Purpose: The department is amending WAC 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.
These amendments are necessary to address the state's revenue shortfall as outlined in the 2009-2011 supplemental operating budget (ESSB 6444).
Citation of Existing Rules Affected by this Order: Amending WAC 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).
Adopted under notice filed as WSR 10-22-123 on November 3, 2010.
Changes Other than Editing from Proposed to Adopted Version: The proposed rules included WAC 388-106-0125, which have [has] been removed from this rule making. The department plans to propose additional amendments to WAC 388-106-0125, and will proceed with permanent adoption at a later date.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: May 5, 2011.
Katherine I. Vasquez
Rules Coordinator
4216.2(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.]