SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)
Preproposal statement of inquiry was filed as WSR 99-15-066.
Title of Rule:
|Proposed Action||Title of Rule||Statutory authority for adoption||Statute being implemented|
|New||388-71-0400 What is the intent of the department's home and community programs?||RCW 74.09.520, 74.08.090, 74.39A.130||RCW 74.39.010, 74.39A.110|
|New||388-71-0405 What are the home and community programs?||RCW 74.09.520, 74.08.090, 74.39A.130||RCW 74.39.010, 74.39A.110|
|New||388-71-0410 What services may I receive under HCP?||RCW 74.08.090, 74.39.010, 74.09.520||RCW 74.39.010, 74.09.520|
|New||388-71-0415 What other services may I receive under the COPES program?||RCW 74.08.090, 74.39.020||RCW 74.39.020|
|New||388-71-0420 What services are not covered under HCP?||RCW 74.09.520, 74.08.090, 74.39A.130||RCW 74.39.020|
|New||388-71-0425 Who can provide HCP services?||Chapter 175, Laws of 1999, chapters 70.126, 70.127 RCW, RCW 74.08.044||Chapter 175, Laws of 1999, chapters 70.126, 70.127 RCW, RCW 74.08.044|
|New||388-71-0430 Am I eligible for one of the HCP programs?||RCW 74.39.010, 74.08.090, 74.39A.110, 74.09.520||RCW 74.39.010, 74.08.090, 74.39A.110, 74.09.520|
|New||388-71-0440 Am I eligible for MPC-funded services?||RCW 74.09.520||RCW 74.09.520|
|New||388-71-0445 Am I eligible for Chore-funded services?||RCW 74.39A.110, 74.39A.150||RCW 74.39A.110, 74.39A.150|
|New||388-71-0450 How do I remain eligible for services?||42 C.F.R. 441.302, RCW 74.09.520||C.F.R. 42.441.302, RCW 74.09.520|
|New||388-71-0455 Can my services be terminated if eligibility requirements for HCP change?||RCW 74.09.510, 74.09.520||RCW 74.09.510, 74.09.520|
|New||388-71-0460 Are there limitations to HCP services I can receive?||RCW 74.09.520||RCW 74.09.520|
|New||388-71-0465 Are there waiting lists for HCP services?||RCW 74.39.010, 74.39A.120||RCW 74.39.010, 74.39A.120|
|New||388-71-0470 Who pays for HCP services?||RCW 74.39A.120, 74.39.010, 74.39.020||RCW 74.39A.120, 74.39.010, 74.39.020|
|New||388-71-0475 What is the maximum amount that the department pays per month for your COPES care?||RCW 74.08.090||42 C.F.R. 441.302(f)|
|New||388-71-0480 If I am employed, can I still receive HCP services?||RCW 74.39A.140, 74.39A.150||RCW 74.39A.140, 74.39A.150|
|New||388-71-0600 What are residential services?||RCW 74.08.44 [74.08.044]||RCW 74.39A.020, 74.39A.010|
|New||388-71-0605 Am I eligible for residential services?||RCW 74.08.44 [74.08.044]||RCW 74.39A.020, 74.39A.010|
|New||388-71-0610 Who pays for residential care?||RCW 74.08.44 [74.08.044]||RCW 74.39A.020, 74.39A.010|
|New||388-71-0615 If I leave a residential facility or nursing facility, are there resources available?||RCW 74.42.450, 74.08.090||RCW 74.42.450|
|New||388-71-0620 Am I eligible for a residential discharge allowance?||RCW 74.42.450, 74.08.090||RCW 74.42.450|
|New||388-71-1000 What is the senior citizens act?||RCW 74.38.030||RCW 74.38.030|
|New||388-71-1005 Who administers the senior citizens services act funds?||RCW 74.38.030||RCW 74.38.030|
|New||388-71-1010 What services does the SCSA fund?||RCW 74.38.030||RCW 74.38.040|
|New||388-71-1015 How do I apply for SCSA-funded services?||RCW 74.38.030||RCW 74.38.050, 74.38.030|
|New||388-71-1020 Am I eligible for SCSA-funded services?||RCW 74.38.030||RCW 74.38.050|
|New||388-71-1025 What income and resources are not considered when determining eligibility?||RCW 74.38.030||RCW 74.38.030|
|New||388-71-1030 What if I am not eligible to receive SCSA-funded services at no cost?||RCW 74.38.030||RCW 74.38.030, 74.38.050|
|New||388-71-1035 What are my rights under this program?||RCW 74.38.030||RCW 74.38.030|
|New||388-71-1065 What is the purpose of the respite care program?||RCW 74.41.040||RCW 74.41.040|
|New||388-71-1070 What definitions apply to respite care services?||RCW 74.41.040||RCW 74.41.030|
|New||388-71-1075 Who is eligible to receive respite care services?||RCW 74.41.040||RCW 74.41.050|
|New||388-71-1080 Who may provide respite care services?||RCW 74.41.040||RCW 74.41.050|
|New||388-71-1085 How are respite care providers reimbursed for their services?||RCW 74.41.040||RCW 74.41.050|
|New||388-71-1090 Are participants required to pay for the cost of their services?||RCW 74.41.040||RCW 74.41.040|
|New||388-71-1095 Are respite care services always available?||RCW 74.41.040||RCW 74.41.050|
|New||388-71-1100 What is volunteer chore services?||RCW 74.08.090, 74.09.520, 74.39A.030, 74.39A.100||RCW 74.08.090, 74.09.520, 74.39A.030, 74.39A.100|
|New||388-71-1105 Am I eligible to receive volunteer chore services?||RCW 74.08.090, 74.09.520, 74.39A.030, 74.39A.100||RCW 74.08.090, 74.09.520, 74.39A.030, 74.39A.100|
|New||388-71-1110 How do I receive information on applying for volunteer chore services?||RCW 74.08.090, 74.09.520, 74.39A.030, 74.39A.100||RCW 74.08.090, 74.09.520, 74.39A.030, 74.39A.100|
|Repeal||388-15-145 Residential care discharge allowance|
|Repeal||388-15-200 Health support services|
|Repeal||388-15-201 Long-term care functional eligibility|
|Repeal||388-15-206 Volunteer chore services|
|Repeal||388-15-207 Chore personal care services for adults -- Legal basis|
|Repeal||388-15-209 Chore personal care services -- Eligibility|
|Repeal||388-15-214 Chore personal care services -- Budget control|
|Repeal||388-15-215 Chore personal care services -- Program limitations|
|Repeal||388-15-219 Chore personal care services -- Payment and client participation|
|Repeal||388-15-222 Chore personal care services -- Employed disabled--Incentive income and resource exemption|
|Repeal||388-15-548 Residential services|
|Repeal||388-15-551 Adult family home -- authority to purchase care -- Standards|
|Repeal||388-15-553 Adult family home -- Determination of need|
|Repeal||388-15-554 Adult family home -- Placement in facility|
|Repeal||388-15-555 Adult family home -- Payment -- Standards -- Procedures|
|Repeal||388-15-560 Congregate care -- Definition -- Authority to purchase care -- Standards|
|Repeal||388-15-562 Congregate care -- Eligible persons|
|Repeal||388-15-563 Congregate care -- Residents of other states|
|Repeal||388-15-564 Congregate care -- Determination of need|
|Repeal||388-15-566 Congregate care -- Placement in facility|
|Repeal||388-15-568 Congregate care--Payment -- Standards -- Procedures|
|Repeal||388-15-600 Community options program entry system (COPES) -- Purpose|
|Repeal||388-15-620 COPES -- Services|
|Repeal||388-15-630 COPES -- Payment procedures|
|Repeal||388-15-690 Respite care services -- Definitions|
|Repeal||388-15-695 Respite care services -- Caregiver eligibility|
|Repeal||388-15-700 Respite care services -- Distribution of cost|
|Repeal||388-15-705 Respite care services -- Rates of payment|
|Repeal||388-15-710 Respite care services -- Service priorities|
|Repeal||388-15-715 Respite care services -- Service priority categories|
|Repeal||388-15-810 Medicaid personal care services -- Legal basis|
|Repeal||388-15-830 Medicaid personal care services -- Eligibility|
|Repeal||388-15-880 Medicaid personal care services -- Payment procedures|
|Repeal||388-15-890 Medicaid personal care services -- Program limitations|
|Repeal||388-15-895 Termination of services|
|Repeal||388-17-010 Legal basis for senior citizens services program|
|Repeal||388-17-100 Rights and responsibilities of applicants and recipients|
|Repeal||388-17-120 Eligibility for senior citizens services -- Application|
|Repeal||388-17-160 Income and resources|
|Repeal||388-17-180 Fee schedule|
|Repeal||388-17-500 Local area agency on aging contracts -- Administrative review process|
|Repeal||388-17-510 Area agency on aging plan -- Administrative review process|
Purpose: The department is rewriting rules to comply with the clear writing standards, per the Governor's Executive Order 97-02. These rules have been rewritten to clarify and simplify language without making any policy changes.
Statutory Authority for Adoption: See Purpose above.
Statute Being Implemented: See Purpose above.
Summary: Repeals rules about social services for adults, which are currently listed in chapters 388-15 and 388-17 WAC, and proposes them as part of a new chapter, chapter 388-71 WAC.
Reasons Supporting Proposal: Governor's Executive Order 97-02.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Brooke Buckingham, 600 Woodland Square Loop, Lacey, WA, (360) 493-2544.
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: Current rules for Medicaid-funded services under the COPES (community options program entry system), MPC (Medicaid personal care), and chore personal care programs; residential care services program; residential care discharge allowance; Senior Citizens Services Act; respite care program; and volunteer chore program are being rewritten to meet clear rule writing standards. New rules will be adopted in chapter 388-71 WAC.
Proposal Changes the Following Existing Rules: We are repealing sections of chapters 388-15 and 388-17 WAC and adopting new rules on this subject in chapter 388-71 WAC. The following rules are being repealed: WAC 388-15-145 Residential care discharge allowance, 388-15-200 Health support services, 388-15-201 Long-term care functional eligibility, 388-15-206 Volunteer chore services, 388-15-207 Chore personal care services for adults -- Legal basis, 388-15-209 Chore personal care services -- Eligibility, 388-15-214 Chore personal care services -- Budget control, 388-15-215 Chore personal care services -- Program limitations, 388-15-219 Chore personal care services -- Payment and client participation, 388-15-222 Chore personal care services -- Employed disabled -- Incentive income and resource exemption, 388-15-548 Residential services, 388-15-551 Adult family home -- Authority to purchase care -- Standards, 388-15-552 Adult family home -- Eligible persons, 388-15-553 Adult family home -- Determination of need, 388-15-554 Adult family home -- Placement in facility, 388-15-555 Adult family home -- Payment -- Standards -- Procedures, 388-15-560 Congregate care -- Definition -- Authority to purchase care -- Standards, 388-15-562 Congregate care -- Eligible persons, 388-15-563 Congregate care -- Residents of other states, 388-15-564 Congregate care -- Determination of need, 388-15-566 Congregate care -- Placement in facility, 388-15-568 Congregate care -- Payment -- Standards -- Procedures, 388-15-600 Community options program entry system (COPES) -- Purpose, 388-15-620 COPES -- Services, 388-15-630 COPES -- Payment procedures, 388-15-690 Respite care services -- Definitions, 388-15-695 Respite care services -- Caregiver edibility, 388-15-700 Respite care services -- Distribution of cost, 388-15-705 Respite care services -- Rates of payment, 388-15-710 Respite care services -- Service priorities, 388-15-715 Respite care services -- Service priority categories, 388-15-810 Medicaid personal care services -- Legal basis, 388-15-830 Medicaid personal care services -- Eligibility, 388-15-880 Medicaid personal care services -- Payment procedures, 388-15-890 Medicaid personal care services -- Program limitations, 388-15-895 Termination of services, 388-17-010 Legal basis for senior citizens services program, 388-17-020 Definitions, 388-17-100 Rights and responsibilities of applicant and recipients, 388-17-120 Eligibility for senior citizens services -- Application, 388-17-160 Income and resources, 388-17-180 Fee schedule, 388-17-500 Local areas agency on aging contracts -- Administrative review process, and 388-17-510 Area agency on aging plan -- Administrative review process.
No small business economic impact statement has been prepared under chapter 19.85 RCW. A small business economic impact statement is not required because the rule does not impact small businesses.
RCW 34.05.328 does not apply to this rule adoption. The proposed amendments do not change the effect of the policy. Rules do meet the definition of "significant legislative rule," but the department is exempt from preparing a cost benefit analysis under RCW 34.05.328 (5)(b)(vii).
Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on January 4, 2000, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Paige Wall by December 21, 1999, phone (360) 664-6094, TTY (360) 664-6178, e-mail firstname.lastname@example.org.
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) 664-6185, by January 4, 2000.
Date of Intended Adoption: January 20, 2000.
November 10, 1999
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit2676.6HOME AND COMMUNITY PROGRAMS
The department offers home and community programs (HCP) as an alternative to nursing facility care so that eligible persons may remain in, or return to, their own homes or community residences with the provision of supportive services. Some of these services may be administered by home and community services (HCS), division of developmental disabilities (DDD), area agency on aging (AAA) or division of children and family services (DCFS).
The HCP are:
(1) Community options program entry system (COPES), described under subsection 1915(c) of the Social Security Act, codified in 42 C.F.R. 441.300 and 310.
(2) Medicaid personal care services (MPC), found under RCW 74.09.520 and in the Medicaid state plan.
(3) Chore personal care services, a state-only funded program authorized under RCW 74.08.090, 74.09.520, and 74.08.570.
You may receive the following HCP services:
(1) Assistance with personal care tasks and household tasks in your own home, as defined in 388-15-202(38); and
(2) Assistance with personal care tasks and household tasks in a residential setting, as described in WAC 388-71-500. Note: Household tasks are included as part of the board and room rate.
In addition to the services listed in WAC 388-71-410, you may be eligible for other services under the COPES program. You may be eligible to receive:
(1) Adult day care, in an adult day care or adult day health center if you:
(a) Are ineligible for Medicaid state plan covered adult day health services;
(b) Are chronically ill or disabled, socially isolated and/or confused or have mild to moderate dementia; or
(c) Meet eligibility requirements for adult day care services defined in WAC 388-15-652 and 388-15-653.
(2) Environmental modifications, if the minor physical adaptations to your home:
(a) Are necessary to ensure your health, welfare and safety;
(b) Enable you to function with greater independence in the home;
(c) Directly benefit you medically or remedially;
(d) Meet applicable state or local codes.
(3) Home delivered meals, limited to one meal per day, if:
(a) You are homebound;
(b) You are unable to prepare the meal;
(c) You don't have a caregiver (paid or unpaid) available to prepare this meal; and
(d) Receiving this meal is more cost-effective than having a paid caregiver.
(4) Home health aide service tasks, if the service tasks:
(a) Include assistance with ambulation, exercise, self-administered medications and hands on person care;
(b) Are beyond the amount, duration or scope of Medicaid reimbursed home health services (WAC 388-86-045) and are in addition to those available services; and
(c) Are health-related. Note: Incidental services such as meal preparation may be performed in conjunction with a health-related task as long as it is not the sole purpose of the aide's visit.
(5) Personal emergency response system (PERS), if the service is necessary to enable you to secure help in the event of an emergency and if you:
(a) Live alone;
(b) Are alone;
(c) Have no regular provider for extended periods of time on a daily basis;
(d) Do not have a live-in provider; or
(e) Do not live with family or friends.
(6) Skilled nursing, if the service is:
(a) Provided by a registered nurse or licensed practical nurse under the supervision of a registered nurse;
(b) Beyond the amount, duration or scope of Medicaid-reimbursed home health services as provided under WAC 388-86-045; and
(c) Limited to short-term service not to exceed twelve visits in a six-month period.
(7) Specialized medical equipment and supplies, if the items are:
(a) Necessary for life support;
(b) Necessary to increase your ability to perform activities of daily living; or
(c) Necessary for you to perceive, control, or communicate with the environment in which you live; and
(d) Directly medically or remedially beneficial to you; and
(e) In addition to any medical equipment and supplies provided under the state plan.
(8) Training, if you need to meet a therapeutic goal such as:
(a) Adjusting to a serious impairment;
(b) Managing personal care needs; or
(c) Developing necessary skills to deal with care providers.
(9) Transportation services, if the service:
(a) Provides the client access to community services and resources provided in accordance with a therapeutic goal;
(b) Is not merely diversional in nature;
(c) Is in addition to Medicaid brokered transportation to medical services; and
(d) Does not replace the Medicaid-brokered transportation.
HCP does not cover the following services:
(1) For chore personal care and MPC:
(a) Teaching, including teaching how to perform personal care tasks;
(b) Development of social, behavioral, recreational, communication, or other types of community living skills;
(c) Nursing care.
(2) Services provided outside of your residence, unless they are:
(a) Authorized in your written service plan; and
(b) Essential shopping or medical appointments.
(3) Child care;
(4) Sterile procedures, administration of medications, or other tasks requiring a licensed health professional, unless authorized as an approved nursing delegation task, client self-directed care task, or provided by a family member;
(5) Services provided over the telephone;
(6) Services provided outside the state of Washington if COPES or chore personal care;
(7) Services to assist other household members not eligible for services;
(8) Yard care.
The following types of providers may provide COPES, MPC, or chore services:
(1) Individual in-home providers, who must meet the requirements outlined in WAC 388-71-500 through 388-71-580;
(2) Home care agencies, which must be licensed under chapters 70.127 RCW and 246-336 WAC, or home health agencies, licensed under chapters 70.126 RCW and 246-327 WAC;
(3) Licensed adult family home and boarding home providers who are contracted with DSHS (see WAC 388-71-600); and
(4) Service providers who have contracted with the AAA to perform COPES services listed in WAC 388-71-415.
You are eligible to receive HCP services if you meet the functional and financial eligibility requirements in WAC 388-15-610 for COPES, WAC 388-71-440 for MPC, or WAC 388-71-445 for Chore.
To be eligible for MPC-funded services you must:
(1) Require assistance with at least one unmet direct personal care task listed in WAC 388-15-202(17); and
(2) Be certified as Title 19 categorically needy, as defined in WAC 388-500-0005.
(3) Be assessed using a comprehensive assessment and unmet need standards, through seventeen years of age or until transferring out of foster care or group care.
To be eligible for Chore-funded services, you must:
(1) Be eighteen years of age or older;
(2) Require assistance with at least one of the direct personal care tasks listed in WAC 388-15-202(17);
(3) 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, 388-450-0015, and 388-450-0210) not exceeding:
(a) The sum of the cost of your chore services, and
(b) One-hundred percent of the 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 before November 1, 1995 for less than fair market value as described in WAC 388-513-1365.
In order to remain eligible for services, you must have and be found still in need of HCP services through a reassessment. The reassessment must be conducted:
(2) In your own home. Note: A case manager may request the interview be conducted in private.
(3) At least annually or sooner if your functional or financial circumstances change.
The department has the right to terminate your services if eligibility requirements for HCP change.
The following are limitations to HCP services you can receive:
(1) HCP services may not replace informal support systems.
(2) The total cost of your care may not exceed AASA published rates for services.
(3) The department may adjust payments to a personal care provider who is doing household tasks (e.g., essential shopping, meal preparation, and laundry) at the same time for:
(a) More than one client living in the same household; or
(b) A client in a shared living arrangement (MPC).
If you are receiving:
(1) COPES services, a waiting list may be created if:
(a) The caseload or expenditures exceed the legislative funding, or
(b) HCFA or the legislature imposes caseload limits.
(2) Chore services, a waiting list may be created to maintain the monthly expenditures within the legislative appropriation. You receive priority if you:
(a) Have received chore as of June 30, 1995;
(b) Need chore:
(i) To return to the community from a nursing home,
(ii) To prevent unnecessary nursing home placement, or
(iii) For protection based on referral from an APS investigation.
(3) MPC, there is no waiting list. Note: Instead of waiting lists, the department may be required to revise HCP rules to reduce caseload size, hours, rates, or payments in order to stay within the legislative appropriation.
Depending on your income and resources, you may be required to pay participation toward the cost of your care. The department determines exactly what amount, if any, you pay. If you are receiving:
(1) COPES in-home services,
(a) You participate income above the Medically needy income level (MNIL) or Federal Poverty Level (FPL) directly to the service provider.
(b) You pay the person providing the highest level of care or multiple providers, so long as the amount authorized for services is greater than the participation amount.
(c) And if you have nonexempt income that exceeds the cost of COPES services, you may retain the difference.
(2) MPC in-home services, you do not participate toward the cost of your personal care services.
(3) Chore services, you may retain an amount equal to one hundred percent of the federal poverty level, adjusted for family size, as the home maintenance allowance and pay the difference between the FPL and your nonexempt income (as defined in WAC 388-513-1340) to your provider.
(4) COPES residential services, you pay toward the cost of your room, board, personal care services, and health insurance premiums. You may retain a fifty-eight dollars and eighty-four cents clothing and personal incidental allowance (CPI) and pay any remaining MNIL income up to the residential facility rate for the cost of room and board. HCFA does not allow COPES clients the twenty dollar disregard.
(5) MPC residential services, and you are:
(a) An SSI or SSI-related Medicaid recipient you participate income toward the room and board only. You are guaranteed a personal allowance of at least thirty-eight dollars and eighty-four cents a month; or
(b) A non-SSI client and become SSI or SSI-related because the cost of your care in the facility exceeds your income, you may be required to participate towards the cost of your room, board, personal care services, and health insurance premiums. You will receive a personal allowance of fifty-eight dollars and eighty-four cents a month.
Total expenditures are limited to the department's published rates not to exceed ninety percent of the statewide average Medicaid nursing home reimbursement rate. The total cost of care includes the COPES maintenance allowance as well as all Medicaid costs associated with the COPES individual's paid services including but not limited to the following list of services:
(1) Personal care,
(2) Residential care services,
(3) Adult day care,
(4) Adult day health,
(5) Environmental modifications,
(6) Home delivered meals,
(7) Home health aide visits,
(8) Personal emergency response,
(9) Skilled nursing visits,
(10) Specialized medical equipment and supplies,
(11) Adult companion services,
(12) Client training,
(13) Transportation services,
(15) Nursing facility care, and
(16) Any other costs paid with a medical card.
If you are disabled, as determined under WAC 388-511-1105, you may be employed and still be eligible to receive chore personal care services. You may be required to pay participation per WAC 388-71-465(3) for any earned income above one hundred percent of the federal poverty level. The department will exempt fifty percent of your earned income after work expense deductions. Work expense deductions are:
(1) Personal work expenses in the form of self-employment taxes (FICA); and income taxes when paid;
(2) Payroll deductions required by law or as a condition of employment in the amounts actually withheld;
(3) The necessary cost of transportation to and from the place of employment by the most economical means, except rental cars;
(4) Expenses necessary for continued employment such as tools, materials, union dues, transportation to service customers is not furnished by the employer;
(5) Uniforms needed on the job and not suitable for wear away from the job;
(6) Spousal income allocated and actually paid as participation in the cost of the spouse's community options program entry system (COPES) services;
(7) Amounts paid for medical expenses not subject to third-party payment; and
(8) Health insurance premiums, coinsurance or deductible charges.
RESIDENTIAL CARE SERVICES
The residential service program provides personal care services, as defined in WAC 388-15-202(38), room, board, supervision, and nursing services for elderly and disabled adults. Eligible individuals may choose to receive services from any of the following licensed and contracted residential settings:
(1) Adult family homes with a state contract provide services for two to six unrelated adults (chapter 388-76 WAC). Services include room, board and supervision. Residents may also receive limited nursing services, under nurse delegation or if the sponsor or the manager is a nurse.
(2) Assisted living provides services in a licensed boarding home with a state contract (chapter 388-110 WAC, part I and II). Structural requirements include two hundred twenty square foot private room, private bathroom, and a kitchen in each unit. Resident services may include room, board, assistance with ADL and IADL, and limited nursing services. Services are provided according to your negotiated service plan.
(3) Enhanced adult residential care provides services in a licensed boarding home with a state contract (chapter 388-110 WAC, part I and III). Services may include a shared room, limited nursing services, assistance with ADL and IADL, limited nursing services, and supervision. Services are provided according to the your negotiated service plan.
(4) Adult residential care provides services in a licensed boarding home with a state contract (chapter 388-110 WAC, part I and IV). Services may include supervision. You may be eligible for up to thirty hours of personal care services.
If you apply for services, you may be eligible to have the department pay for your services through one of the programs listed below. The department assesses and determines your functional and financial eligibility for residential services under one of the following long-term care programs:
(1) Community options program entry system (COPES), defined in WAC 388-515-1505;
(2) Medicaid personal care funding (MPC), described in WAC 388-71-440; or
(3) If you are not eligible for services under one of the programs listed above, you may be able to receive state-only funding for residential services through:
(a) Supplemental Security Income (SSI) as determined under WAC 388-511-1105 or 388-511-1130; or
(b) General assistance unemployment under WAC 388-235-5000.
|Residential care services||COPES||MPC||State-only programs|
|Adult family homes||x||x||x|
|Adult residential care (ARC)||x||x|
|Enhanced adult residential care (EARC)||x|
|Assisted living facilities (AL)||x|
You must use your income to pay for your room and board and services. You are allowed to keep some of your income for clothing and personal incidental (CPI). The department determines the amount of CPI that you may keep. For more information on the amount you must pay or CPI please see WAC 388-513-1380; 388-515-1505 for COPES; or 388-478-0045 for all other programs.
(1) The department pays the facility for the difference between what you pay and the department-set rate for the facility. The rate is based on your assessed needs.
(2) Washington state collects from your estate the cost of the care that the department provides based on chapter 388-527 WAC.
(1) If you are discharged from a residential care facility or a nursing facility, you may receive a residential care discharge allowance. This one-time payment is used to help you establish or resume living in your own home. An allowance up to eight hundred and sixteen dollars covers necessary equipment, remodeling, rent, and utilities if you do not have resources to pay these costs.
(2) The discharge allowance does not pay for items or services paid for by other state programs.
You are eligible for a residential discharge allowance if you:
(1) Receive long-term care services from the department; and
(2) Reside in a hospital, nursing facility, adult residential care, enhanced adult residential care, assisted living, or adult family home. Exception: If you are a DDD client, you are only eligible for the residential discharge allowance if you are being discharged from a nursing facility.
SENIOR CITIZEN'S SERVICES
The Senior Citizens Services Act (chapter 74.38 RCW) provides funds for eligible senior citizens to receive community-based services as an alternative to institutional care when that form of care is premature, unnecessary, or inappropriate.
Aging and adult services administration (AASA) designates the local area agencies on aging (AAA) to directly coordinate and provide senior citizens services. Aging and AASA monitors the use of Senior Citizens Services Act (SCSA) funds.
The community based services funded by SCSA for low-income eligible persons provided by area agencies may include those described in RCW 74.38.040.
To receive SCSA-funded services you or your representative must:
(1) Complete and submit a department application form, providing complete and accurate information; and
(2) Promptly submit a written report of any changes in income or resources. For the definition of income and resources, refer to WAC 388-500-0005.
To be eligible for SCSA-funded services, you must:
(1) Be age:
(a) Sixty-five or older; or
(b) Sixty or older, and:
(i) Either unemployed, or
(ii) Working twenty hours a week or less;
(2) Have a physical, mental, or other type of impairment, which without services would prevent you from remaining in your home;
(3) Have income at or below forty percent of the state median income (SMI) for a family of four adjusted for family size; and
(4) Have nonexempt resources (including cash, marketable securities, and real or personal property) not exceeding ten thousand dollars for a single person or fifteen thousand for a family of two, increased by one thousand dollars for each additional family member of the household. Household means a person living alone or a group of people living together.
(5) If you have income over forty percent of SMI you may be eligible for services on a sliding fee basis.
The following income and resources, regardless of value, are not considered when determining whether you are eligible for SCSA-funded services:
(1) Your home, and the lot it is upon;
(2) Garden produce, livestock, and poultry used for home consumption;
(3) Federal program benefits are exempt from consideration in determining eligibility for needs based programs (e.g., uniform relocation assistance, Older Americans Act funds, foster grandparents stipends or similar monies);
(4) Used and useful household furnishings, personal clothing, and automobiles;
(5) Personal property of great sentimental value;
(6) Personal property used by the individual to earn income or for rehabilitation;
(7) One cemetery plot for each member of the family unit;
(8) Cash surrender value of life insurance; and
(9) Real property held in trust for an individual Indian or Indian tribe.
(1) Even if your income is above the forty percent SMI limit to receive SCSA-funded services at no cost, you may receive SCSA-subsidized services. The department uses a sliding fee schedule to determine what percentage the department pays for the cost of your services. You pay the remaining amount, but not more than the usual rate paid for services as negotiated by the AAA or the department. The formula for determining the department's share of the cost of the services is:
100% State Median Income (SMI) - Household Income x 100
100% - 40% SMI(2) Service providers must be responsible for collecting fees owed by eligible persons and reporting to area agencies all fees paid or owed by eligible persons.
(3) Some services have no charge regardless of income or need requirements. These services include but are not limited to nutritional services, health screening, services under the long-term care ombudsman program, and access services. Note: Well adult clinic services may be provided in lieu of health screening services if such clinics use the fee schedule established by this section.
You have a right to:
(1) Receive notice of eligibility, ineligibility, or any adverse decision, including reasons for denial, within a reasonable period of time;
(2) Be treated with dignity and courtesy, and not be discriminated against because of race, sex, religious creed, political beliefs, national origin, disability, or marital status;
(3) Be informed of your rights and responsibilities under this program;
(4) Have information, given to the department or AAA, held in confidence and used only to provide services to you; and
(5) Request a fair hearing if you disagree with a decision (see WAC 388-08).
RESPITE CARE SERVICES
The respite care program provides relief care for unpaid family or other caregivers of adults with a functional disability. Caregivers may need respite care to:
(1) Relieve some of the stresses of caregiving;
(2) Maintain family structure; or
(3) Keep the adult in his or her home.
The following definitions apply to respite care services:
"Caregivers" means a spouse, relative, or friend who has primary responsibility for the daily care of an adult with a functional disability without receiving payment for services provided.
"Continuous care or supervision" means daily assistance or oversight of an adult with a functional disability.
"Functionally disabled" means requiring substantial assistance in completing activities of daily living and community living skills.
"Participant" means an adult with a functional disability who needs substantial daily continuous care or supervision.
"Respite care services" means services which relieve unpaid caregivers by providing temporary care or supervision to adults with a functional disability.
"Service provider" means an individual, agency, or organization under contract to the area agency on aging (AAA) or its subcontractor.
(1) To be eligible to receive respite care services, the caregivers must:
(a) Have primary responsibility for the daily care of an adult with a functional disability;
(b) Not be compensated for the care; and
(c) Be assessed as being at risk of placing the participant in a long-term care facility if home and community support services, including respite care, are not available.
(2) An eligible participant is an adult who:
(a) Has a functional disability;
(b) Needs daily substantial continuous care or supervision; and
(c) Is assessed as requiring placement in a long-term care facility if home and community support services, including respite care, are not available.
Respite care providers include, but are not limited to the following:
(1) Nursing homes (for more information on respite services provided in a nursing home, refer to WAC 388-97-210);
(2) Adult day services;
(3) Home health/home care agencies;
(5) Licensed residential care facilities such as boarding homes, adult family homes, and assisted living facilities; and
(6) Social service providers such as volunteer chore workers, senior companions, and individual providers.
The department reimburses:
(1) Respite care providers for the number of hours or days of services authorized and used. The rate that is established for the services is negotiated between the respite care program of the local area agency on aging and the respite care service provider.
(2) Medicaid-certified nursing homes and developmental disability facilities providing respite services the Medicaid rate approved for that facility. Contracted nursing homes must not charge beyond the Medicaid rate for any services covered from the date of eligibility unless the department authorizes it (see RCW 18.51.070). Participants must pay for services not included in the Medicaid rate.
(3) Private nursing homes at their published daily rate.
(1) There is no charge to the participant whose income is at or below forty percent of the state median income, based on a family of four.
(2) If the participant's gross income is above forty percent of the state median income, he or she is required to pay for part or all of the cost of the respite care services. The department will determine what amount the participant must contribute based on the state median income and family size.
(3) If the participant's gross income is one hundred percent or more of the state median income, the participant must pay the full cost of services.
(1) The department must first consider requests for emergency respite care. An example of an emergency is when the caregiver becomes ill or injured to the extent that the caregiver's ability to care for the disabled adult is impaired.
(2) In nonemergency situations, respite care is allocated based upon available respite funds at the local level. In addition, the area agency on aging has developed a methodology to determine how much respite care each caregiver may receive based upon present risk factors.
Volunteer chore services (VCS) is a state-funded program which provides volunteer assistance with household tasks to low income elderly and people with disabilities to enable them to stay in their own homes. VCS is a component of the continuum of home and community services provided by the department. The program:
(1) Assists people who need but are not eligible for DSHS services; or
(2) Complements DSHS services by using volunteer assistance to perform tasks which do not require specially-skilled personnel.
(3) Provides assistance with housework, laundry, shopping, cooking, moving, minor home repair, yard care, limited personal care, monitoring and transportation.
You may receive volunteer chore services if you are:
(1) Eighteen years of age or older;
(2) Living at home unless you are moving from a residential facility to home and need assistance moving;
(3) Unable to perform certain household or personal care tasks due to functional or cognitive impairment;
(4) Financially unable to purchase services from a private provider;
(5) Not eligible for services under the COPES, MPC, or chore programs.
You can receive information on applying for services by calling or visiting your local:
(1) Aging and adult services home and community services office;
(2) Developmental disabilities field services office;
(3) Area agency on aging office;
(4) Senior information and assistance office;
(5) Catholic community services office.
The following sections of the Washington Administrative Code are repealed:
|WAC 388-15-145||Residential care discharge allowance.|
|WAC 388-15-200||Health support services.|
|WAC 388-15-201||Long-term care functional eligibility.|
|WAC 388-15-206||Volunteer chore services.|
|WAC 388-15-207||Chore personal care services for adults -- Legal basis -- Purpose -- Goals.|
|WAC 388-15-209||Chore personal care services--Eligibility.|
|WAC 388-15-214||Chore personal care services--Budget control.|
|WAC 388-15-215||Chore personal care services--Program limitations.|
|WAC 388-15-219||Chore personal care service--Payment and client participation.|
|WAC 388-15-222||Chore personal care services--Employed disabled--Incentive income and resource exemption.|
|WAC 388-15-548||Residential services.|
|WAC 388-15-551||Adult family home -- Authority to purchase care -- Standards.|
|WAC 388-15-552||Adult family home -- Eligible persons.|
|WAC 388-15-553||Adult family home -- Determination of need.|
|WAC 388-15-554||Adult family home -- Placement in facility.|
|WAC 388-15-555||Adult family home -- Payments -- Standards -- Procedures.|
|WAC 388-15-560||Congregate care -- Definition -- Authority to purchase care -- Standards.|
|WAC 388-15-562||Congregate care -- Eligible persons.|
|WAC 388-15-563||Congregate care -- Residents of other states.|
|WAC 388-15-564||Congregate care -- Determination of need.|
|WAC 388-15-566||Congregate care -- Placement in facility.|
|WAC 388-15-568||Congregate care -- Payment -- Standards -- Procedures.|
|WAC 388-15-600||Community options program entry system (COPES) -- Purpose -- Legal basis.|
|WAC 388-15-620||COPES -- Services.|
|WAC 388-15-630||COPES -- Payment procedures.|
|WAC 388-15-690||Respite care services--Definitions.|
|WAC 388-15-695||Respite care services--Caregiver eligibility.|
|WAC 388-15-700||Respite care services--Distribution of cost.|
|WAC 388-15-705||Respite care services--Rates of payment.|
|WAC 388-15-710||Respite care services--Service priorities.|
|WAC 388-15-715||Respite care services--Service priority categories.|
|WAC 388-15-810||Medicaid personal care services -- Legal basis -- Purpose.|
|WAC 388-15-830||Medicaid personal care services -- Eligibility.|
|WAC 388-15-880||Medicaid personal care services--Payment procedures.|
|WAC 388-15-890||Medicaid personal care services--Program limitations.|
|WAC 388-15-895||Termination of services.|
The following sections of the Washington Administrative Code are repealed:
|WAC 388-17-010||Legal basis for senior citizens services program.|
|WAC 388-17-100||Rights and responsibilities of applicants and recipients.|
|WAC 388-17-120||Eligibility for senior citizens services -- Application.|
|WAC 388-17-160||Income and resources.|
|WAC 388-17-180||Fee schedule.|
|WAC 388-17-500||Local area agency on aging contracts -- Administrative review process.|
|WAC 388-17-510||Area agency on aging plan -- Administrative review process.|