Date of Adoption: April 24, 2002.

     Purpose: Implements revisions of chapter 388-71 WAC requirements for staff orientation in Medicaid home care and processes for approval of instructors. New WAC 388-71-05936 as proposed in WSR 01-23-072 is being withdrawn. WAC 388-71-05936 as adopted was originally proposed as WAC 388-71-05937. Also, the department will publish a supplemental proposed rule-making notice and revised text of new WAC 388-71-05949, originally proposed as WAC 388-71-05950, which was amended as a result of public comments. The department will accept written comments and conduct a public hearing on revisions to this proposed rule.

     Citation of Existing Rules Affected by this Order: Repealing WAC 388-71-0525, 388-71-0530 and 388-71-0535; and amending WAC 388-71-0500, 388-71-0520, and 388-71-0540.

     Statutory Authority for Adoption: Chapter 74.39A RCW, Long-term care services options -- Expansion.

     Other Authority: Chapter 121, Laws of 2000.

      Adopted under notice filed as WSR 01-23-072 on November 20, 2001.

     Changes Other than Editing from Proposed to Adopted Version: The following changes have been made in response to public comments.

Rules as Proposed	Changes (additions underlined, deletions struck through)	Explanation of changes
WAC 388-71-05910	"Client" means an individual 18 years or older, who is 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.	Clarify that "client" in these WACs applies only to adults.
	"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.	"Outcome based training" is a term used in the statute but not in the WAC, so it is deleted here.
	"Routine interaction" means contact with residents or clients that happens more than infrequently regularly.	Under Routine Interaction, "More than infrequently" was not clear writing. The change should be more understandable.
WAC 388-71-05911	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. Department-developed orientation materials must be used for orientation of individual providers. No test is required for orientation.	Clarification.
WAC 388-71-05912 (4)(a)	Methods for supporting effective communication among the client/guardian, the provider, and family members. (6) (c) The provider's duty to refrain from interfering with protect and promote the rights of each client, and assist the client's to 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 including the client's case manager;	Clarify that communication with a guardian, when there is one, is included in this topic. (6) (c) Clarify intention of teaching active support of clients' rights, consistent with orientation requirements for AFH and BH. (d) Clarification pointing out the importance of the case manager.
WAC 388-71-05915	WAC 388-71-05915 What documentation is required for orientation? The home care agency or individual provider must maintain documentation of completion of orientation issued by the home care agency, area agency on aging, or DSHS office that provides the 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 orientation; and      (5) The date(s) of training orientation.	Clarify who issues the documentation of completion of orientation. Clarify that orientation includes only information, and does not include skills. A number of people found it confusing to refer to orientation as "training," so the term is changed to "orientation."
WAC 388-71-05916(2)	(2) Individual providers must complete orientation provided by DSHS or the area agency on aging (AAA) no later than fourteen calendar days after beginning to work with their first DSHS client. Individual providers who live and are providing care at a great distance from the DSHS or AAA office may be oriented by distance learning, with phone contact by the person overseeing the orientation to answer questions. Orientation must be provided by DSHS or area agency on aging (AAA) staff.	Some individual providers (IPs) live, and are providing care at a great distance from a DSHS or AAA office. Those IPs may be oriented by distance learning, with phone contact by DSHS or AAA staff to answer questions. This situation is unique to individual providers.
WAC 388-71-05919	What core knowledge and skills must be taught in basic training? The Bbasic training knowledge and skills must include all of the learning outcomes and competencies published by the department, for the following core knowledge and skills:.... ....The basic training outcomes and competencies may be obtained from the DSHS Aging and Adult Services Administration.	Clarifies that there are more detailed learning outcomes published by the department, in addition to the core knowledge and skills listed. Explain where to get the outcomes and competencies for basic training.
WAC 388-71-05920	...as provided under WAC 388-71-05940 05938 through 388-71-05946 05944	Reflects renumbering.
WAC 388-71-05922	Basic training must be documented by a certificate of successful completion of training, issued by the instructor or training entity, that includes:	Clarify who issues the certificate.
WAC 388-71-05924	Modified basic training is a subset of the basic training curriculum designed for certain health care workers defined in WAC 388-71-05929,... Only the training curriculum developed by DSHS may be used for modified basic training.	Clarifications.
WAC 388-71-05925	Modified basic training must include the following all of the outcomes and competencies published by DSHS for the following core knowledge and skills:... The modified basic outcomes and competencies may be obtained from the DSHS Aging and Adult Services Administration.	Clarifies that there are more detailed learning outcomes published by the department, in addition to the core knowledge and skills listed. Explain where to get the outcomes and competencies for basic training.
WAC 388-71-05926	...as provided in under WAC 388-71-05940 05938 through 388-71-05946 05944	Reflects renumbering; make wording consistent with other sections.
WAC 388-71-05928	Modified basic training must be documented by a certificate of successful completion of training, issued by the instructor or training entity, that includes:	Clarify who issues the certificate of successful completion.
WAC 388-71-05930	(1) Must possess a certificate... within one hundred eighty days of beginning employment; and	Clarify that both (1) and (2) must be met.
WAC 388-71-05931	(1) Must: (a) Possess a certificate of successfully completing modified basic training or the modified basic challenge test, 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) (b) Possess a certificate of successfully completing basic training or the basic training challenge test. (2) Is exempt from the orientation and continuing education requirements if the parent provides care only for his or her own adult child.	(1) Clarify that taking a class or the challenge test for that class meets the requirements. (2) Clarify that this applies only if the parent provides care only for his or her own adult child.
WAC 388-71-05933	(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) after the year in which they successfully complete basic or modified basic training.	Clarification of when CE requirement begins, based on changes in the statute made in SHB 2707, 2002 legislative session.
WAC 388-71-05936	Section deleted and withdrawn as proposed in WSR 01-23-072. See new WAC 388-71-036 below.	Change in the law made this unnecessary and inaccurate.
WAC # as Proposed WAC 388-71-05937 WAC 388-71-05938 WAC 388-71-05939 WAC 388-71-05940 WAC 388-71-05941 WAC 388-71-05942 WAC 388-71-05943 WAC 388-71-05944 WAC 388-71-05945 WAC 388-71-05946 WAC 388-71-05947 WAC 388-71-05948 WAC 388-71-05949 WAC 388-71-05950 WAC 388-71-05951 WAC 388-71-05952 WAC 388-71-05953	WAC # as Adopted WAC 388-71-05936 WAC 388-71-05937 WAC 388-71-05938 WAC 388-71-05939 WAC 388-71-05940 WAC 388-71-05941 WAC 388-71-05942 WAC 388-71-05943 WAC 388-71-05944 WAC 388-71-05945 WAC 388-71-05946 WAC 388-71-05947 WAC 388-71-05948 WAC 388-71-05949 WAC 388-71-05950 WAC 388-71-05951 WAC 388-71-05952	Editing and renumbering.
WAC 388-71-05938	WAC 388-71-05937 8 Home care individual providers must provide DSHS or the area agency on aging with proof documentation of completion of continuing education credits.	Clarification.
WAC 388-71-05939	WAC 388-71-05938 9 Competency testing, including challenge testing,...	Clarify that challenge testing is included in references to competency testing.
WAC 388-71-05941	WAC 388-71-05940 1 Individuals who perform competency testing must have documentable documented experience or training in assessing competencies.	Edit.
WAC 388-71-05943	WAC 388-71-05942 3 How must competency test administration be standardized? To standardize competency test administration...	Clarification.
WAC 388-71-05945	WAC 388-71-05944 5 A competency test that is part of a course may be taken twice ...administered. If a challenge test is available for a course, it may be taken only once. If the test is failed, the person must take the classroom course.	Differentiate testing procedures for testing as part of a class, and challenge testing.
WAC 388-71-05946	WAC 388-71-05945 6 The instructor or training entity is responsible for:	Where there is an educational entity such as a community college or private business that provides training, the training entity holds some of these responsibilities.
WAC 388-71-05947	WAC 388-71-05946 7 DSHS contracts with area agencies on aging (AAA) or other entities to conduct orientation, basic, modified basic, and continuing education training programs for individual providers and home care agency providers. The AAA training entity must approve any instructor under contract with the AAA entity to conduct training programs. The AAA's entity's contractors must meet the minimum qualifications for instructors under this chapter and any additional qualifications established through the AAA's entity's contracting procedures.	DSHS contracts with other educational entities besides AAAs.
WAC 388-71-05948	WAC 388-71-05947 8 When cCan DSHS or the AAA not approve an instructor? (1) DSHS... programs. No administrative remedies are available to dispute DSHS' or the AAA's decision not to accept an offer, except as may be provided through the contracting process.	This change clarifies that the applicable contracting procedure determines what remedies may be available.
WAC 388-71-05950	WAC 388-71-05949 50 Not included.	The department will publish a supplemental proposed rule-making notice and revised text of proposed new WAC 388-71-05950, which was amended as a result of public comments. The department will accept written comments and conduct a public hearing on revisions to this proposed rule.
WAC 388-71-05952	WAC 388-71-05951 2 What must be included in a class on principles of adult education theory and practice? A class on adult education theory and principles must include...	Editing.
WAC 388-71-05953	WAC 388-71-05952 3 (1) Training, including all breaks, must not exceed eight hours within a day twenty-four hour period;	Clarify "training" to include instruction or testing time plus breaks.
WAC 388-71-0500	What is the purpose of WAC 388-71-0500 through 388-71-0580 05952? 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 388-71-05952...	Correct numbering.
WAC 388-71-0520	An individual provider or a home care agency provider for an adult client must meet the training requirements in WAC 388-71-05910 through 388-71-05952.	Correct numbering.
WAC 388-71-0540	(6) Does not successfully complete the training requirements within the time limits required in WAC 388-71-05910 through 388-71-05952;...	Correct numbering.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 42, Amended 3, Repealed 3.

     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 42, Amended 3, Repealed 3;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

April 24, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     (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.]

     (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.]

     (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 388-71-05952;

     (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.
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?

3013.10
NEW SECTION
WAC 388-71-05910   What definitions apply to WAC 388-71-05911 through 388-71-05952?   "Client" means an individual age eighteen or older, 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.

     "Routine interaction" means contact with clients that happens regularly.

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     (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/guardian, 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 protect and promote the rights of each client, and assist the client to exercise 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, including the client's case manager;

     (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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     (1) The trainee's name;

     (2) A list of the specific information taught;

     (3) Signature of the person overseeing the orientation indicating completion of the required information;

     (4) The trainee's date of employment;

     (5) The location of the orientation; and

     (6) The date(s) of orientation.

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     (2) Individual providers must complete orientation provided by DSHS or the area agency on aging (AAA) no later than fourteen calendar days after beginning to work with their first DSHS client. Individual providers who live and are providing care at a great distance from the DSHS or AAA office may be oriented by distance learning, with phone contact by the person overseeing the orientation to answer questions.

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

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     (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.

The basic training learning outcomes and competencies may be obtained from the DSHS Aging and Adult Services Administration.

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     (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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     (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.

     The modified basic learning outcomes and competencies may be obtained from the DSHS aging and adult services administration.

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     (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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     (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; and

     (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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     (1) Must:

     (a) Possess a certificate of successfully completing modified basic training or the modified basic challenge test 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) Possess a certificate of successfully completing basic training or the basic training challenge test.

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

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     (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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     (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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     (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 documentation of completion of continuing education credits.

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     (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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     (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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     (2) If a challenge test is available for a course, it may be taken only once. If the test is failed, the person must take the classroom course.

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

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     (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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     (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).

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     (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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     (1) Training, including all breaks, must not exceed eight hours within one day;

     (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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