DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Aging and Long-Term Support Administration)

Nursing Facility Certificate of Need

"Activities of daily living", as defined in WAC 388-106-0010, includes tasks such as walking, eating, taking medications, maintaining personal hygiene, moving in bed and toileting.

"Care assessment" is an assessment tool used to determine eligibility for services and level of service need, and identify strengths, preferences and potential referrals to develop an individualized care plan.

"Certificate of need program" is a regulatory process under Chapter 70.38 RCW that requires certain healthcare providers, including nursing homes, to receive approval from the Department of Health before building certain types of facilities or offering new or expanded services.

"Community residential" refers to licensed community settings such as assisted living facilities and adult family homes where long-term care services are provided to residents.

"Department" means the Department of Social and Health Services.

"Department of Health" is the state agency that operates the certificate of need review program and determines the need for specific facilities and services, including nursing homes, in a manner that is consistent with the statewide health resources strategy developed under RCW 43.370.030 and 70.38.

"In-home personal care" is care provided by an agency or individual provider to clients living in their own home.

"Minimum Data Set" or "MDS" is a tool that is used to perform the comprehensive assessment of each resident's functional capabilities, which is required for all residents in medicare or medicaid certified nursing homes.

"RUG III Score" is the classification of each nursing facility resident into a specific group based on the individual's medical condition and level of care required.

The Department of Health's certificate of need program is required to determine the need for nursing homes under WAC 246-310-210 (6)(b)(ii). The determination of need is based in part upon the availability of home and community-based long-term services in the planning area of the proposed nursing facility. When evaluating the need for additional nursing home beds, the data considered by the Department of Health must include data provided by the Department.

The Department uses the following methodology to determine the statewide or county specific nursing home comparable home and community-based long-term services availability.

(1) The department selects a recent, one-year time period from which to use MDS assessment data.

(2) The "typical RUG-III ADL score" is determined as follows. From the MDS data, two activity of daily living (ADL) RUG-III score values are calculated: (1) the mean RUG-III ADL score, rounded to the nearest whole number, and (2) the modal RUG-III ADL score that occurs most commonly in the nursing home population in the selected time period. The "typical RUG-III ADL score" is the lower of the mean and modal values.

(3) Using the most recent month that both payment and assessment data are considered to be complete, persons receiving medicaid paid in-home personal care or community residential services are identified, and the MDS-equivalent ADL score from each home and community-based client's current CARE assessment is constructed.

(4) Using data from the month selected in subsection (3), count the number of in-home personal care clients being served by either the Aging and Long-Term Support or Developmental Disabilities Administrations who have an MDS-equivalent score at or above the typical RUG-III ADL nursing home score that was calculated in subsection (2).

(5) Using data from the month selected in subsection (3), calculate the proportion of medicaid-paid community residential clients with an MDS-equivalent score that is at or above the typical RUG-III ADL nursing home score calculated in subsection (2).

(i) When determining county level measures of nursing home comparable home and community based capacity, the statewide average for Medicaid- paid community residential clients is used.

(6) Calculate the overall statewide licensed capacity of community residential facilities.

(7) The proportion calculated in subsection (5) and the community residential capacity determined in subsection (6) are multiplied to estimate the community residential capacity that is nursing home comparable.

(8) Add the numbers calculated in subsections (4) and (7) to determine the total countable nursing-home-comparable home and community-based long–term capacity to be used in reporting to the Department of Health the availability of other services in the community as required in RCW 70.38.115.

Reviser's note: The section above was filed by the agency as WAC 000-106-1620. However, the other rules for the department of social and health services are found in Title 388 WAC. The section above appears to be WAC 388-106-1620, but pursuant to the requirements of RCW 34.08.040, it is published in the same form as filed by the agency.