SOCIAL AND HEALTH SERVICES

(Aging and Long-Term Support Administration)

[Filed February 15, 2023, 10:04 a.m.]

Preproposal statement of inquiry was filed as WSR 22-17-014.

Title of Rule and Other Identifying Information: Amending sections of two community first choice (CFC) rules related to assistive technology, WAC 388-106-0270(5) What services are available under community first choice (CFC)?, and 388-106-0274 (1) and (3) Are there limits to the assistive technology I may receive? The proposed amendments are to further clarify what is available as assistive technology, what does not qualify, and what knowledge a treating professional providing a written recommendation for the assistive technology must have.

Hearing Location(s): On March 21, 2023, at 10:00 a.m., at Office Building 2, the Department of Social and Health Services (DSHS) Headquarters, 1115 Washington [Street S.E.], Olympia, WA 98504. Public parking at 11th and Jefferson. A map is available at https://www.dshs.wa.gov/office-of-the-secretary/driving-directions-office-bldg-2; or virtually. Due to the COVID-19 pandemic, hearings are held virtually. See the DSHS website https://www.dshs.wa.gov/office-of-the-secretary/filings-and-rules for the most current information.

Date of Intended Adoption: Not earlier than March 22, 2023.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, email DSHSRPAURulesCoordinator@dshs.wa.gov, fax 360-664-6185, by 5:00 p.m. on March 21, 2023.

Assistance for Persons with Disabilities: Contact DSHS rules consultant, phone 360-664-6036, fax 360-664-6185, TTY 711 relay service, email shelley.tencza@dshs.wa.gov, by 5:00 p.m. on March 7, 2023.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the proposed amendments is to provide further clarification to our stakeholders on what is CFC assistive technology, what are examples of CFC assistive technology, what are examples of items that are not covered as CFC assistive technology, and what a treating professional providing a written recommendation should know about the assistive technology item and address related to the individual requesting the assistive technology. The anticipated effects of these proposed amendments are to assist case managers and CFC clients to have a clearer idea of what CFC assistive technology is.

Reasons Supporting Proposal: See above.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520, 74.39A.400; and 42 C.F.R 441.500-590.

Statute Being Implemented: RCW 74.08.090, 74.09.520, 74.39A.400; and 42 C.F.R 441.500-590.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: DSHS, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Victoria Nuesca; Manipon Manivanh; and Peggy Dotson, P.O. Box 45600, Olympia, WA 98504-5600, 360-725-2393; 360-407-1572; 360-407-1563.

A school district fiscal impact statement is not required under RCW 28A.305.135.

A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 (5)(b)(vii) Rules of the department of social and health services relating only to client medical or financial eligibility.

This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:

Is exempt under RCW 19.85.025(3) as the rules only correct typographical errors, make address or name changes, or clarify language of a rule without changing its effect.

Is exempt under RCW 34.05.328 (5)(b)(vii) Rules of the department of social and health services relating only to client medical or financial eligibility.

Scope of exemption for rule proposal:

Katherine I. Vasquez

AMENDATORY SECTION(Amending WSR 17-03-127, filed 1/18/17, effective 2/18/17)

WAC 388-106-0270What services are available under community first choice (CFC)?

The services you may receive under the community first choice program include:

(1) Personal care services as defined in WAC 388-106-0010.

(2) Relief care, which is personal care services by a second individual or agency provider as a back-up to your primary paid personal care provider.

(3) Skills acquisition training, which is training that allows you to acquire, maintain, and enhance skills necessary to accomplish ADLs, IADLs, or health related tasks more independently. Health related tasks are specific tasks related to the needs of an individual that under state law licensed health professionals can delegate or assign to a qualified health care practitioner.

(4) Personal emergency response systems (PERS), which are basic electronic devices that enable you to secure help in an emergency when:

(a) You live alone in your own home;

(b) You are alone in your own home for significant parts of the day and have no provider for extended periods of time; or

(5) Assistive technology, including assistive equipment, which are adaptive and assistive items that increase your independence or substitute for human assistance specifically with ADLs, IADLs, or health related tasks, including but not limited to:

(a) ((Additions to the standard)) PERS ((unit))add-on services, such as fall detection, GPS, or medication ((delivery with or without)) reminder systems;

(b) Department approved devices that are not excluded by WAC 388-106-0274, including but not limited to:((visual alert systems, voice activated systems, switches and eyegazes, and timers or electronic devices that monitor or sense movement and react in a prescribed manner such as turning on or off an appliance;))

(i) Adaptive utensils to assist with activities such as eating, dressing, and writing;

(ii) Communication applications/software or devices;

(iii) Visual alert systems;

(iv) Voice activated systems;

(v) Switches and eyegazes; and

(vi) Timers or electronic devices that monitor or sense movement and react in a prescribed manner such as turning on or off an appliance;

(d) Training of participants and caregivers on the maintenance or upkeep of equipment purchased under assistive technology.

(6) Nurse delegation services as defined in WAC 246-840-910 through 246-840-970.

(7) Nursing services when you are not already receiving nursing services from another source. A registered nurse may visit you and perform any of the following activities:

(a) Nursing assessment/reassessment;

(b) Instruction to you and your providers;

(d) Skilled treatment, which is care that requires authorization, prescription, and supervision by an authorized practitioner prior to its provision by a nurse, including but not limited to medication administration or wound care such as debridement; nursing services will only provide skilled treatment in the event of an emergency and in nonemergency situations, the nurse will refer the need for any skilled medical or nursing treatments to a health care provider, home health agency, or other appropriate resource;

(e) File review; and

(f) Evaluation of health-related care needs that affect service plan and delivery.

(8) Community transition services, which are nonrecurring, setup items or services to assist you with discharge from a nursing facility, institution for mental diseases, or intermediate care facility for individuals with intellectual disabilities, when these items or services are necessary for you to set up your own home, including but not limited to:

(a) Security deposits that are required to lease an apartment or home, including first month's rent;

(b) Essential household furnishings required to occupy and use a community domicile, including furniture, window coverings, food preparation items, and bath and linen supplies;

(d) Services necessary for your health and safety such as pest eradication and one-time cleaning prior to occupancy;

(e) Moving expenses; and

(f) Activities to assess need, arrange for, and procure necessary resources.

(9) Caregiver management training on how to select, manage, and dismiss personal care providers.

AMENDATORY SECTION(Amending WSR 17-03-127, filed 1/18/17, effective 2/18/17)

WAC 388-106-0274Are there limits to the assistive technology I may receive?

(1) There are limits to the assistive technology you may receive. Assistive technology excludes:

(a) Any purchase solely for recreational purposes;

(b) Items of general utility, meaning they are used by people in the absence of illness, injury, or disability, such as a wood splitter, facial wipes, menstrual supplies, or a slow cooker;

(d) Educational software, game applications, or gift cards for educational/game applications;

(((c)))(e) Medical supplies and medical equipment, items available as specialized equipment and supplies, or durable medical equipment;

(f) Specialized clothing or slip-on shoes that are for convenience and not adaptive in nature;

(g) Exercise equipment;

(((d)))(h) Home/environmental modifications; ((and))

(i) Medically necessary items, including but not limited to compression socks/stockings, orthotics, hearing aids, and eyeglasses; and

(((e)))(j) Any item that would otherwise be covered under any other payment source, including but not limited to medicare, medicaid, ((and)) private insurance, or another resource.

(2) In combination with skills acquisition training, assistive technology purchases are limited to a yearly amount determined by the department per fiscal year.

(3) To help decide whether to authorize assistive technology the department may require a treating professional's written recommendation regarding the need for an assistive technology evaluation. The treating professional who makes this recommendation must:

(a) Have personal knowledge of ((or))and experience with the requested assistive technology that is in alignment with their profession; and

(b) Have ((examined))evaluated you, reviewed your medical records, ((and)) have knowledge of your level of functioning, and your ability to use the requested assistive technology or device.

(4) Your choice of assistive technology is limited to the most cost effective option that meets your health and welfare needs.

(5) Replacement of an assistive technology item or piece of equipment is limited to once every two years.