Chapter 388-106 Long-term care services.

You are eligible to receive MCS-funded residential care services if:(1) You meet financial eligibility requirements for medical care services (MCS), described in WAC 182-508-0005;(2) You are not eligible for services under COPES, or MPC; and(3) You are assessed in CARE and meet t…

Community transition or sustainability services are nonrecurring setup items or services necessary to assist you to establish, resume, or stabilize your home or community-based residential setting. Community transition or sustainability services may include, but are not limited t…

You may be eligible for community transition or sustainability services if you:(1) Meet eligibility criteria to receive long-term services and supports from home and community services;(2) Are transitioning to the community from a hospital, nursing facility, licensed assisted liv…

Community transition or sustainability services:(1) Do not include recreational or entertainment items, such as a television, cable, or a DVD player;(2) Do not include room and board; and(3) May not exceed eight hundred fifty dollars per transition or occurrence of instability th…

There are no waiting lists for community transition or sustainability services. Instead of waiting lists, the department may revise rules to reduce the type of available services, the number of individuals served, or maximum rate, in order to stay within the legislative appropria…

The intent of WAC 388-106-1000 through 388-106-1055 is to:(1) Describe the eligibility requirements under which an adult age eighteen or older may receive private duty nursing (PDN) services through the department's aging and disability services administration (ADSA);(2) Provide …

PDN is a program that provides skilled nursing care if you have complex medical needs that cannot be met through other services. PDN is an alternative to institutional care and is the program of last resort.[Statutory Authority: RCW 74.08.090, 74.09.520 and 42 C.F.R. 440.80. WSR …

In order to be eligible for medicaid-funded private duty nursing (PDN):(1) You must be eighteen years of age or older and financially eligible, which means you:(a) Meet medicaid requirements under the categorically needy program or the medically needy program; and(b) Use private …

You are not required to pay participation for PDN services, but the cost of services is subject to estate recovery, under chapter 182-527 WAC. If you are also receiving other services (e.g. COPES), you may be responsible for paying participation as required under WAC 182-515-1505…

The following dates are holidays solely for the purpose of contracted services rates for private duty nursing providers:(1) The first day of January (New Year's Day);(2) The third Monday of January (Martin Luther King, Jr.'s birthday);(3) The third Monday of February (Presidents'…

PDN services can be provided by:(1) A home health agency licensed by the Washington state department of health chapter 246-335 WAC that has a contract with the medicaid agency to provide PDN services; or(2) A Washington state licensed RN, or LPN under the direction of an RN who h…

Limitations and other requirements to PDN services are as follows:(1) You may be authorized to receive PDN services for between four to sixteen hours per day, except as noted in WAC 388-106-1045(4).(2) PDN hours will be deducted from the personal care hours generated by CARE to a…

In order for a home health agency to provide and be paid for your PDN, the home health agency must:(1) Be licensed by the Washington state department of health pursuant to chapter 246-335 WAC and have a contract with the medicaid agency to provide PDN services;(2) Operate under p…

In order to be paid by the department, a private RN under the supervision of a primary care provider or an LPN under the supervision of an RN, must:(1) Be licensed and in good standing, as provided in RCW 18.79.030 (1) (3);(2) Have a contract with the medicaid agency to provide P…

You may receive private duty nursing (PDN) services in an adult family home (AFH) when:(1) You are assessed;(a) Using the comprehensive assessment reporting evaluation (CARE) assessment tool as provided in WAC 388-106-0500; and(b) By an aging and long-term support administration …

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 nur…

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 pa…

(1) In addition to PDN services, you may be eligible to receive care through community options program entry system (COPES), or medicaid personal care (MPC), for unmet personal needs not performed by informal supports.(2) PDN hours will be deducted from the personal care hours ge…

You may choose to self-direct part of your health-related tasks to an individual provider, as outlined in RCW 74.39.050. You may also still receive PDN services, if you meet the PDN eligibility requirements.[Statutory Authority: RCW 74.08.090, 74.09.520 and 42 C.F.R. 440.80. WSR …

You may receive community-based services, described in RCW 74.38.040.[Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-11-082, § 388-106-1100, filed 5/17/05, effective 6/17/05.]

To receive SCSA-funded services, you or your representative must:(1) Complete and submit a department application form, providing complete and accurate information; and(2) Promptly submit a written report of any changes in income or resources. For the definition of income and res…

To be eligible for SCSA-funded services at no cost, you must:(1) Be age:(a) Sixty-five or older; or(b) Sixty or older, and:(i) Either unemployed, or(ii) Working twenty hours a week or less;(2) Have a physical, mental, or other type of impairment, which without services would prev…

The following income and resources, regardless of value, are exempt when determining whether you are eligible for SCSA-funded services:(1) Your home, and the lot it is upon;(2) Garden produce, livestock, and poultry used for home consumption;(3) Program benefits which are exempt …

(1) Even if your income is above the forty percent SMI limit to receive SCSA-funded services at no cost, you may receive SCSA-subsidized services. The department uses a sliding fee schedule to determine what percentage the department pays for the cost of your services. You pay th…

The following definitions apply to respite care services:"Caregivers" means a spouse, relative, or friend who has primary responsibility for the care or supervision of an adult with a functional disability without receiving direct, public or private payment for the caregiver serv…

Respite services relieve unpaid caregivers by providing temporary care or supervision to adults with a functional disability.[Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-11-082, § 388-106-1205, filed 5/17/05, effective 6/17/05.]

(1) To be eligible to receive respite care services, the caregivers must:(a) Have primary responsibility for the care or supervision of an adult with a functional disability who is not receiving a state or medicaid funded, long-term care service (e.g., COPES, personal care servic…

Respite care providers include, but are not limited to the following:(1) Nursing homes (chapter 388-97 WAC).(2) Adult day service providers, whose services includes adult day care, dementia day services and adult day health.(3) Home care and/or home health agencies licensed throu…

The department reimburses:(1) Respite care providers for the number of hours or days of services authorized and provided. If the provider already has a medicaid rate established for providing a similar service, that rate is to be reimbursed by the local area agency on aging. If t…

(1) There is no charge to the care receiver whose income is at or below forty percent of the state median income, based on family size.(2) If the care receiver's gross income is above forty percent of the state median income, he or she is required to pay for part or all of the co…

(1) The department and the area agency on aging (AAA) must first consider requests for emergency respite care. An example of an emergency is when the caregiver becomes ill or injured to the extent that the caregiver's ability to care for the care receiver is impaired. AAA policie…

As a client of the department, you have a right to:(1) Be treated with dignity, respect and without discrimination;(2) Not be abused, neglected, financially exploited, abandoned;(3) Have your property treated with respect;(4) Not answer questions, turn down services, and not acce…

As a client of the department, you have a responsibility to:(1) Give us enough information to assess your needs;(2) Let the social services worker into your home so that your needs can be assessed;(3) Follow your care plan;(4) Not act in a way that puts anyone in danger;(5) Provi…

(1) You have a right to contest the result of your CARE assessment and/or other eligibility decisions made by the department. The department will notify you in writing of the right to contest a decision and provide you with information on how to request a hearing.(2) Additionally…

When you request a fair hearing on your CARE assessment and another CARE assessment(s) is done between your fair hearing request and the fair hearing, the administrative law judge must review the most recent CARE assessment.[Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-1…

Notwithstanding WAC 388-440-0001(3), you have a right to an administrative hearing regarding the department's exception to rule decision if:(1) You receive services in your own home, and:(a) The total number of in-home personal care hours you are currently receiving includes in-h…

(1) In order for services, supports, or items to be purchased under New Freedom, they must:(a) Be for your sole benefit;(b) Be at a reasonable cost;(c) Meet your identified needs and outcomes in the CARE assessment and address your health, safety, and welfare; and(d) Be documente…

(1) Goods, services, and supports that are not consistent with the description in WAC 388-106-1400.(2) Services, supports or items covered by the state plan, medicare, or other programs or services.(3) Any fees related to health or long-term care incurred by you, including co-pay…

You are eligible for NFCDS-funded services if you reside in your own home and meet all of the following criteria. The department must assess your needs using CARE and determine that:(1) You are in NFCDS HCBS waiver specified target groups of:(a) Eighteen or older and blind or hav…

Your New Freedom services begin the date personal care provider(s) are authorized to begin providing services or the spending plan is approved.[Statutory Authority: RCW 74.08.090 and 74.09.520. WSR 13-18-039 and 13-17-125, § 388-106-1415, filed 8/29/13 and 8/21/13, effective 10/1…

(1) In order to remain eligible for NFCDS, you must be in need of services in accordance with WAC 388-106-1410, as determined through a CARE assessment, and continue to meet the financial eligibility requirements in WAC 182-513-1315. (a) The CARE assessment must be performed at l…

If you are admitted to a hospital, nursing home, or ICF/ID, you cannot access or accumulate funds to your New Freedom service budget during your stay.If you are institutionalized for 30 days or less and you intend to return to New Freedom when discharged, your service budget will…

(1) Depending on your income, you may be required to pay participation toward the cost of your care, as described in WAC 182-515-1505. If you have nonexempt income that exceeds the cost of NFCDS services, you may keep the difference. Since you are receiving services in your own h…

You can be employed and receive NFCDS, if eligible, per WAC 182-515-1505.[Statutory Authority: RCW 74.08.090 and 74.09.520. WSR 13-18-039 and 13-17-125, § 388-106-1430, filed 8/29/13 and 8/21/13, effective 10/1/13. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.030. WSR 06…

You, as an NFCDS participant, direct your services. You may also designate, or a court may appoint, a representative to assist you in directing your services, or to direct your services on your behalf. A New Freedom designated representative cannot also be your paid provider.[Sta…

An individual budget means the maximum amount of funding authorized by the department and allocated to the participant for the purchase of New Freedom consumer directed services.[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.030. WSR 06-16-035, § 388-106-1440, filed 7/25/…

The department will calculate your individual budget amount after you are assigned a number of monthly hours resulting from completion of the comprehensive assessment reporting and evaluation tool, CARE. The calculation will be based on the average wage, including a mileage allow…

The program provides funds in an amount proportionate to the amount of resources you would receive through COPES, and gives you flexibility to self-direct the purchase of goods and services to address your long-term care needs. The degree to which the budget meets your needs depe…

(1) The balance of individual budget funds that were not allocated for purchase of personal care may be used to purchase other goods and services in accordance with the approved New Freedom spending plan or saved for future purchase as described in (2) below.(2) Up to $3,500 may …

(1) You create your spending plan in collaboration with your care consultant using the CARE tool.(2) The spending plan must be approved by both you and the care consultant.(3) You, as the participant, must identify how many personal care service units you intend to purchase prior…