WSR 01-23-072

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

[ Filed November 20, 2001, 3:48 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 00-23-049.

Title of Rule: New WAC 388-71-05910 through 388-71-05954, Individual provider and home care agency provider qualifications; amending WAC 388-71-0500, 388-71-0520 and 388-71-0540; and repealing WAC 388-71-0525, 388-71-0530, and 388-71-0535.

Purpose: To implement SSB 6502 (chapter 121, Laws of 2000) on training requirements for individual providers and home care agency providers under Medicaid in-home services.

Statutory Authority for Adoption: RCW 74.39A.050, 34.05.020.

Statute Being Implemented: Chapter 121, Laws of 2000.

Summary: Implements requirements for staff and individual provider orientation in Medicaid home care; implements processes for approval of instructors.

Reasons Supporting Proposal: Implementing statutes referenced above.

Name of Agency Personnel Responsible for Drafting: Dotti Wilke, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2539; Implementation and Enforcement: Marta Acedo, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2549.

Name of Proponent: Department of Social and Health Services, governmental.

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

Explanation of Rule, its Purpose, and Anticipated Effects: This rule implements RCWs on training for Medicaid home care (agency and individual providers). The new requirements in the RCW is an orientation for in-home providers. The rule also describes the process for approval of instructors for certain trainings.

Proposal Changes the Following Existing Rules: This proposal moves existing rules into one new rule.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement

SUMMARY OF PROPOSED RULES: The Department of Social and Health Services' Aging and Adult Services Administration (AASA) is proposing to amend chapter 388-71 WAC, Social services for adults. The amendments to chapter 388-71 WAC contain the training rules for home care provided through the Medicaid personal care, COPES, or chore programs by individual providers or home care agency providers. These include new rules implementing changes in chapter 74.39A RCW, Long-term care services option -- Expansion.

The purpose of this chapter is to:

&sqbul; Define minimum training requirements;
&sqbul; Define the types of training;
&sqbul; Clarify instructor requirements; and
&sqbul; Establish department procedures for approval of instructors.
The statutory authority for this chapter is RCW 74.39A.050 Long-term care services options -- Expansion.

The major proposed changes are:

&sqbul; Incorporating a new requirement for orientation training for new staff, as required in chapter 74.39A RCW; and
&sqbul; Creating an approval system for trainers as required by the RCW.
Background of the proposed rule:

In 1995, as part of long-term care reform, the legislature allocated funds for training during the following year. Providers and caregivers who were trained included:

&sqbul; Caregivers in boarding homes that contract with DSHS;
&sqbul; All licensed adult family home providers and caregivers; and
&sqbul; Home care agency providers and individual providers serving clients through the Medicaid personal care, COPES, and chore programs.
In 1997, two task forces were created under the auspices of the legislature to review caregiver training:

&sqbul; The Joint Executive-Legislative Long Term Care Task Force's subcommittee on training. This task force reported to the legislature in December 1998 and January 2000.
&sqbul; The training task force, which was the responsibility of DSHS, the Department of Health, and the Nursing Care Quality Assurance Commission, was directed to review caregiver training. This task force reported to the legislature in December 1998.
The new training requirements created by legislation in the 2000 session were based largely on the recommendations from the two task forces. This same legislation created the Community Long Term Care Education and Training Steering Committee to advise the department on the development of rules to implement the new law (see RCW 74.39A.190.)

Goal for the proposed rules: The goal for this chapter is to ensure that all caregivers have an orientation when they begin to work with clients or residents.

Training improves caregiving skills and the quality of care delivered to more than 20,000 adults receiving care through these programs.

SMALL BUSINESS ECONOMIC IMPACT STATEMENT: Chapter 19.85 RCW, the Regulatory Fairness Act, requires that the economic impact of proposed regulations be analyzed in relation to small businesses. This statute outlines information that must be included in a small business economic impact statement (SBEIS). Preparation of an SBEIS is required when a proposed rule has the potential of placing a disproportionate economic impact on small businesses.

Aging and Adult Services Administration has analyzed the proposed amendments to their rules and has determined that small businesses will be impacted by these changes, with some costs considered "more than minor."

INDUSTRY ANALYSIS: The Department of Health is responsible for home care agency licensing. As part of licensing, this state agency keeps current internal databases that identify all licensed agencies. Since internal industry information can be obtained at a more accurate level than is required by chapter 19.85 RCW, it is unnecessary to conduct an industry analysis using the four-digit standard industrial classification (SIC) codes.

INVOLVEMENT OF SMALL BUSINESSES: The data used in this analysis was gathered from several sources:

&sqbul; The statewide organizations that represent the fifty-eight home care agencies affected, and
&sqbul; The Department of Health licensing information for home care agencies.
The organizations that contributed current data on wages, benefits, and cost estimates for the businesses they represent, most of which are small businesses, include: The Home Care Association of Washington and the Washington State Association of Home Care Services.

The rule has been developed with the advice of the training steering committee, which has been meeting monthly for fifteen months to consider and recommend the rules to implement these laws. The small businesses affected are represented on the committee by the statewide provider organizations listed above.

In addition, four public forums were held during the summer (in Bellevue, Lacey, Spokane, and Yakima) to discuss the rule development and take public comment on the proposed rules as recommended by the steering committee. Approximately 2000 interested parties were invited; seventy-seven people attended and commented.

AASA staff also have regularly attended meetings with home care providers for the past year to update them on the rule development and take their comments and suggestions. To reach those who could not attend meetings, the proposed rules as recommended by the steering committee have been posted on the AASA Internet web site, with contact person information for anyone wishing to comment or make suggestions on the rule. All the input from these various groups and meetings has helped shape the development of this rule.

COST OF COMPLIANCE: Costs related to record keeping: Each business must keep on file copies of certificates showing successful completion of required trainings for each of their employees. The only new record-keeping requirement for home care agencies is orientation. Keeping orientation certificates on file will result in a minor cost to the business.

Estimated training costs: Expected costs include:

&sqbul; The trainer's wages and benefits (on-staff trainers are used for orientation);
&sqbul; The trainee's wages and benefits; and
&sqbul; Costs for training materials.
See Table 1, below, for estimated costs.

To fairly consider costs of compliance, AASA has elected to look at costs per trainee. This is because there is no reliable data on the number of employees that will be required to have this training, or the rate of turnover, both of which affect total training costs.

The most costly wage scenarios were used for cost estimates. These include using a registered nurse who is on staff as the orientation trainer, and assuming a one-on-one training, rather than group training. Circumstances that may be used to mitigate these costs are noted in the section on mitigating expenses.


Table 1: Costs of Compliance for Home Care Agencies


Orientation is a new requirement for all home care agencies. It is always provided at the agency, by agency staff, requiring no travel or consultant costs.

Orientation Personnel, other costs Wages Benefits & Taxes Total per hour Hours Total Cost
Trainer (RN) $24.24 $6.14 $30.38 2 $60.76
Trainee $7.68 $2.19 $9.87 2 $19.74
Materials $10.00
Total per trainee $90.50

Disproportionate Economic Impact Analysis: When there are more than minor costs to small businesses as a result of proposed rule changes, the Regulatory Fairness Act requires an analysis to be done, comparing these costs between small businesses and ten percent of the largest businesses.

About 17% of home care agencies have more than fifty employees (Department of Health licensing data, 2001), but some are nonprofits. While the per-trainee costs do not differ between small and large businesses, the costs may be a higher proportion of overall costs for a small business. AASA elected to focus on mitigating expenses for small businesses regardless of actual figures resulting from an analysis comparing large and small businesses. AASA proposes several measures that will mitigate the cost impact for small businesses, thus helping them more easily comply with additional training requirements.

Mitigating Expenses: Aging and Adult Services Administration has included the following to help mitigate training costs for small businesses:

&sqbul; Orientation of home care agency staff is already required under home care licensing, chapter 246-336 WAC. Many of the specific topics required in chapter 388-71 WAC may already be included in the orientation that agencies currently provide their staff.
&sqbul; Orientation training costs can be significantly reduced if the person doing the orientation is not an RN (high wage rate). For instance, an RN's median hourly wage is estimated to be $24.24. If an LPN does the orientation, the hourly wage drops to $15.72; if a social worker does the orientation, the hourly wage is $18.74. Both LPNs and social workers are qualified to do this training. The agency has a choice of which staff to use for conducting the orientation training, and may save money with these other choices.
&sqbul; Orientation training costs are further reduced if the agency orients more than one person at a time. This can be done any time the agency hires several new caregivers and has them start working at the same time. By doing this, the cost for the trainer's time is spread across several trainees, reducing the per trainee cost.
&sqbul; Individuals who have already been oriented at another agency can have a much briefer orientation at a new agency, which is a saving for the second business. The orientation can be shorter because basic information on the required topics will be consistent across agencies. The agency will be able to spend less time on basic information, and focus primarily on information specific to the agency.
Additional cost savings: There are additional, overall cost savings for small businesses with the new training requirements, which are important to mention.

&sqbul; The orientation reduces the time it takes new employees to begin to provide quality care to clients, translating into better care and higher satisfaction for the clients, and improved word-of-mouth publicity for the agency, which may increase income for the agency.
&sqbul; Well-trained employees generally have higher job satisfaction and this leads to a lower turnover rate, significantly reducing overall costs. Turnover rates have been estimated as 50% or higher per year, for caregivers. Village Green, a Washington state boarding home, determined that monthly turnover for caregivers dropped from 21% to under 5% after implementing a thorough orientation program.
CONCLUSION: Aging and Adult Services Administration has given careful consideration to the impact of proposed amendments to chapter 388-71 WAC, Social services for adults, on small businesses. In accordance with the Regulatory Fairness Act, chapter 19.85 RCW, Aging and Adult Services Administration has analyzed impacts on small businesses and proposed ways to mitigate those costs associated with implementing the training requirements in these rules. The new requirements being implemented in these rules are contained in chapter 74.39A RCW. The proposed WAC amendments expand on the information in the RCW to assist providers in successfully meeting the new requirements. Training staff adequately to care for adult clients is a benefit to both the client and the provider.

A copy of the statement may be obtained by writing to Tresa Harambasic, Aging and Adult Services Administration, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2548, fax (360) 725-2646.

RCW 34.05.328 applies to this rule adoption. A cost-benefit analysis has been prepared concerning these proposed rules, and may be obtained by contacting Tresa Harambasic, Aging and Adult Services Administration, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2548, fax (360) 725-2646.

Hearing Location: Office Building-2 Auditorium, DSHS Headquarters, 1115 Washington, 14th and Jefferson, Olympia, WA 98504, on January 8, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by January 4, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by 5:00 p.m., January 8, 2002.

Date of Intended Adoption: Not earlier than January 9, 2002.

November 14, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3013.4
NEW SECTION
WAC 388-71-05910   What definitions apply to WAC 388-71-05911 through 388-71-05954?   "Client" means an individual receiving in-home services through Medicaid personal care, COPES, or Chore programs. As applicable, the term client also means the client's legal guardian or other surrogate decision maker.

"Competency" means the minimum level of information and skill trainees are required to know and be able to demonstrate.

"DSHS" refers to the department of social and health services.

"Learning outcomes" means the specific information, skills and behaviors desired of the learner as a result of a specific unit of instruction, such as what they would learn by the end of a single class or an entire course. Learning outcomes are generally identified with a specific lesson plan or curriculum.

"Outcome based training" means training that bases the curriculum design, content, delivery, and assessment on the specific knowledge, skills, and behaviors needed to demonstrate competency.

"Routine interaction" means contact with residents or clients that happens more than infrequently.

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NEW SECTION
WAC 388-71-05911   What is orientation?   Orientation provides basic introductory information appropriate to the in-home setting and population served. The department does not approve specific orientation programs, materials, or trainers for home care agencies. No test is required for orientation.

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NEW SECTION
WAC 388-71-05912   What content must be included in an orientation?   Orientation may include the use of videotapes, audiotapes, and other media if the person overseeing the orientation is available to answer questions or concerns for the person(s) receiving the orientation. Orientation must include introductory information in the following areas:

(1) The care setting;

(2) The characteristics and special needs of the population served;

(3) Fire and life safety, including:

(a) Emergency communication (including phone system if one exists);

(b) Evacuation planning (including fire alarms and fire extinguishers where they exist);

(c) Ways to handle client injuries and falls or other accidents;

(d) Potential risks to clients or providers (for instance, aggressive client behaviors and how to handle them); and

(e) The location of agency policies and procedures, when orientation takes place in a home care agency.

(4) Communication skills and information, including:

(a) Methods for supporting effective communication among the client, the provider, and family members;

(b) Use of verbal and nonverbal communication;

(c) Review of written communications and/or documentation required for the job, including the client's service plan; and

(d) Whom to contact about problems and concerns.

(5) Universal precautions and infection control, including:

(a) Proper hand washing techniques;

(b) Protection from exposure to blood and other body fluids;

(c) Appropriate disposal of contaminated/hazardous articles;

(d) Reporting exposure to contaminated articles, blood, or other body fluids; and

(e) What a provider should do if they are ill.

(6) Client rights, including:

(a) The client's right to confidentiality of information about the client;

(b) The client's right to participate in decisions about the client's care, and to refuse care;

(c) The provider's duty to refrain from interfering with the client's exercise of his or her rights;

(d) How and to whom providers should report any concerns they may have about a client's decision concerning the client's care;

(e) Providers' duty to report any suspected abuse, abandonment, neglect, or exploitation of a client;

(f) Advocates that are available to help clients (LTC ombudsmen, organizations); and

(g) Complaint lines, hot lines, and client grievance procedures.

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NEW SECTION
WAC 388-71-05913   Is competency testing required for orientation?   There is no competency testing required for orientation.

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NEW SECTION
WAC 388-71-05914   Is there a challenge test for orientation?   There is no challenge test for orientation.

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NEW SECTION
WAC 388-71-05915   What documentation is required for orientation?   The home care agency or individual provider must maintain documentation of completion of orientation that includes:

(1) A list of the specific information and skills taught;

(2) Signatures of the instructor and trainee indicating completion of the required information and skills;

(3) The trainee's date of employment;

(4) The location of the training; and

(5) The date(s) of training.

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NEW SECTION
WAC 388-71-05916   Who is required to complete orientation, and when must it be completed?   (1) Home care agency providers must complete orientation before working with the agency's clients. Orientation must be provided by appropriate agency staff.

(2) Individual providers must complete orientation no later than fourteen calendar days after beginning to work with their first DSHS client. Orientation must be provided by DSHS or area agency on aging (AAA) staff.

(3) Parents who are individual providers for their adult children are exempt from the orientation requirement.

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NEW SECTION
WAC 388-71-05917   What is basic training?   Basic training includes the core knowledge and skills that providers need to provide personal care services effectively and safely. Only the training curriculum developed by DSHS may be used for basic training.

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NEW SECTION
WAC 388-71-05918   Is there an alternative to the basic training for some health care workers?   Certain health care workers may complete the modified basic training instead of basic training if they meet the requirements in WAC 388-71-05929.

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NEW SECTION
WAC 388-71-05919   What core knowledge and skills must be taught in basic training?   Basic training must include the following core knowledge and skills:

(1) Understanding and using effective interpersonal and problem solving skills with clients, family members, and other care team members;

(2) Taking appropriate action to promote and protect client rights, dignity, and independence;

(3) Taking appropriate action to promote and protect the health and safety of the client and the caregiver;

(4) Correctly performing required personal care tasks while incorporating client preferences, maintaining the client's privacy and dignity, and creating opportunities that encourage client independence;

(5) Adhering to basic job standards and expectations.

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NEW SECTION
WAC 388-71-05920   Is competency testing required for basic training?   Competency testing is required for basic training as provided under WAC 388-71-05940 through 388-71-05946.

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NEW SECTION
WAC 388-71-05921   Is there a challenge test for basic training?   Individuals may take the DSHS challenge test instead of the required training. If a person does not pass a challenge test on the first attempt, they may not re-take the challenge test and must attend a class.

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NEW SECTION
WAC 388-71-05922   What documentation is required for successful completion of basic training?   Basic training must be documented by a certificate of successful completion of training that includes:

(1) The name of the trainee,

(2) The name of the training,

(3) The location of the training,

(4) The instructor's name and signature, and

(5) The date(s) of training.

The trainee must retain the original certificate. A home care agency must keep a copy of the certificate on file. An individual provider must give a copy of the certificate to DSHS or area agency on aging.

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NEW SECTION
WAC 388-71-05923   Who is required to complete basic training, and when?   Individual providers and home care agency providers must complete department-developed basic training and demonstrate competency within one hundred twenty days after beginning to work with their first DSHS client.

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NEW SECTION
WAC 388-71-05924   What is modified basic training?   Modified basic training is a subset of the basic training curriculum designed for certain health care workers whose previous training teaches many of the competencies taught in the full basic training. Only the training curriculum developed by DSHS may be used for basic training.

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NEW SECTION
WAC 388-71-05925   What core knowledge and skills must be included in modified basic training?   Modified basic training must include the following core knowledge and skills:

(1) Client rights, including mandatory reporting requirements;

(2) Medication assistance regulations;

(3) Nurse delegation regulations;

(4) Assessment and observations in home and community settings;

(5) Documentation in home and community settings;

(6) Service planning in home and community care settings;

(7) Resource information, including information on continuing education; and

(8) Self-directed care regulations.

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NEW SECTION
WAC 388-71-05926   Is competency testing required for modified basic training?   Competency testing is required for modified basic training as provided in WAC 388-71-05940 through 388-71-05946.

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NEW SECTION
WAC 388-71-05927   Is there a challenge test for modified basic training?   Individuals may take the department's challenge test instead of the required training. If a person does not pass a challenge test on the first attempt, they may not re-take the challenge test and must attend the class.

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NEW SECTION
WAC 388-71-05928   What documentation is required for successful completion of modified basic training?   Modified basic training must be documented by a certificate of successful completion of training that includes:

(1) The name of the trainee,

(2) The name of the training,

(3) The location of the training,

(4) The instructor's name and signature, and

(5) The date(s) of training.

The trainee must retain the original certificate. A home care agency must keep a copy of their employees' certificates on file. An individual provider must give a copy to DSHS or area agency on aging.

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NEW SECTION
WAC 388-71-05929   Who may take modified basic training instead of the full basic training?   Modified basic training may be taken, instead of the full basic training, by a person who can document they have successfully completed training as a registered or licensed practical nurse, certified nursing assistant, physical therapist, occupational therapist, or Medicare-certified home health aide. In addition, modified basic training may be taken by a natural, step, or adoptive parent who is the individual provider for his or her adult child who is not receiving services through DSHS' division of developmental disabilities.

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NEW SECTION
WAC 388-71-05930   What are the training requirements and exemptions for parents who are individual providers for their adult children receiving services through DDD?   A natural, step, or adoptive parent who is the individual provider for his or her adult child who is receiving services through DSHS' division of developmental disabilities (DDD):

(1) Must possess a certificate of successfully completing a six-hour DDD-approved training or a specially designed DSHS-approved training within one hundred eighty days of beginning employment;

(2) Is exempt from the orientation, basic training, and continuing education requirements if the parent provides care only for his or her own adult child.

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NEW SECTION
WAC 388-71-05931   What are the training requirements and exemptions for parents who are individual providers for their adult children who do not receive services through DDD?   A natural, step, or adoptive parent who is the individual provider for his or her adult child who is not receiving services through DSHS' division of developmental disabilities:

(1) Must:

(a) Possess a certificate of successfully completing modified basic training within one hundred eighty days of beginning employment, and have documentation that the parent has received individualized or other specific instruction on the care of the adult child; or

(b) Pass the DSHS challenge test; or

(c) Possess a certificate of successfully completing basic training.

(2) Is exempt from the orientation and continuing education requirements.

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NEW SECTION
WAC 388-71-05932   What is continuing education?   Continuing education is additional caregiving-related training designed to increase and keep current a person's knowledge and skills. DSHS does not pre-approve continuing education programs or instructors.

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NEW SECTION
WAC 388-71-05933   How many hours of continuing education are required each year?   (1) Individual providers and home care agency providers must complete at least ten hours of continuing education each calendar year (January 1 through December 31).

(2) One hour of completed classroom instruction or other form of training (such as a video or on-line course) equals one hour of continuing education.

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NEW SECTION
WAC 388-71-05934   What kinds of training topics are required for continuing education?   Continuing education must be on a topic relevant to the care setting and care needs of clients, including but not limited to:

(1) Client rights;

(2) Personal care (such as transfers or skin care);

(3) Mental illness;

(4) Dementia;

(5) Developmental disabilities;

(6) Depression;

(7) Medication assistance;

(8) Communication skills;

(9) Positive client behavior support;

(10) Developing or improving client centered activities;

(11) Dealing with wandering or aggressive client behaviors; and

(12) Medical conditions.

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NEW SECTION
WAC 388-71-05935   Is competency testing required for continuing education?   Competency testing is not required for continuing education.

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NEW SECTION
WAC 388-71-05936   When does the continuing education requirement start?   Continuing education is not required during the first calendar year following the year in which basic or modified basic training is successfully completed. Continuing education is required in each calendar year thereafter.

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NEW SECTION
WAC 388-71-05937   May basic or modified basic training be completed a second time and used to meet the continuing education requirement?   Re-taking basic or modified basic training may not be used to meet the continuing education requirement.

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NEW SECTION
WAC 388-71-05938   What are the documentation requirements for continuing education?   (1) The home care agency or individual provider must maintain documentation of continuing education including:

(a) The trainee's name;

(b) The title or content of the training;

(c) The instructor's name or the name of the video, on-line class, professional journal, or equivalent instruction materials completed;

(d) The number of hours of training; and

(e) The date(s) of training.

(2) Home care individual providers must provide DSHS or the area agency on aging with proof of completion of continuing education credits.

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NEW SECTION
WAC 388-71-05939   What is competency testing?   Competency testing is evaluating a trainee to determine if they can demonstrate the required level of skill, knowledge, and/or behavior with respect to the identified learning outcomes of a particular course.

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NEW SECTION
WAC 388-71-05940   What components must competency testing include?   Competency testing must include the following components:

(1) Skills demonstration of ability to perform and/or implement specific caregiving approaches, and/or activities as appropriate for the training;

(2) Written evaluation to show knowledge of the learning outcomes included in the training; and

(3) A scoring guide for the tester with clearly stated scoring criteria and minimum proficiency standards.

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NEW SECTION
WAC 388-71-05941   What experience or training must individuals have to be able to perform competency testing?   Individuals who perform competency testing must have documentable experience or training in assessing competencies.

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NEW SECTION
WAC 388-71-05942   What training must include the DSHS-developed competency test?   Basic and modified basic training must include the DSHS-developed competency test.

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NEW SECTION
WAC 388-71-05943   How must test administration be standardized?   To standardize test administration, testing must include the following components:

(1) An instructor for the course who meets all minimum qualifications for the course he or she teaches must oversee all testing; and

(2) The tester must follow DSHS guidelines for:

(a) The maximum length of time allowed for testing;

(b) The amount and nature of instruction given to students before beginning a test;

(c) The amount of assistance to students allowed during testing;

(d) The accommodation guidelines for students with disabilities; and

(e) Accessibility guidelines for students with limited English proficiency.

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NEW SECTION
WAC 388-71-05944   What form of identification must providers show a tester before taking a competency or challenge test?   Providers must show a tester photo identification before taking a competency test (or challenge test, when applicable) for basic or modified basic training.

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NEW SECTION
WAC 388-71-05945   How many times may a competency test be taken?   A competency test may be taken only twice for any one course. If the test is failed a second time, the person must re-take the course before any additional tests are administered.

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NEW SECTION
WAC 388-71-05946   What are an instructor's responsibilities?   The instructor is responsible for:

(1) Coordinating and teaching classes;

(2) Assuring that the curriculum used is taught as designed;

(3) Selecting qualified guest speakers where applicable;

(4) Administering or overseeing the administration of DSHS competency and challenge tests;

(5) Maintaining training records including student tests and attendance records for a minimum of six years;

(6) Reporting training data to DSHS in DSHS-identified time frames; and

(7) Issuing or re-issuing training certificates to students.

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NEW SECTION
WAC 388-71-05947   Must instructors be approved by DSHS or an AAA?   (1) DSHS must approve any instructor under contract with DSHS to conduct basic or modified basic training classes using the training curricula developed by DSHS. DSHS may select contracted instructors using any applicable contracting procedures. Contractors must meet the minimum qualifications for instructors under this chapter and any additional qualifications established through the contracting procedure.

(2) DSHS contracts with area agencies on aging (AAA) to conduct orientation, basic, modified basic, and continuing education training programs for individual providers and home care agency providers. The AAA must approve any instructor under contract with the AAA to conduct training programs. The AAA's contractors must meet the minimum qualifications for instructors under this chapter and any additional qualifications established through the AAA's contracting procedures.

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NEW SECTION
WAC 388-71-05948   When can DSHS or the AAA not approve an instructor?   (1) DSHS or an area agency on aging (AAA), as applicable, may determine not to accept an offer by a person or organization seeking a contract with DSHS or the AAA to conduct training programs. No administrative remedies are available to dispute DSHS' or the AAA's decision not to accept an offer.

(2) DSHS or the AAA may terminate any training contract in accordance with the terms of the contract. The contractor's administrative remedies shall be limited to those specified in the contract.

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NEW SECTION
WAC 388-71-05949   What is a guest speaker, and what are the minimum qualifications to be a guest speaker for basic training?   Guest speakers for basic training programs teach a specific subject in which they have expertise, under the supervision of the instructor. The guest speaker must have as minimum qualifications, an appropriate background and experience that demonstrates that the guest speaker has expertise on the topic he or she will teach. The instructor must select guest speakers that meet the minimum qualifications, and maintain documentation of this background. DSHS does not approve guest speakers.

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NEW SECTION
WAC 388-71-05950   What are the minimum qualifications for an instructor for basic or modified basic training?   An instructor for basic or modified basic training must meet the following minimum qualifications:

(1) If the person currently holds a health care or social services license or certification in Washington state, it must be in good standing. However, no license or certification is required;

(2) The instructor must meet the requirements in (a) or (b) of this subsection. The instructor:

(a) Must have at least one hundred hours experience teaching adults within the last ten years in a classroom setting, with at least fifty of those hours teaching content comparable to topics included in basic training, and with documented practice in principles of adult education theory and practice including:

(i) Classroom facilitation skills and techniques;

(ii) Facilitating adult learning activities; and

(iii) Administering competency testing for both skills and written testing.

(b) Must, if the person does not meet the requirements in (a) of this subsection:

(i) Have at least thirty-two hours of classroom instruction in principles of adult education theory and practice that meets the requirements of WAC 388-71-05951; and

(ii) Observe an instructor meeting minimum instructor requirements under this section teaching the entire basic training class.

(3) Upon initial approval or hire, the instructor must have at least five hundred twenty hours (three months full time equivalent) professional work experience within the last five years in an adult family home, boarding home, supported living through DDD per chapter 388-820 WAC, or home care setting; and

(4) The instructor must be experienced in caregiving practices and capable of demonstrating competency with respect to the course content or units being taught;

(5) Instructors who will administer tests must have experience or training in assessment and competency testing; and

(6) Instructors must successfully complete basic or modified basic training prior to beginning to train, if required under WAC 388-71-05923 or 388-71-05929.

[]


NEW SECTION
WAC 388-71-05951   What must be included in a class on principles of adult education theory and practice?   A class on adult education theory and practice principles must include content, student practice, and evaluation of student skills by the instructor in:

(1) Adult education theory and practice principles;

(2) Instructor facilitation techniques;

(3) Facilitating learning activities for adults;

(4) Administering competency testing; and

(5) Working with adults with special training needs (for example, English as a second language or learning and literacy issues).

[]


NEW SECTION
WAC 388-71-05952   What physical resources are required for basic or modified basic classroom training and testing?   (1) Classroom facilities used for basic or modified basic classroom training must be accessible to trainees and provide adequate space for learning activities, comfort, lighting, lack of disturbance, and tools for effective teaching and learning such as white boards and flip charts. Appropriate supplies and equipment must be provided for teaching and practice of caregiving skills in the class being taught.

(2) Testing sites must provide adequate space for testing, comfort, lighting, and lack of disturbance appropriate for the written or skills test being conducted. Appropriate supplies and equipment necessary for the particular test must be provided.

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NEW SECTION
WAC 388-71-05953   What standard training practices must be maintained for basic or modified basic classroom training and testing?   The following training standards must be maintained for basic or modified basic classroom training and testing:

(1) Training must not exceed eight hours within a twenty-four hour period;

(2) Training provided in short time segments must include an entire unit, skill or concept;

(3) Training must include regular breaks; and

(4) Students attending a classroom training must not be expected to leave the class to attend to job duties, except in an emergency.

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3006.4
AMENDATORY SECTION(Amending WSR 01-11-019, filed 5/4/01, effective 6/4/01)

WAC 388-71-0500   What is the purpose of WAC 388-71-0500 through ((388-71-0580)) 388-71-05954?   A client/legal representative may choose an individual provider or a home care agency provider. The intent of WAC 388-71-0500 through ((388-71-0580)) 388-71-0593 is to describe the:

(1) Qualifications of an individual provider, as defined in WAC 388-15-202 (25) and (26);

(2) Qualifications of a home care agency provider, as defined in WAC 388-15-202(2) and chapter 246-336 WAC;

(3) Conditions under which the department or the area agency on aging (AAA) will pay for the services of an individual provider or a home care agency provider;

(4) Training requirements for an individual provider and home care agency provider.

[Statutory Authority: R.W. 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, 388-71-0500, filed 5/4/01, effective 6/4/01. Statutory Authority: R.W. 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, 388-71-0500, filed 1/13/00, effective 2/13/00.]


AMENDATORY SECTION(Amending WSR 00-03-043, filed 1/13/00, effective 2/13/00)

WAC 388-71-0520   Are there ((educational)) training requirements for an individual provider or a home care agency provider of an adult client?   ((There are educational requirements for an)) An individual provider or a home care agency ((employee)) provider for an adult client must meet the training requirements in WAC 388-71-05910 through 388-71-05953. ((They must :

(1) Possess a certificate of successfully completing department-designated fundamentals of care giving training within one hundred and twenty days after beginning employment;

(2) Complete a minimum of ten hours of continuing education credits each calendar year following the year in which the fundamentals of care giving training is taken. One hour of completed instruction equals one hour of credit on topics that pertain to services provided in an in-home setting including, but not limited to:

(a) Client's rights;

(b) Personal care (such as transfers or skin care);

(c) Mental illness;

(d) Dementia;

(e) Depression;

(f) Medication assistance;

(g) Communication skills;

(h) Alternatives to restraints;

(I) Activities for clients; and

(3) Provide the department/AAA with proof of completion of continuing education credits.))

[Statutory Authority: R.W. 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, 388-71-0520, filed 1/13/00, effective 2/13/00.]


AMENDATORY SECTION(Amending WSR 01-11-019, filed 5/4/01, effective 6/4/01)

WAC 388-71-0540   When will the department or AAA deny payment for services of an individual provider or home care agency provider?   The department or AAA will deny payment for the services of an individual provider or home care agency provider who:

(1) Is the client's spouse, per 42 C.F.A. 441.360(g), except in the case of an individual provider for a Chore services client. Note: For Chore espousal providers, the department pays a rate not to exceed the amount of a one-person standard for a continuing general assistance grant, per WAC 388-478-0030;

(2) Is the natural/step/adoptive parent of a minor client aged seventeen or younger receiving services under this chapter;

(3) Has been convicted of a disqualifying crime, under R.W. 43.43.830 and 43.43.842 or of a crime relating to drugs as defined in R.W. 43.43.830;

(4) Has abused, neglected, abandoned, or exploited a minor or vulnerable adult, as defined in chapter 74.34 R.W.;

(5) Has had a license, certification, or a contract for the care of children or vulnerable adults denied, suspended, revoked, or terminated for noncompliance with state and/or federal regulations;

(6) Does not successfully complete the training requirements within the time limits required in WAC ((388-71-0520)) 388-71-05910 through 388-71-05953;

(7) Is already meeting the client's needs on an informal basis, and the client's assessment or reassessment does not identify any unmet need; and/or

(8) Is terminated by the client (in the case of an individual provider) or by the home care agency (in the case of an agency provider).

(9) In addition, the department or AAA may deny payment to or terminate the contract of an individual provider as provided under WAC 388-71-0546, 388-71-0551, and 388-71-0556.

[Statutory Authority: R.W. 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, 388-71-0540, filed 5/4/01, effective 6/4/01. Statutory Authority: R.W. 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, 388-71-0540, filed 1/13/00, effective 2/13/00.]

Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.

Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.
REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 388-71-0525 Are there any exemptions from the training requirements?
WAC 388-71-0530 Are there special rules about training for parents who are the individual providers of division of developmental disabilities (DID) adult children?
WAC 388-71-0535 Are there special rules about training for parents who are the individual providers of non-DID adult children?

Washington State Code Reviser's Office