WSR 02-15-082

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed July 15, 2002, 4:01 p.m. ]

Date of Adoption: July 10, 2002.

Purpose: To meet the requirements of the centers for Medicare and Medicaid services (CMS), the department is amending home health services sections in chapter 388-551 WAC that refer to "homebound" criteria. The rules also update rule content for the home health program, including the addition of a new section, and reflect current department policy and business practices. The department is also changing references to "Plan of treatment (POT)" to "Plan of care (POC)" to be consistent with Department of Health (DOH) rules.

Citation of Existing Rules Affected by this Order: Amending WAC 388-551-2000, 388-551-2010, 388-551-2020, 388-551-2100, 388-551-2110, 388-551-2120, 388-551-2130, 388-551-2200, 388-551-2210, and 388-551-2220.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520, 74.09.530, and 74.09.500.

Adopted under notice filed as WSR 02-08-089 on April 3, 2002.

Changes Other than Editing from Proposed to Adopted Version: Deletions are indicated by strike through and additions by underline:

WAC 388-551-2010 Home health services -- Definitions.

1. "Home health aide" means an individual registered or certified as a nursing assistant under chapter 18.88 RCW who, under the direction and supervision of a registered nurse or licensed therapist, assists in the delivery of nursing or therapy related activities, or both. to patients of a home health or hospice agency, or hospice care center.


Clarifies that the definition for "home health aide" is defined for the purposes of MAA's Home Health Program by deleting references "to patients of a home health or hospice agency or hospice care center."


2. "Home health aide services" means services provided by a home health aide only when a client has an acute, intermittent, short-term need for the services of a registered nurse, physical therapist, occupational therapist, or speech therapist who is employed by or under contract with a home health agency. Such services are provided under the supervision of the previously identified authorized practitioners, and include, but are not limited to, ambulation and exercise, assistance with self-administered medications, reporting changes in a client's condition and needs, and completing appropriate records.


Clarifies what home health aide services include.

3. "Residence" means a client's home or place of living. , including an adult family home and/or boarding home, but not including a hospital, skilled nursing facility, or residential facility with skilled nursing services available (See WAC 388-551-2030 (2)(g)(ii) for clients in residential facilities whose home health services are not covered through MAA's home health program.)


Clarifies the definition of "residence" to include residential facilities that house clients whose home health services are not covered through MAA's Home Health Program.


WAC 388-551-2020 Home health services -- Eligible clients.

4. (1) Clients in the following fee-for-service MAA programs are eligible to receive home health services subject to the limitations described in this chapter. Clients enrolled in a healthy options managed plan receive all home health services through their designated plan, subject to the plan's coverages and limitations.


Clarifies that a client eligible under a Healthy Options managed care plan receives all home health services through their designated plan.

5. (2) Clients in the following emergency-only MAA programs are eligible to receive home health services, subject to the limitations described in this chapter. Coverage is limited to two skilled nursing visits per eligibility enrollment period. Specialized therapy services and home health aide visits are not covered.

(a) CNP-emergency medical only; and

(b) LCP-MNP-emergency medical only.

See WAC 388-551-2100(3) for limitations of coverage under these programs.

MAA does not cover home health services under the home health program for clients in the CNP-emergency medical only and LCP-MNP-emergency medical only programs. MAA evaluates a request for home health skilled nursing visits on a case-by-case basis under the provisions of WAC 388-501-0165, and may cover up to two skilled nursing visits within the eligibility enrollment period if the following criteria are met:

(a) The client requires hospital care due to an emergent medical condition as described in WAC 388-500-0005; and

(b) MAA authorizes up to two skilled nursing visits for follow-up care related to the emergent medical condition.


Clarifies that MAA evaluates requests for home health services for clients receiving medical benefits under the CNP-emergency medical only and LCP-MNP-emergency medical only programs under the provisions of WAC 388-501-0165 and lists the limitations of coverage.


WAC 388-551-2030 Home health skilled services -- Requirements.

6. (2)(g) Be provided in the client's residence, as defined in WAC 388-551-2010.

(i) MAA does not reimburse for services if provided....

(ii) Clients in residential facilities contracted with the state and paid by other programs such as home and community programs to provide limited skilled nursing services, are not eligible for MAA-funded limited skilled nursing services unless the services are prior authorized under the provisions of WAC 388-501-0165.


Clarifies that clients in residential facilities contracted with the state and paid by other programs to provide limited skilled nursing services are not eligible for MAA-funded limited skilled nursing services unless the services are prior authorized under the provisions of WAC 388-501-0165.


7. (2)(h) Be provided by:

(i) A home health agency that is Title XVIII (Medicare) certified and state-licensed.;

(ii) A registered nurse (RN) prior authorized by MAA when no home health agency exists in the area a client resides; or

(iii) An RN authorized by MAA when the RN is unable to contract with a Medicare-certified home health agency.


Deletes "and state-licensed" in subsection (2). If the agency is Medicare-certified, the agency is state-licensed. Adds (i) and (ii) to (h) in subsection (2) to identify other providers that may provide home health services under the Home Health Program.


WAC 388-551-2100 Covered home health services -- Nursing.

8. (3) MAA limits skilled nursing visits provided to eligible clients to two per day. , except clients eligible under either of the emergency medical programs listed in WAC 388-551-2020 (2)(a) and (b) are limited to two skilled nursing visits within the eligibility enrollment period.


Deletes the limitations for clients eligible under the CNP-emergency medical only and LCP-MNP-emergency medical only programs. MAA does not cover home health services under the Home Health Program for these clients except under the provisions of WAC 388-501-0165. Added language to clarify this policy in WAC 388-551-2020(2).


WAC 388-551-2200 Home health services -- Eligible providers.

9. A home health agency may contract with MAA to be a provider if the agency The following may contract with MAA to provide home health services through the home health program, subject to the restrictions or limitations in this section and other applicable published WAC:

(1) A home health agency that:

(a) Is Title XVIII (Medicare) certified;

(2) (b) Is department of health (DOH) licensed as a home health agency;

(3) Meets DOH requirements;

(4) (c) Submits a completed, signed core provider agreement to MAA; and

(5) (d) Is assigned a provider number.


Deletes subsection that is not necessary.


10. (2) A registered nurse (RN) who:

(a) Is prior authorized by MAA to provide intermittent nursing services when no home health agency exists in the area a client resides;

(b) Is unable to contract with a Medicare-certified home health agency;

(c) Submits a completed, signed core provider agreement to MAA; and

(d) Is assigned a provider number.


Adds language that clarifies when a registered nurse may provide intermittent nursing services under the Home Health Program.


WAC 388-551-2210 Home health services -- Provider requirements.

11. (2)(a) The client's name, date of birth, and address (to include name of residential care facility, if applicable);

(a)(b) The primary diagnosis…;

(b)(c) All secondary medical diagnoses…;

(c)(d) The prognosis;

(d)(e) The type(s) of equipment required;

(e)(f) A description of each planned service…;

(f)(g) Specific procedures and modalities;

(g)(h) A description of the client's mental status;

(h)(i) A description of the client's rehabilitation potential;

(i)(j) A list of permitted activities;

(j)(k) A list of safety measures taken on behalf of the client; and

(k)(l) A list of medication which indicates:

(i) Any new prescription; and

(ii) Which medications are changed for dosage or route of administration.


Adds criteria the provider must include in the client's plan of care (POC).

12. (6)(c) Referral to a wound care specialist, if wound If a client's wound is not healing, the client's physician has been notified, the client's wound management program has been appropriately altered and, if possible, the client has been referred to a wound care specialist; and


Clarifies that it must be documented in the client's plan of care that a client's physician must be notified when the client's wound is not healing, that the client's wound management program has been appropriately altered, and that the client has been referred to a wound care specialist, if appropriate.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 1, Amended 10, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

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 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 10, Repealed 0.
Effective Date of Rule: Thirty-one days after filing.

July 10, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 02-16 issue of the Register.

Washington State Code Reviser's Office