The definitions in this section apply throughout this chapter unless the context clearly indicates otherwise.

(1) "Activities of daily living" means bathing, bed mobility, continence, dressing, eating, medication management, mobility, personal hygiene, toileting, or transferring.

(a) "Bathing" means how a person washes their body including showers, baths, sponge baths, or bed baths, and how a person gets into and out of a shower or bathtub.

(b) "Bed mobility" means how a person moves to and from a lying position, turns side-to-side, and positions their body while in bed, in a recliner, or other furniture used for sleeping.

(c) "Continence" means the ability to control bladder and bowel functions, or, when unable to maintain control of bowel or bladder function, the ability to perform associated care and hygiene, including caring for a catheter or colostomy bag.

(d) "Dressing" means how a person puts on and takes off all items of clothing including prosthesis, splints, braces, and orthotics.

(e) "Eating" means how a person eats and drinks. Eating includes any method of receiving nutrition by mouth, tube, or through a vein. Eating does not include any set-up help received.

(f) "Medication management" means how a person organizes and takes prescription medications, over the counter medications, or supplements.

(g) "Mobility" means how a person gets from one place to another within their immediate environment and from outside their home to inside their home.

(h) "Personal hygiene" means how a person completes self-care activities such as combing hair, brushing teeth, shaving, applying makeup, washing face, drying face, washing hands, nail care, perineum care, and menses care. Personal hygiene does not include hygiene tasks completed during bathing.

(i) "Toileting" means how a person uses a toilet, commode, bedpan, or urinal to eliminate, and how they transfer on and off the toilet, perform associated hygiene, and adjust clothing.

(j) "Transferring" means how a person moves between surfaces such as to and from a bed, a chair, wheelchair, or standing position. Transferring does not include how a person moves to and from the bath, toilet, or vehicle.

(2) "Approved services" means long-term services and supports including:

(a) "Adaptive equipment and technology" means devices and services available in the categories listed in (2)(a)(i) through (v) of this subsection that maintain or improve the ability to perform activities of daily living; or maintain or improve functional capabilities; and increase independence, safety, and welfare including:

(i) Assistive technology items used to increase, maintain, or improve the functional capabilities of persons with physical or mental impairment;

(ii) Assistive technology services to evaluate, consult, train, and provide technical assistance regarding assistive or adaptive devices;

(iii) Medical equipment and supplies within one of the following categories:

(A) Incontinence supplies such as reusable or disposable briefs, pullups, wipes, and underpads;

(B) Personal protective equipment;

(C) Bathroom and toileting equipment such as urinals, bedside commodes, raised toilet seats, toilet and tub rails, bath and shower stools, chairs, and benches, including transfer benches and rolling shower chairs;

(D) Blood pressure monitoring devices;

(E) Over the counter non-custom surgical stockings;

(F) Grab bars for use anywhere in the home; and

(G) Lift chairs;

(iv) Specialized equipment and supplies, including non-medical goods and adaptive devices that provide remedial benefit, including weight utensils, waterproof mattress covers, long-handled brushes, and baskets for walkers; and

(v) Vehicle modifications that are necessary to accommodate a disability, including wheelchair ramps and lifts, adding hand controls, and modifying foot pedals, steering devices, or seating;

(vi) Excluded from allowable adaptive equipment and technology are:

(A) Any item purchased for recreational purposes;

(B) Software, game applications, or gift cards;

(C) Exercise equipment;

(D) Pressure reducing support surfaces;

(E) Hospital beds, including their accessories and other positioning devices;

(F) Patient lifts and transfer devices, not including lift chairs;

(G) Wound care supplies;

(H) Diabetic equipment and supplies;

(I) Nutrition equipment and supplies;

(J) Orthotic equipment and supplies;

(K) Ostomy supplies;

(L) Respiratory equipment and supplies;

(M) Transcutaneous electrical nerve stimulation (TENS) systems;

(N) Mobility aids, including but not limited to, crutches, canes, gait trainers, and walkers, as well as their accessories and replacement materials;

(O) Wheelchairs and their accessories and replacement materials;

(P) Eyeglasses, contact lenses, and hearing aids;

(Q) Therapy or service animals and their related expenses; and

(R) Experimental or investigational medical devices or drugs.

(b) "Adult day services" means adult day care or adult day health.

(i) "Adult day care" means a program that provides the services under WAC 388-71-0704.

(ii) "Adult day health" means a program that provides the services under WAC 388-71-0706.

(c) "Adult family home services" means services provided in a home-like residential setting where two to eight adults live and receive personal care, special care, and room and board under chapter 70.128 RCW and chapter 388-76 WAC.

(d) "Assisted living services" means services provided in a residential setting where seven or more adults live and receive basic services for their safety and well-being under chapter 18.20 RCW and chapter 388-78A WAC.

(e) "Care transition coordination" means services that provide comprehensive discharge planning and coordination of health care services for up to 60 days after being discharged from a hospital or nursing home with the goal of avoiding preventable poor outcomes as beneficiaries return home.

(f) "Dementia and behavioral supports" means an assessment by a mental health professional to determine causes, triggers, and purposes behind documented or identified behaviors such as wandering or aggression, and the development of a written strategy with recommendations for specific interactions designed to address identified behaviors.

(g) "Education and consultation" means non-medical skills training for eligible beneficiaries and their paid and unpaid caregivers related to an eligible beneficiary's diagnoses and chronic health issues to support managing their activities of daily living, behavior, health, and wellness.

(h) "Environmental modification" means alterations to a residence that accommodate an eligible beneficiary's disability and promote functional independence, health, welfare, and safety. Environmental modifications include, but are not limited to, installing grab bars, building ramps, widening doorways, and modification to bathrooms.

(i) "Home delivered meals" means nutritionally balanced meals prepared and delivered to an eligible beneficiary's home. Home delivered meals includes, but is not limited to, box meals, prepackaged meals, and hot meals, and must be from a provider that meets the requirements of chapter 246-215 WAC.

(j) "Home safety evaluation" means an assessment of a home to identify and reduce potential hazards, to minimize or prevent injury, and improve accessibility in the home.

(k) "In-home personal care" means assistance with activities of daily living and instrumental activities of daily living provided to a person in their own home.

(l) "Long-term services and supports provided in nursing homes" or "nursing home services" means long-term care or custodial services provided in one of the following settings:

(i) A setting that operates or maintains facilities providing convalescent or chronic care, or both, consistent with chapter 18.51 RCW and chapter 388-97 WAC, for a period in excess of 24 consecutive hours for three or more patients who are not related by blood or marriage to the operator, and who, by reason of illness or infirmity, are unable to properly care for themselves; or

(ii) A swing bed in a critical access hospital to provide post-acute nursing services, where "swing bed" is defined under WAC 246-310-410 and "critical access hospital" is defined under WAC 182-550-2598.

(iii) Excluded from nursing home services is medically necessary care provided in a skilled nursing facility that requires a licensed medical practitioner to perform, including, but not limited to:

(A) Rehabilitation services such as physical or occupational therapy; and

(B) Skilled nursing services such as wound care, intravenous injections, and catheter care.

(m) "Memory care" means a service provided in an assisted living facility that provides specialized, long-term care for individuals with memory loss under chapter 18.20 RCW and chapter 388-78A WAC.

(n) "Personal emergency response system" means a service to secure help in an emergency through an electronic device programmed to signal a response center that is staffed by trained professionals who immediately summon help. Systems must be approved by the Federal Communications Commission and meet the Underwriters Laboratories solutions or Intertek Electronic Testing Laboratories standards for home health care signaling equipment. Personal emergency response systems are limited to basic systems, global positioning systems, medication reminders, and fall detections.

(o) "Professional nursing services" means one or more of the following services:

(i) "Skilled nursing" means a short-term intermittent treatment of a chronic condition, or the treatment of chronic, stable, long-term conditions where the treatment cannot be delegated or self-directed. Excluded from skilled nursing services are treatments for acute care due to acute injury or illness.

(ii) "Nurse delegation" means specific nursing tasks assigned by a registered nurse to a nursing assistant certified pursuant to chapter 18.88A RCW or home care aide certified pursuant to chapter 18.88B RCW. Nurse delegation must be performed pursuant to RCW 18.79.260.

(iii) "Private duty nursing" means in-home skilled nursing care to a person who would otherwise be served in a medical institution. A person receiving private duty nursing is dependent on a technology modality, including mechanical ventilation, complex respiratory support, tracheostomy, intravenous or parenteral, administration of medication, or intravenous administration of nutritional substances.

(p) "Respite for family caregivers" means a short-term service that allows family caregivers a break from caregiving duties while the eligible beneficiary is cared for by an in-home service provider, or in the community by an adult day service provider, adult family home, assisted living facility, or nursing home.

(q) "Services that assist paid and unpaid family members caring for eligible individuals"((which)) means housework, errands, yardwork, and snow removal tasks that are typically done by family members.

(i) "Housework" and "errands" are services supporting beneficiaries to remain in their own home by assisting with instrumental activities of daily living related to their health and safety.

(ii) "Yardwork" and "snow removal" are services to allow safe egress and entry into the home, reduce potential fire danger, assist the beneficiary to comply with local city and county codes, or other local requirements, such as a Homeowner's Association, in order to remain in their choice of setting.

(r) "Transportation"((which)) means ((services that support the ability to))non-emergency travel, by any means other than air, to therapeutic activities that support mental health, physical health, or wellbeing((,)): the grocery store((,)); medical appointments((,)); and social services. ((Services include, but are not limited to, trip or mileage reimbursement, bus passes, taxi scripts, bridge tolls, and ferry tickets.))

(3) "Area agency on aging" means an agency, other than a state agency, designated by the department to carry out certain programs or services in a defined geographical area of the state.

(4) "Benefit unit" has the same meaning as defined in RCW 50B.04.010.

(5) "Care needs assessment" means the department's or its designee's evaluation of a person's ability to complete activities of daily living.

(6) "Consumer-to-consumer online platform" means an e-commerce marketplace where the primary purpose is to facilitate person-to-person transactions through online classifieds or auctions where private individuals list items or services for direct sale to another person.

(7)"Custodial services" means long-term, non-medical care for individuals who need assistance with activities of daily living due to aging, disability, or chronic medical condition.

(((7)))(8)"Department" means the department of social and health services.

(((8)))(9)"Eligible beneficiary" has the same meaning as defined in RCW 50B.04.010.

(((9)))(10)"Eligibility determination" means the department's or its designee's determination of whether a person is an eligible beneficiary.

(((10)))(11)"Evidence-based program provider" means an entity that provides the approved service of care transition coordination or education and consultation, and whose programs have been rigorously tested in controlled settings, proven effective, and translated into practical models. Programs include Enhance®Wellness, Enhance®Fitness, program to encourage active and rewarding lives for seniors (PEARLS), star-caregivers program (STAR-C), powerful tools for caregivers, and community aging in place—advancing better living for elders (CAPABLE).

(((11)))(13)"Health home" means a set of services designed to support individuals with serious chronic conditions, a medical need, or a social service need with the goal of reducing visits to the emergency department and supporting the individual's health, well-being, and self-care.

(((12)))(14)"Health home care coordination organization" means an organization that operationalizes the health home program through a contract with a lead entity.

(((13)))(15)"Health home lead entity" means a managed care organization or qualified community-based organization contracted with the health care authority to oversee the health home program in specific parts of the state.

(((14)))(16)"In-state applicant" means an individual who resides in Washington state and is applying to become an eligible beneficiary to receive services in Washington state.

(((15)))(17)"Instrumental activities of daily living" means essential shopping, meal preparation, ordinary housework, telephone use, travel to medical services, or wood supply.

(a) "Essential shopping" means how a person completes brief, occasional trips within their local area to shop for food, medical necessities, and household items required for their health, nutrition, daily maintenance, or well-being.

(b) "Meal preparation" means how a person completes meal planning, cooking, assembling ingredients, setting out food or utensils, and cleaning up after meals;

(c) "Ordinary housework" means how a person completes routine household chores;

(d) "Telephone use" means how a person makes and receives calls, including dialing, answering, and comprehending spoken information, on the telephone;

(e) "Travel to medical services" means how a person travels by vehicle to a physician's office or clinic within their local area to obtain medical diagnosis or treatment. This travel includes driving a vehicle or traveling as a passenger in a vehicle; and

(f) "Wood supply" means how a person prepares wood or pellets when using wood, pellets, or both, as the only source of fuel for heating or cooking.

(((16)))(18)"Level of assistance" means the amount and type of care a person needs to perform activities of daily living.

(((17)))(19)"Licensed practical nurse" means an individual licensed pursuant to chapter 18.79 RCW and meets the definition of licensed practical nurse pursuant to RCW 18.79.060.

(((18)))(20)"Long-term services and supports" means services and goods purchased that support quality of life, and the ability to perform activities of daily living and instrumental activities of daily living at an eligible beneficiary's own home, in the community, in residential settings, and nursing homes; and

(a) Support the eligible beneficiary's welfare, independence, and wellbeing;

(b) Do not replace services and goods otherwise available under medical insurance; and

(c) Do not include paying for services and goods that are for general utility, meaning the goods and services are not specific to the person's needs based on their disabilities or health conditions.

(((19)))(21)"Long-term services and supports provider" has the same meaning as defined in RCW 50B.04.010.

(((20)))(22)"Own home" means an eligible beneficiary's domicile, their present or intended place of residence:

(a) In a building that is rented where the rental is not contingent upon the purchase of services for assistance with activities of daily living and instrumental activities of daily living;

(b) In a building that is owned by the eligible beneficiary;

(c) In an established residence of a relative of the eligible beneficiary; or

(d) In the home of another where rent is not charged and residence is not contingent upon the purchase of services for assistance with activities of daily living and instrumental activities of daily living.

(((21)))(23)"Provider applicant" means any individual, firm, partnership, corporation, company, association, joint stock association, or any other legal or commercial entity that is applying to become a long-term services and supports provider.

(((22)))(24)"Qualified individual" has the same meaning as defined in RCW 50B.04.010.

(((23)))(25)"Registered nurse" means an individual licensed pursuant to chapter 18.79 RCW and who meets the definition of registered nursing practice pursuant to RCW 18.79.040.

(1) An eligible beneficiary may pay out-of-pocket and request reimbursement up to the maximum rate for the following approved services:

(a) Adaptive equipment and technology; and

(b) Transportation. Transportation does not include expenses such as fuel, maintenance, vehicle upgrades, vehicle purchases, and repairs.

(2) To request reimbursement for the purchase of an approved service, the eligible beneficiary must submit ((a reimbursement request and)) a receipt for the purchased ((item))approved service and a reimbursement request to a financial management services vendor.

(3) The purchase receipt must include the:

(a) Name of the seller;

(b) Date of the transaction;

(c) Name of the ((approved))item or service;

(d) Method of payment; and

(e) ((Total))The itemized total amount paid for the ((approved))item or service, which includes ((additional)) required fees or costs, such as tax, shipping, or transaction fees.

(4) A request for reimbursement must be submitted to the financial management services vendor no more than 60 days after the date of the transaction.

(5) ((For the purposes of this section, the following definitions apply.

(b) "Reimbursement" means payment to an eligible beneficiary from their benefit, by the financial management services vendor, for amount paid in the purchase of an approved service.))An eligible beneficiary may not receive reimbursement for a purchase made using a consumer-to-consumer online platform.

(1) Transportation by family member or friend:

(a) An eligible beneficiary may select a family member or friend to provide transportation for the beneficiary using a personal vehicle.

(b) The family member or friend may be paid, up to the preauthorized amount of miles driven, up to the maximum rate for mileage outlined in WAC 388-116-4020.

(2) To request payment to a family member or friend for transportation, the eligible beneficiary must be enrolled with the financial management services vendor and follow their requirements for processing and issuing payment.

(3) To be eligible to receive payment, the family member or friend must:

(a) Be age 18 or older; and

(b) Be enrolled with the financial management services vendor by providing the financial management services vendor:

(i) Proof of valid driver license;

(ii) Proof of current auto insurance;

(iii) Proof of vehicle registration.

(4) To request payment, the family member or friend must:

(a) Document the number of miles traveled with the eligible beneficiary and the date of service; and

(b) Submit the documentation to the financial management services vendor no more than 60 days after the date the transportation was provided.

(5) The family member or friend is not required to be a long-term services and supports provider under WAC 388-116-3010.

(1) An eligible beneficiary may request the financial management services vendor purchase adaptive equipment and technology on their behalf.

(2) The adaptive equipment and technology must be allowable under WAC 388-116-1010.

(3) The total cost for the item, which includes required fees or costs, such as tax, shipping, or transaction fees, must not exceed the maximum rate under WAC 388-116-4020.

(4) The financial management services vendor must not purchase adaptive equipment and technology using a consumer-to-consumer online platform.