Purpose: The health care authority added a new subchapter III, Medical respite program, under chapter 182-565 WAC, Health-related social needs (HRSN) program. This program provides medical respite care for individuals with significant health needs. The program serves individuals with significant behavioral health needs and medical issues who do not require hospitalization but are unable to provide adequate self-care for their medical conditions. The program prioritizes services to individuals with complex medical and behavioral health issues who are homeless or who were recently discharged from a hospital setting.

Medical respite programs offer a lower-intensity care setting for patients who are homeless or at risk of homelessness and who would otherwise require a hospital stay or lack a safe option for discharge and recovery. Medical respite programs must meet the minimum operating standards and meet the required medical respite standards of the facility through the national institute for medical respite care (NIMRC), offer required services, meet local codes and ordinances for licensing, safety, and occupancy.

The following definitions and those found in chapter 182-500 WAC apply to this chapter:

"Behavioral health need" - See WAC 182-565-0110.

"Demonstration period" - See WAC 182-565-0110.

"Facility" - The physical location where the medical respite program provides medical respite care services to clients.

"Homelessness" or "at risk of homelessness" - See WAC 182-565-0110.

"Medical respite care services" - Temporary, short-term room and board, health care services and supports.

"Medical respite program (a.k.a., recuperative care and short-term post-hospitalization housing)" - A not-for-profit organization that serves clients whose medical and behavioral health need medical respite care services.

(1) A person must have or be eligible for apple health coverage before entering a medical respite program. If a person does not have coverage and wants to participate in the medical respite program, the program can help them register for coverage.

(2) To receive medical respite care services, a client must have a qualifying acute medical condition that requires treatment and/or care, does not require a hospital inpatient stay, and is too ill or frail to recover from a physical illness or injury while living on the street and is at risk of being homeless or experiencing homelessness.

A client is eligible for admission to a medical respite program when the client:

(1) Is experiencing homelessness or is at risk of becoming homeless;

(2) Is experiencing medical and behavioral health needs and meets one of the following:

(a) Has recently been discharged from a hospital setting including emergency room visits; or

(b) Is referred from a medical clinic (e.g., a primary care clinic, federally qualified health center, urgent care facility, mobile medical clinic, street medicine) and both of the following are true:

(i) The client has an acute medical condition that can be safely managed in a sheltered outpatient setting; and

(ii) Medical respite care is appropriate to provide the conditions to support recovery from the acute medical condition;

(3) Can perform activities of daily living (ADLs) with minimal or no assistance; and

(4) Has signed an admission agreement.

(1) The medical respite program will discharge the client when the client meets one of the following:

(a) No longer benefits from medical respite care services;

(b) Reaches the 90-day utilization limit for their current admission or the six-month utilization during the demonstration period; or

(2) The six-month utilization period limit is shared amongst other housing support services including, but not limited to, housing transition navigation services, and rent/temporary housing.

(3) The medical respite program must begin discharge planning upon the client's admission and maintain discharge planning throughout the client's stay at the facility.

(4) To discharge a client, the program must provide a referral tailored to client needs, to include:

(a) Potential housing options;

(b) Referrals to appropriate health care providers;

(d) Provide advance and written notice of discharge to the client, and as applicable, the client's health care provider, managed care organization, and caregivers.

(5) Upon admission and discharge, the program must provide an admission or discharge summary to the client, the health care provider, the managed care organization if applicable, and other persons or entities requested by the client. The admission or discharge summary must include the following:

(a) Written medication list and medication refill information;

(b) Admitting primary diagnosis following discharge from the hospital or referral from a medical clinic;

(d) Ongoing medical needs or conditions;

(e) Instructions for accessing relevant resources within the community including shelters or other housing options;

(f) A list of follow-up appointments and contact information for treating providers;

(g) Special medical instructions (e.g., weight-bearing limitations, dietary precautions, allergies, wound orders);

(h) Pain management plan; and

(i) A point of contact for the client.

(6) The medical respite program must ensure adequate protocols are in place for the transfer of client information and access to electronic records to appropriate providers and, if applicable, the client's managed care organization.

(1) Medical respite programs must provide or arrange for the provision of the following services:

(a) Room and board which must include, at a minimum:

(i) A dedicated bed that is available to the client 24 hours a day, seven days a week;

(ii) Three meals a day in accordance with medical respite standards;

(iii) Laundry services;

(iv) Secured storage for personal belongings and medications;

(v) Compliance with standards set by NIMRC; and

(vi) Compliance with local codes and ordinances for licensing, safety, and occupancy.

(b) The medical respite provider must notify the agency if they no longer meet the requirements to provide medical respite care.

(2) The agency may conduct a post pay review to ensure medical respite care requirements are met. If requirements are not met at the time services are provided, the agency may recoup payment.

The medical respite program must provide coordination such that the client can access the following services:

(1) Clinical assessments;

(2) Behavioral health screenings for psychosocial needs;

(3) Medical case management;

(4) Case management support in accessing benefits and housing;

(5) Twenty-four hour wellness checks;

(6) Medical oversight to include:

(a) Medication monitoring; and

(b) Ongoing assessments to determine effectiveness of care plan and/or treatments;

(7) Minor clinical interventions (e.g., wound care, infection control, nonpharmacological pain management);

(8) Arrangement for transportation for the client to and from appointments that are not covered by nonemergency transportation as defined in WAC 182-546-5500; and

(9) Access to equipment for telehealth services and communication related to medical needs or care.

A medical respite program may provide medical respite care services when the medical respite program:

(1) Is enrolled as a Washington apple health medicaid provider for claims to be paid and be able to provide documentation of proof of service;

(2) Meets the standards for medical respite care programs set by NIMRC;

(3) Completes all necessary agency forms and attestation and receives agency approval; and

(4) Meets local codes and ordinances for licensing, safety, and occupancy.