Effective Date of Rule: Thirty-one days after filing.

     Purpose: The department is revising WAC 388-106-1200 through 388-106-1230, respite care services, to add language regarding the new tailored caregiver assessment and referral (TCARE) process and clarifying who is eligible to receive respite care services. Also, it is important to clarify that access to respite services is limited to caregivers providing care to adults not already receiving another state or medicaid funded long-term care services.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-106-1200, 388-106-1210, 388-106-1215, 388-106-1220, 388-106-1225, and 388-106-1230.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

      Adopted under notice filed as WSR 11-24-047 on December 2, 2011.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 6, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 6, Repealed 0.

     Date Adopted: June 8, 2012.

Katherine I. Vasquez

Rules Coordinator

     "Caregivers" means a spouse, relative, or friend who has primary responsibility for the ((daily)) care or supervision of an adult with a functional disability without receiving direct, public or private payment for the caregiver services ((provided)) they provide.

     "Continuous care or supervision" means daily assistance or oversight of an adult with a functional disability.

     "Family caregiver support program or FCSP" means a statewide program offered by area agencies on aging to provide support for unpaid caregivers who provide care to an adult with a functional disability.

     "((Functionally)) Functional disability" means a physical, mental or cognitive condition requiring ((substantial assistance)) continuous care or supervision in completing activities of daily living ((and community living skills)) or instrumental activities for daily living.

     "((Participant)) Care receiver" means an adult (age eighteen and over) with a functional disability who needs ((substantial)) daily continuous care or supervision.

     "Service provider" means an ((individual,)) agency, or organization under contract to the area agency on aging (AAA) or its subcontractor.

     "Supervision" means providing oversight of an individual to assure his/her safety and well-being.

     "TCAREŠ, tailored caregiver assessment and referral system" means the process (screening, assessment and care planning) to establish eligibility for respite care and other caregiver support services for unpaid family caregivers.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-1200, filed 5/17/05, effective 6/17/05.]

     (a) Have primary responsibility for the ((daily continuous)) care or supervision of an adult with a functional disability who is not receiving a state or medicaid funded, long-term care service (e.g., COPES, personal care services, DD waiver); and

     (b) Provide a minimum of an average of ((twelve)) forty hours per ((day for)) week of care, and/or supervision, or live with an adult who needs continuous care or supervision; and

     (c) Not ((be compensated)) receive financial payment for the care; and

     (d) Be assessed ((as being at risk of placing the participant in a long-term care facility if home and community support services, including respite care, are not available)) in the TCAREŠ, tailored caregiver assessment and referral system and determined to meet the eligibility threshold levels determined by state level policy and have TCAREŠ recommend the strategy to introduce alternate sources for care to provide respite.

     (2) An eligible participant is an adult who:

     (a) Has a functional disability;

     (b) ((Needs daily substantial continuous care or supervision)) Has a caregiver who is assessed in the TCAREŠ system and meets the criteria in WAC 388-106-1210(1); and

     (c) ((Is assessed as requiring placement in a long-term care facility if home and community support services, including respite care, are not available)) Is not receiving a state or medicaid funded, long-term care service (e.g., COPES, personal care services, DD waiver).

     (((3) The area agency on aging (AAA) determines how many hours of continuous care or supervision a day an unpaid caregiver must provide to a participant to become eligible for respite care services, as long as it is a minimum of twelve hours per day, as outlined in subsection (1)(b) of this section.))

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-1210, filed 5/17/05, effective 6/17/05.]

     (1) Nursing homes (chapter 388-97 WAC).

     (2) Adult day ((services)) service providers, ((which)) whose services includes adult day care, dementia day services and adult day health.

     (3) Home care and/or home health((/care)) agencies licensed through the department of health for in-home services.

     (4) Hospitals.

     (5) Licensed residential care facilities such as boarding homes, adult family homes, and assisted living facilities.

     (6) Providers such as volunteer ((chore workers)) services, and senior companions((, and individual providers)).

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-1215, filed 5/17/05, effective 6/17/05.]

     (1) Respite care providers for the number of hours or days of services authorized and ((used)) provided. ((The)) If the provider already has a medicaid rate ((that is)) established for ((the services)) providing a similar service, that rate is ((negotiated between the respite care program of the local area agency on aging and the respite care service provider)) to be reimbursed by the local area agency on aging. If there is no established rate for the service, one can be negotiated between the local area agency on aging and the respite care service provider.

     (2) Medicaid-certified ((nursing homes and DDD-certified group homes)) licensed residential facilities providing respite services at the medicaid rate approved for that facility. Medicaid contracted ((nursing homes)) providers must not charge more than the medicaid rate for any services covered from the date of eligibility, unless authorized by the department (see RCW 18.51.070). Participants must pay for services not included in the medicaid rate.

     (3) Private nursing homes at their published daily rate.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-1220, filed 5/17/05, effective 6/17/05.]

     (2) If the ((participant's)) care receiver's gross income is above forty percent of the state median income, he or she is required to pay for part or all of the cost of the respite care services. The department will determine what amount the participant must contribute based on the state median income and family size.

     (3) If the ((participant's)) care receiver's gross income is one hundred percent or more of the state median income, the participant must pay the full cost of the respite care services.

     (4) If the care receiver is experiencing extreme financial hardship (e.g., high medical expenses) and cannot pay for their share of the cost of the respite care services, the area agency on aging may grant an exception to policy and then must document this in the client's records.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-1225, filed 5/17/05, effective 6/17/05.]

     (2) In nonemergency situations, respite care is allocated based upon ((available respite funds at the local level)) the results of the TCAREŠ assessment and available local FCSP funds. ((Respite care must be provided on a first-come, first-served basis.)) If sufficient funds are not available when ((respite care is requested, services are made available using waiting lists and department-approved priority categories, developed by the AAA, including caregiver vulnerability and health condition, availability of other support systems, and whether other family members need care)) an eligible caregiver requests services, AAA may establish wait lists to prioritize clients receiving services as funding becomes available.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-1230, filed 5/17/05, effective 6/17/05.]

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