WSR 18-05-073
(Aging and Long-Term Support Administration)
[Filed February 16, 2018, 3:19 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 17-11-094.
Title of Rule and Other Identifying Information: The department is proposing to amend WAC 388-106-1045 Can I receive PDN services in a licensed adult family home (AFH)? and create new WAC 388-106-1046 When may an adult family home (AFH) be paid an all-inclusive daily rate for private duty nursing (PDN) services? and 388-106-1047 What is included in the all-inclusive daily rate payment to the adult family home (AFH) providing private duty nursing (PDN) services?
Hearing Location(s): On March 27, 2018, at 10:00 a.m., at the Office Building 2, Department of Social and Health Services (DSHS) Headquarters, 1115 Washington, Olympia, WA 98504. Public parking at 11th and Jefferson. A map is available at
Date of Intended Adoption: Not earlier than March 28, 2018.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, email, fax 360-664-6185, by 5:00 p.m., March 27, 2018.
Assistance for Persons with Disabilities: Contact Jeff Kildahl, DSHS rules consultant, phone 360-664-6092, fax 360-664-6185, TTY 711 relay service, email, by March 13, 2018.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is proposing to amend WAC 388-106-1045 and create WAC 388-106-1046 and 388-106-1047 in order to clarify the definition for nurse services intervention, specifically PDN, to define the scope of services to be authorized and the necessity for documentation to support the required services in contracted AFH.
Reasons Supporting Proposal: See purpose statement above.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.
Statute Being Implemented: RCW 74.09.520.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: DSHS, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation: Jevahly Wark, P.O. Box 45600, Olympia, WA 98504-5600, 360-725-1737.
A school district fiscal impact statement is not required under RCW 28A.305.135.
A cost-benefit analysis is not required under RCW 34.05.328. The preparation of a small business economic impact statement is not required, as no new costs will be imposed on small businesses or nonprofits as a result of this rule amendment.
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Is exempt under RCW 19.85.025(3) as the rule content is explicitly and specifically dictated by statute.
February 14, 2018
Katherine I. Vasquez
Rules Coordinator
AMENDATORY SECTION (Amending WSR 11-05-079, filed 2/15/11, effective 3/18/11)
WAC 388-106-1045 ((Can)) When may I receive private duty nursing (PDN) services in a ((licensed)) contracted PDN adult family home (AFH)?
You may ((be eligible to)) receive private duty nursing (PDN) services ((if you are residing)) in an adult family home (AFH) ((if the AFH provider (owner and operator))) when:
(1) ((Possesses a current Washington state registered nurse license and is in good standing)) You are assessed;
(((2) Signs a contract amendment with ADSA by which the provider agrees to ensure provision of twenty-four-hour personal care and nursing care services. Nursing care services must be provided in accordance with chapter 18.79 RCW)) (a) Using the comprehensive assessment reporting evaluation (CARE) assessment tool as provided in WAC 388-106-0500; and
(((3) Provides your PDN service through an RN or an LPN under the supervision of an RN. The level of PDN services provided to you is based on the CARE assessment, the department-designated PDN skilled task log or its approved equivalent, and other documentation that determines eligibility and the number)) (b) By an aging and long-term support administration (ALTSA) community nurse consultant (CNC) or developmental disabilities administration (DDA) nurse care consultant (NCC) who, using their professional judgment, determines that you require a minimum of eight hours of PDN ((hours to be authorized;)) services per day.
(((4) Provides the PDN services to you. Your service plan may authorize you to receive four to eight hours per day and cannot exceed eight PDN care hours per day;
(5) Has a nursing service plan prescribed for you by your primary care provider. The primary care provider must)) (2) You reside in an AFH that:
(a) ((Oversee your care plan, which must be updated at least once every six months)) Meets all AFH licensing requirements under chapter 388-76 WAC; and
(b) ((Monitor your client's medical stability)) Has a PDN contract with ALTSA; and
(c) Meets all other requirements in WAC 388-106-1046.
(((6) Document the services provided in the care plan, including the submission of the PDN seven-day look back skilled nursing task log by the licensed nursing to the CN or NCC for review for initial eligibility and ongoing eligibility every six months; and
(7) Maintain records in compliance with AFH licensing and contract requirements)) (3) Your detailed service plan is reviewed and signed by your primary care provider at your initial assessment and at least every six months thereafter, and your detailed service plan is submitted to an ALTSA CNC or DDA NCC for review along with the following documents:
(a) Physical exam findings completed by your physician;
(b) Current Physician's orders;
(c) Current nursing assessment;
(d) Current plan of care;
(e) The nursing progress notes for the seven days prior to assessment, if applicable; and
(f) The PDN skilled nursing task log for dates corresponding with the nursing progress notes, if applicable.
WAC 388-106-1046 When may an adult family home (AFH) be paid an all-inclusive daily rate for private duty nursing (PDN) services?
An adult family home (AFH) may be paid for private duty nursing (PDN) services when:
(1) The AFH provider, as defined in WAC 388-76-10000, ensures that personal care and nursing services are available in the home 24 hours per day.
(2) The AFH provider is either:
(a) A registered nurse (RN) licensed in Washington state in good standing under RCW 18.79.030(1); or
(b) Operates an in-home services agency licensed through the Washington state department of health (DOH) to provide home health services under chapter 246-335 WAC; and
(i) Employs a resident manager or entity representative, who is a registered nurse licensed in Washington state in good standing under RCW 18.79.030(1); and
(ii) The PDN program manager has approved a plan submitted by the AFH provider to replace the resident manager or entity representative in the event the resident manager or entity representative is no longer employed by the AFH; and
(iii) Ensures that a sufficient number of capable, qualified, and trained staff are available to provide necessary care and services consistent with each client's negotiated service agreement at all times, including but not limited to routine conditions, emergencies, fires, and disaster situations; and
(iv) May use nurses employed by their own in-home services agency to provide PDN for clients in the AFH.
(3) The RN resident manager or RN entity representative employed by the AFH provider, as required under subsection (2):
(a) Manages the daily operations of the AFH and oversees the care provided to the client; and
(b) Must notify the local fire agency, gas, phone, and electric companies at the time of each PDN client's admission to the AFH.
WAC 388-106-1047 What is included in the all-inclusive daily rate payment to the adult family home (AFH) providing private duty nursing (PDN) services?
Department of social and health services (DSHS) will pay the adult family home (AFH) an all-inclusive daily rate for a private duty nursing (PDN) client, which includes payment for PDN services, all skilled nursing tasks, and all personal care services. DSHS will not authorize payment for nurse delegation services or hours provided by the in-home services agency nurses in addition to the PDN all-inclusive daily rate.