Chapter 388-106 Long-term care services.

This chapter applies to applicants and recipients of long-term care services.[Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-11-082, § 388-106-0005, filed 5/17/05, effective 6/17/05.]

"Ability to make self understood" means how you made yourself understood to those closest to you in the last seven days before the assessment; expressed or communicated requests, needs, opinions, urgent problems, and social conversations, whether in speech, writing, sign language…

The department provides long-term care services through programs that are designed to help you remain in the community. These programs offer an alternative to nursing home care (which is described in WAC 388-106-0350 through 388-106-0360). You may receive services from any of the…

The following types of services are not covered under MPC, CFC, COPES, and chore:(1) Child care.(2) Individual providers must not provide:(a) Sterile procedures unless the provider is a family member or the client self directs the procedure;(b) Administration of medications or ot…

To apply for long-term care services, you must request an assessment from the department and submit a medicaid application.[Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-11-082, § 388-106-0025, filed 5/17/05, effective 6/17/05.]

You may receive services:(1) In your own home.(2) In a residential facility, which includes licensed:(a) Adult family homes, as defined in RCW 70.128.010; and(b) Assisted living facilities. Types of licensed and contracted assisted living facilities include:(i) Assisted living fa…

(1) You may be eligible to receive services in a licensed assisted living facility that has DSHS "enhanced adult residential care-specialized dementia care ("EARC-SDC")," which is defined in WAC 388-110-220. You may be eligible to receive EARC-SDC services in a licensed assisted …

(1) You may receive personal care assistance through any long-term care programs in WAC 388-106-0015 subsections (1) through (5) when temporarily traveling out of state for less than thirty days, as long as your:(a) Individual provider is contracted with the state of Washington o…

The following types of providers can provide long-term care services:(1) Individual providers (IPs), who provide services to clients in their own home.(2) Home care agencies that provide services to clients in their own home. Home care agencies must be licensed under chapter 70.1…

The department will authorize long-term care services when you:(1) Are assessed using CARE;(2) Are found financially and functionally eligible for services including, if applicable, the determination of the amount of participation toward the cost of your care and/or the amount of…

(1) The department will deny or terminate long-term care services if you are not eligible for long-term care services pursuant to WAC 388-106-0210, 388-106-0277, 388-106-0310, or 388-106-0610.(2) The department may deny or terminate long-term care services to you if, after exhaus…

(1) An assessment is an in-person interview in your home, current residence, or another location that is convenient to you that is conducted by the department, to inventory and evaluate your ability to care for yourself. The department will assess you at least every twelve months…

The purpose of an assessment is to:(1) Determine eligibility for long-term care programs;(2) Identify your strengths, limitations, goals, and preferences;(3) Evaluate your living situation and environment;(4) Evaluate your physical health, functional, and cognitive abilities;(5) …

The assessment must be performed by the department, an area agency on aging, or a federally recognized Indian tribe contracted with the department, as described in chapters 388-106 and 388-828 WAC.[Statutory Authority: 2022 c 255, RCW 74.09.520, 74.39A.009, 74.39A.090, 74.39A.095…

The department:(1) Will assess you using a department-prescribed assessment tool, titled the comprehensive assessment reporting evaluation (CARE).(2) May request the assessment be conducted in private. However, you have the right to request that third parties be present.(3) Has t…

You will be assessed in CARE if you are applying for or receiving DDA services, CFC, COPES, MPC, chore, respite, adult day health, medical care services, PACE, private duty nursing, residential support, and new freedom.If you are under the age of eighteen and within thirty calend…

The department gathers information from you, your caregivers, family members, and other sources to assess your abilities and how you perform personal care tasks. The department will also consider developmental milestones for children as defined in WAC 388-106-0130 when individual…

The amount of long-term care services you can receive in your own home or in a residential facility is determined through a classification system. Seventeen classifications apply to clients served in residential and in-home settings. The department has assigned each classificatio…

The department uses CARE to assess your characteristics. Based on this assessment, the CARE tool uses the following criteria to place you in one of the classification groups:(1) Cognitive performance.(2) Clinical complexity.(3) Mood/behaviors symptoms.(4) Activities of daily livi…

(1) The CARE tool uses the cognitive performance scale (CPS) to evaluate your cognitive impairment. The CPS results in a score that ranges from zero (intact) to six (very severe impairment). Your CPS score is based on information given at your assessment and documented in the CAR…

The CARE tool places you in the clinically complex classification group only when you have one or more of the following criteria and corresponding ADL scores:ConditionAND an ADL score ofALS (Lou Gehrig's Disease)˃14Aphasia (expressive, receptive, or both)˃=2Cerebral Palsy˃14Diabe…

(1) When you do not meet the criteria for the clinically complex classification group, or the criteria for exceptional care, or for in-home only have a cognitive performance scale score of five or six, then the mood and behavior criteria listed in subsections (3) and (4) below de…

(1) CARE determines an ADL score ranging from zero to twenty-eight for each of the following ADLs.(a) Personal hygiene;(b) Bed mobility;(c) Transfers;(d) Eating;(e) Toilet use;(f) Dressing;(g) Locomotion in room;(h) Locomotion outside room; and(i) Walk in room.(2) The department …

CARE places you in the exceptional care E Group classifications when the following criteria are met in either diagram 1 or 2:Diagram 1You have an ADL score of greater than or equal to 22.andYou need a turning/repositioning program.andYou need at least one of the following:■ Exter…

The CARE tool uses the criteria of cognitive performance as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behaviors as determined under WAC 388-106-0100, ADLs as determined under WAC 388-106-0105 and exceptional care under WAC 3…

The department publishes rates and/or adopts rules to establish how much the department pays toward the cost of your care in a residential facility.(1) For CFC, COPES, MPC, medical care services, RCL, and new freedom programs, the department assigns payment rates to the CARE clas…

CARE uses the criteria of cognitive performance score as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behavior and behavior point score as determined under WAC 388-106-0100, ADLs as determined under WAC 388-106-0105, and except…

(1) The department assigns a base number of hours to each classification group as described in WAC 388-106-0125.(2) The department will adjust base hours to account for informal supports and age appropriate functioning (as those terms are defined in WAC 388-106-0010), and other p…

(1) If you are age 21 or older, the maximum number of hours that you may receive is the base hours assigned to your classification group and adjusted per WAC 388-106-0130, unless additional hours are authorized through an exception to rule per WAC 388-440-0001. For chore program …

(1) In addition to your right to contest the result of your CARE assessment under WAC 388-106-1305, if you are under the age of twenty-one you have the right to an administrative hearing to contest the number of personal care hours authorized pursuant to WAC 388-106-0135(3).(2) T…

The maximum number of in-home personal care hours you can receive may change:(1) When you have a change in any of the criteria listed in WAC 388-106-0125 and/or 388-106-0130; or(2) Because you meet the criteria in WAC 388-440-0001, an exception to rule is approved by the departme…

The maximum payment rate that will be paid for residential personal care services provided to you may change:(1) When you have a change in any of the criteria listed in WAC 388-106-0115 and/or 388-106-0120; or(2) Because you meet the criteria in WAC 388-440-0001, an exception to …

You may be eligible to receive only the following services under medicaid personal care (MPC):(1) Personal care services, as defined in WAC 388-106-0010, in your own home and, as applicable, assistance with personal care tasks while you are out of the home accessing community res…

You are eligible for MPC-funded services when the department assesses your functional ability and determines that you meet all of the following criteria:(1) You are certified as noninstitutional categorically needy, as defined in WAC 182-500-0020, or have been determined eligible…

Your eligibility for MPC begins the date the department authorizes services.[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. WSR 06-05-022, § 388-106-0215, filed 2/6/06, effective 3/9/06.]

(1) In order to remain eligible for MPC, you must be in need of services in accordance with WAC 388-106-0210 as determined through a CARE assessment. The assessment in CARE must be at least annually or more often when there are significant changes in your functional or financial …

You pay for medicaid personal care (MPC) as follows:(1) If you live in your own home, you do not share in the cost of your personal care services.(2) If you live in a residential facility, you:(a) Keep a personal needs allowance as described in WAC 182-513-1105;(b) Pay for room a…

You can be employed and receive MPC services if you remain medicaid eligible under the noninstitutional categorically needy program.[Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-11-082, § 388-106-0230, filed 5/17/05, effective 6/17/05.]

There are no waiting lists for MPC. Instead of waiting lists, the department may revise rules to reduce caseload size, hours, rates, or payments in order to stay within the legislative appropriation.[Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-11-082, § 388-106-0235, fi…

(1) Roads to community living (RCL) is a demonstration project, funded by a "money follows the person" grant originally authorized under section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171) and extended through the Patient Affordable Care Act (P.L. 111-148). It is des…

Following eligibility and case management criteria outlined in chapters 388-106 or 388-845 WAC:(1) The state plan or medicaid waiver services for which you would otherwise be eligible;(2) You may receive additional RCL demonstration services; and(3) When you are discharged to a q…

(1) RCL services to prepare for your discharge may begin while you are in the institution.(2) After discharge, roads to community living (RCL) can be authorized for no longer than three hundred sixty-five days in a qualified community setting. Day one of the demonstration year is…

You remain eligible for RCL until any of the following occur:(1) Reach the end of your demonstration year;(2) Return to an institution for longer than 30 days (you can re-enroll later);(3) Move out of state; or(4) No longer want the service.[Statutory Authority: RCW 74.08.090, 74…

Depending on your income and resources, you may be required to participate toward the cost of the services you receive under RCL, including personal care and demonstration services, as outlined in chapters 388-515 or 388-106 WAC.[Statutory Authority: RCW 74.08.090, 74.09.520, and…

(1) The number of personal care hours you receive is determined by the CARE assessment as outlined in chapter 388-106 WAC.(2) The payment rate structure for residential personal care received in a residential facility is outlined in chapter 388-106 WAC.[Statutory Authority: RCW 7…

The maximum number of in-home personal care hours or payment rate you can receive may change:(1) When you have a change in any of the criteria listed in WAC 388-106-0125, 388-106-0115, 388-106-0120 and/or 388-106-0130; or(2) Because you meet the criteria in WAC 388-440-0001, an e…

Yes, you may request an administrative hearing based on the rules outlined in WAC 388-106-1305 to contest eligibility decisions made by the department. Once your three hundred sixty-five days of roads to community living (RCL) eligibility end, per WAC 388-106-0256, you may not re…

The services you may receive under the community first choice program include:(1) Personal care services as defined in WAC 388-106-0010.(2) Relief care, which is personal care services by a second individual or agency provider as a back-up to your primary paid personal care provi…

Skills acquisition training:(1) Shall not replace any training or therapy otherwise provided under medicaid, medicare, or any private insurance;(2) Does not include therapy or nursing services that must be performed by a licensed therapist or nurse, but may be used to complement …

(1) Long term care workers, who must only provide skills acquisition training on IADLs and the following ADL tasks: dressing, application of deodorant, washing hands and face, hair washing, hair combing and styling, application of make-up, menses care, shaving with an electric ra…