Preproposal statement of inquiry was filed as WSR 97-23-081.

Title of Rule: WAC 388-15-196 Individual providers for in-home care, contract qualifications and conditions for payment and new related sections.

Purpose: The proposed rules describe in-home individual provider qualifications, the conditions under which the department can pay an in-home individual provider, and the conditions under which the department may deny or terminate payment to an in-home individual provider. It amends WAC 388-15-196 according to new statutory changes. It also divides the information into easy-to-use sections using clear rule writing techniques.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050.

Statute Being Implemented: RCW 43.20A.710, 74.39A.050, 42 CFR 1002.210, 42 CFR 431.51, RCW 43.43.830.

Summary: The rule describes the requirements to be contracted as a paid in-home individual provider. It describes the conditions under which the department may deny or terminate a contract. The effect of this rule is to provide clear information to in-home individual providers, clients, and other stakeholders about how and when in-home individual providers can be paid and cannot be paid.

Reasons Supporting Proposal: Changes are made to comply with the governor's executive order, and rules established to comply with new statutes, RCW 43.20A.710 and 74.39A.050(8).

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Sue McDonough, Program Manager, Home and Community Programs, HCSD, AASA, Olympia, Washington, (360) 407-0331.

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

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

Explanation of Rule, its Purpose, and Anticipated Effects: The rules define contract qualifications and conditions for payment for individual providers of in-home care. The purpose is to comply with the governor's executive order regarding regulatory improvement, and to comply with legislation directing the department to deny contracts and terminate payment to individual providers with disqualifying crimes, convictions of abuse, neglect, financial exploitation, or abandonment and other quality assurances.

The anticipated effects are to improve the quality of personal care provided to elderly and disabled adults who live in home and community settings that they receive from in-home individual providers.

Proposal Changes the Following Existing Rules: WAC 388-15-196 is being amended to implement to [two] new statutory changes. The rule is being divided into easy-to-use sections using clear rule writing techniques. These rule-making amendments comply with the criteria under the Governor's Executive Order 97-02.

No small business economic impact statement has been prepared under chapter 19.85 RCW. These rules do not have an economic impact on small businesses. In-home individual providers are independent contractors of DSHS.

RCW 34.05.328 applies to this rule adoption. These rules do meet the definition of significant "legislative rule" but are exempt under RCW 34.05.328 (5)(b)(v).

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on August 4, 1998, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by July 24, 1998, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 902-8292, by August 4, 1998.

Date of Intended Adoption: August 14, 1998.

June 29, 1998

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION (Amending WSR 97-16-106, filed 8/6/97, effective 9/6/97)

WAC 388-15-196  ((Home and community services--Minimum qualifications for care)) In-home individual providers ((in home and community settings)). ((To protect the health and welfare of a long-term care service client receiving an AASA administered service, the adult client's care provider shall:

(1) Be eighteen years of age or older;

(2) Complete and submit a criminal history background inquiry form prescribed by the department;

(3) Possess the following minimum standards of knowledge and experience:

(a) General knowledge of acceptable standards of performance, including the necessity to perform dependably, report punctually, maintain flexibility, and to demonstrate kindliness and caring to the client;

(b) Knowledge of when and how to contact the client's representative and the client's case manager.

(4) Have the following required skills:

(a) Adequate skills to read, either directly or through an interpreter, understand and implement the client's service plan;

(b) Adequate communication skills to convey and understand either directly or through an interpreter information required to implement the client's written service plan and verbal instructions;

(c) Adequate skills to maintain provider records of services performed and payments received.

(5) Be able to:

(a) Understand specific directions for providing the care which the individual client requires;

(b) Observe the client for change in health status, including weakness, confusion, and loss of appetite;

(c) Identify problem situations and take appropriate action;

(d) Respond to emergencies without direct supervision;

(e) Perform authorized housework functions competently;

(f) Perform authorized direct personal care functions competently;

(g) Accept the client's individual differences and preferences when performing routine tasks; and

(h) Work independently and perform responsibly within the boundaries of the nonmedical personal care task limits.

(6)(a) Complete the department's fundamentals of caregiving training according to the following schedule:

(i) All in-home personal care providers hired on or after the effective date of this section shall successfully complete the department-designated fundamentals of caregiving training within one hundred twenty days of employment, unless he or she meets the requirements under (iii) or (iv) of this subsection or in subsection (6)(c) or (6)(f);

(ii) All in-home care providers hired prior to November 1, 1996 shall successfully complete the department designated fundamentals of caregiving training prior to October 31, 1997, unless he or she meets the requirements under (iii) or (iv) of this subsection or in subsection (6)(c) or (6)(f);

(iii) Natural, step, or adoptive parents hired as personal care providers for their division of developmental disabilities (DDD) adult children prior to the effective date of this section, will have until September 1, 1998 to complete the caregiving training;

(iv) Natural, step, or adoptive parents hired as personal care providers for their own adult children on or after the effective date of this section will have one hundred eighty days to complete the training requirements.

(b) Complete a minimum of ten hours of continuing education credits per calendar year, on topics relevant to caregiving unless he or she is a parent hired as a personal care provider for their own DDD adult child:

(i) Topics include, but are not limited to:

(A) Residents' rights;

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

(C) Dementia;

(D) Mental illness;

(E) Developmental disabilities;

(F) Depression;

(G) Medication assistance;

(H) Communication skills;

(I) Alternatives to restraints; and

(J) Activities for clients.

(ii) Parent providers of their own DDD adult children are exempt from continuing education requirements;

(iii) Other caregivers are required to earn a certificate of completion to meet the requirement for continuing education credit and each hour of completed instruction will count as one hour of continuing education credit; and

(iv) The continuing education requirement begins the calendar year after the year in which the caregiver completes the fundamentals or modified fundamentals of caregiving training.

(c) The following providers are exempt from the fundamentals of caregiving training requirement in subsection (6)(a) of this section if the provider successfully completes the department designated modified fundamentals of caregiving training in accordance with the dates specified in subsection (6)(a) of this section.

(i) A provider who has successfully completed training as a registered or licensed practical nurse, a physical or occupational therapist, a certified nursing assistant, a Medicare-certified home health aide, or who has successfully completed department-approved adult family home training, or department-approved personal care training from an area agency on aging or their subcontractor.

(ii) A provider who has successfully completed the DDD staff training as required by chapter 275-26 WAC is exempt from the fundamentals of caregiving training in subsection (6)(a) of this section as long as the provider continues to work for a DDD-contracted agency. This exemption no longer applies if the provider leaves the DDD-contracted agency.

(iii) Parent hired as a personal care provider for their own DD adult child. This exemption no longer applies if the parent provides services to anyone who is not their own adult child.

(d) The provider shall provide documentation upon request that the provider has met the education and training requirements.

(e) The department shall not continue to authorize reimbursement for services rendered by a care provider who does not meet the educational requirement in subsection (6) of this section.

(f) All in-home personal care providers are exempt from attending the "fundamentals of caregiving" or "modified fundamentals of caregiving" training if they successfully pass the department's challenge test for the class they are required to take. The provider only has one opportunity to successfully pass the challenge test. If the provider does not pass the challenge test then he/she must attend the "fundamentals of caregiving" or "modified fundamentals of caregiving" training as required)) The intent of WAC 388-15-196 through 388-15-19680 is to describe in-home individual provider (IP) qualifications, the conditions under which the department can pay an in-home IP, as defined in WAC 388-15-202 (25) and (26), and the conditions under which the department may deny a contract or terminate payment to an in-home IP.

[Statutory Authority: RCW 74.04.050, 74.08.090, 74.39A.005, 74.39A.007, 74.39A.050 and 74.39A.070. 97-16-106, § 388-15-196, filed 8/6/97, effective 9/6/97. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-196, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-196, filed 9/28/95, effective 10/29/95.]

NEW SECTION

WAC 388-15-19600  How do I apply to be an in-home individual provider of an adult client? A person who wants to be an in-home IP must contact the client's home and community services (HCS) social worker or area agencies on aging (AAA) case manager to apply.

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NEW SECTION

WAC 388-15-19610  What requirements must an adult client's in-home individual provider meet in order to be paid? In order to be paid, an in-home IP of an adult must:

(1) Be eighteen years of age or older;

(2) Be hired by a client;

(3) Not be the spouse of the client receiving services, unless the client is on the chore personal care program;

(4) Provide the HCS social worker or AAA case manager with a Social Security card, picture identification, and authorization to work in the United States;

(5) Sign a home and community-based service provider contract/agreement to provide services to a COPES or Medicaid personal care client;

(6) Complete and submit to the client's social worker/case manager the department's criminal conviction background inquiry application;

(7) Have no conviction for a disqualifying crime, as listed in RCW 43.43.830 and RCW 43.43.842;

(8) Have no findings of fact or conclusions of law related to abuse, neglect, financial exploitation or abandonment of a minor or vulnerable adult, as defined in RCW 74.39A.050(8);

(9) Have not had an adult family home, boarding home, adult residential, enhanced adult residential, or assisted living facility license denied, suspended, or revoked for noncompliance with state and federal regulations in providing care to minors or vulnerable adults;

(10) Have read and understand the client's service plan, translated or interpreted, as necessary, for the client and/or IP; and

(11) Provide the services, as outlined in the client's service plan.

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NEW SECTION

WAC 388-15-19620  Under what conditions will the department deny payment to an individual provider? The department will deny payment when the IP:

(1) Does not meet the conditions of the contract;

(2) Does not provide services in a manner described in the individual provider handbook;

(3)Has had his/her contract terminated by the department;

(4) Does not successfully complete the training requirements within the time limits in WAC 388-15-19650 through 388-15-19680;

(5) Demonstrates an unwillingness or inability to provide care following mandatory training or other training provided by the client's social worker/case manager or through the nurse expertise service; or

(6) Does not meet the conditions as stated in WAC 388-15-19610 (6) through (11).

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NEW SECTION

WAC 388-15-19630  Where are the duties of client's individual provider written? The responsibilities of an IP are described on the client's service plan, as described in WAC 388-15-205, the contract, and in the provider handbook. See WAC 388-15-19640 (1) through (7).

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NEW SECTION

WAC 388-15-19640  Does the individual provider have responsibilities in addition to the service plan? The IP has responsibilities in addition to the client's service plan. The IP must:

(1) Accommodate client's individual preferences and differences in providing care;

(2) Contact the client's representative and case manager when there are changes which affect the personal care and other tasks listed on the service plan;

(3) Notify the case manager immediately when the client enters the hospital, an adult family home, an adult residential care facility, an enhanced adult residential care facility, an assisted living facility, or a nursing facility;

(4) Notify the case manager immediately when the client dies; and

(5) Meet other responsibilities as outlined in the individual provider handbook.

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NEW SECTION

WAC 388-15-19650  What are the educational requirements for an individual provider? To meet the educational requirements, an IP must:

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

(2) Complete a minimum of ten hours of continuing education credits each calendar year following the year in which the fundamentals of caregiving training is taken. One hour of completed instruction equals one hour of credit on topics that pertain to services provided in an in-home setting including:

(a) Client's rights;

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

(c) Dementia;

(d) Mental illness;

(e) Depression;

(f) Medication assistance;

(g) Communication skills;

(h) Alternatives to restraints;

(i) Activities for clients; and

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

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NEW SECTION

WAC 388-15-19660  Do all individual providers have to take the fundamentals of caregiving training? An IP can do the following instead of taking the fundamentals of caregiving:

(1) Pass the department's challenge test for the required class. This test can be taken once only. An IP contacts the AAA designated trainer to request the test; or

(2) Complete the department designated modified fundamentals of caregiving training and be a:

(a) Registered or licensed practical nurse;

(b) Physical or occupational therapist;

(c) Certified nursing assistant; or

(d) Medicare-certified home health aide; or

(3) Complete the division of developmental disabilities' (DDD) staff training required by chapter 275-26 WAC and continue to work for a DDD-contracted agency.

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NEW SECTION

WAC 388-15-19670  Are there special rules about training for parents who are the individual providers of division of developmental disabilities (DDD) adult children? Natural, step, or adoptive parents of adult DDD children:

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

(2) Are exempt from continuing education requirements; and

(3) Are exempt from the fundamentals of caregiving training if they provide care only for their own adult DDD child.

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NEW SECTION

WAC 388-15-19680  Are there special rules about training for parents who are individual providers of non-DDD adult children? Natural, step, or adoptive parents of adult non-DDD children must:

(1) Possess a certificate of successfully completing the fundamentals of caregiving training within one hundred eighty days after beginning employment; or

(2) Pass the department's challenge test; and

(3) Complete and provide proof of ten hours of continuing education credits as required under WAC 388-15-19650 (2) and (3).

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