WSR 98-20-022
PERMANENT RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)
[Filed September 25, 1998, 2:34 p.m.]
Date of Adoption: September 25, 1998.
Purpose: To implement RCW 74.09.520 (3)(b) which requires that the plans of care for Medicaid personal care (MPC) clients be reviewed by a registered nurse. This rule enhances the services that a registered nurse can perform on behalf of a MPC or a community options program entry (COPES) client. This rule also ensures this service will not duplicate services which can be provided by another health care provider.
Citation of Existing Rules Affected by this Order: Amending WAC 388-15-194.
Statutory Authority for Adoption: RCW 74.09.520, 74.08.090.
Adopted under notice filed as WSR 98-16-092 on August 5, 1998.
Changes Other than Editing from Proposed to Adopted Version: Deleted the detailed description of tasks the nurse may perform. The frequency and scope of the nursing services will be based on individual client need using critical indicators approved by each division as appropriate. The new language reinforced that this nursing service will not duplicate services which the client is receiving from some other resource. The new language also clarifies that registered nurses performing this role will not provide skilled treatment except in the event of an emergency, the need for any skilled medical or nursing treatment will be referred to a health care provider, a home health agency or to a contracted delegating nurse.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, amended 0, repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 1, repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 1, repealed 0.
Effective Date of Rule: Thirty-one days after filing.
September 25, 1998
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit
SHS-2458.7
AMENDATORY SECTION (Amending Order 3904, filed 9/28/95, effective 10/29/95)
WAC 388-15-194 Home and community services--((Nurse
oversight))Nursing services. (1) A registered nurse will review
the plan of care for all Medicaid personal care clients.
(2) Upon department or designee referral, a registered nurse
((shall visit)) will consult about or visit a community options
program entry system client ((and)) or a Medicaid personal care
client ((one time per year or more often)) to perform a nursing
service which may include the following activities:
(a) ((Review the personal care task delivery portion of the
client's service plan)) Nursing assessment/reassessment;
(b) ((Evaluate the effectiveness of the personal care task
delivery portion of the client's service plan)) Instruction to
care providers and clients;
(c) Care coordination;
(d) Evaluation.
(((2) The department or its designee may authorize a
registered nurse's oversight visit more frequently than once a
year when the client appears to:
(a) Be at high risk; or
(b) Have an unstable condition; or
(c) Have a provider who requires training.))
(3) The frequency and scope of the nursing service will be based on individual client need and will be provided as outlined in a nursing service design developed in coordination with each area agency on aging. Each design will include critical indicators of the need for the nursing service and must be approved by the following divisions as appropriate: aging and adult services administration, developmental disabilities, children's administration and mental health.
(4) This nursing service will not be provided if activities duplicate services that the client is receiving from some other resource. Coordination and/or referrals to appropriate health care providers will occur as necessary.
(5) The registered nurse ((shall document the result of the
nurse's oversight visit on the department-prescribed form))
providing this service will not perform skilled treatment except
in the event of an emergency. The need for any skilled medical
or nursing treatments will be referred to a health care provider,
a home health agency or a contracted delegating nurse.
(6) The registered nurse must document the result of the nursing service provided on a department-approved form. The registered nurse provides a copy to the staff who has case management responsibility.
[Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-194, filed 9/28/95, effective 10/29/95.]