WSR 05-10-086

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed May 3, 2005, 4:14 p.m. , effective June 3, 2005 ]


     

     Purpose: The purpose of amending these rules is to correct the cross section references from chapter 388-820 WAC to the recodified chapter 388-101 WAC, Certified community residential services and support.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-101-1020, 388-101-1220, 388-101-1260, 388-101-1400, 388-101-1420, 388-101-1470, 388-101-1670, 388-101-1750, 388-101-2150, and 388-101-2410.

     Statutory Authority for Adoption: RCW 71A.12.030 and 71A.12.080.

     Other Authority: Title 71A RCW.

      Adopted under notice filed as WSR 05-07-136 on March 22, 2005.

     Changes Other than Editing from Proposed to Adopted Version: WAC 388-101-2310 was proposed for amendment as WSR 05-07-136 on March 22, 2005. On that same date a document was filed as WSR 05-07-138 recodifying WAC 388-101-2310 to 388-101-2410. This permanent order reflects that change.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 10, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 10, Repealed 0.

     Date Adopted: April 27, 2005.

Andy Fernando, Manager

Rules and Policies Assistance Unit

3539.1
AMENDATORY SECTION(Amending WSR 04-23-070 [05-05-077], filed 2/15/05, effective 2/15/05)

WAC 388-101-1020   What definitions apply to this chapter?   "Agency" refers to an entity interested in becoming a service provider that offers residential instruction and support services to clients.

     "ADSA" refers to aging and disability services administration at DSHS. Residential care services and the division of developmental disabilities are divisions under aging and disability services.

     "Certification" refers to the determination by RCS that an agency or service provider has satisfactorily complied with the requirements outlined in this chapter and in the department contract.

     "Client" refers to a person who has a developmental disability and is eligible under RCW 71A.10.020. (For eligibility criteria, see chapter 388-825 WAC and WAC ((388-820-060)) 388-101-1210.)

     "Client services" refers to instruction and support activities that benefit clients, as specified under WAC ((388-820-450)) 388-101-1800 through ((388-820-510)) 388-101-1860.

     "Community protection services" (Community Protection Intensive Supported Living Services, or CP-ISLS) refers to intensive supported living services provided to clients who meet the criteria of "Individual with Community Protection Issues."

     "Crisis diversion services (CDS)" refers to DDD-authorized crisis residential services and supports offered to clients on a temporary basis. These clients show a serious decline in mental functioning, making the client at risk for psychiatric hospitalization (see WAC ((388-820-050)) 388-101-1200 and ((388-820-085)) 388-101-1250 for details).

     "Crisis service plan" refers to a document that identifies needs and services a client will receive while placed in crisis diversion services.

     "DDD" refers to the division of developmental disabilities of aging and disability services administration (ADSA).

     "DSHS" refers to the department of social and health services of Washington state.

     "Exceptions" refers to residential care services' (RCS) approval of a written request for an exception to a rule in this chapter. (There are no exceptions to RCWs.)

     "Group home" refers to residential services provided in a dwelling that is:

     (1) Owned, leased, or rented by an entity other than the client;

     (2) Licensed by the applicable state authority; and

     (3) Operated by a provider.

     (See WAC ((388-820-090)) 388-101-1260 for further details.)

     "Group training home" refers to a certified nonprofit residential facility that provides full-time care, treatment, training, and maintenance for clients, as defined under RCW 71A.22.020(2).

     "HCBS" refers to home and community based services waivers. This is a Title XIX Medicaid waiver program that serves a specific number of individuals. This waiver is for particular home and community based services not covered under the Medicaid state plan. (See WAC 388-825-170 for more details.)

     "IFP" refers to individual financial plan. (See WAC ((388-820-620)) 388-101-2070.)

     "IISP" refers to the individual instruction and support plan for clients. (See WAC ((388-820-560)) 388-101-2010 through ((388-820-580)) 388-101-2030.)

     "Individual with community protection issues" refers to a client identified by DDD as needing one or more of the following criteria:

     (1) The person has been convicted of or charged with a crime of sexual violence as defined in chapter 71.09 RCW, including, but not limited to, rape, statutory rape, rape of a child, and child molestation;

     (2) The person has been convicted of or charged with acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization;

     (3) The person has been convicted of or charged with a sexually violent offense and/or predatory act, and may constitute a future danger;

     (4) The person has not been convicted and/or charged, but has a history of stalking, sexually violent, predatory, and/or opportunistic behavior which demonstrates a likelihood to commit a sexually violent and/or predatory act based on current behaviors that may escalate to violence;

     (5) The person has committed one or more violent crimes, such as murder, attempted murder, arson, first degree assault, kidnapping, or use of a weapon to commit a crime.

     "Initial assessment" refers to a written evaluation that identifies a client's needs upon entry into crisis diversion services.

     "Instruction" refers to goal-oriented teaching that is designed for acquiring and enhancing skills.

     "ISP" refers to the individual service plan for clients. (See WAC ((388-820-520)) 388-101-1870 through ((388-820-550)) 388-101-1900.)

     "Nursing assistant" refers to a person who is registered or certified by department of health under chapter 18.88A RCW. A nursing assistant performs certain nursing care tasks that are delegated by a registered nurse for a specific client in authorized settings. (See chapter 246-841 WAC for more details.)

     "POC" refers to the plan of care for clients based on the criteria of the home and community based waivers. (See WAC ((388-820-520)) 388-101-1870 through ((388-820-550)) 388-101-1900.)

     "RCS" refers to residential care services of aging and disability services (ADSA).

     "Regional support network (RSN)" refers to a county, combination of counties or other member entities under contract with DSHS mental health division (MHD). These RSNs administer all mental health service activities within their jurisdiction, using available resources. (See WAC 388-865-200 for details.)

     "Reprisal" refers to any negative action taken as retaliation against an employee.

     "Residential service" refers to client services offered by certified service providers.

     "Secretary" refers to the secretary of the department of social and health services or the secretary's designee.

     "Service provider" refers to an agency RCS has certified and DDD has contracted to provide residential services to clients. Also refers to state operated living alternative (SOLA) program.

     "Severity" refers to the seriousness of an incident. This is determined by the extent to which a client's physical, mental, or psychosocial well-being is or may be compromised or threatened.

     "SSP" (state supplemental payment) refers to DDD administered state paid cash assistance program for certain clients of DDD. (See chapter 388-827 WAC for details.)

     "Support" refers to assistance as requested or needed by a client, based on their abilities, needs, and goals.

     "Supported living" refers to residential services provided to clients living in their own homes, which are owned, rented, or leased by the clients or their legal representatives. (See WAC ((388-820-080)) 388-101-1240 for more details.)

     "Trust account" refers to a bank account containing two or more clients' funds where the service provider has the authority to make deposits and withdrawals.

[05-05-077, recodified as § 388-101-1020, filed 2/15/05, effective 2/15/05. Statutory Authority: RCW 71A.12.030, 71A.12.080, and chapter 71A.12 RCW. 04-23-070, § 388-820-020, filed 11/15/04, effective 12/16/04. Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, § 388-820-020, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-020, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-020, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-020, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 86-08-003 (Order 2349), § 275-26-020, filed 3/20/86; 83-05-017 (Order 1945), § 275-26-020, filed 2/9/83.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 04-04-043 [05-05-077], filed 2/15/05, effective 2/15/05)

WAC 388-101-1220   What physical and safety requirements exist for residential services?   (1) Crisis diversion service providers who offer services in a client's own home are exempt from the physical and safety requirements described in this section.

     For clients who receive more than forty hours of residential service per month.

     (2) When clients receive more than forty hours of residential services per month, the service provider must ensure that the following physical and safety requirements are met for the client:

     (a) A safe and healthy environment;

     (b) Accessible telephone equipment;

     (c) An evacuation plan developed and practiced with the client;

     (d) An entrance and/or exit that does not rely solely upon windows, ladders, folding stairs, or trap doors;

     (e) A safe storage area for flammable and combustible materials;

     (f) Unblocked exits;

     (g) A working smoke detector, with a light-alarm for clients with hearing impairments, located close to sleeping rooms;

     (h) A flashlight or a nonelectrical light source in working condition; and

     (i) Basic first-aid supplies.

     For clients who receive forty hours or less of residential service per month.

     (3) When clients receive forty hours or less of residential services per month, at least once every six months, the service provider must ensure the following physical safety requirements are met:

     (a) A safe and healthy environment;

     (b) An entrance and/or exit that does not rely solely upon windows, ladders, folding stairs, or trap doors;

     (c) A safe storage area for flammable and combustible materials;

     (d) Unblocked exits; and

     (e) A working smoke detector, with a light-alarm for clients with hearing impairments, located close to sleeping rooms.

     (4) The following supports are also offered to clients who receive forty hours or less of residential services. These clients may choose not to participate in meeting these requirements. This choice must be documented by the service provider, as per WAC ((388-820-100)) 388-101-1400. The supports offered include:

     (a) Accessible telephone equipment;

     (b) An evacuation plan developed and practiced with the client;

     (c) A flashlight or a nonelectrical light source in working condition; and

     (d) Basic first-aid supplies.

     For all clients:

     (5) The service provider must ensure that documentation is kept, showing that physical safety requirements are met. The client may independently document that these requirements are met as long as the client's IISP shows this involvement.

[05-05-077, recodified as § 388-101-1220, filed 2/15/05, effective 2/15/05. Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, § 388-820-070, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-070, filed 10/26/01, effective 1/1/02. 99-19-104, recodified as § 388-820-070, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-072, filed 8/9/91, effective 9/9/91.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 04-23-070 [05-05-077], filed 2/15/05, effective 2/15/05)

WAC 388-101-1260   What are group homes?   (1) Group homes are residences that are licensed as either a boarding home or an adult family home by RCS, under chapters 388-78A and 388-76 WAC, respectively.

     (2) Group homes must have a contract with DDD.

     (3) The service provider must ensure that group homes comply with all applicable licensing regulations.

     (4) Group homes provide residential services to two or more clients who are unrelated to the provider.

     (5) Clients who live in group homes pay costs of room and board from their own financial resources. (See WAC ((388-820-120)) 388-101-1420 for additional information.)

[05-05-077, recodified as § 388-101-1260, filed 2/15/05, effective 2/15/05. Statutory Authority: RCW 71A.12.030, 71A.12.080, and chapter 71A.12 RCW. 04-23-070, § 388-820-090, filed 11/15/04, effective 12/16/04. Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, § 388-820-090, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-090, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-090, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapters 18.88A and 71A.12 RCW. 96-10-076 (Order 3978), § 275-26-076, filed 5/1/96, effective 6/1/96.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 04-04-043 [05-05-077], filed 2/15/05, effective 2/15/05)

WAC 388-101-1400   When must a service provider document a client's refusal to participate in services?   (1) A service provider must document a client's refusal to participate in:

     (a) Physical and safety requirements, as outlined in WAC ((388-820-070(3))) 388-101-1220(3); and

     (b) Health services under WAC ((388-820-690)) 388-101-2140.

     (2) Documentation must include the following:

     (a) A description of events relating to the client's refusal to participate in these services;

     (b) A plan to inform the client of the benefits of these services;

     (c) A description of the service provider's efforts to give the services to the client; and

     (d) Any health or safety concerns that the refusal may pose.

     (3) The service provider must review this documentation with the client at least every six months. The client or client's guardian must sign the documentation after reviewing it.

[05-05-077, recodified as § 388-101-1400, filed 2/15/05, effective 2/15/05. Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, § 388-820-100, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-100, filed 10/26/01, effective 1/1/02. 99-19-104, recodified as § 388-820-100, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-087, filed 8/9/91, effective 9/9/91.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 04-04-043 [05-05-077], filed 2/15/05, effective 2/15/05)

WAC 388-101-1420   Who pays for a client's residential services?   (1) DSHS must pay for contracted residential services provided to department-funded clients. Residential services are paid at the contracted rate.

     (2) DSHS must require a client to share the cost of services when mandated by federal or state statute or regulation.

     (3) Clients funded through SSP may purchase services through a separate agreement with the service provider.

     (4) The service provider must inform DSHS when the client requires additional supports.

     (a) The service provider must submit a written request with justification for additional service hours.

     (b) DSHS may approve and provide payment for additional expenses or services.

     (c) The service provider must retain a copy of department response.

     (5) For a client who is receiving group home services and support:

     (a) The client must pay for cost of care or services from earnings or other financial resources. Clients receiving SSI are responsible only for the cost of room and board.

     (b) DSHS may pay for these services only after a client has used his or her own financial resources.

     (c) When a client's guardian or legal representative controls the client's income, estate, or trust fund, he or she must reimburse the service provider as described in WAC ((388-820-120)) 388-101-1420.

     (6) Clients receiving supported living services must pay for their own housing, utilities, food, clothing, and other personal and incidental expenses from earnings and other financial resources.

[05-05-077, recodified as § 388-101-1420, filed 2/15/05, effective 2/15/05. Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, § 388-820-120, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-120, filed 10/26/01, effective 1/1/02. 99-19-104, recodified as § 388-820-120, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-107, filed 8/9/91, effective 9/9/91.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 04-23-070 [05-05-077], filed 2/15/05, effective 2/15/05)

WAC 388-101-1470   How does an agency apply for initial certification?   To apply for initial certification, an agency must go through the following application procedures.

     (1) DDD will review:

     (a) Verification of financial stability;

     (b) A budget forecast; and

     (c) A staff-coverage schedule.

     (2) After reviewing, DDD will send a letter of suggestion to RCS.

     (3) The interested agency will submit to RCS:

     (a) A letter of intent;

     (b) Relevant experience and qualifications of the agency;

     (c) A minimum of two professional references;

     (d) The administrator's resume;

     (e) A list of the agency board of directors and affiliations, if applicable;

     (f) Policies, principles and procedures regarding health and safety and;

     (g) Methods on the prevention and reporting of abuse, neglect, exploitation and mistreatment to clients according to state law.

     RCS may request additional information as needed to complete the application process.

     (4) Before applying to RCS, the interested agency will keep in their records the following:

     (a) A letter of intent;

     (b) A mission statement;

     (c) A statement of assurance stating that the service provider will not discriminate against a client or employee (see WAC ((388-820-280)) 388-101-1630);

     (d) Verification of financial stability;

     (e) A budget forecast;

     (f) A staff coverage;

     (g) A staff in-service training plan;

     (h) The agency's policies and procedures;

     (i) Relevant experience and qualifications of the agency;

     (j) A minimum of two professional references;

     (k) A copy of the license if applying for a group home;

     (l) The administrator's resume; and

     (m) A list of the agency board of directors and affiliations, if applicable.

     (5) RCS must provide the county with a copy of the agency's letter of intent.

     (6) The county may submit written recommendations about the application to RCS within thirty calendar days after receiving the letter of intent. RCS reviews the county's recommendations.

     (7) An agency must comply within one hundred and eighty days of the certification's effective date with:

     (a) Relevant federal, state, and local laws and ordinances; and

     (b) RCS/DDD established requirements.

     (8) After receiving all materials requested, a determination will be made on initial certification based on the information received. RCS notifies the agency in writing that all documentation has been received and determines if the agency meets the minimal requirements for initial certification.

[05-05-077, recodified as § 388-1010-1470, filed 2/15/05, effective 2/15/05. Statutory Authority: RCW 71A.12.030, 71A.12.080, and chapter 71A.12 RCW. 04-23-070, § 388-820-160, filed 11/15/04, effective 12/16/04. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-160, filed 10/26/01, effective 1/1/02.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 04-04-043 [05-05-077], filed 2/15/05, effective 2/15/05)

WAC 388-101-1670   What are the minimum requirements for staff employed by service providers?   Service provider staff must meet the following minimum requirements:

     (1) Pass background check as per WAC ((388-820-310)) 388-101-1660;

     (2) Exhibit job-related competency and the ability to make independent judgments;

     (3) Have a high school diploma or GED equivalent, unless the employees were hired before September 1, 1991;

     (4) Be at least eighteen years of age when employed as a direct care staff, or at least twenty-one years of age when employed as an administrator; and

     (5) Treat clients with dignity and consideration, respecting the clients' civil and human rights at all times.

[05-05-077, recodified as § 388-101-1670, filed 2/15/05, effective 2/15/05. Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, § 388-820-320, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-320, filed 10/26/01, effective 1/1/02.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 04-23-070 [05-05-077], filed 2/15/05, effective 2/15/05)

WAC 388-101-1750   What information do service providers need to keep in client records?   (1) Crisis diversion service providers are exempt from the client record requirements specified in this section. Instead, they must follow requirements outlined in WAC ((388-820-405)) 388-101-1760.

     (2) Service providers must keep certain information in client records to fulfill DSHS requirements. The client's records must include, but not be limited to, the following:

     (a) The client's name, address, and Social Security number.

     (b) The name, address, and telephone number of the client's relative, guardian or legal representative.

     (c) Copies of legal guardianship papers, if any.

     (d) Client health records, including:

     (i) The name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other health care service provider;

     (ii) Health care service providers' instructions about health care needed, including appointment dates and date of next appointment if appropriate;

     (iii) Written documentation that the health care service providers' instructions have been followed; and

     (iv) A record of major health events and surgeries when known.

     (e) A copy of the client's most recent individual service plan or plan of care (ISP/POC).

     (f) The client's individual instruction and support plan (IISP), including:

     (i) Instruction and support activities for each client as a basis for review and evaluation of client's progress;

     (ii) Semiannual review of the IISP;

     (iii) Consultation with other service providers and other interested persons;

     (iv) IISP revisions and changes; and

     (v) Other activities relevant to the client that the client wants included.

     (g) Progress notes and incident reports on clients.

     (h) The client's financial records for funds managed by the service provider, including:

     (i) Receipts, ledgers and records of the client's financial transactions; and

     (ii) Client's related bankbooks, checkbooks, bank registers, tax records and bank statements.

     (i) Burial plans and wills.

[05-05-077, recodified as § 388-101-1750, filed 2/15/05, effective 2/15/05. Statutory Authority: RCW 71A.12.030, 71A.12.080, and chapter 71A.12 RCW. 04-23-070, § 388-820-400, filed 11/15/04, effective 12/16/04. Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, § 388-820-400, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-400, filed 10/26/01, effective 1/1/02.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 01-22-020 [05-05-077], filed 2/15/05, effective 2/15/05)

WAC 388-101-2150   May a client refuse health care services?   A client may refuse to participate in health care services. Service providers must document these situations, according to WAC ((388-820-100)) 388-101-1400.

[05-05-077, recodified as § 388-101-2150, filed 2/15/05, effective 2/15/05. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-700, filed 10/26/01, effective 1/1/02.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 01-22-020 [05-07-138], filed 2/15/05 [3/22/05], effective 2/15/05 [3/22/05])

WAC 388-101-2410   What training is required before staff are qualified to perform delegated tasks?   (1) Before performing delegated tasks, staff must:

     (a) Be registered or certified as a nursing assistant (NAR or NAC, respectively);

     (b) Complete nurse delegation core training approved by DSHS and receive a certificate; and

     (c) Receive client-specific training from the delegating registered nurse.

     (2) In addition, registered nursing assistants must complete thirty-two hours of staff training required by WAC ((388-820-330)) 388-101-1680 before doing nursing care tasks. Certified nursing assistants may perform delegated tasks before completing the required thirty-two hours of staff training.

     (3) After the staff member completes the required training, the service provider must keep:

     (a) Written instructions provided by the delegating registered nurse; and

     (b) A copy of the current registration or certification for each employee.

[05-07-138, recodified as § 388-101-2410, filed 3/22/05, effective 3/22/05. 05-05-077, recodified as § 388-101-2310, filed 2/15/05, effective 2/15/05. Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-740, filed 10/26/01, effective 1/1/02.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.

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