WSR 04-19-103

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed September 20, 2004, 3:58 p.m. , effective October 21, 2004 ]


     

     Purpose: Revises chapter 388-72A WAC, Comprehensive assessment reporting evaluation (CARE) tool, to include the CARE algorithm component in rule, incorporate CARE assessment criteria for children receiving state plan Medicaid personal care (MPC) services, and amend other sections as needed to update program rules.

     Citation of Existing Rules Affected by this Order: Repealing WAC 388-72A-0040 and 388-72A-0075; and amending WAC 388-72A-0010, 388-72A-0035, 388-72A-0055, 388-72A-0060, 388-72A-0065, 388-72A-0070, 388-72A-0080, 388-72A-0085, 388-72A-0090, and 388-72A-0095.

     Statutory Authority for Adoption: RCW 74.08.090 and 74.09.520.

     Other Authority: RCW 74.39A.090 and 74.39A.095.

      Adopted under notice filed as WSR 04-14-099 on July 6, 2004.

     Changes Other than Editing from Proposed to Adopted Version: Proposed WAC 388-72A-0042 has been withdrawn and filed under supplemental proposal WSR 04-18-071.

     WAC 388-72A-0035, clarifies the definition of personal hygiene. Menses is a type of perineum care.

     WAC 388-72A-0060(2), clarifies that only one of the criteria applies. The permanent rule also incorporates amendments adopted as WSR 04-16-029.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 15, Amended 10, Repealed 2.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 15, Amended 10, Repealed 2.

     Date Adopted: September 15, 2004.

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3389.10
AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0010   ((Does)) Do chapter 388-71 WAC and WAC 388-845-1300 apply to me?   Yes. Chapter 388-71 WAC ((applies)) and WAC 388-845-1300 apply with the exception of the following((:)) definitions in WAC 388-71-0202: Direct personal care services, household assistance, medically oriented tasks, personal care services, plan of care, supervision, and unscheduled tasks. Also, the following WAC sections do not apply to you: WAC 388-71-0203, 388-71-0205, 388-71-0430, 388-71-0435, 388-71-0440, 388-71-0442, and 388-71-0445.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0010, filed 2/19/03, effective 3/22/03.]


AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0035   What are personal care services?   Personal care services means physical or verbal assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL). ((Assistance means verbal or physical assistance with ADL and IADL.)) Assistance is evaluated with the use of assistive devices.

     (1) Activities of daily living consist of the following care tasks that are directly related to your disabling condition:

     (a) Bathing((,)): How you take a full-body bath/shower, sponge bath, and transfer in/out of tub/shower;

     (b) Bed mobility((,)): How you move to and from a lying position, turn side to side, and position your body while in bed;

     (c) Body care((,)): How you perform with passive range of motion, applications of dressings and ointments or lotions to the body and pedicure to trim toenails and apply lotion to feet. In adult family homes or in ((licensed boarding homes contracting with DSHS to provide)) contracted assisted living ((services)) facilities, dressing changes using clean technique and topical ointments ((must be delegated by a registered nurse)) require nurse delegation in accordance with chapter 246-840 WAC. Body care excludes:

     (i) Foot care for clients who are diabetic or have poor circulation; or

     (ii) Changing bandages or dressings when sterile procedures are required.

     (d) Dressing((,)): How you put on, fasten, and take off all items of clothing, including donning/removing prosthesis;

     (e) Eating((,)): How you eat and drink, regardless of skill. Eating includes any method of receiving nutrition, e.g., by mouth, tube or through a vein;

     (f) Locomotion in room and immediate living environment((,)): How you move between locations in your room and immediate living environment. If you are in a wheelchair, locomotion includes how self-sufficient you are once in your wheelchair;

     (g) Locomotion outside of immediate living environment including outdoors((,)): How you move to and return from more distant areas. If you are living in a boarding home or nursing facility (NF), this includes areas set aside for dining, activities, etc. If you are living in your own home or in an adult family home, locomotion outside immediate living environment including outdoors, includes how you move to and return from a patio or porch, backyard, to the mailbox, to see the next-door neighbor, etc;

     (h) Walk in room, hallway and rest of immediate living environment((,)): How you walk between locations in your room and immediate living environment;

     (i) Medication management((,)): Describes the amount of assistance, if any, required to receive medications, over the counter preparations or herbal supplements;

     (j) Toilet use((,)): How you use the toilet room, commode, bedpan, or urinal, transfer on/off toilet, cleanse, change pad, manage ostomy or catheter, and adjust clothes;

     (k) Transfer((,)): How you move between surfaces, i.e., to/from bed, chair, wheelchair, standing position. Transfer does not include how you move to/from the bath ((or)), toilet, or vehicle; and

     (l) Personal hygiene((,)): How you maintain personal hygiene, including combing hair, brushing teeth, shaving, applying makeup, washing/drying face ((hands, menses care)), hands (includes nail care), and perineum (menses care). This does not include personal hygiene in baths and showers.

     (2) Instrumental activities of daily living (IADL) consist of the following routine activities performed around the home or in the community.

     (a) Meal preparation((,)): How meals are prepared (e.g., planning meals, cooking, assembling ingredients, setting out food, utensils, and cleaning up after meals). NOTE: This task may not be authorized to just plan meals or clean up after meals. You must need assistance with actual meal preparation;

     (b) Ordinary housework((,)): How ordinary work around the house is performed (e.g., doing dishes, dusting, making bed, tidying up, laundry);

     (c) Essential shopping((,)): How shopping is completed to meet your health and nutritional needs (e.g., selecting items). Shopping is limited to brief, occasional trips in the local area to shop for food, medical necessities and household items required specifically for your health, maintenance or well-being. This includes shopping with or for you;

     (d) Wood supply((,)): How wood is supplied (e.g., splitting, stacking, or carrying wood) when you use wood as the sole source of fuel for heating and/or cooking;

     (e) Travel to medical services((,)): How you travel by vehicle to a physician's office or clinic in the local area to obtain medical diagnosis or treatment-includes driving vehicle yourself, traveling as a passenger in a car, bus, or taxi;

     (f) Managing finances((,)): How bills are paid, checkbook is balanced, household expenses are managed. The department cannot pay for any assistance with managing finances; and

     (g) Telephone use((,)): How telephone calls are made or received (with assistive devices such as large numbers on telephone, amplification as needed).

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0035, filed 2/19/03, effective 3/22/03.]


NEW SECTION
WAC 388-72A-0036   How are my needs for personal care services determined?   The assessor gathers information from you, your caregivers, family members, and other sources to determine how much assistance you need with personal care services. For children age seventeen and younger, age expectations and the role of legally responsible natural/step/adoptive parents are considered and documented. This is measured by your:

     (1) Self-performance, what you actually did in the last seven days before the assessment, not what you might be capable of doing. Coding is based on the level of performance that occurred three or more times in the seven-day period.

     (2) Support provided, which means the highest level of support provided by others in the last seven days before the assessment, even if that level of support occurred only once.

     (3) Status, which identifies whether a need is met, unmet, partially met, or declined.

     (4) Assistance available.

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NEW SECTION
WAC 388-72A-0037   How are self performance and support provided for the activities of daily living (ADLs) scored?   (1) For each ADL, except as otherwise provided for bathing, body care, and medication management, the assessor determines your ability to self-perform the ADL. Your self performance is scored as:

     (a) Independent if you received no help or oversight, or if you needed help or oversight only once or twice;

     (b) Supervision if you received oversight (monitoring or standby), encouragement, or cueing three or more times;

     (c) Limited assistance if you were highly involved in the activity and given physical help in guided maneuvering of limbs or other nonweight bearing assistance on three or more occasions;

     (d) Extensive assistance if you performed part of the activity, but on three or more occasions, you needed weight bearing support or you received full performance of the activity during part, but not all, of the activity;

     (e) Total dependence if you received full caregiver performance of the activity and all subtasks during the entire seven-day period from others. Total dependence means complete nonparticipation by you in all aspects of the ADL; or

     (f) Activity did not occur if you or others do not perform an ADL over the last seven days before your assessment. The activity may not have occurred because:

     (i) You were not able (e.g., walking, if paralyzed); or

     (ii) No provider was available to assist; or

     (iii) You declined assistance with the task.

     (2) The assessor also determines the level of support provided. Your support provided is scored as:

     (a) No set-up or physical help provided by others;

     (b) Set-up help only provided, which is the type of help characterized by providing you with articles, devices, or preparation necessary for greater self-performance of the activity (such as giving or holding out an item that you take from others);

     (c) One-person physical assist provided;

     (d) Two- or more person physical assist provided; or

     (e) Activity did not occur during entire seven-day period.

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NEW SECTION
WAC 388-72A-0038   How are the ADLs bathing, body care, and medication management scored?   (1) The activity of bathing is assessed in the same way as other ADLs in WAC 388-72A-0037, except you are assessed as needing:

     (a) Limited assistance with bathing if physical help is limited to transfer only; or

     (b) Extensive assistance with bathing if you needed physical help with part of the activity (other than transfer).

     (2) The activity of body care is assessed to determine whether you need assistance. You are scored as needing assistance if you require:

     (a) Application of ointment or lotions;

     (b) Trimming of toenails;

     (c) Dry bandage changes; or

     (d) Passive range of motion treatment.

     (3) The activity of medication management is assessed to determine whether you need assistance managing your medications. This assistance is scored as:

     (a) Independent if you remember to take medications as prescribed and manage your medications without assistance;

     (b) Assistance required if you need assistance from a nonlicensed provider to facilitate your self-administration of a prescribed, over the counter, or herbal medication, you are assessed as needing assistance with medication management. Assistance required includes reminding or coaching you, handing you the medication container, opening the container, using an enabler to assist you in getting the medication into your mouth, and placing the medication in your hand. This does not include assistance with intravenous or injectable medications. You must be aware that you are taking medications;

     (c) Self-directed medication assistance/administration if you are a person with a functional disability who is capable of and who chooses to self-direct your medication assistance/administration. In licensed boarding homes, this may include situations in which you cannot physically self-administer medications but can accurately direct others, per WAC 388-78A-0300; or

     (d) Must be administered if you must have medications placed in your mouth or applied or instilled to your skin or mucus membrane. Administration must either be performed by a licensed professional or delegated by a registered nurse to a qualified caregiver (per chapter 246-840 WAC). Intravenous or injectable medications may never be delegated. Administration may also be performed by a family member or unpaid caregiver if facility licensing regulations allow.

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NEW SECTION
WAC 388-72A-0039   How are self performance and difficulty for the instrumental activities of daily living (IADLs) scored?   (1) For each IADL, the assessor determines your ability to self-perform the IADL. Your self performance is scored as:

     (a) Independent if you received no help, set-up help, or supervision;

     (b) Supervision if you received set-up help or arrangements only;

     (c) Limited assistance if you sometimes performed the activity yourself and other times needed assistance;

     (d) Extensive assistance if you were involved in performing the activity, but required cueing/supervision or partial assistance at all times;

     (e) Total dependence if you needed the activity fully performed by others; or

     (f) Activity did not occur if you or others did not perform the activity in the last seven days before the assessment.

     (2) For each IADL, the assessor determines how difficult it is or would be for you to perform the activity. This is scored as:

     (a) No difficulty in performing the activity;

     (b) Some difficulty in performing the activity (e.g., you need some help, are very slow, or fatigue easily); or

     (c) Great difficulty in performing the activity (e.g., little or no involvement in the activity is possible).

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NEW SECTION
WAC 388-72A-0041   How are status and assistance available scored for ADLs and IADLs?   (1) For each ADL and IADL, the assessor determines whether there is an informal support available. An informal support is a person or resource that is available to provide assistance without home and community program funding. The assessor determines whether the ADL or IADL is:

     (a) Met, which means the ADL or IADL will be fully provided by an informal support;

     (b) Unmet, which means an informal support will not be available to provide assistance with the identified ADL or IADL;

     (c) Partially met, which means an informal support will be available to provide some assistance, but not all, with the identified ADL or IADL; or

     (d) Client declines, which means you do not want assistance with the task.

     (2) If partially met is selected, then the amount of the assistance available is determined using one of four categories:

     (a) Less than one-fourth of the time;

     (b) One-fourth to one-half of the time;

     (c) Over one-half of the time to three-fourths of the time; or

     (d) Over three-fourths of the time.

     Note: For children seventeen years and younger living with their legally responsible natural/step/adoptive parents, the status and assistance available will be met or partially met over three fourths of the time.

     The following table is used to determine the percentages outlined in subsection (2)(a) through (d) of this section.

Place illustration here.

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AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0055   Am I eligible for COPES-funded services?   You are eligible for COPES-funded services if you meet all of the following criteria. The department or its designee must assess your needs and determine that:

     (1) You are age:

     (a) Eighteen or older and blind or disabled, as defined in WAC 388-511-1105; or

     (b) Sixty-five or older.

     (2) You meet financial eligibility requirements. This means the department will assess your finances and determine if your income and resources fall within the limits set in WAC 388-515-1505, Community options program entry system (COPES);

     (3) You:

     (a) Are not eligible for Medicaid personal care services (MPC); or

     (b) Are eligible for MPC services, but the department determines that the amount, duration, or scope of your needs is beyond what MPC can provide.

     (4) Your ((comprehensive)) CARE assessment shows you need the level of care provided in a nursing facility (or will likely need the level of care within thirty days unless COPES services are provided) which means one of the following applies((.)):

     (a) You require care provided by or under the supervision of a registered nurse or a licensed practical nurse on a daily basis, or:

     (b) You have an unmet or partially met need or the activity did not occur (because you were unable or no provider was available) with at least three or more of the following((, as defined in WAC 388-72A-0040)):

     (i) Setup in eating (e.g., cutting meat and opening containers at meals; giving one food category at a time);

     (ii) Supervision in toileting;

     (iii) Supervision in bathing;

     (iv) Supervision plus setup in transfer;

     (v) Supervision plus setup in bed mobility;

     (vi) Supervision plus set up help in one of the following three tasks:

     (A) Walk in room, hallway and rest of immediate living environment;

     (B) Locomotion in room and immediate living environment;

     (C) Locomotion outside of immediate living environment including outdoors.

     (vii) Assistance required in medication management; or

     (c) You have an unmet or partially met need with at least two or more of the following((, as defined in WAC 388-72A-0040)):

     (i) Extensive assistance plus one person physical assistance in toileting;

     (ii) Extensive assistance plus one person physical assistance in one of the following three tasks:

     (A) Walk in room, hallway and rest of immediate living environment;

     (B) Locomotion in room and immediate living environment;

     (C) Locomotion outside of immediate living environment including outdoors.

     (iii) Extensive assistance plus one person physical assistance in transfer;

     (iv) Limited assistance plus one person physical assistance in bed mobility and need turning/repositioning;

     (v) Physical help limited to transfer plus one person physical assist in bathing;

     (vi) Supervision plus one person physical assist in eating; or

     (vii) Daily assistance required in medication management; or

     (d) You have a cognitive impairment and require supervision due to one or more of the following: Disorientation, memory impairment, impaired decision making, or wandering and have an unmet or partially met need with at least one or more of the following((, as defined in WAC 388-72A-0040)):

     (i) Extensive assistance plus one person physical assistance in toileting;

     (ii) Extensive assistance plus one person physical assistance in one of the following three tasks:

     (A) Walk in room, hallway and rest of immediate living environment;

     (B) Locomotion in room and immediate living environment;

     (C) Locomotion outside of immediate living environment including outdoors.

     (iii) Extensive assistance plus one person physical assistance in transfer;

     (iv) Limited assistance plus one person physical assistance in bed mobility;

     (v) Physical help limited to transfer plus one person physical assist in bathing;

     (vi) Supervision plus one person physical assist in eating; or

     (vii) Daily assistance required in medication management.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0055, filed 2/19/03, effective 3/22/03.]


AMENDATORY SECTION(Amending WSR 04-16-029, filed 7/26/04, effective 8/26/04)

WAC 388-72A-0060   Am I eligible for MPC-funded services?   You are eligible for MPC-funded services when the department or its designee assesses your needs and determines that you meet all of the following criteria:

     (1) You are certified as ((Title XIX)) noninstitutional categorically needy, as defined in WAC 388-500-0005. Categorically needy medical institutional programs described in chapter 388-513 WAC do not meet this criteria.

     (2) You are functionally eligible which means one of the following applies:

     (a) You have an unmet or partially met need or the activity did not occur (because you were unable or no provider was available) in at least three or more of the following:

     (((a))) (i) Help/oversight one or two times during the last seven days plus setup in eating;

     (((b))) (ii) Supervision in toileting;

     (((c))) (iii) Supervision in bathing;

     (((d))) (iv) Supervision in dressing;

     (((e))) (v) Supervision plus setup in transfer;

     (((f))) (vi) Supervision plus setup in bed mobility;

     (((g))) (vii) Supervision plus set up help in one of the following three tasks:

     (((i))) (A) Walk in room, hallway and rest of immediate living environment;

     (((ii))) (B) Locomotion in room and immediate living environment((;

     (iii))); or

     (C) Locomotion outside of immediate living environment including outdoors.

     (((h))) (viii) Assistance required in medication management;

     (((i))) (ix) Supervision in personal hygiene;

     (((j))) (x) Assistance with body care, which means you need:

     (((i))) (A) Application of ointment or lotions;

     (((ii))) (B) Your toenails trimmed;

     (((iii))) (C) Dry bandage changes; or

     (((iv))) (D) Passive range of motion treatment.

     (((3))) (b) You have an unmet or partially met need or the activity did not occur (because you were unable or no provider was available) with at least one or more of the following:

     (((a))) (i) Extensive assistance plus one person physical assistance in toileting;

     (((b))) (ii) Extensive assistance plus one person physical assistance in one of the following three tasks:

     (((i))) (A) Walk in room, hallway and rest of immediate living environment((;

     (ii))); or

     (B) Locomotion in room and immediate living environment((;

     (iii))); or

     (C) Locomotion outside of immediate living environment including outdoors.

     (((c))) (iii) Extensive assistance plus one person physical assistance in transfer;

     (((d))) (iv) Limited assistance plus one person physical assistance in bed mobility and need turning/repositioning;

     (((e))) (v) Physical help limited to transfer plus one person physical assist in bathing;

     (((f))) (vi) Supervision plus one person physical assist in eating; ((or

     (g)))(vii) Daily assistance required in medication management; or

     (((h))) (viii) Assistance with body care, which means you need:

     (((i))) (A) Application of ointment or lotions;

     (((ii))) (B) Your toenails trimmed;

     (((iii))) (C) Dry bandage changes; or

     (((iv))) (D) Passive range of motion treatment.

     (((i))) (ix) Extensive assistance plus one person physical assistance in dressing((.

     (j))); or

     (x) Extensive assistance plus one person physical assistance in personal hygiene.

[Statutory Authority: 2004 c 276 § 206 (6)(b) and Townsend vs. DSHS, U.S. District Court, Western District of Washington, No. C 00-0944Z. 04-16-029, § 388-72A-0060, filed 7/26/04, effective 8/26/04. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.04.200, 74.09.520, 74.39.020, 74.39A.090, 2003 1st sp.s. c 25, 2003 c 140. 03-24-001, § 388-72A-0060, filed 11/19/03, effective 12/20/03. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0060, filed 2/19/03, effective 3/22/03.]


AMENDATORY SECTION(Amending WSR 03-05-097 [04-16-029], filed 2/19/03 [7/26/04], effective 3/22/03 [8/26/04])

WAC 388-72A-0065   Am I eligible for Chore-funded services?   To be eligible for Chore-funded services, you must:

     (1) Be eighteen years of age or older;

     (2) Have an unmet or partially met need or the activity did not occur (because you were unable or no provider was available) in at least one or more of the following((, as defined in WAC 388-72A-0040)):

     (a) Help/oversight one or two times during the last seven days plus setup in eating;

     (b) Supervision in toileting;

     (c) Supervision in bathing;

     (d) Supervision in dressing;

     (e) Supervision plus setup in transfer;

     (f) Supervision plus setup in bed mobility;

     (g) Supervision plus set up help in one of the following three tasks:

     (i) Walk in room, hallway and rest of immediate living environment;

     (ii) Locomotion in room and immediate living environment; or

     (iii) Locomotion outside of immediate living environment including outdoors.

     (h) Assistance required in medication management;

     (i) Supervision in personal hygiene;

     (j) Assistance with body care, which means you need:

     (i) Application of ointment or lotions;

     (ii) Your toenails trimmed; or

     (iii) Dry bandage changes; or

     (iv) Passive range of motion treatment.

     (3) Currently be on the Chore program and not be eligible for MPC or COPES, Medicare home health or other programs if these programs can meet your needs;

     (4) Have net household income (as described in WAC 388-450-0005((, 388-450-0020,)) and 388-450-0040((, and 388-511-1130))) not exceeding:

     (a) The sum of the cost of your Chore services; and

     (b) One-hundred percent of the Federal Poverty Level (FPL) adjusted for family size.

     (5) Have resources, as described in chapter 388-470 WAC, which does not exceed ten thousand dollars for a one-person family or fifteen thousand dollars for a two-person family. (Note: One thousand dollars for each additional family member may be added to these limits.)

     (6) Not transfer assets on or after November 1, 1995 for less than fair market value as described in WAC 388-513-1365.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0065, filed 2/19/03, effective 3/22/03.]

     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 bracketed material preceding the section above was supplied by the code reviser's office.
NEW SECTION
WAC 388-72A-0069   How does CARE use the information the assessor gathers?   CARE processes the information that the assessor gathers through algorithms. An algorithm is a numerical formula utilized by the CARE assessment software that determines a classification group, payment level and referral needs based upon the information documented in the CARE assessment.

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AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0070   What are the in-home hours and residential rate based on?   The department employs a client classification methodology consisting of fourteen care groups. Twelve groups apply to clients served in residential and in-home settings. For the in-home setting, two additional exceptional care groups apply. The department uses ((an automated assessment tool known as the comprehensive assessment reporting evaluation ())CARE(() tool)) to assess client characteristics. CARE places clients in a classification group based on the assessment. For in-home settings, each classification group is assigned a base number of care hours.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0070, filed 2/19/03, effective 3/22/03.]


AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0080   What ((are the elements that)) criteria does the CARE tool ((evaluates for each of the criteria in WAC 388-72A-0075)) use to place a client in one of the classification groups?   The CARE tool ((evaluates for)) uses the following criteria to place a client in one of the classification groups:

     (1) Cognitive performance

     (((a) Short term memory;

     (b) Self-performance in eating;

     (c) Ability to make self understood;

     (d) Ability to make decisions regarding ADLs; and

     (e) Comatose or in a persistent vegetative state)), as defined in WAC 388-72A-0081, by using the cognitive performance scale (CPS) and assigning a score from zero to six.

     (2) Clinical complexity

     (((a) Diagnoses requiring more than average care time and/or special care;

     (b) Skin problems receiving treatment;

     (c) Unstable clinical conditions; and

     (d) Skilled nursing needs)), as defined in WAC 388-72A-0082.

     (3) Mood/behaviors ((the assessment data evaluated may include, but is not limited to the following:

     (a) Assaulting care givers;

     (b) Resisting care;

     (c) Wandering; and

     (d) Depression)) symptoms, as defined in WAC 388-72A-0083.

     (4) ((Activities of daily living ())ADLs((),)) by scoring the amount of assistance ((the client needs)) received to perform ((ADLs)) ADL in the past seven days, as defined in WAC 388-72A-0084.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0080, filed 2/19/03, effective 3/22/03.]


NEW SECTION
WAC 388-72A-0081   How is cognitive performance measured in the CARE tool?   The CARE tool uses a standardized tool called the cognitive performance scale (CPS) to evaluate a client's cognitive impairment. The CPS results in a score that ranges from zero (intact) to six (very severe impairment), as shown in the table below. Answers to the following questions are used to determine a client's CPS score:

     (1) Is the client comatose?

     (a) No,

     (b) Yes.

     (2) What is the client's ability to make everyday decisions about tasks or activities of daily living in the seven days prior to the assessment?

     (a) Independent -- Decisions about the client's daily routine are consistent and organized; reflecting the client's lifestyle, choices, culture, and values.

     (b) Modified Independence/difficulty in new situations -- The client has an organized daily routine, was able to make decisions in familiar situations, but experienced some difficulty in decision making when faced with new tasks or situations.

     (c) Moderately impaired/poor decisions; unaware of consequences -- Decisions are poor and the client requires reminders, cues and supervision in planning, organizing and correcting daily routines. Client attempts to make decisions, although poorly.

     (d) Severely impaired/no or few decisions or preferences regarding ADLs -- Decision making severely impaired, never/rarely makes decisions.

     (3) How is the client able to make himself/herself understood (to those closest to him/her), to express or communicate requests, needs, opinions, urgent problems and social conversations, whether in speech, writing, sign language, symbols, or a combination of these including use of a communication board or keyboard?

     (a) Understood -- The client expresses ideas clearly;

     (b) Usually understood -- The client has difficulty finding the right words or finishing thoughts, resulting in delayed responses; or requires some prompting to make self understood.

     (c) Sometimes understood -- The client has limited ability, but is able;

     (d) Rarely/never understood.

     (4) Does the client have short-term memory problem, which is defined as client's capacity to remember recent events; or does the client have delayed recall?

     (5) Does the client have total dependence for self performance in eating, as defined in WAC 388-72A-0037?

Place illustration here.

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NEW SECTION
WAC 388-72A-0082   How is clinical complexity measured within the CARE tool?   Clinical complexity is determined only when you have one or more of the following conditions and corresponding ADL scores:


Condition AND an ADL Score of
ALS (Lou Gehrig's disease) >14
Aphasia (expressive and/or receptive) >=2
Cerebral Palsy >14
Diabetes Mellitus (insulin dependent) >14
Diabetes Mellitus (noninsulin dependent) >14
Emphysema & (SOB (at rest or exertion) or dizziness/vertigo) >10
COPD & (SOB (at rest or exertion) or dizziness/vertigo) >10
Explicit terminal prognosis >14
Hemiplegia >14
Multiple sclerosis >14
Parkinson disease >14
Pathological bone fracture >14
Pressure ulcers, areas of persistent skin redness     OR

Pressure ulcers, partial loss of skin layers     OR

Pressure ulcers, a full thickness lost     OR

Skin problem, skin desensitized to pain/pressure     OR

Skin problem, open lesions     OR

Skin problem, stasis ulcers

>=2
AND
Receives ulcer care     OR

(Received) or (needs and received) or (need met) pressure relieving device     OR

(Receive) or (needs and received) or (need met) turning/reposition program     OR

Receives application of dressing     OR

Receives wound/skin care

Quadriplegia >14
Rheumatoid Arthritis >14
Skin problem, burns

AND

Receives application of dressings     OR

Receives wound/skin care

>=2
Frequently incontinent, bladder     OR

Incontinent all or most of the time, bladder     OR

Frequently incontinent, bowel     OR

Incontinent all or most of the time, bowel

AND

Uses, has leakage, needs assistance     OR

Does not use, has leakage OR

Any scheduled toileting plan

>10

Current swallowing problem and not independent in eating >10
Edema >14
Pain daily >14
Bowel program receives and needs >10
Dialysis, needs >10
IV nutritional support, needs     OR

Tube feedings, needs

AND

Total calories received per IV or tube was greater than 50%     OR

Total calories per IV or tube was 25-50%

AND

Fluid intake greater than 2 cups

>=2

Hospice care, needs >14
Injections, needs >14
Intravenous medications, needs >10
Management of IV lines, needs >10
Ostomy care, needs >=2
Oxygen therapy, needs >10
Radiation, needs >10
Range of motion, passive, receives and needs >10
Walking, training, receives and needs >10
Suction, needs >=2
Tracheostomy care, needs >10
Ventilator/respirator, needs >10

[]


NEW SECTION
WAC 388-72A-0083   How are mood and behaviors measured within the CARE tool?   (1) When you do not meet the criteria for clinical complexity as defined in WAC 388-72A-0082 or the criteria for exceptional care, as defined in WAC 388-72A-0085, or have a cognitive performance scale score of five or six (in-home only), as defined in WAC 388-72A-0082, the mood and behavior criteria listed in subsection (3) below determines your classification group.

     (2) Each documented behavior within CARE is described as:

     (a) Current, which means it occurred within seven days of the assessment date, including the day of the assessment. Behaviors that are indicated as current must also include information about:

     (i) Whether the behavior is easily altered or not easily altered; and

     (ii) The frequency of the behavior.

     (b) Past, which means it occurred between eight days and five years of the assessment date. For behaviors indicated as past, the assessor determines whether the behavior is addressed with current interventions or whether no interventions are in place.

     (3) CARE places you in the Mood and behavior classification group only if you have one or more of the following behavior/moods that meets the corresponding description in the status, frequency, and alterability column. No other moods or behaviors documented in CARE are pertinent to this group.


Behavior/Mood AND Status, Frequency & Alterability
Assaultive Current
Combative during personal care Current
Combative during personal care In past and addressed with current interventions
Crying tearfulness Current, frequency 4 or more days per week
Delusions In past, addressed with current interventions
Depression score >=14 N/A
Disrobes in public Current and not easily altered
Easily irritable/agitated Current and not easily altered
Eats nonedible substances Current
Eats nonedible substances In past, addressed with current interventions
Hallucinations Current
Hiding items In past, addressed with current interventions
Hoarding/collecting In past, addressed with current interventions
Mental health therapy/program Need
Repetitive complaints/questions Current, daily
Repetitive complaints/questions In past, addressed with current interventions
Repetitive movement/pacing Current, daily
Resistive to care Current
Resistive to care In past, addressed with current interventions
Sexual acting out Current
Sexual acting out In past, addressed with current interventions
Spitting Current and not easily altered
Spitting In past, addressed with current interventions
Breaks/throws items Current
Unsafe smoking Current and not easily altered
Up at night and requires intervention Current
Wanders exit seeking Current
Wanders exit seeking In past, addressed with current interventions
Wanders not exit seeking Current
Wanders not exit seeking In past, addressed with current interventions
Yelling/screaming Current, frequency 4 or more days per week

[]


NEW SECTION
WAC 388-72A-0084   How are ADL scores measured within the CARE tool?   (1) CARE determines an ADL score ranging from zero to twenty-eight. The ADL scores are determined by looking at the self-performance coding for each of the ADLs listed below. Although assessed in CARE, bathing and medication management are not scored to determine the classification groups.

     (a) Personal hygiene;

     (b) Bed mobility;

     (c) Transfers;

     (d) Eating;

     (e) Toilet use;

     (f) Dressing;

     (g) Locomotion in room;

     (h) Locomotion outside room; and

     (i) Walk in room.

     (2) CARE assigns a points value as described in the chart below. Only one score is used for the locomotion in room, locomotion outside of room and walk in room. The highest score of the three is used in determining the overall ADL score.


ADL Scoring Chart
If Self Performance is: Score Equals
Independent 0
Supervision 1
Limited assistance 2
Extensive assistance 3
Total dependence 4
Did not occur/no provider 4
Did not occur/client not able 4
Did not occur/client declined 0

[]


AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0085   How does the CARE tool evaluate ((the criteria elements)) for the two exceptional care classifications of in-home care?   ((The CARE tool evaluates the criteria elements for:

     (1) Cognitive performance by using the cognitive performance scale (CPS) and assigning a score. The score assigns ranges from zero to six with six being very severely impaired;

     (2) Clinical complexity by determining whether your medical conditions take more or less time and/or require special care;

     (3) Mood/behavior by determining whether your mood/behavior symptoms take more or less time;

     (4) ADLs by scoring the assistance needed to perform ADLs.)) Exceptional care classification groups for the in-home setting occur only when the following criteria are met in either of the diagrams below:


Diagram 1 of Condition
One of the following diagnoses:

Quadriplegia

Paraplegia

ALS (Amyotrophic Lateral Sclerosis)

Parkinson's Disease

Multiple Sclerosis

Comatose

Muscular Dystrophy

Cerebral Palsy

Post Polio Syndrome

TBI (traumatic brain injury)

AND

ADL score of greater than or equal to 22 AND
(Needs) or (needs and received) or (need met)

Turning/repositioning program

AND

External catheter

or

Intermittent catheter

or

Indwelling catheter care

or

Bowel program

or

Ostomy care

AND

Needs active range of motion (AROM)

or

Needs passive range of motion (PROM) performed by one of the following providers:

Individual provider or agency provider;

Self-directed care (individual provider only); or

Private duty nurse.

Diagram 2 of Condition
ADL score greater than or equal to 22 AND
(Needs) or (needs and received) or (need met)

Turning/repositioning program

AND
Need for AROM or need for PROM

and

Performed by one of the following providers:

Individual provider or agency provider;

Self-directed care (individual provider only); or

Private duty nurse.

AND
IV nutrition support or tube feeding

and

Total calories received per IV or tube was greater than 50%

and

Fluid intake greater than 2 cups

AND
Needs dialysis (performed by individual provider or agency provider); Self-directed care (individual provider only); or Private duty nurse.

or

Needs ventilator/respirator (performed by individual provider or agency provider); Self-directed care (individual provider only); or Private duty nurse.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0085, filed 2/19/03, effective 3/22/03.]


NEW SECTION
WAC 388-72A-0086   How is the information in WAC 388-72A-0081 through 388-72A-0084 used to determine the client's classification payment group for residential settings?   The information in WAC 388-72A-0081 through 388-72A-0084 is used to place an adult applicant or recipient into one of the twelve residential classification groups, as shown in the table below.


Classification ADL Score Group
Group D

Cognitive performance score = 4-6

and

Clinically complex = yes

and

Mood/behavior = yes or no

ADL Score 18-28 D High (12)
ADL Score 13-17 D Med (11)
ADL Score 2-12 D Low (10)
Group C

Cognitive performance score = 0-3

and

Clinically complex = yes

and

Mood/behavior = yes or no

ADL Score 18-28 C High (9)
ADL Score 9-17 C Med (8)
ADL Score 2-8 C Low (7)
Group B

Mood & behavior = Yes

and

Clinically complex = no

and

Cognitive performance score = 0-6

ADL Score 15-28 B High (6)
ADL Score 5-14 B Med (5)
ADL Score 0-4 B Low (4)
Group A

Mood & behavior = No

and

Clinically complex = No

and

Cognitive performance score = 0-6

ADL Score 10-28 A High (3)
ADL Score 5-9 A Med (2)
ADL Score 0-4 A Low (1)

[]


NEW SECTION
WAC 388-72A-0087   How is the information in WAC 388-72A-0081 through 388-72A-0085 used to determine the classification payment group for in-home clients?   You are placed in a classification group based upon the criteria outlined in WAC 388-72A-0081 through 388-72A-0085. The in-home classification system is comprised of fourteen classification groups as shown in the table below.


Classification ADL Score Group Base Hours of Group
Group E

Exceptional care = yes

and

Mood and behavior = yes or no

and

Cognitive performance score = 0-6

ADL Score 26-28 E High (14) 420
ADL Score 22-25 E Med (13) 350
Group D

Cognitive performance score = 4-6

and

Clinically complex = yes

and

Mood and behavior = yes or no

OR

Cognitive performance score = 5-6

and

Clinically complex = no

and

Mood and behavior = yes or no

ADL Score 18-28 D High (12) 240
ADL Score 13-17 D Med (11) 190
ADL Score 2-12 D Low (10) 145
Group C

Cognitive performance score = 0-3

and

Clinically complex = yes

and

Mood and behavior = yes or no

ADL Score 18-28 C High (9) 180
ADL Score 9-17 C Med (8) 140
ADL Score 2-8 C Low (7) 83
Group B

Mood and behavior = yes

and

Clinically complex = no

and

Cognitive performance score = 0-4

ADL Score 15-28 B High (6) 155
ADL Score 5-14 B Med (5) 90
ADL Score 0-4 B Low (4) 52
Group A

Mood and behavior = no

and

Clinically complex = no

and

Cognitive performance score = 0-4

ADL Score 10-28 A High (3) 78
ADL Score 5-9 A Med (2) 62
ADL Score 0-4 A Low (1) 29

[]

DETERMINING HOURS FOR IN-HOME SERVICES
AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0090   What are the maximum hours that I can receive for in-home services?   The maximum hours that you can receive for in-home services ((is)) are determined through the CARE tool. The maximum hours are based upon your classification group. The highest hours attached to an in-home classification group is four hundred twenty per month. These hours are based on criteria outlined in WAC 388-72A-0095. For Chore program clients, the maximum personal care hours per month the department will pay is one hundred sixteen.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0090, filed 2/19/03, effective 3/22/03.]


NEW SECTION
WAC 388-72A-0092   How are my in-home hours determined?   (1) A base number of hours is assigned to each classification group as described in WAC 388-72A-0087.

     (2) In accordance with WAC 388-72A-0095 and 388-71-0460, the base hours are adjusted to account for informal support, paid by individual(s) or group(s) other than the department and support shared living circumstances.

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AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0095   ((How are)) What additional criteria are considered to determine the number of hours I ((can)) will receive for in-home services ((determined))?   (1) In addition to criteria defined in WAC ((388-72A-0075, 388-72A-0080, and 388-72A-0085)) 388-72A-0081, 388-72A-0082, 388-72A-0083, 388-72A-0084, 388-72A-0087, or 388-71-0460, CARE will take into account ((your)):

     (a) ((Assistance available to meet your needs. This is defined as:

     (i) Met;

     (ii) Unmet;

     (iii) Partially met.

     NOTE: Home and community programs (HCP) services may not replace other available resources the department identified when completing CARE. The hours will be adjusted to account for tasks that are either fully or partially met by other available resources. These resources may be unpaid or paid for by other state or community sources.

     (b) Environment, such as whether you:

     (i) Have laundry facilities out of home; and/or

     (ii) Use wood as a primary source of heat and/or;

     (iii) The time it takes to access essential shopping services.

     (c) Living arrangement. The department will adjust payments to a personal care provider who is doing household tasks at the same time (e.g., essential shopping, meal preparation, laundry, and wood supply) if:

     (i) There is more than one client living in the same household; or

     (ii) You and your paid provider live in the same household.

     (2) The CARE tool will provide a)) The amount of informal supports available to fully or partially meet your needs as described in WAC 388-72A-0041.

     (i) As shown in the following table, CARE determines the adjustment by placing a numeric value on the amount of assistance available to meet your needs and reduces the base hours assigned to the classification group using the values listed below for each ADL and IADL.


Meds Self Performance Status Assistance Available Value

Percentage

Self administration of medications Rules for all codes apply except independent is not counted Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .9
1/4 to 1/2 time .7
1/2 to 3/4 time .5
> 3/4 time .3
Unscheduled ADLs Self Performance Status Assistance Available Value

Percentage

Bed mobility, transfer, walk in room, eating, toilet use Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider= 1;

Did not occur/client declined and independent are not counted.

Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .9
1/4 to 1/2 time .7
1/2 to 3/4 time .5
>3/4 time .3
Scheduled ADLs Self Performance Status Assistance Available Value

Percentage

Dressing

personal hygiene

bathing

Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider= 1;

Did not occur/client declined and independent are not counted .

Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .75
1/4 to 1/2 time .55
1/2 to 3/4 time .35
> 3/4 time .15
IADLs Self Performance Status Assistance Available Value

Percentage

Meal preparation

Ordinary housework

Essential shopping

Rules for all codes apply except independent is not counted. Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met < 1/4 time .3
1/4 to 1/2 time .2
1/2 to 3/4 time .1
> 3/4 time .05
IADLs Self Performance Status Assistance Available Value

Percentage

Travel to medical Rules for all codes apply except independent is not counted. Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met < 1/4 time .9
1/4 to 1/2 time .7
1/2 to 3/4 time .5
> 3/4 time .3

     (ii) The value percentage assigned to each specified ADL/IADL is summed and carried two decimal places. The resulting number is then divided by the number of qualifying ADL and IADL needs. If self-performance is coded as independent or did not occur/client declined then they are not qualifying ADLs and IADLs. The result is value A. Value A is then subtracted from one. This is value B. Value B is divided by three. This is value C. Value A and value C are summed. This is value D. Value D is multiplied by the "base hours" assigned to the client's classification group in WAC 388-72A-0087.

     (b) Your environment, as described in the diagrams below.


Condition Status Assistance Available Add On Hours
Offsite laundry facilities, which means the client does not have facilities in own home and the caregiver is not available to perform any other personal or household tasks while laundry is done. N/A N/A 8
Client is > 45 minutes from essential services (which means he/she lives more than 45 minutes one-way from a full-service market). Unmet N/A 5
Met N/A 0
Partially met <1/4 time 5
between 1/4 to 1/2 time 4
between 1/2 to 3/4 time 2
>3/4 time 2
Wood supply used as sole source of heat. Unmet N/A 8
Met N/A 0
Declines N/A 0
Partially met < 1/4 time 8
between 1/4 to 1/2 time 6
between 1/2 to 3/4 time 4
> 3/4 time 2

     (c) Your living arrangement.

     (i) If there is more than one client living in the same household, the status cannot be unmet for the following IADLs:

     (A) Meal preparation,

     (B) Housekeeping,

     (C) Shopping,

     (D) Wood supply.

     (ii) If you and your paid provider live in the same household, the status must be met for the following IADLs:

     (A) Meal preparation,

     (B) Housekeeping,

     (C) Shopping,

     (D) Wood supply.

     (iii) When there is more than one client living in the same household and your paid provider lives in your household, the status must be met for the following IADLs:

     (A) Meal preparation,

     (B) Housekeeping,

     (C) Shopping, and

     (D) Wood supply.

     (2) The hours identified in WAC 388-72A-0095 (1)(b) are added to the resulting hours in WAC 388-72A-0095 (1)(a). The result is the maximum number of hours that can be used to develop your care plan. The assessor must take into account cost effectiveness, client health and safety, and program limits in determining how hours can be used to meet identified client needs.

     (3) Within the limits of subsection (2) of this section, you and your case manager will work to determine what services you choose to receive if you are eligible. The hours may be used to authorize:

     (a) Personal care services (per WAC 388-72A-0055, 388-72A-0060, ((or)) 388-72A-0065, or 388-845-1300);

     (b) Home delivered meals (per WAC ((388-72A-0055)) 388-71-0415);

     (c) Adult day care (per WAC ((388-72A-055 or 388-15-652)) 388-71-0708);

     (d) ((Adult day health (per WAC 388-72A-055 or 388-15-653);

     (c))) A home health aide (per WAC ((388-72A-0055)) 388-71-0415).

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, § 388-72A-0095, filed 2/19/03, effective 3/22/03.]


NEW SECTION
WAC 388-72A-0115   When the department adjusts an algorithm, when does the adjustment become effective?   When the department adjusts an algorithm used to evaluate the information gathered by the CARE tool, the effective date of any change generated by the adjustment(s) to the client's CARE level or hours shall be:

     (1) Immediate for applicants;

     (2) At the time of the recipient's next assessment.

[]


NEW SECTION
WAC 388-72A-0120   When a client requests a fair hearing to have the client's CARE tool assessment results reviewed and there is (are) a more recent CARE assessment(s), which CARE tool assessment does the administrative law judge review in the fair hearing?   The administrative law judge must review the most recent CARE tool assessment.

[]


REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 388-72A-0040 What information does the assessor gather?
WAC 388-72A-0075 What does the CARE computerized assessment tool do with the client information entered by department staff?

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