WSR 12-11-114

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed May 22, 2012, 11:37 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 12-02-082.

Title of Rule and Other Identifying Information: WAC 388-106-0015, 388-106-0020, 388-106-0070, 388-106-0310, 388-106-0400, 388-106-0410, 388-106-0415, 388-106-0420, 388-106-0425, 388-106-0430, 388-106-0435, 388-106-0500, 388-106-0510, 388-106-0515, 388-106-0520, 388-106-0525, 388-106-0530 and 388-106-0535, to consolidate the medically needy in-home (MNI) and medically needy residential (MNR) waivers into the COPES waiver.

Hearing Location(s): Office Building 2, Lookout Room, 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 June 26, 2012, at 10:00 a.m.

Date of Intended Adoption: Not earlier than June 27, 2012.

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 June 26, 2012.

Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by June 6, 2012, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at jennisha.johnson@dshs.wa.gov.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is consolidating three waivers into one to improve efficiency. This rule amendment is necessary to manage budget shortfalls and maintain fund solvency. The Centers for Medicare and Medicaid Services (CMS) gave the department approval effective April 1, 2012.

Reasons Supporting Proposal: See Purpose statement above.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

Statute Being Implemented: RCW 74.08.090, 74.09.520.

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: Debbie Johnson, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2531.

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 34.053.328 [34.05.328] (5)(b)(v), rules the content of which is explicitly and specifically dictated by statute.

May 18, 2012

Katherine I. Vasquez

Rules Coordinator

4356.3
AMENDATORY SECTION(Amending WSR 08-12-023, filed 5/29/08, effective 7/1/08)

WAC 388-106-0015   What long-term care services does the department provide?   The department provides long-term care services through programs that are designed to help you remain in the community. These programs offer an alternative to nursing home care (which is described in WAC 388-106-0350 through 388-106-0360). You may receive services from any of the following:

(1) Medicaid personal care (MPC) is a medicaid state plan program authorized under RCW 74.09.520. Clients eligible for this program may receive personal care in their own home or in a residential facility.

(2) Community options program entry system (COPES) is a medicaid waiver program authorized under RCW 74.39A.030. Clients eligible for this program may receive personal care in their own home or in a residential facility.

(3) ((Medically needy residential waiver (MNRW) is a medicaid waiver program authorized under RCW 74.39.041. Clients eligible for this program may receive personal care in a residential facility.

(4) Medically needy in-home waiver (MNIW) is a medicaid waiver program authorized under RCW 74.09.700. Clients eligible for this program may receive personal care in their own home.

(5))) Chore is a state-only funded program authorized under RCW 74.39A.110. Grandfathered clients may receive assistance with personal care in their own home.

(((6))) (4) Volunteer chore is a state-funded program that provides volunteer assistance with household tasks to eligible clients.

(((7))) (5) Program of all-inclusive care for the elderly (PACE) is a medicaid/medicare managed care program authorized under 42 CFR 460.2. Clients eligible for this program may receive personal care and medical services in their own home, in residential facilities, and in adult day health centers.

(((8))) (6) Adult day health is a supervised daytime program providing skilled nursing and rehabilitative therapy services in addition to core services outlined in WAC 388-106-0800.

(((9))) (7) Adult day care is a supervised daytime program providing core services, as defined under WAC 388-106-0800.

(((10))) (8) GAU-funded residential care is a state-funded program authorized under WAC 388-400-0025. Clients eligible for this program may receive personal care services in an adult family home or an adult residential care facility.

(((11))) (9) Residential care discharge allowance is a service that helps eligible clients to establish or resume living in their own home.

(((12))) (10) Private duty nursing is a medicaid service that provides an alternative to institutionalization in a hospital or nursing facility setting. Clients eligible for this program may receive at least four continuous hours of skilled nursing care on a day to day basis in their own home.

(((13))) (11) Senior Citizens Services Act (SCSA) is a program authorized under chapter 74.38 RCW. Clients eligible for this program may receive community-based services as defined in RCW 74.38.040.

(((14))) (12) Respite program is a program authorized under RCW 74.41.040 and WAC 388-106-1200. This program provides relief care for unpaid family or other caregivers of adults with a functional disability.

(((15))) (13) Programs for persons with developmental disabilities are discussed in chapter 388-823 through 388-853 WAC.

(((16))) (14) Nursing facility.

(((17))) (15) New Freedom consumer directed services (NFCDS) is a medicaid waiver program authorized under RCW 74.39A.030.

[Statutory Authority: RCW 74.08.090 and 74.09.520. 08-12-023, 388-106-0015, filed 5/29/08, effective 7/1/08. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.030. 06-16-035, 388-106-0015, 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, 388-106-0015, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 42 C.F.R. 441.302(a), Social Security Act, Section 1915(c) waiver rules, 42 C.F.R. 438. 05-19-045, 388-106-0015, filed 9/15/05, effective 10/16/05. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0015, 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.

[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.]


AMENDATORY SECTION(Amending WSR 08-12-023, filed 5/29/08, effective 7/1/08)

WAC 388-106-0070   Will I be assessed in CARE?   You will be assessed in CARE if you are applying for or receiving DDD services, COPES, ((MNIW, MNRW,)) MPC, chore, respite, adult day health, GAU-funded residential care, PACE, private duty nursing, New Freedom or long-term care services within the WMIP program.

If you are under the age of eighteen and within thirty calendar days of your next birthday, CARE determines your assessment age to be that of your next birthday.

[Statutory Authority: RCW 74.08.090 and 74.09.520. 08-12-023, 388-106-0070, filed 5/29/08, effective 7/1/08; 07-24-026, 388-106-0070, filed 11/28/07, effective 1/1/08; 07-10-024, 388-106-0070, filed 4/23/07, effective 6/1/07; 05-11-082, 388-106-0070, filed 5/17/05, effective 6/17/05.]


AMENDATORY SECTION(Amending WSR 08-11-047, filed 5/15/08, effective 6/15/08)

WAC 388-106-0310   Am I eligible for COPES-funded services?   You are eligible for COPES-funded services if you meet all of the following criteria. The department must assess your needs in CARE and determine that:

(1) You are age:

(a) Eighteen or older and blind or have a disability, as defined in WAC ((388-475-0050)) 182-512-0050; or

(b) Sixty-five or older.

(2) You meet financial eligibility requirements. This means the department will assess your finances and determine if your income and resources fall within the limits set in WAC 388-515-1505, community options program entry system (COPES).

(3) You:

(a) Are not eligible for medicaid personal care services (MPC); or

(b) Are eligible for MPC services, but the department determines that the amount, duration, or scope of your needs is beyond what MPC can provide.

(4) Your CARE assessment shows you need the level of care provided in a nursing facility (or will likely need the level of care within thirty days unless COPES services are provided) which is defined in WAC 388-106-0355(1).

[Statutory Authority: RCW 34.05.353 (2)(d), 74.08.090, and chapters 74.09, 74.04 RCW. 08-11-047, 388-106-0310, filed 5/15/08, effective 6/15/08. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0310, filed 5/17/05, effective 6/17/05.]


REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 388-106-0400 What services may I receive under medically needy residential waiver (MNRW)?
WAC 388-106-0410 Am I eligible for MNRW-funded services?
WAC 388-106-0415 When do MNRW services start?
WAC 388-106-0420 How do I remain eligible for MNRW?
WAC 388-106-0425 How do I pay for MNRW services?
WAC 388-106-0430 Can I be employed and receive MNRW?
WAC 388-106-0435 Are there waiting lists for MNRW?
WAC 388-106-0500 What services may I receive under medically needy in-home waiver (MNIW)?
WAC 388-106-0510 Am I eligible for MNIW-funded services?
WAC 388-106-0515 When do MNIW services start?
WAC 388-106-0520 How do I remain eligible for MNIW?
WAC 388-106-0525 How do I pay for MNIW?
WAC 388-106-0530 Can I be employed and receive MNIW?
WAC 388-106-0535 Are there waiting lists for MNIW?

Washington State Code Reviser's Office