PERMANENT RULESDEPARTMENT OF
SOCIAL AND HEALTH SERVICES[
Filed February 24, 2000,
(Aging and Adult Services Administration)
Date of Adoption: February 24, 2000.
Purpose: The rules were revised to: Comply with the
Governor's Executive Order 97-02 for clarifying, updating, and
simplifying where possible; to consider stakeholder input where
appropriate; to apply clear rule-writing techniques; to update
with statutory changes since the last revision; and to reorganize
the chapter to make it easier for users to find the information
Citation of Existing Rules Affected by this Order: Repealing WAC 388-97-010 License application, 388-97-015 License
qualification, 388-97-020 Nursing home fees, 388-97-025 License
capacity, 388-97-030 Change of ownership, 388-97-035 Change in
administrator or director of nursing services, 388-97-040 Name of
nursing home, 388-97-045 License relinquishment upon closure,
388-97-050 License denial, modification, nonrenewal, revocation,
388-97-070 Resident rights, 388-97-080 Quality of life,
388-97-095 Dementia care unit, 388-97-100 Discharge planning,
388-97-105 Relocation due to decertification, license revocation
closure, evacuation, 388-97-145 Early identification of persons
with active tuberculosis, 388-97-150 Surveillance and management
of tuberculosis, 388-97-200 Criminal history disclosure and
background inquiries, 388-97-210 Respite services, 388-97-215
Adult day or night care, 388-97-225 Nursing facility care,
388-97-230 Discrimination prohibited, 388-97-235 Medical
eligibility for nursing facility care, 388-97-240 Nursing
facility admission, 388-97-245 Pre-admission screening,
388-97-250 Identification screening for current residents,
388-97-255 Pre-admission screening and annual resident review
(PASARR), 388-97-265 Utilization review, 388-97-270 Individual
transfer and discharge rights, procedures, appeals, 388-97-275
Resident assessment instrument, 388-97-280 Discharge or leave of
a nursing facility resident, 388-97-300 Fire standards and
approval, 388-97-305 Other standards, 388-97-320 Space and
equipment, 388-97-380 Maintenance and repair, 388-97-390 General,
388-97-395 Design requirements, 388-97-435 Resident care unit,
388-97-440 Resident rooms, 388-97-445 Resident room equipment,
388-97-450 Resident toilet and bathing facilities and 388-97-475
Electrical; and amending WAC 388-97-005 Definitions, 388-97-055
Resident representative and decision making, 388-97-060 Informed
consent, 388-97-065 Advance directives, 388-97-075 Nursing home
practices -- Resident restraint and prevention of abuse, 388-97-085
Resident assessment, 388-97-090 Comprehensive care planning,
388-97-110 Quality of care, 388-97-115 Nursing services,
388-97-120 Dietary services, 388-97-125 Physician services,
388-97-130 Specialized habilitative and rehabilitative services,
388-97-135 Pharmacy services, 388-97-140 Infection control,
388-97-155 Care of residents with active tuberculosis, 388-97-160
General administration, 388-97-165 Staff and equipment,
388-97-170 Staff development, 388-97-175 Medical director,
388-97-180 Clinical records, 388-97-185 Disaster and emergency
preparedness, 388-97-190 Quality assessment and assurance,
388-97-195 Policies and procedures, 388-97-205 Laundry services,
388-97-220 Dialysis services, 388-97-260 PASARR determination and
appeal rights, 388-97-295 General, 388-97-310 IMR exceptions to
physical plant requirements, 388-97-315 Emergency power,
388-97-325 Resident care unit, 388-97-330 Resident rooms,
388-97-335 Resident room equipment, 388-97-340 Resident toilet
and bathing facilities or rooms, 388-97-345 Dining, day rooms,
and resident activity areas, 388-97-350 Dementia care unit,
388-97-355 Food service areas, 388-97-360 Lighting, 388-97-365
Safety, 388-97-370 Water supply, 388-97-375 Pest control,
388-97-385 Sewage and liquid waste disposal, 388-97-400 General
new construction documents, 388-97-405 Exemptions to new
construction requirements, 388-97-410 State building code in new
construction, 388-97-415 Electrical codes and standards in new
construction, 388-97-420 Elevator codes in new construction,
388-97-425 Local codes and ordinances in new construction,
388-97-430 Entrances and exits in new construction, 388-97-455
Visiting and private spaces in new construction, 388-97-460 Pools
in new construction, 388-97-465 Elevators in new construction,
388-97-470 Heating systems in new construction, and 388-97-480
Handwashing sinks in new construction.
Statutory Authority for Adoption: RCW 18.51.070 and
Adopted under notice filed as WSR 99-24-045
on November 24,
Changes Other than Editing from Proposed to Adopted Version: The suggested addition was made for clarification.
WAC 388-97-005 Definitions.
WAC 388-97-027 Nursing facility admission and payment
||Neglect: It was suggested that the federal definition of
"neglect" be added to the state definition to clarify for
skilled nursing facilities and nursing facilities that the
federal definition of neglect must also be considered.
||The suggested addition was made for clarification.
WAC 388-97-042 Individual transfer and discharge rights for
residents in Medicaid certified facilities.
||Concern was expressed about the lack of clarity of the
timelines related to medical and financial eligibility and
how this might effect the Medicaid payment to the nursing
||Home and Community Services Division (HCS) is in the process
of changing their system for Medicaid applicants or
recipients being discharged from the hospital to the nursing
home. This process was not finalized in time to incorporate
it into the proposed rule. As a result this section will be
reopened after the chapter is final and we will work with
HCS staff and providers to develop a clear rule outlining
admission and payment issues. Some language clarification
regarding payment for current nursing home residents
converting to Medicaid in nursing homes was included.
WAC 388-97-043 Transfer and discharge appeal rights for residents
in Medicare or Medicaid certified facilities.
||There was a comment that the terms "nursing facility" and
"nursing home," related to different notice requirements,
were not distinct enough and needed clarification.
||Subsection (1) was clarified by identifying the specific
state laws the nursing home must follow, and the federal and
state laws that the skilled nursing facility and nursing
facility must follow. The definition section already
includes definitions for nursing home, skilled nursing
facility and nursing facility.
||Title: It was suggested that "...Medicare or..." be added to
the title in order to comply with federal regulations.
||The suggested change was made.
||(1): It was suggested that the word "payment" be changed to
||The suggested change was made.
WAC 388-97-060 Informed consent.
||(3): There was a suggestion to add the term "skilled
nursing facility" to this section.
||The suggested change was made.
WAC 388-97-075 Chemical and physical restraints.
||(4) A stakeholder commented that the phrase "The nursing
home must take into account..." was too vague and asked that
it be changed to make it more specific.
||The information in subsection (4) was deleted and placed
under subsection (1)(b). We believe that this will clarify
WAC 388-97-076 Prevention of abuse.
||Specific language was suggested to replace the entire
||Much of the requested language was already in the section
but some would be considered a substantive change that
cannot be done at this stage of the rule-making process.
However some clarifying language was added and the
subsections reordered for clarity. Some of the specific
areas addressed follow:
WAC 388-97-29510 New construction compliance.
||Some concern was expressed related to a possible conflict
between federal and state law regarding abuse in this
||The issue was reviewed and some clarifying changes made.
WAC 388-97-315 Emergency power.
||It was suggested that "...and give approval..." be inserted
between "...is contacted..." and "...for all new construction..."
||This language was clarified to include the approval and
applicable determination pieces that were implicit in the
WAC 388-97-32510 Required service areas on resident care units.
||(2): It was suggested that the subsection would be clearer
if the term "generator" were moved to the beginning of the
subsection and unnecessary words deleted in (a) - (c) of
this subsection. In addition there was a suggestion that we
add clarifying new construction language to that subsection.
||The suggested clarification to subsection (2) was done. The
clarifying new construction language was added to subsection
WAC 388-97-32550 Utility service rooms on resident care units.
||(2): It was suggested that this was a new construction
requirement and should have the words "in new construction"
inserted in the beginning of the sentence.
||The current 1994 WAC 388-97-325 (2)(b) had this requirement
under existing facilities language, not under new
construction. However we asked the Department of Health's
construction review program for clarification and they
agreed that this was an area applying to new construction
only. The change has been made.
WAC 388-97-32580 Janitor's closets on resident care units.
||(1)(b): There was a suggestion to "chunk" out the items
listed and to add language to clarify that the clean and
soiled utility rooms must be separate.
||The "chunking" changes suggested for subsection (1) were
done. Even though the intent of subsection (2) was to show
that in new construction the clean utility room and the
soiled utility room must be separate rooms it was not
clearly understood. An additional subsection was added to
WAC 388-97-340 Resident toilet facilities or rooms.
||It was suggested that a reference to the ventilation
requirements for new construction be added.
||This suggested clarifying reference was made.
WAC 388-97-345 Dining, dayrooms, and resident activity areas.
||(2)(e): Specific language was suggested related to the grab
||These clarifying changes were made.
WAC 388-97-35030 Indoor areas on a dementia care unit.
||(2): It was suggested that language be added to require
that in new construction these rooms be on the same floor as
the residents who will use the rooms.
||The language in WAC 388-97-325(2) supports this clarifying
addition and the language has been included.
WAC 388-97-35050 Physical plant on a dementia care unit.
||(1): It was suggested that the language regarding the
phrase "...maintained free of equipment..." be clarified.
||The current language uses the phrase "...providing ambulation
areas that meet the needs of residents and are maintained
free of equipment..." The word "ambulation" was added to
WAC 388-97-35060 Special egress control devices on a dementia
||(2)(a) and (b): It was suggested that specific language be
added to exclude exit doors and doorways from being
disguised and to delete the word "exterior" to clarify the
Uniform Building Code requirements in this area.
||These clarifying changes have been made.
WAC 388-97-370 Water supply.
||It was suggested that the phrase "automatic door locks" be
replaced with "special egress control devices" throughout.
In addition specific language was suggested for subsection
(2) regarding the circumstances under which approval is
needed and regarding approval for the devices.
||The meaning of the term "special egress control devices" is
synonymous with the term "automatic locking devices" and the
term used in current practice. We have made this and the
other suggested clarifying changes.
WAC 388-97-401 Final new construction documents.
||It was suggested that another WAC reference be added to the
||This clarifying change was made.
WAC 388-97-46550 Carpets in new construction.
||(2): It was suggested that this subsection specify that the
architect or engineer be licensed by the state of
||It has been the practice of the Department of Health's
construction review approval process that both professions
be licensed by the state thus this clarifying change was
WAC 388-97-48020 Mixing valves in new construction.
||(1)(a): It was suggested that some outdated language be
deleted and that the formula for carpet density be written
out for clarification.
||The deletion was done and the clarifying change to the
carpet density formula made.
||It was suggested that the term "mixing valves" to "water
supply" be changed throughout. Additional language was also
||Because both mixing valves and mixing faucets can be used to
ensure acceptable water temperatures the term mixing faucet
was added as an alternative choice for new construction.
The water supply section is found at WAC 388-97-370.
Number of Sections Adopted in Order to Comply with Federal Statute:
Federal Rules or Standards:
or Recently Enacted State Statutes:
Number of Sections Adopted at Request of a Nongovernmental Entity:
Number of Sections Adopted on the Agency's Own Initiative:
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures:
Number of Sections Adopted Using Negotiated Rule Making:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule:
Thirty-one days after filing.
February 24, 2000
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit
Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 00-08 issue of the Register.
© Washington State Code Reviser's Office