Chapter 388-106 Long-term care services.

Your NFSP may be denied when the plan you develop includes noncovered items from WAC 388-106-1405 and/or does not:(a) Include only services in the New Freedom service definition found in WAC 388-106-1400;(b) Address your needs as it relates to performance of activities of daily l…

Your plan can be denied by your New Freedom consultant, who assists NFCDS participants to develop and use a New Freedom spending plan to:(a) Address identified personal care, health and safety needs;(b) Develop options to meet those needs;(c) Make informed decisions about their i…

The department will create a waiting list for NFCDS in accordance with caseload limits determined by legislative funding. Participants on the waiting list will gain access in the following order:(1) Nursing home residents who are returning home and are assessed for NFCDS waiver s…

(1) You may choose to voluntarily end your enrollment from NFCDS without cause at any time. To do so, you must give notice to the department. If you give notice:(a) Before the 15th of the month, the department will end your enrollment at the end of the month; or(b) After the 15th…

You have a right to a hearing under WAC 388-106-1300 through 388-106-1315, and under chapter 182-526 WAC.[Statutory Authority: RCW 74.08.090 and 74.09.520. WSR 13-18-039 and 13-17-125, § 388-106-1480, filed 8/29/13 and 8/21/13, effective 10/1/13. Statutory Authority: RCW 74.08.09…

"Activities of daily living", as defined in WAC 388-106-0010, includes tasks such as walking, eating, taking medications, maintaining personal hygiene, moving in bed and toileting."Care assessment" is an assessment tool used to determine eligibility for services and level of serv…

The department of health's certificate of need program is required to determine the need for nursing homes under WAC 246-310-210 (6)(b)(ii). The determination of need is based in part upon the availability of home and community-based long-term services in the planning area of the…

The department uses the following methodology to determine the statewide or county specific nursing home comparable home and community-based long-term services availability.(1) The department selects a recent, one-year time period from which to use MDS assessment data.(2) The "ty…

The following definitions apply to WAC 388-106-1700 through 388-106-1765:"Supportive housing tenant" is a person utilizing voluntary supportive services who is:(1) Living in a stable community setting of their choosing including hotels/motels; or(2) Entitled to occupy a dwelling …

(1) The services you may receive under supportive housing include, but are not limited to, activities that assist you to:(a) Identify appropriate housing;(b) Prepare for and transition to housing;(c) Connect with direct and collateral services;(d) Maintain your housing;(e) Develo…

(1) You may receive supportive housing services in:(a) Your place of residence; or(b) The community setting where the authorized service occurs.(2) Supportive housing services must be provided in:(a) Washington state or a recognized out-of-state bordering city as defined in WAC 1…

To provide supportive housing services, supportive housing providers must meet minimum qualifications as established by DSHS supportive housing contract language and pass a DSHS criminal history background check.[Statutory Authority: RCW 74.08.090, 74.08.283 and 74.08.390. WSR 17…

You are eligible for supportive housing services if you meet the following criteria:(1) Meet functional eligibility as defined in WAC 388-106-0210, 388-106-0277, 388-106-0310, 388-106-0338, or 388-106-1410;(2) Meet financial eligibility as defined in chapters 182-513 and 182-515 …

Your supportive housing services begin on the date the department authorizes your supportive housing services.[Statutory Authority: RCW 74.08.090, 74.08.283 and 74.08.390. WSR 17-11-016, § 388-106-1725, filed 5/9/17, effective 6/9/17.]

(1) To remain eligible for supportive housing you must remain functionally eligible as defined in WAC 388-106-0210, 388-106-0277, 388-106-0310, 388-106-0338, or 388-106-1410 and financially eligible as defined in chapters 182-513 and 182-515 WAC.(2) If eligibility laws, regulatio…

The department will not require you to pay toward the cost of your supportive housing services.[Statutory Authority: RCW 74.08.090, 74.08.283 and 74.08.390. WSR 17-11-016, § 388-106-1735, filed 5/9/17, effective 6/9/17.]

You may be employed and receive supportive housing services as long as you remain medicaid eligible under the categorically needy (CN) program or alternative benefit plan (ABP) program.[Statutory Authority: RCW 74.08.090, 74.08.283 and 74.08.390. WSR 17-11-016, § 388-106-1745, fi…

There are limits to the supportive housing services you receive. Supportive housing services must not:(1) Exceed the amount authorized by the department;(2) Replace or duplicate existing services already available to you such as foundational community supports as defined in WAC 1…

The department may create a waiting list for supportive housing services in accordance with funding appropriation.[Statutory Authority: RCW 74.08.090, 74.08.283 and 74.08.390. WSR 17-11-016, § 388-106-1755, filed 5/9/17, effective 6/9/17.]

The department may deny or terminate supportive housing services if you are not eligible for long-term care services pursuant to WAC 388-106-0047, 388-106-0210, 388-106-0277, 388-106-0310, 388-106-0338, or 388-106-1410.[Statutory Authority: RCW 74.08.090, 74.08.283 and 74.08.390.…

"Abbreviated care plan" means the document generated using the presumptive eligibility screening tool in CARE that identifies the long-term services and supports you are eligible to receive during the presumptive eligibility period under step 1."Acute care hospital" as defined in…

You are eligible to receive LTSS NFLOC PE services if you meet the following criteria based upon the attested information in your PE screening:(1) Meet functional eligibility requirements as defined in WAC 388-106-0355 (1)(a), (b), (c), or (d); and(2) Meet financial eligibility r…

You may receive LTSS NFLOC PE services under either of the two steps depending on your needs and requests identified in the LTSS PE screening for step 1 or the LTSS PE assessment for step 2. Steps do not need to be used in order. For example, you may begin services at step 1 or 2…

You are eligible to receive LTSS MPC PE services if you meet the following criteria based upon the attested information in your PE screening:(1) Meet functional eligibility requirements as defined in WAC 388-106-0210; and(2) Meet financial eligibility requirements as defined in W…

Under LTSS MPC PE you may receive up to 34 hours per month of personal care services as defined in WAC 388-106-0010.[Statutory Authority: RCW 74.08.090 and 74.39A.030. WSR 23-21-012, § 388-106-1820, filed 10/5/23, effective 11/6/23.]

The following types of providers can provide long-term care services:(1) Individual providers (IPs) as defined in WAC 388-115-0503, who provide services to clients in the client's own home.(2) Home care agencies that provide services to clients in the client's own home. Home care…

The department will authorize LTSS NFLOC PE or LTSS MPC PE services when you:(1) Are found both financially and functionally eligible for PE services by completing your PE screening which includes the amount of participation toward the cost of your care that you must pay (if any)…

(1) Your LTSS NFLOC PE or LTSS MPC PE services end with the earlier date of:(a) The date the decision was made on your application as defined in WAC 388-106-0010;(b) The date you were confirmed by a CARE assessment to not meet functional eligibility criteria as defined in WAC 388…

You can receive LTSS NFLOC PE or LTSS MPC PE services:(1) In your own home as defined in WAC 388-106-0010;(2) While you are out of your home accessing the community or working while:(a) within the state of Washington; or(b) in a recognized out-of-state bordering city as defined i…

(1) If you receive LTSS MPC PE services you are not required to pay toward the cost of care for those services.(2) If you receive LTSS NFLOC PE, you may be required to pay toward the cost of your care as outlined in WAC 182-515-1509. You are allowed to keep some of your income fo…

Applicants do not have an administrative hearing right as defined in chapter 388-02 WAC on LTSS NFLOC PE or LTSS MPC PE eligibility determinations.[Statutory Authority: RCW 74.08.090 and 74.39A.030. WSR 23-21-012, § 388-106-1850, filed 10/5/23, effective 11/6/23.]

ETRs will not be granted for LTSS NFLOC PE or LTSS MPC PE eligibility determinations or service determinations.[Statutory Authority: RCW 74.08.090 and 74.39A.030. WSR 23-21-012, § 388-106-1855, filed 10/5/23, effective 11/6/23.]

The following definitions apply to MAC and TSOA services:"Care plan" means the plan developed by the department in GetCare that summarizes the services described in WAC 388-106-1915 that you chose to receive."Care receiver" means an adult age 55 and over who has been authorized f…

(1) You are eligible to receive MAC services if you, as a care receiver, meet the following criteria:(a) Are age 55 or older;(b) Meet nursing facility level of care as defined in WAC 388-106-0355;(c) Meet medicaid financial eligibility requirements as defined in WAC 182-513-1605;…

(1) You are eligible to receive TSOA services if you, as a care receiver, meet the following criteria:(a) Are age 55 or older;(b) Meet nursing facility level of care as defined in WAC 388-106-0355;(c) Meet financial eligibility requirements defined in WAC 182-513-1615 or 182-513-…

MAC and TSOA services include the following three benefit levels referred to as steps in subsections (1) through (3) of this section. You and your family caregiver may receive services under any of the three steps depending upon your requests and needs identified in the screening…

(1) Unless the department authorizes additional funds through an exception to rule under WAC 388-440-0001, beginning January 1, 2019, the maximum amount of step three services you and your caregiver may receive in MAC and TSOA will be published on the ALTSA/HCS rates website at: …

(1) The TCARE assessment process gathers the following information reflecting the current status of both you and your caregiver in order to recommend services for your caregiver:(a) TCARE screening scores from the five measures described in WAC 388-106-1931;(b) Caregiver obligati…

The three primary goals for caregivers identified in TCARE are:(1) Maintain current identity: The goal appropriate for caregivers who experience modest levels of identity discrepancy and stress and are willing and able to continue in their current role. Suggested support services…

The purpose of the TCARE assessment is to gather critical information about the caregiving context, identity, strengths, problems and concerns. These data are used to identify strategies and goals to address your caregiver's needs. Program limits are established in WAC 388-106-19…

The following six TCARE screening measures and response options will be presented to your caregiver in order to receive step two services and to determine whether a TCARE assessment is needed for step three services:(1) Identity discrepancy: The following are some thoughts and fe…

(1) The TCARE screening measures are scored with a number value of one through six for the measure on identity discrepancy or one through five for the remaining measures based upon the caregiver's responses. Ranges for each measure determine whether the measure score is high, med…

(1) To be eligible for a GetCare assessment, care plan, and associated step three services as described in WAC 388-106-1915 (3)(b)(ii), a TSOA individual without a caregiver must have a moderate or high risk score resulting from the thirteen screening questions listed in the foll…

You may receive MAC and TSOA services:(1) In your own home; and(2) In the community setting where the authorized service occurs:(a) Within the state of Washington; or(b) In a recognized out-of-state bordering city as defined in WAC 182-501-0175.[Statutory Authority: RCW 74.08.090…

Your MAC or TSOA services will be authorized when you:(1) Have completed initial requirements for intake including but not limited to screenings and assessments;(2) Are found to be at least presumptively eligible, both financially and functionally;(3) Have chosen a provider(s) qu…

Your MAC or TSOA services may begin once you have approved your care plan and as early as the date authorized by the department.[Statutory Authority: RCW 74.08.090 and 74.39A.030. WSR 22-18-004, § 388-106-1945, filed 8/25/22, effective 9/25/22. Statutory Authority: RCW 74.08.090.…

(1) In order to remain eligible for MAC and TSOA services, you, as the care receiver must:(a) Remain functionally eligible as defined in WAC 388-106-0355 and financially eligible as defined in WAC 182-513-1605, 182-513-1615, and 182-513-1620;(b) Have your functional and financial…

You, as a caregiver or a care receiver, will not be required to pay toward the cost of your MAC or TSOA services. This means that neither estate recovery nor participation towards cost of care are required.[Statutory Authority: RCW 74.08.090. WSR 18-08-033, § 388-106-1955, filed …

You, as the care receiver may be employed and receive MAC or TSOA services. Your caregiver may be employed in roles other than caregiving and receive services under MAC or TSOA.[Statutory Authority: RCW 74.08.090. WSR 18-08-033, § 388-106-1960, filed 3/27/18, effective 4/27/18.]

The services you may receive under MAC or TSOA will not include the following:(1) Rent or mortgage;(2) Groceries;(3) Car repairs;(4) Utility bills;(5) Household appliances;(6) Vacation expenses;(7) Entertainment items such as TVs, radios, computers, cell phones;(8) Pet care items…