WSR 20-23-089
EXPEDITED RULES
DEPARTMENT OF HEALTH
[Filed November 17, 2020, 2:23 p.m.]
Title of Rule and Other Identifying Information: WAC 246-335-510 Definitions, in-home services, home health. The department of health (department) is proposing a permanent rule amendment to WAC 246-335-510(3), adding physician assistants to the list of practitioners authorized to order home health services and to sign plans of care, consistent with federal changes due to the coronavirus disease (COVID-19) pandemic.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the proposed amendment to WAC 246-335-510(3) is to add physician assistants to the list of practitioners authorized to order home health services and to sign plans of care. This change will expand health care facilities' ability to provide appropriate care for individuals who no longer need to be in a hospital or other health care facility, while also allowing health care facility resources to be used more effectively, facilitating the response to the public health emergency created by the coronavirus disease (COVID-19) pandemic.
This rule amendment would make permanent the amendments adopted as emergency rules initially filed on June 1, 2020, as WSR 20-12-075, and continued in subsequent emergency rule packages. This rule amendment is consistent with the change authorizing physician assistants to order home health services that was enacted by the 116th United States Congress in Section 3708 of H.R. 748 "Coronavirus Aid, Relief and Economic Security (CARES) Act." The CARES Act requires that this become a permanent federal regulation change effective no later than six months after the signing of the CARES Act.
Reasons Supporting Proposal: The proposed amendment to WAC 246-335-510(3) is prompted by the federal CARES Act, codified at 42 U.S.C. 1395f. The CARES Act requires that this change be incorporated into federal regulation, effective no later than six months after the signing of the CARES Act, which occurred March 27, 2020. The proposed amendment will align the department's rules with both the CARES Act and forthcoming federal regulations. The amendments will also align department rules with amendments made by the Washington health care authority in WAC 182-543-0500 and 182-551-2040 under WSR 20-09-016.
Statutory Authority for Adoption: RCW 70.127.120.
Statute Being Implemented: 42 U.S.C. 1395f.
Rule is necessary because of federal law, PL 116-136 3708, codified at 42 U.S.C. 1395f.
Name of Proponent: Department of health, governmental.
Name of Agency Personnel Responsible for Drafting and Implementation: John Hilger, 111 Israel Road S.E., Tumwater, WA, 360-236-2929; Enforcement: John Williams, 111 Israel Road S.E., Tumwater, WA, 360-236-2950.
This notice meets the following criteria to use the expedited adoption process for these rules:
Adopts or incorporates by reference without material change federal statutes or regulations, Washington state statutes, rules of other Washington state agencies, shoreline master programs other than those programs governing shorelines of statewide significance, or, as referenced by Washington state law, national consensus codes that generally establish industry standards, if the material adopted or incorporated regulates the same subject matter and conduct as the adopting or incorporating rule.
Explanation of the Reason the Agency Believes the Expedited Rule-Making Process is Appropriate: This amendment is being proposed pursuant to the federal CARES Act and forthcoming federal regulations required by the CARES Act. The proposed rules incorporate changes made at the federal level without material change.
NOTICE
THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO John Hilger, Department of Health, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-2929, email https://fortress.wa.gov/doh/policyreview, AND RECEIVED BY January 18, 2020.
November 16, 2020
Jessica Todorovich
Chief of Staff
for John Wiesman, DrPH, MPH
Secretary
AMENDATORY SECTION(Amending WSR 18-06-093, filed 3/6/18, effective 4/6/18)
WAC 246-335-510Definitions—Home health.
The definitions in the section apply throughout WAC 246-335-505 through 246-335-560 unless the context clearly indicates otherwise:
(1) "Acute care" means care provided by an in-home services agency licensed to provide home health services for patients who are not medically stable or have not attained a satisfactory level of rehabilitation. These patients require frequent monitoring by a registered nurse licensed under chapter 18.79 RCW, a physical therapist licensed under chapter 18.74 RCW, a respiratory therapist licensed under chapter 18.89 RCW, an occupational therapist licensed under chapter 18.59 RCW, a speech therapist licensed under chapter 18.35 RCW, a dietitian or nutritionist as defined in subsection (5) of this section, or social worker licensed under chapter 18.320 RCW to assess health status and progress.
(2) "Assessment" means an evaluation performed by an appropriate health care professional of a patient's needs.
(3) "Authorizing practitioner" means the individual practitioners licensed in Washington state, or another state according to the exemption criteria established in chapters 18.57, 18.71, and 18.79 RCW, and authorized to approve a home health plan of care:
(a) A physician licensed under chapter 18.57 or 18.71 RCW;
(b) A podiatric physician and surgeon licensed under chapter 18.22 RCW; ((or))
(c) A physician assistant licensed under chapter 18.71A or 18.57A RCW; or
(d) An advanced registered nurse practitioner (ARNP), as authorized under chapter 18.79 RCW.
(4) "Cardiopulmonary resuscitation" or "CPR" means a procedure to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) or whose heart has stopped (cardiac arrest).
(5) "Dietitian or nutritionist" means a person certified as such under chapter 18.138 RCW or registered by the Academy of Nutrition and Dietetics as a registered dietitian nutritionist; certified by the board for certification of nutrition specialists as a certified nutrition specialist; or certified by the American Clinical Board of Nutrition as a diplomate of the American Clinical Board of Nutrition.
(6) "Director of clinical services" means an individual responsible for nursing, therapy, nutritional, social, and related services that support the plan of care provided by in-home health and hospice agencies.
(7) "Home health agency" means a person administering or providing two or more home health services directly or through a contract arrangement to individuals in places of temporary or permanent residence. A person administering or providing nursing services only may elect to be designated a home health agency for purposes of licensure.
(8) "Home health aide" means an individual who is a nursing assistant certified or nursing assistant registered under chapter 18.88A RCW.
(9) "Home health aide services" means services provided by a home health agency or a hospice agency under the supervision of a registered nurse, physical therapist, occupational therapist, or speech therapist who is employed by or under contract to a home health or hospice agency. Such care includes ambulation and exercise, assistance with self-administered medications, reporting changes in patients' conditions and needs, completing appropriate records, and personal care or homemaker services.
(10) "Home health services" means services provided to ill, disabled, or vulnerable individuals. These services include, but are not limited to, nursing services, home health aide services, physical therapy services, occupational therapy services, speech therapy services, respiratory therapy services, nutritional services, medical social services, and home medical supplies or equipment services.
(11) "Home medical supplies or equipment services" means diagnostic, treatment, and monitoring equipment and supplies provided for the direct care of individuals within a plan of care.
(12) "Licensed practical nurse" or "LPN" means an individual licensed under chapter 18.79 RCW.
(13) "Licensed nurse" means a licensed practical nurse or registered nurse under chapter 18.79 RCW.
(14) "Maintenance care" means care provided by in-home services agencies licensed to provide home health services that are necessary to support an existing level of health, to preserve a patient from further failure or decline, or to manage expected deterioration of disease. Maintenance care consists of periodic monitoring by a licensed nurse, therapist, dietitian or nutritionist, or social worker to assess a patient's health status and progress.
(15) "Medication administration" means assistance with the application, instillation, or insertion of medications according to a plan of care, for patients of an in-home services agency licensed to provide home health services and are under the direction of appropriate agency health care personnel. The assistance is provided in accordance with the Nurse Practice Act as defined in chapters 18.79 RCW and 246-840 WAC and the nursing assistant scope of practice as defined in chapters 18.88A RCW and 246-841 WAC.
(16) "Palliative care" means specialized care for people living with serious illness. Care is focused on relief from the symptoms and stress of the illness and treatment whatever the diagnosis. The goal is to improve and sustain quality of life for both the patient, loved ones, and other care companions. It is appropriate at any age and at any stage in a serious illness and can be provided along with active treatment. Palliative care facilitates patient autonomy, access to information, and choice. The palliative care team helps patients and families understand the nature of their illness, and make timely, informed decisions about care.
(17) "Patient" means an individual receiving home health services.
(18) "Professional medical equipment assessment services" means periodic care provided by a registered nurse licensed under chapter 18.79 RCW, a physical therapist licensed under chapter 18.74 RCW, an occupational therapist licensed under chapter 18.59 RCW, a respiratory therapist licensed under chapter 18.89 RCW, or dietitian or nutritionist as defined in subsection (5) of this section within their scope of practice, for patients who are medically stable, for the purpose of assessing the patient's medical response to prescribed professional medical equipment, including, but not limited to, measurement of vital signs, oximetry testing, and assessment of breath sounds and lung function (spirometry).
(19) "Registered nurse" or "RN" means an individual licensed under chapter 18.79 RCW.
(20) "Social worker" means a person with a degree from a social work educational program accredited and approved as provided in RCW 18.320.010 or who meets qualifications provided in 42 C.F.R. Sec. 418.114 as it existed on January 1, 2012.
(21) "Telehealth" means a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technology. Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.
(22) "Telemedicine" means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. "Telemedicine" does not include the use of audio-only telephone, facsimile, or electronic mail.
(23) "Therapist" means an individual who is:
(a) A physical therapist licensed under chapter 18.74 RCW;
(b) A respiratory therapist licensed under chapter 18.89 RCW;
(c) An occupational therapist licensed under chapter 18.59 RCW;
(d) A speech therapist licensed under chapter 18.35 RCW; or
(e) A massage therapist licensed under chapter 18.108 RCW.
(24) "Therapy assistant" means a licensed occupational therapy assistant defined under chapter 18.59 RCW or physical therapist assistant defined under chapter 18.74 RCW.