Chapter 388-15 WAC

SOCIAL SERVICES FOR FAMILIES, CHILDREN AND ADULTS

Last Update: 3/30/01


WAC
388-15-130 Child protective services -- Authority.
388-15-131 Child protective services -- Special requirements for Indian children.
388-15-132 Child protective services -- Acceptance of reports -- Eligibility for services and limits to authority.
388-15-134 Child protective services -- Notification.
388-15-194 Home and community services--Nursing services.
388-15-202 Long-term care services -- Definitions.
388-15-203 Long-term care services--Assessment of task self-performance and determination of required assistance.
388-15-204 Home and community services--Reassessment.
388-15-205 Long-term care services--Service plan development.
388-15-240 Family planning.
388-15-400 Services to individuals released from mental hospitals or in danger of requiring commitment to such institutions.
388-15-650 Purpose.
388-15-651 Definitions.
388-15-652 Adult day care (COPES level I).
388-15-653 Adult day health (level II).
388-15-654 Plan of care.
388-15-655 Title XIX adult day health certification and monitoring.
388-15-656 Administration and organization.
388-15-657 Staffing.
388-15-658 Personnel requirements.
388-15-659 Facility.
388-15-660 Coordination of services.
388-15-661 Clients in residential care or nursing facility care settings.
388-15-662 Expenditures not to exceed.

DISPOSITIONS OF SECTIONS FORMERLY CODIFIED IN THIS CHAPTER
388-15-010 Definition of service goals. Statutory Authority: RCW 74.08.090. 81-20-063 (Order 1708), § 388-15-010, filed 10/5/81; 78-09-098 (Order 1335), § 388-15-010, filed 9/1/78; Order 1238, § 388-15-010, filed 8/31/77; Order 1088, § 388-15-010, filed 1/19/76.  Repealed by 98-01-125, filed 12/18/97, effective 1/18/98.  Statutory Authority: RCW 34.05.210, 74.08.090 and 1997 c 409 § 209.
388-15-020 Eligible persons. Statutory Authority: RCW 74.12.340. 87-22-091 (Order 2552), § 388-15-020, filed 11/4/87. Statutory Authority: RCW 74.08.090. 81-18-045 (Order 1697), § 388-15-020, filed 8/28/81; 81-10-013 (Order 1645), § 388-15-020, filed 4/27/81; 81-01-087 (Order 1581), § 388-15-020, filed 12/19/80; 80-02-049 (Order 1477), § 388-15-020, filed 1/16/80; 79-01-041 (Order 1360), § 388-15-020, filed 12/21/78; 78-09-098 (Order 1335), § 388-15-020, filed 9/1/78. Statutory Authority: RCW 43.20A.550. 78-04-004 (Order 1276), § 388-15-020, filed 3/2/78; Order 1238, § 388-15-020, filed 8/31/77; Order 1204, § 388-15-020, filed 4/1/77; Order 1171, § 388-15-020, filed 11/24/76; Order 1147, § 388-15-020, filed 8/26/76; Order 1124, § 388-15-020, filed 6/9/76; Order 1120, § 388-15-020, filed 5/13/76; Order 1088, § 388-15-020, filed 1/29/76.  Repealed by 98-01-125, filed 12/18/97, effective 1/18/98.  Statutory Authority: RCW 34.05.210, 74.08.090 and 1997 c 409 § 209.
388-15-030 Rights of applicant for services.Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-030, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090. 81-09-058 (Order 1640), § 388-15-030, filed 4/20/81; 79-08-112 (Order 1420), § 388-15-030, filed 7/31/79; Order 1238, § 388-15-030, filed 8/31/77; Order 1147, § 388-15-030, filed 8/26/76; Order 1088, § 388-15-030, filed 1/19/76.  Repealed by 98-07-041, filed 3/12/98, effective 4/12/98. Statutory Authority: RCW 74.08.090 and 1997 c 409 § 209. 
388-15-100 Services offered by the economic and social services office of the bureau of social services. Order 1088, § 388-15-100, filed 1/19/76.  Repealed by Order 1238, filed 8/31/77. 
388-15-110 Information and referral services. Statutory Authority: RCW 74.08.090. 84-15-059 (Order 2125), § 388-15-110, filed 7/18/84; 82-11-095 (Order 1811), § 388-15-110, filed 5/19/82; Order 1238, § 388-15-110, filed 8/31/77; Order 1088, § 388-15-110, filed 1/19/76.  Repealed by 98-01-125, filed 12/18/97, effective 1/18/98.  Statutory Authority: RCW 34.05.210, 74.08.090 and 1997 c 409 § 209.
388-15-120 Adult protective services. Statutory Authority: RCW 74.08.090, chapters 74.34 and 26.44 RCW and 42 USC 1397 and 3058. 97-21-108, § 388-15-120, filed 10/20/97, effective 11/20/97. Statutory Authority: RCW 74.08.090. 91-01-096 (Order 3116), § 388-15-120, filed 12/18/90, effective 1/18/91; 86-20-017 (Order 2426), § 388-15-120, filed 9/22/86; 85-13-059 (Order 2239), § 388-15-120, filed 6/18/85; 84-17-071 (Order 2141), § 388-15-120, filed 8/15/84; 80-16-025 (Order 1562), § 388-15-120, filed 10/30/80. Statutory Authority: RCW 43.20A.550. 78-04-004 (Order 1276), § 388-15-120, filed 3/2/78; Order 1238, § 388-15-120, filed 8/31/77; Order 1088, § 388-15-120, filed 1/19/76.  Repealed by 00-03-029, filed 1/11/00, effective 2/11/00. Statutory Authority: RCW 74.08.090, 74.34.165, and 74.39A.050(9). 
388-15-136 Central registry -- Duty to maintain. Statutory Authority: 1987 c 206. 87-23-057 and 87-24-039 (Orders 2561 and 2561A), § 388-15-136, filed 11/18/87 and 11/25/87. Statutory Authority: RCW 74.08.090 and 1979 c 155. 79-10-026 (Order 1431), § 388-15-136, filed 9/10/79; Order 1238, § 388-15-136, filed 8/31/77.  Repealed by 93-13-021 (Order 3567), filed 6/9/93, effective 7/10/93.  Statutory Authority: RCW 26.44.050 and 26.44.070.
388-15-137 Central registry -- Reports. Statutory Authority: RCW 74.08.090 and 1979 c 155. 79-10-026 (Order 1431), § 388-15-137, filed 9/10/79; Order 1238, § 388-15-137, filed 8/31/77.  Repealed by 87-23-057 and 87-24-039 (Orders 2561 and 2561A), filed 11/18/87 and 11/25/87.  Statutory Authority: 1987 c 206.
388-15-138 Central registry -- Information -- Release -- Dissemination -- Expungement. Statutory Authority: RCW 74.08.090 and 1979 c 155. 79-10-026 (Order 1431), § 388-15-138, filed 9/10/79; Order 1238, § 388-15-138, filed 8/31/77.  Repealed by 87-23-057 and 87-24-039 (Orders 2561 and 2561A), filed 11/18/87 and 11/25/87.  Statutory Authority: 1987 c 206.
388-15-139 Central registry -- Eligibility -- Procedures and criteria. Order 1238, § 388-15-139, filed 8/31/77.  Repealed by 87-23-057 and 87-24-039 (Orders 2561 and 2561A), filed 11/18/87 and 11/25/87.  Statutory Authority: 1987 c 206.
388-15-140 Residential services. Statutory Authority: RCW 74.08.044. 79-09-039 (Order 1425), § 388-15-140, filed 8/17/79; Order 1238, § 388-15-140, filed 8/31/77; Order 1147, § 388-15-140, filed 8/26/76; Order 1088, § 388-15-140, filed 1/19/76.  Repealed by 86-16-019 (Order 2392), filed 7/28/86.  Statutory Authority: RCW 74.08.044.
388-15-145 Residential care discharge allowance. Statutory Authority: RCW 74.42.450 and 74.08.090. 96-09-035 (Order 3962), § 388-15-145, filed 4/10/96, effective 5/11/96. Statutory Authority: RCW 74.08.090. 86-10-021 (Order 2367), § 388-15-145, filed 5/1/86; 79-12-028 (Order 1456), § 388-15-145, filed 11/16/79.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-150 Child foster care. Order 1238, § 388-15-150, filed 8/31/77; Order 1088, § 388-15-150, filed 1/19/76.  Repealed by 01-08-047, filed 3/30/01, effective 4/30/01. Statutory Authority: RCW 74.13.031. 
388-15-160 Adoption services. Order 1238, § 388-15-160, filed 8/31/77; Order 1088, § 388-15-160, filed 1/19/76.  Repealed by 01-08-047, filed 3/30/01, effective 4/30/01. Statutory Authority: RCW 74.13.031. 
388-15-170 Definitions. Statutory Authority: RCW 74.12.340, 74.04.050, 74.04.055, 74.08.090 and 74.13.0903. 98-22-008, § 388-15-170, filed 10/22/98, effective 11/22/98. Statutory Authority: RCW 74.12.340 and 45 CFR Part 98.41 Child Care and Development Block Grant. 93-10-021 (Order 3535), § 388-15-170, filed 4/28/93, effective 5/29/93. Statutory Authority: RCW 74.12.340 and 45 CFR 98.20, 98.30, 98.43 and 98.45; and 45 CFR 257.21, 257.30, 257.31 and 257.41. 92-11-062 (Order 3393), § 388-15-170, filed 5/19/92, effective 6/19/92. Statutory Authority: RCW 74.08.090. 88-24-023 (Order 2732), § 388-15-170, filed 12/2/88; 86-12-051 (Order 2387), § 388-15-170, filed 6/3/86; 86-03-078 (Order 2333), § 388-15-170, filed 1/22/86; 83-02-028 (Order 1931), § 388-15-170, filed 12/29/82. Statutory Authority: RCW 43.20A.550. 82-14-048 (Order 1839), § 388-15-170, filed 6/30/82. Statutory Authority: RCW 74.08.090. 82-01-051 (Order 1735), § 388-15-170, filed 12/16/81; 81-10-034 (Order 1650), § 388-15-170, filed 4/29/81; 80-15-010 (Order 1552), § 388-15-170, filed 10/6/80. Statutory Authority: RCW 43.20A.550. 78-04-004 (Order 1276), § 388-15-170, filed 3/2/78; Order 1238, § 388-15-170, filed 8/31/77; Order 1204, § 388-15-170, filed 4/1/77; Order 1147, § 388-15-170, filed 8/26/76; Order 1124, § 388-15-170, filed 6/9/76; Order 1120, § 388-15-170, filed 5/13/76; Order 1088, § 388-15-170, filed 1/19/76.  Decodified by 99-15-076, filed 7/20/99, effective 7/20/99. Recodified as 388-165-110. 
388-15-171 Subsidized child care for teen parents. Statutory Authority: RCW 74.12.340, 74.04.050, 74.04.055, 74.08.090 and 74.13.0903. 98-22-008, § 388-15-171, filed 10/22/98, effective 11/22/98.  Decodified by 99-15-076, filed 7/20/99, effective 7/20/99. Recodified as 388-165-120. 
388-15-172 Day care participation. Statutory Authority: RCW 74.08.090. 80-15-010 (Order 1552, § 388-15-172, filed 10/6/80. Statutory Authority: RCW 43.20A.550. 78-07-021 (Order 1306), § 388-15-172, filed 6/15/78.  Repealed by 82-04-074 (Order 1757), filed 2/3/82.  Statutory Authority: RCW 74.08.090.
388-15-173 Parent participation day care. Statutory Authority: RCW 74.08.090. 82-14-046 (Order 1837), § 388-15-173, filed 6/30/82.  Repealed by 86-03-078 (Order 2333), filed 1/22/86.  Statutory Authority: RCW 74.08.090.
388-15-174 Subsidized child care for seasonal workers. Statutory Authority: RCW 74.12.340, 74.04.050, 74.04.055, 74.08.090 and 74.13.0903. 98-22-008, § 388-15-174, filed 10/22/98, effective 11/22/98.  Decodified by 99-19-087, filed 9/17/99, effective 9/17/99. 
388-15-175 Child care for child protective services (CPS) and child welfare services (CWS). Statutory Authority: RCW 74.12.340, 74.04.050, 74.04.055, 74.08.090 and 74.13.0903. 98-22-008, § 388-15-175, filed 10/22/98, effective 11/22/98.  Decodified by 99-15-076, filed 7/20/99, effective 7/20/99. Recodified as 388-165-140. 
388-15-176 In-home/relative child care. Statutory Authority: RCW 74.12.340, 74.04.050, 74.04.055, 74.08.090 and 74.13.0903. 98-22-008, § 388-15-176, filed 10/22/98, effective 11/22/98.  Decodified by 99-15-076, filed 7/20/99, effective 7/20/99. Recodified as 388-165-235. 
388-15-180 Migrant day care services. Order 1088, § 388-15-180, filed 1/19/76.  Repealed by Order 1147, filed 8/26/76. 
388-15-190 Day care for the aged -- Age 60 and over. Order 1238, § 388-15-190, filed 8/31/77; Order 1088, § 388-15-190, filed 1/19/76.  Repealed by 97-18-052, filed 8/28/97, effective 9/28/97.  Statutory Authority: RCW 74.08.090 and 1997 c 409 § 209.
388-15-192 Long-term care services--Estate recovery procedures. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-192, filed 9/28/95, effective 10/29/95.  Repealed by 97-18-052, filed 8/28/97, effective 9/28/97.  Statutory Authority: RCW 74.08.090 and 1997 c 409 § 209.
388-15-196 Individual providers and home care agency providers. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-196, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-196, filed 8/27/98, effective 9/27/98. Statutory Authority: RCW 74.04.050, 74.08.090, 74.39A.005, 74.39A.007, 74.39A.050 and 74.39A.070. 97-16-106, § 388-15-196, filed 8/6/97, effective 9/6/97. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-196, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-196, filed 9/28/95, effective 10/29/95.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-19600 How do I apply to be an individual provider of an adult client? Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-19600, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-19600, filed 8/27/98, effective 9/27/98.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-19610 What requirements must an adult client's individual provider or a home care agency provider meet? Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-19610, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-19610, filed 8/27/98, effective 9/27/98.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-19620 How do I get paid as an individual provider? Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-19620, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-19620, filed 8/27/98, effective 9/27/98.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-19630 Under what conditions will the department deny payment to an individual provider or a home care agency provider? Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-19630, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-19630, filed 8/27/98, effective 9/27/98.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-19640 Does the individual provider or the home care agency provider have responsibilities in addition to the service plan? Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-19640, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-19640, filed 8/27/98, effective 9/27/98.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-19650 What are the educational requirements for an individual provider or a home care agency provider? Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-19650, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-19650, filed 8/27/98, effective 9/27/98.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-19660 Do all individual providers or home care agency providers have to take the fundamentals of caregiving training? Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-19660, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-19660, filed 8/27/98, effective 9/27/98.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-19670 Are there special rules about training for parents who are the individual providers of division of developmental disabilities (DDD) adult children? Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-19670, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-19670, filed 8/27/98, effective 9/27/98.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-19680 Are there special rules about training for parents who are the individual providers of non-DDD adult children? Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842 and 74.39A.050. 99-03-041, § 388-15-19680, filed 1/14/99, effective 2/14/99. Statutory Authority: RCW 74.08.090, 74.09.520, 43.43.842, 74.39A.050, 43.20A.710, 42 C.F.R. 1002.210 and 42 C.F.R. 431.51. 98-18-037, § 388-15-19680, filed 8/27/98, effective 9/27/98.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-198 Home and community services--Client and provider responsibilities. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-198, filed 10/1/96, effective 11/1/96.  Repealed by 00-03-043, filed 1/13/00, effective 2/13/00. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 
388-15-200 Health support services. Order 1238, § 388-15-200, filed 8/31/77; Order 1147, § 388-15-200, filed 8/26/76; Order 1088, § 388-15-200, filed 1/19/76.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-201 Long-term care functional eligibility. Statutory Authority: RCW 74.39A.120, 74.39A.030, 74.09.520, 74.39A.110,[74.39A.130 and 1998 c 346 §§ 205 (1)(c) and 206(3). 98-19-055, § 388-15-201, filed 9/15/98, effective 10/16/98. Statutory Authority: RCW 74.08.090, 74.09.035, [74.09.520, [74.09.530, 74.39A.110, [74.39A.120 and [74.39A.030. 98-04-026, § 388-15-201, filed 1/28/98, effective 2/28/98.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-206 Volunteer chore services. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-206, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-206, filed 9/28/95, effective 10/29/95.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-207 Chore personal care services for adults -- Legal basis -- Purpose -- Goals. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-207, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.08.530 and 74.08.545. 93-04-036 (Order 3500), § 388-15-207, filed 1/27/93, effective 2/27/93. Statutory Authority: RCW 74.08.090. 90-15-029 (Order 3041), § 388-15-207, filed 7/13/90, effective 8/13/90; 89-18-026 (Order 2852), § 388-15-207, filed 8/29/89, effective 9/29/89; 88-17-064 (Order 2674), § 388-15-207, filed 8/17/88; 88-06-088 (Order 2605), § 388-15-207, filed 3/2/88; 81-18-045 (Order 1697), § 388-15-207, filed 8/28/81; 81-06-063 (Order 1618), § 388-15-207, filed 3/4/81.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-208 Definitions. Statutory Authority: RCW 74.08.530 and 74.08.545. 93-04-036 (Order 3500), § 388-15-208, filed 1/27/93, effective 2/27/93. Statutory Authority: RCW 74.08.090. 91-08-011 (Order 3152), § 388-15-208, filed 3/26/91, effective 4/26/91; 90-15-029 (Order 3041), § 388-15-208, filed 7/13/90, effective 8/13/90; 89-13-084 (Order 2815), § 388-15-208, filed 6/21/89; 88-17-064 (Order 2674), § 388-15-208, filed 8/17/88; 88-06-088 (Order 2605), § 388-15-208, filed 3/2/88; 86-12-040 (Order 2383), § 388-15-208, filed 5/30/86; 84-22-017 (Order 2165), § 388-15-208, filed 10/31/84; 83-14-029 (Order 1977), § 388-15-208, filed 6/30/83; 82-23-056 (Order 1904), § 388-15-208, filed 11/16/82; 81-18-045 (Order 1697), § 388-15-208, filed 8/28/81; 81-11-044 (Order 1652), § 388-15-208, filed 5/20/81; 81-06-063 (Order 1618), § 388-15-208, filed 3/4/81.  Repealed by 95-20-041 (Order 3904), filed 9/28/95, effective 10/29/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-209 Chore personal care services--Eligibility. Statutory Authority: RCW 74.39A.120, 74.39A.030, 74.09.520, 74.39A.110,[74.39A.130 and 1998 c 346 §§ 205 (1)(c) and 206(3). 98-19-055, § 388-15-209, filed 9/15/98, effective 10/16/98. Statutory Authority: RCW 74.08.090, 74.09.035, [74.09.520, [74.09.530, 74.39A.110, [74.39A.120 and [74.39A.030. 98-04-026, § 388-15-209, filed 1/28/98, effective 2/28/98. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-209, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-209, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.08.530 and 74.08.545. 93-04-036 (Order 3500), § 388-15-209, filed 1/27/93, effective 2/27/93. Statutory Authority: RCW 74.08.090. 91-08-011 (Order 3152), § 388-15-209, filed 3/26/91, effective 4/26/91; 90-15-029 (Order 3041), § 388-15-209, filed 7/13/90, effective 8/13/90; 89-18-026 (Order 2852), § 388-15-209, filed 8/29/89, effective 9/29/89; 88-17-064 (Order 2674), § 388-15-209, filed 8/17/88; 88-06-088 (Order 2605), § 388-15-209, filed 3/2/88. Statutory Authority: ESHB 1221. 87-22-013 (Order 2550), § 388-15-209, filed 10/26/87. Statutory Authority: RCW 74.08.090. 86-12-040 (Order 2383), § 388-15-209, filed 5/30/86; 84-22-017 (Order 2165), § 388-15-209, filed 10/31/84; 83-21-007 (Order 2028), § 388-15-209, filed 10/6/83; 82-23-056 (Order 1904), § 388-15-209, filed 11/16/82; 81-18-045 (Order 1697), § 388-15-209, filed 8/28/81; 81-06-063 (Order 1618), § 388-15-209, filed 3/4/81.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-210 Chore services for adults and families. Order 1238, § 388-15-210, filed 8/31/77; Order 1147, § 388-15-210, filed 8/26/76; Order 1124, § 388-15-210, filed 6/9/76; Order 1088, § 388-15-210, filed 1/19/76.  Repealed by 81-06-063 (Order 1618), filed 3/4/81.  Statutory Authority: RCW 74.08.090.
388-15-211 Chore services for families. Order 1238, § 388-15-211, filed 8/31/77.  Repealed by 81-06-063 (Order 1618), filed 3/4/81.  Statutory Authority: RCW 74.08.090.
388-15-212 Service determination. Statutory Authority: RCW 74.08.530 and 74.08.545. 93-04-036 (Order 3500), § 388-15-212, filed 1/27/93, effective 2/27/93. Statutory Authority: RCW 74.08.090. 91-08-011 (Order 3152), § 388-15-212, filed 3/26/91, effective 4/26/91; 90-15-029 (Order 3041), § 388-15-212, filed 7/13/90, effective 8/13/90; 89-13-084 (Order 2815), § 388-15-212, filed 6/21/89; 88-17-064 (Order 2674), § 388-15-212, filed 8/17/88; 88-06-088 (Order 2605), § 388-15-212, filed 3/2/88. Statutory Authority: ESHB 1221. 87-22-013 (Order 2550), § 388-15-212, filed 10/26/87. Statutory Authority: RCW 74.08.090. 86-12-040 (Order 2383), § 388-15-212, filed 5/30/86; 84-22-017 (Order 2165), § 388-15-212, filed 10/31/84; 83-21-007 (Order 2028), § 388-15-212, filed 10/6/83; 82-23-056 (Order 1904), § 388-15-212, filed 11/16/82; 81-18-045 (Order 1697), § 388-15-212, filed 8/28/81; 81-11-044 (Order 1652), § 388-15-212, filed 5/20/81; 81-06-063 (Order 1618), § 388-15-212, filed 3/4/81; 79-01-042 (Order 1361), § 388-15-212, filed 12/21/78.  Repealed by 95-20-041 (Order 3904), filed 9/28/95, effective 10/29/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-213 Payment. Statutory Authority: RCW 74.08.530 and 74.08.545. 93-04-036 (Order 3500), § 388-15-213, filed 1/27/93, effective 2/27/93. Statutory Authority: RCW 74.08.090. 90-15-029 (Order 3041), § 388-15-213, filed 7/13/90, effective 8/13/90; 88-17-064 (Order 2674), § 388-15-213, filed 8/17/88; 88-06-088 (Order 2605), § 388-15-213, filed 3/2/88. Statutory Authority: ESHB 1221. 87-22-013 (Order 2550), § 388-15-213, filed 10/26/87. Statutory Authority: RCW 74.08.090. 86-08-085 (Order 2361), § 388-15-213, filed 4/2/86; 84-22-017 (Order 2165), § 388-15-213, filed 10/31/84; 83-21-007 (Order 2028), § 388-15-213, filed 10/6/83; 82-23-056 (Order 1904), § 388-15-213, filed 11/16/82; 81-18-045 (Order 1697), § 388-15-213, filed 8/28/81; 81-06-063 (Order 1618), § 388-15-213, filed 3/4/81; Order 1238, § 388-15-213, filed 8/31/77.  Repealed by 95-20-041 (Order 3904), filed 9/28/95, effective 10/29/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-214 Chore personal care services--Budget control. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-214, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.08.545. 94-10-025 (Order 3730), § 388-15-214, filed 4/27/94, effective 5/28/94. Statutory Authority: RCW 74.08.530 and 74.08.545. 93-04-036 (Order 3500), § 388-15-214, filed 1/27/93, effective 2/27/93. Statutory Authority: RCW 74.08.090. 90-15-029 (Order 3041), § 388-15-214, filed 7/13/90, effective 8/13/90; 88-19-031 (Order 2693), § 388-15-214, filed 9/12/88; 88-06-088 (Order 2605), § 388-15-214, filed 3/2/88.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-215 Chore personal care services--Program limitations. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-215, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.08.530 and 74.08.545. 93-04-036 (Order 3500), § 388-15-215, filed 1/27/93, effective 2/27/93. Statutory Authority: RCW 74.08.090. 91-08-011 (Order 3152), § 388-15-215, filed 3/26/91, effective 4/26/91; 90-15-029 (Order 3041), § 388-15-215, filed 7/13/90, effective 8/13/90; 89-18-026 (Order 2852), § 388-15-215, filed 8/29/89, effective 9/29/89; 88-11-062 (Order 2625), § 388-15-215, filed 5/17/88; 85-22-021 (Order 2298), § 388-15-215, filed 10/30/85; 84-22-017 (Order 2165), § 388-15-215, filed 10/31/84; 83-21-007 (Order 2028), § 388-15-215, filed 10/6/83; 82-23-056 (Order 1904), § 388-15-215, filed 11/16/82; 81-18-045 (Order 1697), § 388-15-215, filed 8/28/81; 81-06-063 (Order 1618), § 388-15-215, filed 3/4/81; Order 1238, § 388-15-215, filed 8/31/77.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-216 Chore personal care services--Grandfathered clients. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-216, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.08.530 and 74.08.545. 93-04-036 (Order 3500), § 388-15-216, filed 1/27/93, effective 2/27/93. Statutory Authority: RCW 74.08.090. 91-08-011 (Order 3152), § 388-15-216, filed 3/26/91, effective 4/26/91; 90-15-029 (Order 3041), § 388-15-216, filed 7/13/90, effective 8/13/90; 89-18-026 (Order 2852), § 388-15-216, filed 8/29/89, effective 9/29/89.  Repealed by 98-14-052, filed 6/26/98, effective 7/27/98. Statutory Authority: RCW 74.08.090. 
388-15-217 Chore personal care services for employed disabled adults. Statutory Authority: RCW 74.08.530 and 74.08.545. 93-04-036 (Order 3500), § 388-15-217, filed 1/27/93, effective 2/27/93. Statutory Authority: RCW 74.08.090. 90-15-029 (Order 3041), § 388-15-217, filed 7/13/90, effective 8/13/90; 89-18-026 (Order 2852), § 388-15-217, filed 8/29/89, effective 9/29/89; 88-11-062 (Order 2625), § 388-15-217, filed 5/17/88; 83-21-007 (Order 2028), § 388-15-217, filed 10/6/83; 82-23-056 (Order 1904), § 388-15-217, filed 11/16/82; 81-18-045 (Order 1697), § 388-15-217, filed 8/28/81; 81-03-075 (Order 1589), § 388-15-217, filed 1/21/81.  Repealed by 95-23-032 (Order 3919), filed 11/8/95, effective 12/9/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-219 Chore personal care service--Payment and client participation. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-219, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-219, filed 9/28/95, effective 10/29/95.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-220 Homemaker services. Statutory Authority: RCW 74.08.090. 81-17-024 (Order 1689), § 388-15-220, filed 8/12/81; 80-15-003 (Order 1551), § 388-15-220, filed 10/2/80; Order 1238, § 388-15-220, filed 8/31/77; Order 1088, § 388-15-220, filed 1/19/76.  Repealed by 01-08-047, filed 3/30/01, effective 4/30/01. Statutory Authority: RCW 74.13.031. 
388-15-222 Chore personal care services--Employed disabled--Incentive income and resource exemption. Statutory Authority: RCW 74.39A.120, 74.39A.030, 74.09.520, 74.39A.110, [74.39A.130 and 1998 c 346 §§ 205 (1)(c) and 206(3). 98-19-055, § 388-15-222, filed 9/15/98, effective 10/16/98. Statutory Authority: RCW 74.08.090, 74.09.035, [74.09.520, [74.09.530,74.39A.110 , [74.39A.120 and [74.39A.030. 98-04-026, § 388-15-222, filed 1/28/98, effective 2/28/98. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-222, filed 9/28/95, effective 10/29/95.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-230 Employment oriented casework. Order 1238, § 388-15-230, filed 8/31/77; Order 1165, § 388-15-230, filed 10/27/76; Order 1105, § 388-15-230, filed 3/11/76.  Repealed by 79-03-013 (Order 1368), filed 2/15/79.  Statutory Authority: RCW 74.08.090.
388-15-250 School age parent services. Order 1124, § 388-15-250, filed 6/9/76; Order 1088, § 388-15-250, filed 1/19/76.  Repealed by Order 1147, filed 8/26/76. 
388-15-260 Home delivered meals. Order 1088, § 388-15-260, filed 1/19/76.  Repealed by Order 1147, filed 8/26/76. 
388-15-270 Services to the blind. Order 1088, § 388-15-270, filed 1/19/76.  Repealed by Order 1238, filed 8/31/77. 
388-15-280 Library services to the blind and physically handicapped. Order 1088, § 388-15-280, filed 1/19/76.  Repealed by Order 1124, filed 6/9/76. 
388-15-290 Juvenile delinquency prevention services. Order 1238, § 388-15-290, filed 8/31/77; Order 1088, § 388-15-290, filed 1/19/76.  Repealed by 81-20-063 (Order 1708), filed 10/5/81.  Statutory Authority: RCW 74.08.090.
388-15-300 Developmental disabilities case services. Order 1238, § 388-15-300, filed 8/31/77; Order 1088, § 388-15-300, filed 1/19/76.  Repealed by 98-02-058, filed 1/6/98, effective 2/6/98.  Statutory Authority: RCW 74.09.290 and 74.08.090.
388-15-310 Developmental disabilities home (aid) services. Order 1238, § 388-15-310, filed 8/31/77; Order 1088, § 388-15-310, filed 1/19/76.  Repealed by 98-02-058, filed 1/6/98, effective 2/6/98.  Statutory Authority: RCW 74.09.290 and 74.08.090.
388-15-320 Developmental center services. Order 1238, § 388-15-320, filed 8/31/77; Order 1088, § 388-15-320, filed 1/19/76.  Repealed by 98-02-058, filed 1/6/98, effective 2/6/98.  Statutory Authority: RCW 74.09.290 and 74.08.090.
388-15-330 Sheltered workshops. Order 1238, § 388-15-330, filed 8/31/77; Order 1088, § 388-15-330, filed 1/19/76.  Repealed by 98-02-058, filed 1/6/98, effective 2/6/98.  Statutory Authority: RCW 74.09.290 and 74.08.090.
388-15-340 Alcoholism treatment. Order 1238, § 388-15-340, filed 8/31/77; Order 1088, § 388-15-340, filed 1/19/76.  Repealed by 98-01-125, filed 12/18/97, effective 1/18/98.  Statutory Authority: RCW 34.05.210, 74.08.090 and 1997 c 409 § 209.
388-15-350 Mental health. Order 1124, § 388-15-350, filed 6/9/76; Order 1088, § 388-15-350, filed 1/19/76.  Repealed by Order 1238, filed 8/31/77. 
388-15-360 Refugee assistance. Statutory Authority: RCW 43.20A.550. 82-02-032 (Order 1742), § 388-15-360, filed 12/31/81; 81-17-027 (Order 1692), § 388-15-360, filed 8/12/81; 78-04-004 (Order 1276), § 388-15-360, filed 3/2/78; Order 1238, § 388-15-360, filed 8/31/77; Order 1204, § 388-15-360, filed 4/1/77; Order 1147, § 388-15-360, filed 8/26/76; Order 1124, § 388-15-360, filed 6/9/76.  Repealed by 00-22-085, filed 10/31/00, effective 12/1/00. Statutory Authority: RCW 74.08.090. 
388-15-548 Residential services. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-548, filed 7/28/86.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-500 Redetermination of service eligibility. Order 1238, § 388-15-500, filed 8/31/77; Order 1088, § 388-15-500, filed 1/19/76.  Repealed by 98-01-125, filed 12/18/97, effective 1/18/98.  Statutory Authority: RCW 34.05.210, 74.08.090 and 1997 c 409 § 209.
388-15-550 Service delivery. Order 1238, § 388-15-550, filed 8/31/77; Order 1147, § 388-15-550, filed 8/26/76; Order 1124, § 388-15-550, filed 6/9/76; Order 1088, § 388-15-550, filed 1/19/76.  Repealed by 98-01-125, filed 12/18/97, effective 1/18/98.  Statutory Authority: RCW 34.05.210, 74.08.090 and 1997 c 409 § 209.
388-15-551 Adult family home -- Authority to purchase care -- Standards. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-551, filed 7/28/86; 79-09-039 (Order 1425), § 388-15-551, filed 8/17/79.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-552 Adult family home -- Eligible persons. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-552, filed 7/28/86; 83-21-008 (Order 2029), § 388-15-552, filed 10/6/83; 79-09-039 (Order 1425), § 388-15-552, filed 8/17/79.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-553 Adult family home -- Determination of need. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-553, filed 7/28/86; 79-09-039 (Order 1425), § 388-15-553, filed 8/17/79.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-554 Adult family home -- Placement in facility. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-554, filed 7/28/86; 79-09-039 (Order 1425), § 388-15-554, filed 8/17/79.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-555 Adult family home -- Payments -- Standards -- Procedures. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-555, filed 7/28/86; 79-09-039 (Order 1425), § 388-15-555, filed 8/17/79.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-560 Congregate care -- Definition -- Authority to purchase care -- Standards. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-560, filed 7/28/86; 81-01-077 (Order 1579), § 388-15-560, filed 12/17/80; Order 1238, § 388-15-560, filed 8/31/77.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-562 Congregate care -- Eligible persons. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-562, filed 7/28/86; 82-10-064 (Order 1805), § 388-15-562, filed 5/5/82; 81-01-077 (Order 1579), § 388-15-562, filed 12/17/80; Order 1238, § 388-15-562, filed 8/31/77.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-563 Congregate care -- Residents of other states. Statutory Authority: RCW 74.08.044. 81-01-077 (Order 1579), § 388-15-563, filed 12/17/80.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-564 Congregate care -- Determination of need. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-564, filed 7/28/86; Order 1238, § 388-15-564, filed 8/31/77.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-566 Congregate care -- Placement in facility. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-566, filed 7/28/86; 81-01-077 (Order 1579), § 388-15-566, filed 12/17/80; Order 1238, § 388-15-566, filed 8/31/77.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-568 Congregate care -- Payment -- Standards -- Procedures. Statutory Authority: RCW 74.08.044. 86-16-019 (Order 2392), § 388-15-568, filed 7/28/86; 82-10-064 (Order 1805), § 388-15-568, filed 5/5/82; Order 1238, § 388-15-568, filed 8/31/77.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-570 Family reconciliation services. Statutory Authority: RCW 74.08.090. 82-01-040 (Order 1732), § 388-15-570, filed 12/16/81; 81-20-063 (Order 1708), § 388-15-570, filed 10/5/81. Statutory Authority: RCW 74.08.090 and 1979 c 155. 79-10-026 (Order 1431), § 388-15-570, filed 9/10/79. Statutory Authority: RCW 74.08.090. 78-09-098 (Order 1335), § 388-15-570, filed 9/1/78; Order 1238, § 388-15-570, filed 8/31/77.  Repealed by 01-08-047, filed 3/30/01, effective 4/30/01. Statutory Authority: RCW 74.13.031. 
388-15-580 Support services. Order 1238, § 388-15-580, filed 8/31/77.  Repealed by 98-01-125, filed 12/18/97, effective 1/18/98.  Statutory Authority: RCW 34.05.210, 74.08.090 and 1997 c 409 § 209.
388-15-600 Community options program entry system (COPES) -- Purpose -- Legal basis. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-600, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.04.057 and 74.08.090. 93-13-135 (Order 3577), § 388-15-600, filed 6/23/93, effective 7/24/93. Statutory Authority: 1987 1st ex.s. c 7. 87-23-054 (Order 2558), § 388-15-600, filed 11/18/87. Statutory Authority: RCW 74.08.090. 86-11-024 (Order 2377), § 388-15-600, filed 5/14/86; 83-08-024 (Order 1954), § 388-15-600, filed 3/30/83.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-610 COPES -- Eligibility. Statutory Authority: RCW 74.39A.120, 74.39A.030, 74.09.520, 74.39A.110, [74.39A.130 and 1998 c 346 §§ 205 (1)(c) and 206(3). 98-19-055, § 388-15-610, filed 9/15/98, effective 10/16/98. Statutory Authority: RCW 74.08.090, 74.09.035, [74.09.520, [74.09.530, 74.39A.110, [74.39A.120 and [74.39A.030. 98-04-026, § 388-15-610, filed 1/28/98, effective 2/28/98. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-610, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-610, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.04.057 and 74.08.090. 93-13-135 (Order 3577), § 388-15-610, filed 6/23/93, effective 7/24/93. Statutory Authority: RCW 74.09.500. 92-20-013 (Order 3460), § 388-15-610, filed 9/24/92, effective 10/25/92. Statutory Authority: RCW 74.08.090. 90-15-019 (Order 3039), § 388-15-610, filed 7/12/90, effective 8/12/90. Statutory Authority: 1987 1st ex.s. c 7. 87-23-054 (Order 2558), § 388-15-610, filed 11/18/87. Statutory Authority: RCW 74.08.090. 86-11-024 (Order 2377), § 388-15-610, filed 5/14/86. Statutory Authority: RCW 74.08.044. 84-12-038 (Order 2101), § 388-15-610, filed 5/30/84. Statutory Authority: RCW 74.08.090. 83-08-024 (Order 1954), § 388-15-610, filed 3/30/83.  Repealed by 00-13-077, filed 6/19/00, effective 7/20/00. Statutory Authority: RCW 74.39A.030. 
388-15-615 COPES -- Program restrictions. Statutory Authority: RCW 74.04.057 and 74.08.090. 93-13-135 (Order 3577), § 388-15-615, filed 6/23/93, effective 7/24/93. Statutory Authority: RCW 74.09.500. 92-18-041 (Order 3445), § 388-15-615, filed 8/27/92, effective 9/27/92.  Repealed by 95-20-041 (Order 3904), filed 9/28/95, effective 10/29/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-620 COPES -- Services. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-620, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-620, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.04.057 and 74.08.090. 93-13-135 (Order 3577), § 388-15-620, filed 6/23/93, effective 7/24/93. Statutory Authority: RCW 74.08.090. 90-15-019 (Order 3039), § 388-15-620, filed 7/12/90, effective 8/12/90. Statutory Authority: 1987 1st ex.s. c 7. 87-23-054 (Order 2558), § 388-15-620, filed 11/18/87. Statutory Authority: RCW 74.08.090. 86-11-024 (Order 2377), § 388-15-620, filed 5/14/86; 85-18-067 (Order 2281), § 388-15-620, filed 9/4/85. Statutory Authority: RCW 74.08.044. 84-12-038 (Order 2101), § 388-15-620, filed 5/30/84. Statutory Authority: RCW 74.08.090. 83-08-024 (Order 1954), § 388-15-620, filed 3/30/83.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-630 COPES -- Payment procedures. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-630, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.04.057 and 74.08.090. 93-13-135 (Order 3577), § 388-15-630, filed 6/23/93, effective 7/24/93. Statutory Authority: RCW 74.08.090. 90-15-019 (Order 3039), § 388-15-630, filed 7/12/90, effective 8/12/90. Statutory Authority: 1987 1st ex.s. c 7. 87-23-054 (Order 2558), § 388-15-630, filed 11/18/87. Statutory Authority: RCW 74.08.090. 86-11-024 (Order 2377), § 388-15-630, filed 5/14/86; 85-18-067 (Order 2281), § 388-15-630, filed 9/4/85. Statutory Authority: RCW 74.08.044. 84-12-038 (Order 2101), § 388-15-630, filed 5/30/84. Statutory Authority: RCW 74.08.090. 83-08-024 (Order 1954), § 388-15-630, filed 3/30/83.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-690 Respite care services--Definitions. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-690, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.44 [74.08.044]. 88-03-020 (Order 2570), § 388-15-690, filed 1/12/88.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-695 Respite care services--Caregiver eligibility. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-695, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.44 [74.08.044]. 88-03-020 (Order 2570), § 388-15-695, filed 1/12/88.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-700 Respite care services--Distribution of cost. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-700, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.44 [74.08.044]. 88-03-020 (Order 2570), § 388-15-700, filed 1/12/88.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-705 Respite care services--Rates of payment. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-705, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.44 [74.08.044]. 88-03-020 (Order 2570), § 388-15-705, filed 1/12/88.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-710 Respite care services--Service priorities. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-710, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.44 [74.08.044]. 88-03-020 (Order 2570), § 388-15-710, filed 1/12/88.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-715 Respite care services--Service priority categories. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-715, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.44 [74.08.044]. 88-03-020 (Order 2570), § 388-15-715, filed 1/12/88.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-810 Medicaid personal care services -- Legal basis -- Purpose. Statutory Authority: RCW 74.08.090. 89-18-029 (Order 2856), § 388-15-810, filed 8/29/89, effective 9/29/89.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-820 Medicaid personal care services -- Definitions. Statutory Authority: RCW 74.08.090 and 74.09.520, OBRA '93 and c 21, Laws of 1994 amending RCW 74.09.520, Thurston Co. Superior Court Cause #93-2-1817-4. 94-21-042 (Order 3796), § 388-15-820, filed 10/12/94, effective 11/12/94. Statutory Authority: RCW 74.09.520. 93-10-023 (Order 3538), § 388-15-820, filed 4/28/93, effective 5/29/93. Statutory Authority: RCW 74.08.090. 91-21-026 (Order 3264), § 388-15-820, filed 10/8/91, effective 11/8/91; 90-06-038 (Order 2950), § 388-15-820, filed 3/1/90, effective 4/1/90; 89-18-029 (Order 2856), § 388-15-820, filed 8/29/89, effective 9/29/89.  Repealed by 95-23-032 (Order 3919), filed 11/8/95, effective 12/9/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-830 Medicaid personal care services -- Eligibility. Statutory Authority: RCW 74.39A.120, 74.39A.030, 74.09.520, 74.39A.110,[74.39A.130 and 1998 c 346 §§ 205 (1)(c) and 206(3). 98-19-055, § 388-15-830, filed 9/15/98, effective 10/16/98. Statutory Authority: RCW 74.08.090, 74.09.035, [74.09.520, [74.09.530, 74.39A.110, [74.39A.120 and [74.39A.030. 98-04-026, § 388-15-830, filed 1/28/98, effective 2/28/98. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-830, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.08.090 and 74.09.520, OBRA '93 and c 21, Laws of 1994 amending RCW 74.09.520, Thurston Co. Superior Court Cause #93-2-1817-4. 94-21-042 (Order 3796), § 388-15-830, filed 10/12/94, effective 11/12/94. Statutory Authority: RCW 74.09.520. 93-10-023 (Order 3538), § 388-15-830, filed 4/28/93, effective 5/29/93. Statutory Authority: RCW 74.08.090. 89-18-029 (Order 2856), § 388-15-830, filed 8/29/89, effective 9/29/89.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-840 Medicaid personal care services -- Assessment -- Authorization. Statutory Authority: RCW 74.08.090 and 74.09.520, OBRA '93 and c 21, Laws of 1994 amending RCW 74.09.520, Thurston Co. Superior Court Cause #93-2-1817-4. 94-21-042 (Order 3796), § 388-15-840, filed 10/12/94, effective 11/12/94. Statutory Authority: RCW 74.09.520. 93-10-023 (Order 3538), § 388-15-840, filed 4/28/93, effective 5/29/93. Statutory Authority: RCW 74.08.090. 91-21-026 (Order 3264), § 388-15-840, filed 10/8/91, effective 11/8/91; 89-18-029 (Order 2856), § 388-15-840, filed 8/29/89, effective 9/29/89.  Repealed by 95-23-032 (Order 3919), filed 11/8/95, effective 12/9/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-850 Medicaid personal care services -- Nurse oversight. Statutory Authority: RCW 74.08.090 and 74.09.520, OBRA '93 and c 21, Laws of 1994 amending RCW 74.09.520, Thurston Co. Superior Court Cause #93-2-1817-4. 94-21-042 (Order 3796), § 388-15-850, filed 10/12/94, effective 11/12/94. Statutory Authority: RCW 74.09.520. 93-10-023 (Order 3538), § 388-15-850, filed 4/28/93, effective 5/29/93. Statutory Authority: RCW 74.08.090. 91-21-026 (Order 3264), § 388-15-850, filed 10/8/91, effective 11/8/91; 89-18-029 (Order 2856), § 388-15-850, filed 8/29/89, effective 9/29/89.  Repealed by 95-20-041 (Order 3904), filed 9/28/95, effective 10/29/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-860 Medicaid personal care services -- Personal care aide qualifications. Statutory Authority: RCW 74.09.520. 93-10-023 (Order 3538), § 388-15-860, filed 4/28/93, effective 5/29/93. Statutory Authority: RCW 74.08.090. 91-21-026 (Order 3264), § 388-15-860, filed 10/8/91, effective 11/8/91; 89-18-029 (Order 2856), § 388-15-860, filed 8/29/89, effective 9/29/89.  Repealed by 95-20-041 (Order 3904), filed 9/28/95, effective 10/29/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-870 Medicaid personal care services -- Service provision system. Statutory Authority: RCW 74.09.520. 93-10-023 (Order 3538), § 388-15-870, filed 4/28/93, effective 5/29/93. Statutory Authority: RCW 74.08.090. 91-21-026 (Order 3264), § 388-15-870, filed 10/8/91, effective 11/8/91; 90-06-038 (Order 2950), § 388-15-870, filed 3/1/90, effective 4/1/90; 89-18-029 (Order 2856), § 388-15-870, filed 8/29/89, effective 9/29/89.  Repealed by 95-20-041 (Order 3904), filed 9/28/95, effective 10/29/95.  Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18.
388-15-880 Medicaid personal care services--Payment procedures. Statutory Authority: RCW 74.08.090, 74.09.035, [74.09.520,[74.09.530 , 74.39A.110, [74.39A.120 and [74.39A.030. 98-04-026, § 388-15-880, filed 1/28/98, effective 2/28/98. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-880, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-880, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.09.520. 93-10-023 (Order 3538), § 388-15-880, filed 4/28/93, effective 5/29/93. Statutory Authority: RCW 74.08.090. 91-21-026 (Order 3264), § 388-15-880, filed 10/8/91, effective 11/8/91; 90-06-038 (Order 2950), § 388-15-880, filed 3/1/90, effective 4/1/90; 89-18-029 (Order 2856), § 388-15-880, filed 8/29/89, effective 9/29/89.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-890 Medicaid personal care services--Program limitations. Statutory Authority: RCW 74.39A.120, 74.39A.030, 74.09.520, 74.39A.110, [74.39A.130 and 1998 c 346 §§ 205 (1)(c) and 206(3). 98-19-055, § 388-15-890, filed 9/15/98, effective 10/16/98. Statutory Authority: RCW 74.08.090, 74.09.035, [74.09.520, [74.09.530, 74.39A.110, [74.39A.120 and[74.39A.030 . 98-04-026, § 388-15-890, filed 1/28/98, effective 2/28/98. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-890, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-890, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.09.520. 93-10-023 (Order 3538), § 388-15-890, filed 4/28/93, effective 5/29/93.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-895 Termination of services. Statutory Authority: RCW 74.39A.120, 74.39A.030, 74.09.520, 74.39A.110, [74.39A.130 and 1998 c 346 §§ 205 (1)(c) and 206(3). 98-19-055, § 388-15-895, filed 9/15/98, effective 10/16/98. Statutory Authority: RCW 74.08.090, 74.09.035, [74.09.520, [74.09.530, 74.39A.110, [74.39A.120 and [74.39A.030. 98-04-026, § 388-15-895, filed 1/28/98, effective 2/28/98.  Repealed by 00-04-056, filed 1/28/00, effective 2/28/00. 
388-15-900 Authority. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-900, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045 (Order 3979), filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040.
388-15-905 Assisted living services. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-905, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.
388-15-910 Definitions. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-910, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.
388-15-915 Facility structural requirements. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-915, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.
388-15-920 Service requirements. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-920, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.
388-15-925 External or additional services coordinated by the contractor. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-925, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.
388-15-935 Contract application process. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-935, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.
388-15-940 Change of parties to the contract. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-940, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.
388-15-945 Client eligibility. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-945, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.
388-15-950 Relocation criteria. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-950, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.
388-15-955 Assisted living services contract payment procedures. Statutory Authority: RCW 74.39A.010. 95-15-011 (Order 3864), § 388-15-955, filed 7/7/95, effective 8/7/95.  Repealed by 96-11-045, filed 5/8/96, effective 6/8/96.  Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-240 and 70.129.040.



























































WAC 388-15-130   Child protective services -- Authority.  The authority for the department's child protective services (CPS) program is chapter 26.44 RCW and RCW 74.13.031.
     (1) Goal statement. The purpose of CPS is to protect children from child abuse and neglect (CA/N) through the provision of services to:
     (a) Assess risk of abuse or neglect to children;
     (b) Develop case plans preventing or remedying CA/N in the shortest reasonable time; and
     (c) Maintain, support, or reunify families to the extent possible consistent with the safety of the child.
     (2) Definition of service. Child protective services are those services provided by the department on behalf of children who are reported to be abused, neglected, or exploited or who are threatened with harm through abusive, neglectful, or exploitive acts by:
     (a) The child's parent, legal custodian, or persons serving in loco parentis; or
     (b) Persons licensed or certified under chapter 74.15 RCW; or
     (c) Persons included within those categories of alleged perpetrators and subject to CPS investigation, as specified by department manual provisions or policy directives.
     (3) Definition of child abuse, neglect, or exploitation (ca/n). Abusive, neglectful, or exploitive acts defined in RCW 26.44.020 include:
     (a) Inflicting physical injury on a child by other than accidental means, causing death, disfigurement, skin bruising, impairment of physical or emotional health, or loss or impairment of any bodily function.
     (b) Creating a substantial risk of physical harm to such child's bodily functioning.
     (c) Committing or allowing to be committed any sexual offense against such child as defined in the criminal code or intentionally touching, either directly or through the clothing, the genitals, anus, or breasts of a child for other than hygiene or child care purposes.
     (d) Committing acts which are cruel or inhumane regardless of observable injury. Such acts may include, but are not limited to, instances of extreme discipline demonstrating a disregard of a child's pain and/or mental suffering.
     (e) Assaulting or criminally mistreating a child as defined by the criminal code.
     (f) Failing to provide food, shelter, clothing, supervision, or health care necessary to a child's health or safety.
     (g) Engaging in actions or omissions resulting in injury to, or creating a substantial risk to the physical or mental health or development of a child.
     (h) Failing to take reasonable steps to prevent the occurrence of (a) through (g).
     (4) Description of services.
     (a) The department's child protective services shall include:
     (i) Investigation of CA/N reports (RCW 26.44.050);
     (ii) Development, management, and provision of services to ameliorate conditions endangering the welfare of children;
     (iii) Coordination of programs and services relevant to the prevention and treatment of CA/N;
     (iv) Case planning to ensure each child has a permanent home;
     (v) Community education; and
     (vi) Development of preventative services to reduce and/or eliminate CA/N.
     (b) Department services may also include:
     (i) Counseling with the children and their families or other responsible individuals;
     (ii) Arranging out-of-home placement, e.g., relative placement, emergency foster care, etc.;
     (iii) In-home support services;
     (iv) Petitions to courts;
     (v) Information about and/or referral to other agencies or persons; and
     (vi) Cooperating with out-of-state child protective service agencies.
     (5) Community involvement. The department shall involve local community resources in the planning and provision of needed services. Involvement shall include:
     (a) Notifying law enforcement of department activity in cases being investigated by both agencies.
     (b) Coordination of community resources to provide identification, prevention, and treatment of CA/N.
     (c) Organizing community child protection teams of professional persons or agencies providing services to abused or neglected children and/or parents of such children.
     (d) Other activities to coordinate the investigation and keep participants apprised of case progress per RCW 26.44.035.

[Statutory Authority: RCW 74.15.030. 89-07-024 (Order 2773), § 388-15-130, filed 3/8/89. Statutory Authority: RCW 74.08.090 and 1979 c 155. 79-10-026 (Order 1431), § 388-15-130, filed 9/10/79. Statutory Authority: RCW 74.08.090. 78-09-098 (Order 1335), § 388-15-130, filed 9/1/78; Order 1238, § 388-15-130, filed 8/31/77; Order 1088, § 388-15-130, filed 1/19/76.]

WAC 388-15-131   Child protective services -- Special requirements for Indian children.  (1) These special requirements apply to children defined as "Indians" in WAC 388-70-091 and 388-70-450 (1)(a) through (c).
     (2) The CSO shall document in case records its efforts to keep Indian families together and to avoid separating the Indian child from his parents, relatives, tribe or cultural heritage, as per RCW 26.44.010, WAC 388-15-130 and 388-70-093.
     (3) In alleged child abuse and neglect situations, the CSO shall document in case records, its efforts to utilize staff and services particularly capable of meeting the special needs of Indian children and their families, assisted by the local Indian child welfare advisory committee as per WAC 388-70-600 through 388-70-640.
     (4) The CSO shall promptly advise its Indian child welfare advisory committee and appropriate tribal council that an (unnamed) child with (named) tribal affiliation is the victim of substantiated child abuse or neglect. The provisions of RCW 26.44.070, WAC 388-15-138 and 388-70-640, limiting who has access to confidential information, shall be followed in all cases.

[Statutory Authority: RCW 74.08.090 and 1979 c 155. 79-10-026 (Order 1431), § 388-15-131, filed 9/10/79; Order 1255, § 388-15-131, filed 12/1/77.]

WAC 388-15-132   Child protective services -- Acceptance of reports -- Eligibility for services and limits to authority.  (1) Acceptance of reports. The department shall accept a report of CA/N from any source, including a report made anonymously. Reports shall be made directly to the department's division of children and family services (DCFS) local office per RCW 26.44.030. The department shall:
     (a) Determine whether reports allege incidents, conditions, or circumstances meeting the definition of CA/N in RCW 26.44.020 and WAC 388-15-130; and
     (b) Have the authority to refuse to investigate reports which do not meet the statutory definition of CA/N.
     (2) Reports to law enforcement. The department shall report to the appropriate law enforcement agency any reported incident of death, sexual abuse, or nonaccidental physical injury of a child and any incident where the CPS investigation reveals reasonable cause to believe a crime has been committed against a child. The department shall create and send the incident report to law enforcement within three working days following:
     (a) Receipt of a complaint alleging death, sexual abuse, or nonaccidental physical injury of a child;
     (b) Discovery of information during a CPS investigation, creating reasonable cause to believe a child died, suffered sexual abuse, or had a nonaccidental physical injury; or
     (c) Discovery of information during a CPS investigation, creating reasonable cause to believe a crime has been committed against a child.
     (3) Investigation. The department, except as provided by RCW 26.44.050 and WAC 388-15-130(2), shall be responsible for investigation of reports of suspected CA/N.
     (a) The department shall begin its investigation within twenty-four hours for all CA/N reports where a child is assessed to be at risk of imminent harm.
     (b) The department shall investigate all other reports meeting the legal definition of CA/N, but may determine an appropriate response time based on the assessed risk of CA/N.
     (c) The department:
     (i) Shall develop and maintain records of department investigations of CA/N per RCW 26.44.035; and
     (ii) May arrange for ongoing services by another agency.
     (d) Upon receiving a report of incidents, conditions, or circumstances of CA/N, the department shall:
     (i) Have access to any and all records of the child in the possession of mandated reporters and reporters' employers;
     (ii) Have the authority to interview a child without prior parental notification or consent;
     (iii) Have authority to interview a child outside of the presence of parents at locations determined by the department to be suitable for an interview. The child or the department may have a third party present at the interview when the third party does not jeopardize the investigation per RCW 26.44.030;
     (iv) Have authority to photograph the child victims for the purpose of documenting the physical condition of the child per RCW 26.44.050; and
     (v) Notify the child's parent, guardian, or caretaker about the interview per RCW 26.44.030(9).
     (e) The department shall complete the investigation within ninety days from the date of report. The department shall make written findings of all investigations including:
     (i) A description of any injuries or harm inflicted on the child;
     (ii) An account of the department's investigation;
     (iii) The findings regarding specific allegations;
     (iv) An assessment of risk to the child; and
     (v) The department's disposition of the case as described under RCW 13.34.120 and 26.44.040.
     (4) Limits to authority. The department:
     (a) Shall have the authority to share information for case planning and case consultation purposes with mandated reporters and agencies which have provided or will provide services to the child and family per RCW 26.44.030; and
     (b) May share information with community child protection teams, designated members of Washington Indian tribes, and/or citizen advisory groups to assist in case planning, consultation, and policy review per RCW 26.44.030.
     (5) Service options (ninety-day rule). Within ninety days of receipt of a report alleging a child is at risk of CA/N, the department shall:
     (a) Develop, with the family, a mutually agreed upon written service plan;
     (b) File a dependency petition with the juvenile court; or
     (c) Close the case.
     (6) Juvenile court case plans. When the department files a dependency petition, the department shall develop a written social study and proposed case plan for the court to consider at the dispositional hearing per RCW 13.34.120. The department shall:
     (a) Mail a dependency petition copy to the parents and the parents' attorney ten or more days before the disposition hearing; and
     (b) Provide the parents an opportunity to review and comment on the plan at the local DCFS office.
     (7) Reopening closed cases. The department may reopen any closed case for good cause including, but not limited to:
     (a) Further allegations of CA/N;
     (b) Additional information pertaining to the department's investigation; or
     (c) When necessary witnesses or other persons, for example, parent or child, are located or become available to complete the investigation.
     (8) Length of eligibility. Any child reported to the department shall be eligible for child protective services. A child shall remain eligible until the child is no longer:
     (a) Abused or neglected; or
     (b) At risk of CA/N subject to the provisions of WAC 388-15-130 and 388-15-132.

[Statutory Authority: RCW 26.44.050 and 26.44.070. 93-13-021 (Order 3567), § 388-15-132, filed 6/9/93, effective 7/10/93. Statutory Authority: RCW 74.15.030. 89-07-024 (Order 2773), § 388-15-132, filed 3/8/89. Statutory Authority: RCW 74.08.090 and 1979 c 155. 79-10-026 (Order 1431), § 388-15-132, filed 9/10/79; Order 1238, § 388-15-132, filed 8/31/77.]

WAC 388-15-134   Child protective services -- Notification.  (1) Duty to notify. The department shall notify the parent or legal custodian of a child when:
     (a) The department is investigating a report alleging an act or acts of child abuse or neglect (CA/N); and
     (i) Their child is alleged to be the victim; and/or
     (ii) The department interviews a child alleged to be the victim of CA/N.
     (b) The department takes a child into custody pursuant to a court order issued under RCW 13.34.050;
     (c) The department receives custody of a child from law enforcement pursuant to RCW 26.44.050; and
     (d) The department files a dependency petition.
     (2) Notification of noncustodial parents.
     (a) The department shall notify noncustodial parents when a child is taken into custody pursuant to RCW 26.44.050 or 13.34.050 and placed into the custody of the department, and
     (b) Notification shall also occur when the department files a dependency petition.
     (3) Notification of alleged perpetrator. The department shall notify the alleged perpetrator of the allegations of child abuse and neglect at the earliest point in the investigation that will not jeopardize the safety and protection of the child or the investigation process.
     (4) Notification contents. Whenever a child is taken into custody under RCW 13.34.050 or 26.44.050, the notification required by this section shall comply with the requirement of RCW 26.44.120. The notification shall also include:
     (a) A description of the department's action; and
     (b) The reason or reasons for the department's actions.
     (5) Opportunity to review case information. The department shall:
     (a) Notify the person or persons legally responsible for the child of the address of the office where the case record information will be on file; and
     (b) Provide them with the opportunity to read parts of the case record relating to the allegations, provided:
     (i) They have requested access to the information, and
     (ii) Such access is not otherwise prohibited by law.
     (6) Disclosure of case information. The department shall not disclose case record information except as permitted under provisions of chapter 388-320 WAC and applicable statutes. The department shall not disclose the name and address of any referent who requests their identity be held in confidence. Even if disclosure is otherwise permissible, the department may refuse disclosure of the name and address of any victim.
     (7) Notification of CPS investigative findings. Whenever the department completes an investigation of a child abuse or neglect report under chapter 26.44 RCW, the department shall notify the alleged perpetrator of the report and the department's investigative findings, whether founded, unfounded, or inconclusive. The notice shall also advise the person that:
     (a) A written response to the report may be provided to the department and that such response will be filed in the record following receipt by the department;
     (b) Information in the department's record may be considered in subsequent investigations or proceedings related to child protection or child custody;
     (c) There is currently information in the department's record that may be considered in determining that the person is disqualified from being licensed to provide child care, employed by a licensed child care agency, or authorized by the department to care for children; and
     (d) A person who has demonstrated a good faith desire to work in a licensed agency may request an informal meeting with the department to have an opportunity to discuss and contest the information currently in the record, pursuant to WAC 388-330-035(1).
     (8) Method of notification. The notification required by this section shall be made by regular mail to the person's last known address, with a copy of the notice placed in the case file.
     (9) Limits of duty to notify. The duty of notification created by this section shall be subject to the ability of the department to ascertain the location of the person to be notified. The department shall exercise reasonable, good-faith efforts to ascertain the location of persons entitled to notification under this section.

[Statutory Authority: RCW 74.15.030. 97-13-002, § 388-15-134, filed 6/4/97, effective 7/5/97; 89-07-024 (Order 2773), § 388-15-134, filed 3/8/89. Statutory Authority: RCW 74.08.090 and 1979 c 155. 79-10-026 (Order 1431), § 388-15-134, filed 9/10/79; Order 1238, § 388-15-134, filed 8/31/77.]

WAC 388-15-194   Home and community services--Nursing services.  (1) A registered nurse will review the plan of care for all Medicaid personal care clients.
     (2) Upon department or designee referral, a registered nurse will consult about or visit a community options program entry system client or a Medicaid personal care client to perform a nursing service which may include the following activities:
     (a) Nursing assessment/reassessment;
     (b) Instruction to care providers and clients;
     (c) Care coordination;
     (d) Evaluation.
     (3) The frequency and scope of the nursing service will be based on individual client need and will be provided as outlined in a nursing service design developed in coordination with each area agency on aging. Each design will include critical indicators of the need for the nursing service and must be approved by the following divisions as appropriate: aging and adult services administration, developmental disabilities, children's administration and mental health.
     (4) This nursing service will not be provided if activities duplicate services that the client is receiving from some other resource. Coordination and/or referrals to appropriate health care providers will occur as necessary.
     (5) The registered nurse providing this service will not perform skilled treatment except in the event of an emergency. The need for any skilled medical or nursing treatments will be referred to a health care provider, a home health agency or a contracted delegating nurse.
     (6) The registered nurse must document the result of the nursing service provided on a department-approved form. The registered nurse provides a copy to the staff who has case management responsibility.

[Statutory Authority: RCW 74.09.520 and 74.08.090. 98-20-022, § 388-15-194, filed 9/25/98, effective 10/26/98. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-194, filed 9/28/95, effective 10/29/95.]

WAC 388-15-202   Long-term care services -- Definitions.  The department shall use the definition in subsections (1) through (50) of this section for long-term care services. "Long-term care services" means the services administered directly or through contract by the aging and adult services administration of the department, including but not limited to nursing facility care and home and community services.
     (1) "Aged person" means a person sixty-five years of age or older.
     (2) "Agency provider" means a licensed home care agency or a licensed home health agency having a contract to provide long-term care personal care services to a client in the client's own home.
     (3) "Application" means a written request for medical assistance or long-term care services submitted to the department by the applicant, the applicant's authorized representative, or, if the applicant is incompetent or incapacitated, someone acting responsibly for the applicant. The applicant shall submit the request on a form prescribed by the department.
     (4) "Assessment" means an inventory and evaluation of abilities and needs.
     (5) "Attendant care" means the chore personal care service provided to a grandfathered client needing full-time care due to the client's need for:
     (a) Assistance with personal care; or
     (b) Protective supervision due to confusion, forgetfulness, or lack of judgment. Protective supervision does not include responsibilities a legal guardian should assume such as management of property and financial affairs.
     (6) "Authorization" means an official approval of a departmental action, for example, a determination of client eligibility for service or payment for a client's long-term care services.
     (7) "Available resources" is a term to describe a chore personal care client's assets accessible for use and conversion into money or its equivalent without significant depreciation in the property value.
     (8) "Blind person" means a person determined blind as described under WAC 388-511-1105 by the division of disability determination services of the medical assistance administration.
     (9) "Categorically needy" means the financial status of a person as defined under WAC 388-503-0310.
     (10) "Client" means an applicant for service or a person currently receiving services.
     (11) "Community residence" means:
     (a) The client's "own home" as defined in this section;
     (b) Licensed adult family home under department contract;
     (c) Licensed boarding home under department contract;
     (d) Licensed children's foster home;
     (e) Licensed group care facility, as defined in WAC 388-73-014(8); or
     (f) Shared living arrangement as defined in this section.
     (12) "Community spouse" means a person as described under WAC 388-513-1365 (1)(b).
     (13) "Companionship" means the activity of a person in a client's own home to prevent the client's loneliness or to accompany the client outside the home for other than personal care services.
     (14) "Contracted program" means services provided by a licensed and contracted home care agency or home health agency.
     (15) "COPES" means community options program entry system.
     (16) "Department" means the state department of social and health services.
     (17) "Direct personal care services" means verbal or physical assistance with tasks involving direct client care which are directly related to the client's handicapping condition. Such assistance is limited to allowable help with the tasks of ambulation, bathing, body care, dressing, eating, personal hygiene, positioning, self-medication, toileting, transfer, as defined under WAC 388-15-202 (38)(a) through (e), (j) through (l), (n), and (o).
     (18) "Disabled" means a person determined disabled as described under WAC 388-511-1105 by the division of disability determination services of the medical assistance administration.
     (19) "Disabling condition" means a condition which prevents a person from self-performance of personal care tasks without assistance.
     (20) "Estate recovery" means the department's activity in recouping funds after the client's death which were expended for long-term care services provided to the client during the client's lifetime per WAC 388-15-192.
     (21) "Grandfathered client" means a chore personal care services client approved for either:
     (a) Attendant care services provided under the chore personal care program when these services began before April 1, 1988; and
     (b) Family care services provided under the chore personal care program when these services began before December 14, 1987; and
     (c) The client was receiving the same services as of June 30, 1989.
     (22) "Home health agency" means a licensed:
     (a) Agency or organization certified under Medicare to provide comprehensive health care on a part-time or intermittent basis to a patient in the patient's place of residence and reimbursed through the use of the client's medical identification card; or
     (b) Home health agency, certified or not certified under Medicare, contracted and authorized to provide:
     (i) Private duty nursing; or
     (ii) Skilled nursing services under an approved Medicaid waiver program.
     (23) "Household assistance" means assistance with incidental household tasks provided as an integral, but subordinate part of the personal care furnished directly to a client by and through the long-term care programs as described in this chapter. Household assistance is considered an integral part of personal care when such assistance is directly related to the client's medical or mental health condition, is reflected in the client's service plan, and is provided only when a client is assessed as needing personal care assistance with one or more direct personal care tasks. Household assistance tasks include travel to medical services, essential shopping, meal preparation, laundry, housework, and wood supply.
     (24) "Income" means "income" as defined under WAC 388-500-0005.
     (25) "Individual provider" means a person employed by a community options program entry system (COPES) or Medicaid personal care client when the person:
     (a) Meets or exceeds the qualifications as defined under WAC 388-15-196;
     (b) Has signed an agreement to provide personal care services to a client; and
     (c) Has been authorized payment for the services provided in accordance with the client's service plan.
     (26) "Individual provider program (IPP)" means a method of chore personal care service delivery where the client employs and supervises the chore personal care service provider.
     (27) "Institution" means an establishment which furnishes food, shelter, medically-related services, and medical care to four or more persons unrelated to the proprietor. "Institution" includes medical facilities, nursing facilities, and institutions for the mentally retarded, but does not include correctional institutions.
     (28) "Institutional eligible client" means a person whose eligibility is determined under WAC 388-513-1315. "Institutionalized client" means the same as defined in WAC 388-513-1365(f).
     (29) "Institutional spouse" means a person described under WAC 388-513-1365 (1)(e).
     (30) "Medicaid" means the federal aid Title XIX program under which medical care is provided to:
     (a) Categorically needy as defined under WAC 388-503-0310; and
     (b) Medically needy as defined under WAC 388-503-0320.
     (31) "Medical assistance" means the federal aid Title XIX program under which medical care is provided to the categorically needy as defined under WAC 388-503-0310 and 388-503-1105.
     (32) "Medical institution" means an institution defined under WAC 388-500-0005.
     (33) "Medically necessary" and "medical necessity" mean the same as defined under WAC 388-500-0005.
     (34) "Medically oriented tasks" means direct personal care services and household assistance provided as an integral but subordinate part of the personal care and supervision furnished directly to a client.
     (35) "Mental health professional" means a person defined under WAC 275-57-020(25).
     (36) "Own home" means the client's present or intended place of residence:
     (a) In a building the client rents and the rental is not contingent upon the purchase of personal care services as defined in this section; or
     (b) In a building the client owns; or
     (c) In a relative's established residence; or
     (d) In the home of another where rent is not charged and residence is not contingent upon the purchase of personal care services as defined in this section.
     (37) "Personal care aide" means a person meeting the department's qualification and training requirements and providing direct Medicaid personal care services to a client. The personal care aide may be an employee of a contracted agency provider or may be an individual provider employed by the Medicaid personal care client.
     (38) "Personal care services" means both physical assistance and/or prompting and supervising the performance of direct personal care tasks and household tasks, as listed in subdivisions (a) through (q) of this subsection. Such services may be provided for clients who are functionally unable to perform all or part of such tasks or who are incapable of performing the tasks without specific instructions. Personal care services do not include assistance with tasks performed by a licensed health professional.
     (a) "Ambulation" means assisting the client to move around. Ambulation includes supervising the client when walking alone or with the help of a mechanical device such as a walker if guided, assisting with difficult parts of walking such as climbing stairs, supervising the client if client is able to propel a wheelchair if guided, pushing of the wheelchair, and providing constant or standby physical assistance to the client if totally unable to walk alone or with a mechanical device.
     (b) "Bathing" means assisting a client to wash. Bathing includes supervising the client able to bathe when guided, assisting the client with difficult tasks such as getting in or out of the tub or washing back, and completely bathing the client if totally unable to wash self.
     (c) "Body care" means assisting the client with exercises, skin care including the application of nonprescribed ointments or lotions, changing dry bandages or dressings when professional judgment is not required and pedicure to trim toenails and apply lotion to feet. In adult family homes or in licensed boarding homes contracting with DSHS to provide assisted living services, dressing changes using clean technique and topical ointments must be delegated by a registered nurse in accordance with chapter 246-840 WAC. "Body care" excludes:
     (i) Foot care for clients who are diabetic or have poor circulation; or
     (ii) Changing bandages or dressings when sterile procedures are required.
     (d) "Dressing" means assistance with dressing and undressing. Dressing includes supervising and guiding client when client is dressing and undressing, assisting with difficult tasks such as tying shoes and buttoning, and completely dressing or undressing client when unable to participate in dressing or undressing self.
     (e) "Eating" means assistance with eating. Eating includes supervising client when able to feed self if guided, assisting with difficult tasks such as cutting food or buttering bread, and feeding the client when unable to feed self.
     (f) "Essential shopping" means assistance with shopping to meet the client's health care or nutritional needs. Limited to brief, occasional trips in the local area to shop for food, medical necessities, and household items required specifically for the health, maintenance, and well-being of the client. Essential shopping includes assisting when the client can participate in shopping and doing the shopping when the client is unable to participate.
     (g) "Housework" means performing or helping the client perform those periodic tasks required to maintain the client in a safe and healthy environment. Activities performed include such things as cleaning the kitchen and bathroom, sweeping, vacuuming, mopping, cleaning the oven, and defrosting the freezer, shoveling snow. Washing inside windows and walls is allowed, but is limited to twice a year. Assistance with housework is limited to those areas of the home which are actually used by the client. This task is not a maid service and does not include yard care.
     (h) "Laundry" means washing, drying, ironing, and mending clothes and linens used by the client or helping the client perform these tasks.
     (i) "Meal preparation" means assistance with preparing meals. Meal preparation includes planning meals including special diets, assisting clients able to participate in meal preparation, preparing meals for clients unable to participate, and cleaning up after meals. This task may not be authorized to just plan meals or clean up after meals. The client must need assistance with actual meal preparation.
     (j) "Personal hygiene" means assistance with care of hair, teeth, dentures, shaving, filing of nails, and other basic personal hygiene and grooming needs. Personal hygiene includes supervising the client when performing the tasks, assisting the client to care for the client's own appearance, and performing grooming tasks for the client when the client is unable to care for own appearance.
     (k) "Positioning" means assisting the client to assume a desired position, assistance in turning and positioning to prevent secondary disabilities, such as contractures and balance deficits or exercises to maintain the highest level of functioning which has already been attained and/or to prevent the decline in physical functional level. (Range of motion ordered as part of a physical therapy treatment is not included.)
     (l) "Self-medication" means assisting the client to self-administer medications prescribed by attending physician. Self-medication includes reminding the client of when it is time to take prescribed medication, handing the medication container to the client, and opening a container.
     (m) "Supervision" means being available to:
     (i) Help the client with personal care tasks that cannot be scheduled, such as toileting, ambulation, transfer, positioning, some medication assistance; and
     (ii) Provide protective supervision to a client who cannot be left alone because of impaired judgment.
     (n) "Toileting" means assistance with bladder or bowel functions. Toileting includes guidance when the client is able to care for own toileting needs, helping client to and from the bathroom, assisting with bedpan routines, using incontinent briefs on client, and lifting client on and off the toilet. Toileting may include performing routine perineal care, colostomy care, or catheter care for the client when client is able to supervise the activities. In adult family homes or in licensed boarding homes contracting with DSHS to provide assisted living services colostomy care and catheterization using clean technique must be delegated by a registered nurse in accordance with chapter 246-840 WAC.
     (o) "Transfer" means assistance with getting in and out of a bed or wheelchair or on and off the toilet or in and out of the bathtub. Transfer includes supervising the client when able to transfer if guided, providing steadying, and helping the client when client assists in own transfer. Lifting the client when client is unable to assist in their own transfer requires specialized training.
     (p) "Travel to medical services" means accompanying or transporting the client to a physician's office or clinic in the local area to obtain medical diagnosis or treatment.
     (q) "Wood supply" means splitting, stacking, or carrying wood for the client when the client uses wood as the sole source of fuel for heating and/or cooking. This task is limited to splitting, stacking, or carrying wood the client has at own home. The department shall not allow payment for a provider to use a chain saw or to fell trees.
     (39) "Physician" means a doctor of medicine, osteopathy, or podiatry, as defined under WAC 388-500-0005.
     (40) "Plan of care" means a "service plan" as described under WAC 388-15-205.
     (41) "Property owned" means any real and personal property and other assets over which the client has any legal title or interest.
     (42) "Provider" or "provider of service" means an institution, agency, or person:
     (a) Having a signed department agreement to furnish long-term care client services; and
     (b) Qualified and eligible to receive department payment.
     (43) "Relative" means:
     (a) For chore personal care service, a client's spouse, father, mother, son, or daughter;
     (b) For Medicaid personal care service:
     (i) "Legally responsible relative" means a spouse caring for a spouse or a biological, adoptive, or stepparent caring for a minor child.
     (ii) "Nonresponsible relative" means a parent caring for an adult child and an adult child caring for a parent.
     (44) "Service plan" means a plan for long-term care service delivery as described under WAC 388-15-205.
     (45) "Shared living arrangement" for purposes of Medicaid personal care means an arrangement where:
     (a) A nonresponsible relative as defined in (43)(b)(ii) above is the personal care provider and resides in the same residence with common facilities, such as living, cooking, and eating areas; or
     (b) A minor child age seventeen or younger lives in the home of a legally responsible relative as defined in (43)(b)(i) above.
     (46) "SSI-related" means a person who is aged, blind, or disabled.
     (47) "Supervision" means a person available to a long-term care client as defined under WAC 388-15-202 (36)(m).
     (48) "Supplemental Security Income (SSI)" means the federal program as described under WAC 388-500-0005.
     (49) "Title XIX" is the portion of the federal Social Security Act which authorizes federal funding for medical assistance programs, e.g., nursing facility care, COPES, and Medicaid personal care home and community-based services.
     (50) "Transfer of resources" means the same as defined under WAC 388-513-1365 (1)(g).
     (51) "Unscheduled tasks" means ambulation, toileting, transfer, positioning, and unscheduled medication assistance as described in this chapter.

[Statutory Authority: RCW 74.09.520. 97-20-066, § 388-15-202, filed 9/25/97, effective 10/1/97. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-202, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-202, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.09.520, 74.39.005, 74.08.043 and 74.08.545. 93-06-042 (Order 3501), § 388-15-202, filed 2/24/93, effective 3/27/93.]

WAC 388-15-203   Long-term care services--Assessment of task self-performance and determination of required assistance.  (1) Purpose. The assessor as identified in subsection (2)(a) of this section shall:
     (a) Identify client strengths to maximize current strengths and promote client independence;
     (b) Evaluate physical health, functional and cognitive abilities, social resources and emotional and social functioning for service planning for long-term care;
     (c) Identify client values and preferences for effective service planning based on the person's values and lifestyles; and
     (d) Determine client's need for informal support, community support and services, and department paid services.
     (2) Assessment responsibility.
     (a) Department staff or designee while assessing need for case management shall perform the assessment.
     (b) Except for adult protective service, the assessors shall perform a separate assessment for each client.
     (c) The assessors shall document the assessment on a prescribed form.
     (d) The assessors shall perform the assessment based on an in- person interview with the client.
     (e) When performing the assessment, the assessors shall take into account the client's:
     (i) Risk of and eligibility for nursing facility placement;
     (ii) Health status, psychological/social/cognitive functioning, income and resources, and functional abilities;
     (iii) Living situation; and
     (iv) Availability of alternative resources providing needed assistance, including family, neighbors, friends, community programs, and volunteers.
     (3) The adult client's functional ability to self-perform each personal care task and household task shall be determined using the following definitions of the assistance required:
     (a) Ambulation:
     (i) Independent. The client is mobile, with or without an assistive device, both inside and outside the household without the assistance of another person.
     (ii) Minimal. The client is mobile inside without assistance but needs the assistance of another person outside; or the client needs occasional assistance of another person inside, and usually needs assistance of another person outside.
     (iii) Substantial. The client is only mobile with regular assistance of another person both inside and outside.
     (iv) Total. The client is not mobile.
     (b) Bathing:
     (i) Independent. The client can bathe self.
     (ii) Minimal. The client requires oversight help or reminding only. The client can bathe without assistance or supervision, but must be reminded some of the time; or the client cannot get into the tub alone and physical help is limited to stand-by assist only.
     (iii) Substantial. The client requires physical help in a large part of the bathing activity, for example, to lather, wash, and/or rinse own body or hair.
     (iv) Total. The client is dependent on others to provide a complete bath.
     (c) Body care:
     (i) Independent. The client can apply ointment, lotion, change bandages or dressings, and perform exercises without assistance.
     (ii) Minimal. The client requires oversight help or reminding only, or requires occasional assistance.
     (iii) Substantial. The client requires limited physical help to apply ointment, lotion, or to perform dry bandage or dressing change.
     (iv) Total. The client is dependent on others to perform all required body care.
     (d) Dressing:
     (i) Independent. The client can dress and undress without assistance or supervision.
     (ii) Minimal. The client can dress and undress, but may need to be reminded or supervised to do so on some days; the client can assist dressing and undressing, but frequently or most of the time needs some physical assistance.
     (iii) Substantial. The client always needs assistance to do parts of dressing and undressing.
     (iv) Total. The client is dependent on others to do all dressing and undressing.
     (e) Eating:
     (i) Independent. The client can feed self, chew and swallow solid foods without difficulty, or can feed self by stomach tube or catheter.
     (ii) Minimal. The client:
     (A) Can feed self, chew and swallow foods, but needs reminding to maintain adequate intake;
     (B) May need food cut up;
     (C) Can feed self only if food is brought to the client.
     (iii) Substantial. The client:
     (A) Can feed self but needs standby assistance for occasional gagging, choking, or swallowing difficulty; or
     (B) Needs reminders/assistance with adaptive feeding equipment; or
     (C) Must be fed some or all food by mouth by another person.
     (iv) Total. The client must be totally fed by another person and/or frequently gags or chokes due to difficulty in swallowing; or the client must be fed by another person by stomach tube or by venous access.
     (f) Essential shopping:
     (i) Independent. The client can drive and is licensed or the client is capable of using public transportation.
     (ii) Minimal. The client can use available transportation and does not need assistance with shopping, but needs instructions or physical assistance to get to or from transportation vehicle.
     (iii) Substantial. The client is dependent on being accompanied or helped by others to access community shops and needs assistance with shopping.
     (iv) Total. The client is totally dependent on others to do essential shopping.
     (g) Housework:
     (i) Independent. The client can perform essential housework.
     (ii) Minimal. The client needs assistance or needs cuing or supervision in self-performance of essential housework one or two times per month in client use areas.
     (iii) Substantial. The client needs weekly assistance of another with essential housework in client use areas.
     (iv) Total. The client is dependent on others to do all housework in client use areas.
     (h) Laundry:
     (i) Independent. The client is capable of using available laundry facilities.
     (ii) Minimal. The client is physically capable of using laundry facilities, but requires cuing and/or supervision.
     (iii) Substantial. The client is not able to use laundry facilities without physical assistance.
     (iv) Total. The client is dependent upon others to do all laundry.
     (i) Meal preparation:
     (i) Independent. The client can prepare and cook required meals.
     (ii) Minimal. The client requires some instruction or physical assistance to prepare meals.
     (iii) Substantial. The client can participate but needs substantial assistance to prepare meals.
     (iv) Total. The client cannot prepare or participate in preparation of meals.
     (j) Personal hygiene:
     (i) Independent. The client can manage personal hygiene and grooming tasks on a regular basis.
     (ii) Minimal. The client can manage their personal hygiene and grooming but must be reminded or supervised at least some of the time; the client regularly requires some limited assistance with both personal hygiene and grooming.
     (iii) Substantial. The client regularly requires assistance with personal hygiene and grooming and cooperates in the process.
     (iv) Total. The client is dependent on others to provide all personal hygiene and grooming.
     (k) Positioning:
     (i) Independent. The client can move to and from a lying position, position their body in bed, and get into and out of bed and chairs.
     (ii) Minimal. The client can move to and from a lying position, turn from side to side, and position their body while in bed and chairs but requires assistance some of the time.
     (iii) Substantial. The client needs occasional assistance to move to and from a lying position, turn from side to side, and position body while in bed and chairs.
     (iv) Total. The client needs assistance most or all of the time to move to and from a lying position, turn from side to side, and position body while in bed and chairs.
     (l) Self-medication:
     (i) Independent. The client can take own medications or does not take medication.
     (ii) Minimal. The client is physically able to take medications but requires another person to:
     (A) Remind, monitor, or observe the taking of medications less than daily; or
     (B) Open a container, lay out, or organize medications less than daily.
     (iii) Substantial. The client can physically take medications, but requires another person to either remind, monitor, or observe the taking of medications daily; or the client can physically take medications if another person daily opens containers, lays out, organizes medications.
     (iv) Total. The client cannot physically take medications and requires another person to assist and administer all medications.
     (m) Toileting:
     (i) Independent. The client can use the toilet without physical assistance or supervision; or the client can manage own closed drainage system if the system has a catheter or sheath; or the client uses and manages protective aids. The client may need grab bars or raised toilet seat.
     (ii) Minimal. The client needs stand-by assistance for safety or encouragement. The client may need minimal physical assistance with parts of the task, such as clothing adjustment, washing hands, wiping, and cleansing. The client may need a protective garment and may or may not be aware of this need.
     (iii) Substantial. The client cannot get to the toilet without assistance; or the client needs substantial physical assistance with part of the task; or the client needs someone else to manage care of a closed drainage system if it has a catheter or sheath. The client may or may not be aware of own needs.
     (iv) Total. The client is physically unable to use toilet. Requires continual observation and total cleansing. The client may require protective garments or padding or linen changes. The client may or may not be aware of own needs.
     (n) Transfer:
     (i) Independent. The client can transfer without physical assistance.
     (ii) Minimal. The client transfers without assistance most of the time, but needs assistance on occasion.
     (iii) Substantial. The client can assist with own transfers, but frequently or most of the time needs assistance.
     (iv) Total. The client transfers must be done by someone else.
     (o) Travel to medical services:
     (i) Independent. The client can drive and is licensed; or is capable of using available public transportation.
     (ii) Minimal. The client cannot drive or can drive but should not; or public transportation is not available.
     (iii) Substantial. The client requires physical assistance or supervision to both get into and out of a vehicle, but can use the transportation without assistance during the trip.
     (iv) Total. The client is totally dependent on being accompanied or helped by others during the trip.
     (p) Wood supply:
     (i) Independent. The client does not rely on wood as the sole fuel source or is capable of splitting, stacking, or carrying wood for heating or cooking.
     (ii) Minimal. The client can carry wood but needs occasional assistance with splitting or stacking wood.
     (iii) Substantial. The client is not able to carry, split, or stack wood, but is able to use the wood supply once it is inside the residence.
     (iv) Total. The client is dependent on another person to establish and maintain heat for cooking or residential heating.
     (4) Scoring of functional abilities and supports.
     (a) For each direct personal care service and household assistance task listed on the assessment form, the assessor shall determine:
     (i) The client's ability to perform each activity;
     (ii) Assistance available to the client through alternative resources, including families, friends, neighbors, community programs, and unpaid caregivers; and
     (iii) Assistance needed from department programs after alternative resources have been taken into account.
     (b) The assessor shall award points for each task based on the level of unmet need. The number of points allowable for each task are listed below under columns identified as 0 = none, M = minimal, S = substantial, and T = total:

TASK
  
0
M
S
T
Eating  
     Breakfast 0 4 7 10
     Light meal 0 4 7 10
     Main meal 0 5 10 15
Toileting 0 5 10 15
Ambulation 0 4 7 10
Transfer 0 1 3 5
Positioning 0 1 3 5
Body care 0 5 10 15
Personal hygiene 0 1 3 5
Dressing 0 4 7 10
Bathing 0 4 7 10
Self-medication 0 2 4 6
Travel to medical services 0 1 2 3
Essential shopping
     With client
          or		 0 5 10 15
     For client 0 1 3 5
Meal preparation
     Breakfast		 0 4 7 10
     Light meal 0 4 7 10
     Main meal 0 5 10 15
Laundry
     Facilities in home
          or		 0 1 2 3
     Facilities out of home 0 3 5 7
Housework 0 1 2 3
Wood supply
 0
 3
 5
 7
         
     (c) The assessor shall add together the points awarded for each task to obtain the total score for the applicant or client.
     (5) Hour computation. The assessor shall:
     (a) Convert the total score into maximum hours per month which may be authorized using the scoring conversion chart.

Scoring Conversion Chart
 
MAXIMUM		  
MAXIMUM
MAXIMUM
Score
 Hours
Score
   Hours
 Score
 Hours
1 - 4 5   60 - 64 44   120 - 124 83  
5 - 9 8   65 - 69 47   125 - 129 87  
10 - 14 11   70 - 74 51   130 - 134 90  
15 - 19 14   75 - 79 54   135 - 139 93  
20 - 24 18   80 - 84 57   140 - 144 97  
25 - 29 21   85 - 89 60   145 - 149 100  
30 - 34 24   90 - 94 64   150 - 154 103  
35 - 39 28   95 - 99 67   155 - 159 106  
40 - 44 31   100 - 104 70   160 - 164 110  
45 - 49 34   105 - 109 74   165 - 169 113  
50 - 54 37   110 - 114 77   170 and
55
-
 59
 41
   115
 -
 119
 80
   Above
 116
  
                         
     (b) Recognize conversion hours show client need, and may not reflect department-paid hours as determined by program standards.
     (6) The assessor shall determine the client's additional hours of supervision needed:
     (a) Due to impaired judgment; and
     (b) For standby assistance necessary for unscheduled tasks defined under WAC 388-15-202(51); and
     (c) Recognize supervision hours show client need, and may not reflect department paid hours as determined by program standards.
     (7) Department staff or the department's designee shall authorize services to correspond with the client's assessed need according to eligibility criteria for aging and adult services administration programs or the eligibility criteria for the division authorizing the service. The department or the department's designee shall notify the client of the right to contest a denial or reduction of services.
     (8) Department staff or the department designee shall be responsible for representing the department at any hearing involving the assessment or decisions made relating to such assessment.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-203, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-203, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.09.520, 74.39.005, 74.08.043 and 74.08.545. 93-06-042 (Order 3501), § 388-15-203, filed 2/24/93, effective 3/27/93.]

WAC 388-15-204   Home and community services--Reassessment.  (1) The assessor shall perform a full reassessment based on an in-person interview of the client's strengths, physical health, functional and cognitive abilities, social resources, emotional and social functioning, preferences, need for informal and community support and services, and need for department paid services:
     (a) As required by the program standards in which the client has been authorized services; and
     (b) When deemed necessary because of a change in the client's condition or situation.
     (2) The department or the department's designee shall continue, deny, or alter services to correspond with the client's present need. The department shall notify the client of the right to contest a denial or reduction of services.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.100, 74.39.010, 74.39.030 and 1996 c 302 § 5. 96-20-093, § 388-15-204, filed 10/1/96, effective 11/1/96. Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-204, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.09.520, 74.39.005, 74.08.043 and 74.08.545. 93-06-042 (Order 3501), § 388-15-204, filed 2/24/93, effective 3/27/93.]

WAC 388-15-205   Long-term care services--Service plan development.  (1) The department or its designee shall develop a service plan with the client which identifies ways to meet the client's needs with the most appropriate services, both formal and informal.
     (2) Staff who develop the service plan shall document the:
     (a) Client's specific problems and needs;
     (b) Plan for meeting each need;
     (c) Responsible parties for carrying out each part of the plan;
     (d) Anticipated outcomes;
     (e) Dates and changes to the plan;
     (f) Dates of referral, service initiation, follow-up reviews; and
     (g) Agreement to the service plan by the client or the client's representative.

[Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-205, filed 9/28/95, effective 10/29/95. Statutory Authority: RCW 74.09.520, 74.39.005, 74.08.043 and 74.08.545. 93-06-042 (Order 3501), § 388-15-205, filed 2/24/93, effective 3/27/93.]

WAC 388-15-240   Family planning.  (1) Family planning services are those services which enable individuals including minors and handicapped persons, to make choices regarding the number and spacing of children. These services include outreach, information, referral, support services (such as transportation and child care), counseling, education, medical care and follow-up. Family planning medical services include physical examinations, lab tests, diagnosis, treatment, surgical procedures as appropriate, drugs, supplies, devices furnished, prescribed by or under the supervision of a physician.
     (2) Goals for family planning shall be limited to those specified in WAC 388-15-010 (1)(a) through (e). Also see WAC 388-15-010(2).
     (3) Family planning is a federally mandated service offered to all appropriate persons in the aid to families of dependent children program and also to any appropriate individual who meets the state's financial eligibility requirements (including anyone who within three months has been an applicant for or a recipient of AFDC (see WAC 388-15-020 (1)(e)(i))). Services will be provided promptly to all of the foregoing individuals who voluntarily request such services.

[Order 1238, § 388-15-240, filed 8/31/77; Order 1204, § 388-15-240, filed 4/1/77; Order 1147, § 388-15-240, filed 8/26/76; Order 1088, § 388-15-240, filed 1/19/76.]

WAC 388-15-400   Services to individuals released from mental hospitals or in danger of requiring commitment to such institutions.  (1) These services are those services necessary to enable eligible individuals age 65 or over to remain in the community in lieu of care in a mental hospital, or upon release from a mental hospital, to return to and live in the community. Services may also be provided to recipients of AFDC who are being released from mental institutions.
     (2) Necessary adult services shall be provided to beneficiaries of SSI, recipients of Title XIX, and other individuals whose income does not exceed the standard in WAC 388-15-020 who:
     (a) Are released from a mental hospital, or
     (b) Need alternate care to continue to live in the community.
     (3) Services provided to accomplish the objective to assist the recipient to maintain or be restored to the greatest possible degree of independent functioning and self help shall be any appropriate adult services described in WAC 388-15-100 through 388-15-400.
     (4) Services to be provided to accomplish this objective for recipients of AFDC age 21 or under being released from mental institutions shall be any appropriate family or children's service described in WAC 388-15-100 through 388-15-400.
     (5) See also chapter 388-95 WAC.

[Order 1088, § 388-15-400, filed 1/19/76.]

WAC 388-15-650   Purpose.  To assist individuals to remain in the community in the least restrictive environment while enabling families and other caregivers to continue providing needed support. WAC 388-15-650 through 388-15-662 is to regulate adult day health facilities that receive Medicaid or state general funding for client care. Adult day health programs that do not receive any Medicaid or state general funds are exempt from these requirements.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-650, filed 5/27/99, effective 6/27/99.]

WAC 388-15-651   Definitions.  "Adult day care" (level I). Adult day care provides supervised daytime programs where frail and disabled adults can participate in social, educational, and recreational activities. Services at this level are the basic "core services" that must be provided in all adult day care and adult day health programs. Level I is appropriate for clients who have chronic medical conditions that do not require the services of a skilled health professional on a routine basis. A registered nurse and social worker provide consultation regarding the individual's participation in the program and assessment of the client's overall well-being and need for additional services. Level I offers respite to caregivers by providing a safe alternative to home care.
     "Adult day health" (level II). Adult day health is a structured program that provides licensed rehabilitative and skilled nursing services in an environment that also offers social work services and socialization for frail and disabled adults. Level II services provide rehabilitative, nursing, and professional level of psychological/counseling services with a focus on prevention, teaching, and health monitoring. Each participant has a specialized plan of care designed to structure his or her participation and to address particular needs.
     "Certification." The process by which an area agency on aging as authorized by the department certifies an adult day health center to be eligible for Medicaid (Title XIX) reimbursement for direct, level II services provided to eligible individuals. The program must directly provide the services and meet requirements set by the department including fiscal requirements for contracting with the department. Adult day health centers that do not accept Medicaid or state-funded clients are not certified through this process.
     "Core services." A common set of services that is provided by all programs. Services must include: client screening, individual assessment, plan of care; basic health monitoring with consultation from a registered nurse; social services, therapeutic activities, at least one nutritional meal per day, including modified diet if needed; coordination and/or provision of transportation; and emergency care for participants.
     "Intake evaluation." The screening process conducted by the adult day health program must be completed in order to gain an initial assessment of the appropriateness of the adult day health program for the client. During the intake process, clients for whom the program is not appropriate, are referred to other community agencies.
     "Plan of care." The written plan that is developed with the participation of the client, and/or the client's authorized representative, is monitored by the individual responsible from the multidisciplinary team for each participant's plan. The plan of care details the services to be provided through identifying services needed with goals, objectives, and duration of the services.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-651, filed 5/27/99, effective 6/27/99.]

WAC 388-15-652   Adult day care (COPES level I).  (1) Determining eligibility for COPES level I adult day care.
     (a) Home and community services staff (HCS) or area agency on aging (AAA) case managers determine eligibility, by determining the needs of the client cannot be appropriately met in a less structured setting and in accordance with the criteria listed in subsection (2) of this section.
     (b) The need for services must be documented in the plan of care, assessed, and re-authorized at regular, specified intervals.
     (c) A physician does not need to authorize adult day care services as is required for level II adult day health.
     (2) A person who is eligible for COPES and needing supervision or activities of daily living who can benefit from level I services to remain in their own home may receive level I services if it is an approved part of the clients service plan developed by HCS staff, AAA staff or authorized subcontractors.
     Eligibility criteria for adult day care COPES level I. Clients are eligible when they are:
     (a) Eligible for COPES as defined in WAC 388-15-620; and
     (b) Ineligible for, and/or are eligible for, but do not have access to, level II adult day health; and
     (c) Determined to be in need of one or more of the following services:
     (i) Provision of personal care as defined in WAC 388-15-202(38);
     (ii) Basic health monitoring with consultation from a registered nurse;
     (iii) Therapeutic activities; or
     (iv) Supervision or protection.
     (3) Identifying providers. The AAA directly designates adult day care level I providers through a COPES contract.
     (4) Rates and sources of payment for adult day care level I.
     (a) Transportation is not reimbursed under this rate. Arrangements for transportation for eligible Medicaid recipients are made with the local Medicaid transportation brokers or with individual client COPES funds.
     (b) Services are reimbursed on an hourly basis up to four hours per day. Any service provided over four hours per day shall be reimbursed at the daily rate. Effective July 1, 1999 the rates are as follows:
Counties COPES Level I
  Daily rate Hourly rate
King $34.51 $8.62
Benton, Clark, Franklin, Kitsap, Pierce, Snohomish, Spokane, Thurston, Whatcom, and Yakima $30.70 $7.68
All other counties $29.10 $7.27
     (c) Service plan for adult day care level I. The level I service is a part of the COPES service plan for the client. This plan is developed by HCS, AAA (or authorized subcontractor) staff. A client/participant may receive both level I and level II services on different days. If, according to an adult day health center plan of care, a client/participant may need a level II service three days per week, but only wishes and would benefit from socialization or activities of daily living (ADL) assistance two additional days, both services may be authorized to complement the week.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-652, filed 5/27/99, effective 6/27/99.]

WAC 388-15-653   Adult day health (level II).  (1) Determining eligibility for level II.
     (a) Certified providers assess the prospective client's need for day health. The assessment must include all services that the client has been authorized to receive. A state-approved assessment tool must be used. The two approved tools are:
     (i) The OARS multidimensional functional assessment; and
     (ii) The comprehensive assessment (CA) provided by AASA. The CA must not contain the AASA/DSHS logo.
     (b) The adult day health provider must document the client's need for skilled nursing care or rehabilitative therapy and the frequency of the planned care provision.
     (c) Day health providers must verify each client's Medicaid (Title XIX) and/or COPES eligibility.
     (d) The provider must obtain a current medical report from the client's physician. The report must have been completed and dated by the client's physician within the last three months. The facility must inform the physician that he or she is documenting the need for skilled nursing or professional rehabilitative therapy services. The facility staff must obtain, from the attending physician, the following additional medical information:
     (i) Frequency with which the client must be seen by the physician (client must agree to visits as ordered by the physician);
     (ii) Orders for physical, speech, and hearing or other rehabilitative therapy; and
     (iii) The physician's signature shall indicate that the client has a medical need for adult day health services and orders the development of a plan of care, and the provision of adult day health services.
     (e) The multidisciplinary team, in preparing the plan of care, shall include input from the attending physician of any client funded by Medicaid.
     (f) The plan of care shall be forwarded to the attending physician within one week of completion.
     (g) Medicaid clients shall have their plan of care reassessed at least once every three months by the multidisciplinary team, which is to include the clients attending physician.
     (h) Progress notes on Medicaid clients must be recorded weekly.
     (i) Changes in the Medicaid clients plan of care are to be filed in their case record and a copy forwarded to the clients physician.
     (2) Eligibility criteria for adult day health level II.
     (a) Applicants are considered eligible for level II when they are:
     (i) Active Title XIX recipients in the following categories:
Medical ID Code Medical program eligibility
CNP Categorically needy program
CNP-QMB Categorically needy qualified medical beneficiaries
GAU/W General assistance unemployable alcohol and drug addiction treatment and support act
     or
     (ii) Enrolled COPES clients receiving at least one COPES service (not including level II day health).
     (b) In addition to subsection (1)(a) of this section, eligible clients must also be in need of one or more of the following and not have access to:
     (i) Skilled nursing services: Skilled nursing services are services provided by a registered nurse (RN), or a licensed practical nurse (LPN). Reminding or coaching a client is not a skilled service. Skilled nursing services may include, but is not limited to, one or more of the following:
     (A) Observation and assessment: This service may be medically necessary for a client who is in an unstable condition.
     (B) Teaching and training activities: Teaching and training activities enable the client to become independent. Examples of teaching a client are:
     (I) Self-administration of an injection,
     (II) Prefill insulin syringes,
     (III) Irrigate a catheter,
     (IV) Care for a colostomy or ileostomy,
     (V) Dressing changes and aseptic techniques,
     (VI) Management of activities of daily living,
     (VII) Understand an illness, medications, its symptoms and how to cope.
     (C) Intervention: Services provided directly by the licensed nurse may include, but are not limited to:
     (I) Insert or irrigate a catheter,
     (II) Administer medications or medical gases,
     (III) The administration and management of infusion therapy services.
     (ii) Rehabilitative therapies: Therapy services must be medically necessary for preventing further deterioration or restoring a function affected by the client's illness, disability, or injury. These services must be provided by or under the supervision of the therapist.
     (A) Physical therapy: Physical therapy must be provided according to applicable state practice laws and regulations. Physical therapy may include but not be limited to:
     (I) Assessing the participant's mobility level, strength, range of motion, endurance, balance, ability to transfer.
     (II) Provide treatment to relieve pain and/or develop, restore, or maintain functioning.
     (III) Establish a maintenance program and provide written and verbal instructions to program staff and the family/caregiver to assist the participant with implementation.
     (B) Occupational therapy: Occupational therapy services must be provided according to applicable state practice laws and regulations. Occupational therapy may include, but are not limited to:
     (I) Administer basic evaluation to determine baseline level of functioning, ability to transfer, range of motion, balance, strength and coordination, activities of daily living and cognitive-perceptual functioning.
     (II) Teach and train participant and/or staff in the use of therapeutic, creative, and self-care activities to improve or maintain the participant's capacity for self-care and independence, and increase the range of motion, strength and coordination.
     (C) Speech pathology and audiology: Speech pathology and audiology services must be provided according to applicable state practice laws and regulations. Services may include, but are not limited to:
     (I) Establish a treatment program to improve communication ability and correct disorders.
     (II) Provide speech therapy procedures that include auditory comprehension tasks, visual and/or reading comprehensive tasks, language intelligibility tasks, or training involving the use of alternative communication devices.
     (III) Swallowing assessment and treatment.
     (c) The client must receive services from one of the licensed professionals listed above. If, at the time of reassessment, it is determined that the participant requires fewer or more days of attendance, based on documentation of care delivered, the plan of care will be adjusted.
     (3) Identifying providers. Level II providers for billing purposes are designated through a contract with the DSHS medical assistance administration (MAA). In order to be eligible to contract with MAA, they must be certified by the AAA. The AAA is required to conduct an annual review for continuing certification for each provider.
     (4) Rates for level II and sources of payment.
     (a) Transportation is not reimbursed under level II adult day health rate. Arrangements for transportation are made with the local Medicaid transportation brokers.
     (b) Effective July 1, 1999 the rates are as follows:
Counties Rate  
  Level II  
King $44.92  
Benton, Clark, Franklin, Kitsap, Pierce, Snohomish, Spokane, Thurston, Whatcon, and Yakima $40.73  
All other counties $38.49  
     (c) There is a one time only intake evaluation that is reimbursed at eighty-four dollars and fifty-six cents.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-653, filed 5/27/99, effective 6/27/99.]

WAC 388-15-654   Plan of care.  The plan of care:
     (1) Is developed by the multidisciplinary team of the adult day health program. In determining days of attendance for each participant, the program will assess the individual for the frequency of need for any of the above listed services. In addition, the plan should determine the frequency for active psycho-social therapy, which includes assessment for and treatment of mental illness, which must be provided by an appropriate therapist as defined in RCW or state regulations.
     (2) For level II determine the frequency of attendance based on frequency of need for skilled nursing or rehabilitation therapy.
     (3) Must be authorized by the participant's physician. The physician must be informed that he or she is documenting the participant's need for services described in the plan of care.
     (4) Must include at a minimum the following:
     (a) Identified needs in each service area;
     (b) Time-limited measurable goals and objectives of the care for the person served;
     (c) Type and scope of interventions to be provided in order to reach predicted outcomes;
     (d) Discharge/transition plan for the person, including specific criteria for discharge/transition.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-654, filed 5/27/99, effective 6/27/99.]

WAC 388-15-655   Title XIX adult day health certification and monitoring.  (1) Administration.
     (a) Role of the AAA.
     (i) The AAA, as authorized by the department, is responsible for the administration of the certification process for determining eligibility of an adult day health program to receive Medicaid (Title XIX) funds. The AAA will make the initial certification and annual review (recertification) of applicants. A letter of certification will be given to applicants meeting all requirements, administrative and fiscal, for contracting with the department. The AAA shall notify the department in writing of all certifications.
     (ii) When an applicant applying for initial certification does not meet all the certification requirements, certification will be denied. A notice from the AAA setting forth the reason for denial will be mailed to the applicant within thirty days after completion of the site visit.
     (iii) The department may take action such as, but not limited to, stop placement, corrective action or revocation of certification at any time the adult day health center is found not to be in compliance with client eligibility requirements, or not meeting the administrative or fiscal requirements. The AAA shall notify the program in writing of the reasons for revocation. Revocation will become effective sixty days after notice is mailed to the facility. Revocation may be suspended if the program submits an approved corrective action plan within thirty days after the mailing date of the revocation notice. The AAA will determine the date by which the corrective action must be completed.
     (2) Minimum requirements for certification.
     (a) Mission statement, articles of incorporation and bylaws.
     (b) Names and addresses of the board of directors (including minutes of the last three meetings) if the applicant is a nonprofit organization. Names and addresses of all owners if the applicant is a proprietary.
     (c) Organizational chart.
     (d) Total program operating budget including all revenue sources and client fees generated.
     (e) Program policies and operating procedures manual (all programs must operate at least three days a week and provide a structured program for participants at least four hours a day.
     (f) Personnel policies and job descriptions of each paid staff position and volunteer positions.
     (g) Definitions, policies and procedures about suspected abuse, neglect, or exploitation and mandatory reporting to adult protective services.
     (h) Financial statement or the latest audit report of the organization by a certified public accountant (CPA).
     (i) A floor plan of the facility indicating usage of space with interior measurements.
     (j) Building inspection report, fire department inspection report, local health department inspection report, and food handler permit if food is prepared in the facility.
     (k) Updated TB test for each staff member.
     (l) All forms used in client's case records/files.
     (m) Program/activities calendar for the month prior to application.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-655, filed 5/27/99, effective 6/27/99.]

WAC 388-15-656   Administration and organization.  (1) Governing board.
     (a) Unless the program is independently owned or functions through a governmental unit, a formal governing body shall have full legal authority and fiduciary responsibility for the operation of the program, adopting bylaws, and rules that address:
     (i) Purposes of the program;
     (ii) Governing body's composition and size, and members' and committee chairs' terms of office;
     (iii) Frequency of meetings.
     (b) The organization shall develop a written plan, reviewed on a regular basis, that addresses:
     (i) The core values and mission of the organization, that promote seeing the persons served as the focus of the adult day health program;
     (ii) That supports leadership that identifies and demonstrates ethical behavior in business, marketing, communication, and the provision of services; and
     (iii) Information dissemination from a variety of sources to plan and improve performance and to educate, inform and demonstrate to all stakeholders the value of adult day health services.
     (2) The advisory committee.
     (a) Every adult day health program shall have a body that serves as an advisory committee. When an adult day health program is a subdivision or subunit of a multifunction organization, a committee or subcommittee of the governing body of the multifunction organization may serve as the advisory committee of the program.
     (b) For a single purpose agency the governing body may fulfill the functions of the advisory committee.
     (c) The advisory committee shall meet at least twice a year, but preferably quarterly, and shall have an opportunity, at least annually, to review and make recommendations on program policies. The advisory committee should be representative of the community and include family members of current or past participants and nonvoting staff representatives.
     (3) A written plan of operation.
     The administrator shall be responsible for the development of a current, written plan of operation with approval of the governing body. The plan of operation shall be reviewed, and if necessary, revised annually. The plan may include:
     (a) Short- and long-range program goals;
     (b) Definition of the target population, including number, age and needs of participants;
     (c) Geographical definition of the service area;
     (d) Hours and days of operation;
     (e) Description of basic services and any optional services;
     (f) Policies and procedures for service delivery;
     (g) Policies and procedures for admission and discharge;
     (h) Policies and procedures for assessment and reassessment, and the development of a plan of care with participants and/or family/caregiver by an interdisciplinary team;
     (i) Staffing pattern;
     (j) A plan for utilizing community resources;
     (k) Policies and procedures for recruitment, orientation, training, evaluation, and professional development of staff and volunteers;
     (l) General record policies;
     (m) Statement of participant rights;
     (n) Mandated reporting procedures;
     (o) Marketing plan;
     (p) Strategic planning;
     (q) Accident, illness, and emergency procedures;
     (r) Grievance procedures;
     (s) Procedures for reporting suspected abuse;
     (t) Payment mechanisms, funding sources and rates; or
     (u) Operational budget.
     (4) A written emergency plan. A written plan for handling emergencies shall be developed, and posted at each program site and on all program owned vehicles. Staff shall be trained to ensure smooth implementation of the emergency plan. If a single participant is present, at least one staff member on site shall be trained in cardiopulmonary resuscitation (CPR) and first aid.
     (5) Lines of supervision and responsibility.
     (a) To ensure continuity of direction and supervision, there shall be a clear division of responsibility between the governing body and the adult day health program administrator.
     (b) An administrator shall be appointed and given full authority and responsibility to plan, staff, direct, and implement the program. The administrator shall also have the responsibility for establishing collaborative relations with other community organizations to ensure necessary support services to participants and their families/caregivers.
     (c) The administrator or the individual(s) designated by the administrator shall be on site to manage the program's day-to-day operations during hours of operation. If the administrator is responsible for more than one site, or has duties not related to adult day health administration or provision of services, a program director shall be designated for each additional site and shall report to the administrator.
     (d) An organizational chart shall be developed to illustrate the lines of authority and communication channels, and shall be provided to all staff.
     (6) Administrative policies and procedures.
     (a) Every adult day health program shall demonstrate fiscal responsibility by utilizing generally accepted principles of accounting in all its financial transactions. Fiscal policies, procedures, and records shall be developed to enable the administrator to meet the fiscal reporting needs of the governing body.
     (b) Every adult day health program shall develop a plan to address the future financial needs of the program. The plan shall include projected program growth, capital purchases, projected revenue, projected expenses, and plans for fund raising.
     (7) Quality improvement.
     (a) Every adult day health program shall develop a quality improvement plan, with specific measurable objectives, designed to meet requirements of any licensing, funding sources, and professional standards.
     (b) Policies and procedures for monitoring program quality and determining further action shall be developed by the administrator with the advice of the multidisciplinary staff team and the advisory committee with the approval of the governing body.
     (8) Personnel policies and practices.
     (a) There shall be a written job description for each staff position that specifies:
     (i) Qualifications for the job;
     (ii) Delineation of tasks; and
     (iii) Lines of supervision and authority.
     (b) Each employee shall receive, review, and sign a copy of the job description at the time of employment. Volunteers who function as staff also shall be provided written descriptions of responsibilities.
     (c) Provision shall be made for orientation of new employees and volunteers. All staff and volunteers shall receive regular in-service training and staff development that meet their individual training needs. This shall be documented.
     (d) Probationary evaluations and annual performance evaluations, in accordance with job descriptions, shall be conducted and shall conform to the policy of the funding or parent organization. Staff members shall review the written evaluation, that shall be signed by both the employee and supervisor. Copies shall be kept in locked personnel files.
     (e) Each employee shall receive and/or review a copy of the program's personnel policies at the time of employment.
     (f) Each employee shall have an individual file containing: Employee's qualifications, verification of training completed, signed job description and all performance evaluations. In addition, personnel files shall contain a copy of a current license or certificate, if applicable to the staff position, and certification of CPR and first aid training, if applicable.
     (g) Whenever volunteers function in the capacity of staff, all applicable personnel policies pertain.
     (h) The program shall conform to federal and state labor laws, must be in compliance with equal opportunity guidelines, and must adhere to federal and state employment regulations.
     (9) Participant policies. Policies shall define the target population, admission criteria, discharge criteria, medication policy, participant rights, fee schedule, confidentiality, grievance procedures, and staff/participant ratios. Policies shall conform to the following:
     (a) Nondiscrimination policy. No individual shall be excluded from participation in or be denied the benefits of or be otherwise subjected to discrimination in the adult day health program on the grounds of age, race, color, sex, religion, or national origin, creed, marital status, Vietnam era or disabled veteran's status, sensory, physical, or mental handicap.
     (b) Bill of rights. A participant bill of rights shall be developed, posted, distributed to, and explained to participants, families, staff, and volunteers in the language understood by the individual.
     (c) Illness/injury procedure. There shall be written procedures to be followed in case a participant becomes ill or is injured. The procedures shall be posted in at least one visible location at all program sites and shall be thoroughly explained, to staff, volunteers and participants. The procedures shall describe arrangements for hospital inpatient and emergency room service and include directions on how to secure ambulance transportation.
     (d) Medications. Participants who need to take medications while at the program, and who are sufficiently mentally alert, shall be encouraged and expected to bring, keep and take their own medications as prescribed. Some participants may need assistance with their medications, and a few may need to have their medications administered by program staff. In order for program staff to administer any prescribed medication, there must be a written authorization from the participant's physician stating that the medication is to be administered at the program site and identifying the licensed person responsible for administration.
     (e) The program shall develop written mediation procedures that are explained to all staff and anyone else who has responsibility in this area. At a minimum, these procedures shall describe the following:
     (i) How medications will be stored;
     (ii) Under what conditions licensed program staff will administer medications;
     (iii) How medications brought to the program by a participant must be labeled;
     (iv) How general medications such as aspirin or laxatives are to be used;
     (v) How the use of medications will be entered in participants' case records.
     (10) General record.
     The adult day health program shall maintain a secure participant record system to ensure confidentiality. The record system shall include, but is not limited to:
     (a) A permanent registry of all participants with dates of admission and discharge;
     (b) A written policy on confidentiality and the protection of records that defines procedures governing their use and removal, and conditions for release of information contained in the records;
     (c) A written policy on conditions that require authorization in writing by the participant or the legally responsible party for release of appropriate information not otherwise authorized by law;
     (d) A written policy providing for the retention and storage of records for at least five years (or in accordance with state or local requirement) from the date of the last service to the participant;
     (e) A written policy on the retention and storage of such records in the event the program discontinues operation, depending on the requirements of funding sources;
     (f) A policy and procedure manual governing the record system and procedures for all agency staff;
     (g) Maintenance of records on the agency's premises in secure storage area;
     (h) Notes and reports in the participant's record that are typewritten or legibly written in ink, dated, and signed by the recording person with his/her title.
     (11) Participant records. The following shall be maintained as a record for each participant. This shall include, but is not limited to, the following:
     (a) Application and enrollment forms;
     (b) Medical history and functional assessment (initial and ongoing);
     (c) Plan of care (initial and reviews) and revisions;
     (d) Fee determination form;
     (e) Service contract;
     (f) Signed authorizations for releases of medical information and photos, as appropriate;
     (g) Signed authorizations for participant to receive emergency medical care if necessary;
     (h) Correspondence;
     (i) Attendance and service records;
     (j) Transportation plans;
     (k) Where appropriate:
     (i) Medical information form;
     (ii) Documentation of physicians' orders;
     (iii) Physical examinations;
     (iv) Treatment, therapy, and medication notes;
     (l) Progress notes, chronological and timely;
     (m) Where appropriate, discharge plan and summary;
     (n) Current photograph of client;
     (o) Emergency contacts;
     (p) Signed statement that participant or legal representative has read the policies of the program with respect to the Patient Self-Determination Act of 1990.
     (12) Administrative records. Administrative records shall include the following:
     (a) Personnel records (including personnel training);
     (b) Fiscal records;
     (c) Statistical records;
     (d) Government-related records (funding sources/regulatory);
     (e) Contracts;
     (f) Organizational records;
     (g) Results of quality improvement plan which could include annual evaluation, utilization review, or care plan audit;
     (h) Board and advisory group meeting minutes;
     (i) Certificates of fire and health inspections;
     (j) Incident reports;
     (k) Emergency plan;
     (l) Criteria for participant termination.
     (13) Community relations. Adult day health programs shall provide information on adult day health to target populations and the general public. Participants and their families shall be made aware of community agencies for financial, social, recreational, educational and medical services. In addition, the program staff shall establish linkages with other community agencies and institutions to coordinate services and form service networks.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-656, filed 5/27/99, effective 6/27/99.]

WAC 388-15-657   Staffing.  (1) Staff selection is dependent on participant needs, program design, and regulatory requirements. The program must have the proper balance of professionals and paraprofessionals or nonprofessionals to adequately meet the needs of participants. Services must be delivered by those with adequate professional training. One staff person can have multiple functions; for example, an administrator who is also responsible for providing nursing services or social services.
     (2) All core services shall have an administrator/program director and an activity coordinator on staff. Health care and social services personnel may be on staff or consulting. Personnel delivering level II services may be on staff or on contract.
     (3) Staffing levels in all adult day health programs will vary based upon the number of participants and the care provided. The staffing level shall be sufficient to:
     (a) Serve the number and functioning levels of adult day health program participants;
     (b) Meet program objectives;
     (c) Provide access to other community resources.
     (4) The staff-participant ratio shall be a minimum of one to six. Persons counted in the staff-participant ratio are those who provide direct service with participants. When there is more than one participant present there shall be at least two staff members on the premises, one of whom is directly supervising the participants.
     (5) As the number of participants with functional impairments increases, the staff-participant ratio shall be adjusted accordingly. Programs serving a high percentage of participants who are severely impaired shall have a staff-participant ratio of one to four. All programs shall have a written policy regarding staff-participant ratios.
     (6) To ensure adequate care and safety of participants, there shall be provision for qualified substitute staff.
     (7) Volunteers shall be included in the staff ratio only when they conform to the same standards and requirements as paid staff, meet the job qualification standards of the organization, and have designated responsibilities.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-657, filed 5/27/99, effective 6/27/99.]

WAC 388-15-658   Personnel requirements.  (1) Administrator. The administrator:
     (a) Is responsible for the development, coordination, supervision, fiscal control and evaluation of services provided through the adult day health program.
     (b) Shall have a master's degree and one year supervisory experience in health or social services (full-time or equivalent) or a bachelor's degree and two years supervisory experience in a social or health service setting.
     (2) Program director.
     (a) For level I, adult day care services the program director shall have a bachelor's degree in health, social services or a related field, with one year supervisory experience (full-time or equivalent) in a social or health service setting, or a high school diploma and four years of experience in a health or social services field of which two years must be supervision.
     (b) For level II, adult day health services, minimum requirements for the program director shall be a bachelor's degree in health, social services or a related field, with one year supervisory experience (full-time or equivalent) in a social or health service setting.
     (3) Social worker.
     (a) The social worker shall have a master's degree in social work or counseling and at least one year of professional work experience (full-time or the equivalent), or a bachelor's degree in social work or counseling and two years of experience in a human service field.
     (b) Depending on the setting and licensing requirements, social work functions may be performed by other human service professionals, such as rehabilitation counselors, gerontologists, or mental health workers (although they may not call themselves social workers without appropriate credentials).
     (4) Registered nurse (RN). The nurse shall be a registered nurse (RN) with valid state credentials and a minimum of one year applicable experience (full-time equivalent).
     (5) Licensed practical nurse (LPN). The licensed practical nurse (LPN) shall have valid state credentials and a minimum of one year applicable experience (full-time equivalent).
     (6) Activities coordinator. The activities coordinator shall have a bachelor's degree in recreational therapy or a related field and one year of experience (full-time equivalent) in social or health services or an associate degree in recreational therapy or a related field plus two years of appropriate experience.
     (7) Certified occupational therapy assistant (COTA) or physical therapy assistant. The COTA or physical therapy assistant shall be certified with valid state credentials and a minimum of one year applicable experience (full-time equivalent).
     (8) Nursing assistant/certified (NAC). The nursing assistant shall be certified with valid state credentials and a minimum of one year applicable experience (full-time equivalent).
     (9) Program assistant/aide/personal care aide. The program assistant or aide shall have one or more years of experience in working with adults in a health care or social service setting.
     (10) Therapists. Physical therapists, occupational therapists, speech therapists, recreation therapists, mental health therapists or any other therapists, utilized shall have valid state credentials and one year of experience in a social or health setting.
     (11) Consultants. Consultants shall be available to provide services as needed in order to supplement professional staff and enhance the program's quality.
     (12) Secretary/bookkeeper. The secretary/bookkeeper shall have at least a high school diploma or equivalent and skills and training to carry out the duties of the position.
     (13) Driver. The driver shall have a valid and appropriate state driver's license, a safe driving record, and training in first aid and CPR. The driver shall meet any state requirements for licensure or certification.
     (14) Volunteers. The volunteers shall be individuals or groups who desire to work with adult day health participants and shall take part in program orientation and training. The duties of volunteers shall be mutually determined by volunteers and staff. Duties, to be performed under the supervision of a staff member, shall either supplement staff in established activities or provide additional services for which the volunteer has special talents.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-658, filed 5/27/99, effective 6/27/99.]

WAC 388-15-659   Facility.  (1) Location.
     (a) Selection of a location for a program facility shall be based on information about potential participants in its service area and be made in consultation with other agencies, organizations, and institutions serving older individuals and those with functional impairments, as well as considering the availability of a suitable location.
     (b) Space.
     (i) The facility shall comply with applicable state and local building regulations, zoning, fire, and health codes or ordinances. When possible, the facility shall be located on the street level. If the facility is not located at street level, it is essential to have a ramp and/or elevators. An evacuation plan for relocation of participants shall also be in place in the event of an emergency.
     (ii) Each adult day health program, when it is co-located in a facility housing other services, shall have its own separate identifiable space for main activity areas during operational hours. Certain space can be shared, such as the kitchen and therapy rooms.
     (iii) The facility shall have sufficient space to accommodate the full range of program activities and services. The facility shall provide at least sixty square feet of program space for multi-purpose use for each day health participant. In determining adequate square footage, only those activity areas commonly used by participants are to be included. Dining and kitchen areas are to be included only if these areas are used by participants for activities other than meals. Reception areas, storage areas, offices, restrooms, passage ways, treatment rooms, service areas, or specialized spaces used only for therapies are not to be included when calculating square footage.
     (iv) The facility shall be adaptable to accommodate variations of activities (group and/or individual) and services. The program shall provide and maintain essential space necessary to provide services and to protect the privacy of the participants receiving services. There shall be sufficient private space to permit staff to work effectively and without interruption. There shall be sufficient space available for private discussions.
     (v) There shall be adequate storage space for program and operating supplies.
     (vi) The facility's restrooms shall be located as near the activity area as possible, preferably no more than forty feet away. The facility shall include at least one toilet for each ten participants. Programs that have a large number of participants that require more scheduled toileting or assistance with toileting shall have at least one toilet for each eight participants. The toilet shall be equipped for use by mobility-limited persons, easily accessible from all program areas, and one or two of the toilet areas should be designed to allow assistance from one or two staff.
     (vii) Each bathroom shall contain an adequate supply of soap, toilet tissues and paper towels.
     (ix) In addition to space for program activities, the facility shall have a rest area and designated areas to permit privacy and to isolate participants who become ill or disruptive, or may require rest. It shall be located away from activity areas and near a restroom and the nurse's office. There shall be at least one bed, couch or recliner for each ten participants which can be used for resting or the isolation of a participant who is ill or suspected of coming down with a communicable disease. If beds are used, the mattresses shall be protected and linen changed after each use by different participants.
     (x) A loading zone with sufficient space for getting on and off a vehicle shall be available for the safe arrival and departure of participants. There should be sufficient parking available to accommodate family caregivers, visitors, and staff. Adequate lighting should be provided.
     (2) Atmosphere and design.
     (a) The design shall facilitate the participants' movement throughout the facility and encourage involvement in activities and services. The environment shall reinforce orientation and awareness of the surroundings by providing cues and information about specific rooms, locations, and functions that help the participant to get his/her orientation to time and space.
     (b) A facility shall be architecturally designed in conformance with the requirements of sections 504 of the Rehabilitation Act of 1973 to accommodate individuals with a disability and meet any state and local barrier-free requirements and/or the Americans with Disabilities Act.
     (c) Illumination levels in all areas shall be adequate, and careful attention shall be given to avoiding glare. Attention shall be paid to lighting in transitional areas such as outside to inside and different areas of the facility.
     (d) Sound transmission shall be controlled. Excessive noise, such as fan noise, shall be avoided.
     (e) Comfortable conditions shall be maintained within a comfortable temperature range. Excessive drafts shall be avoided uniformly throughout the facility.
     (f) Sufficient furniture shall be available for the entire participant population present. Furnishings shall accommodate the needs of participants and be attractive, comfortable, sturdy and safe. Straight-backed chairs with arms shall be used during activities and meals.
     (g) An adult day health facility shall be visible and recognizable as a part of the community. The entrance to the facility shall be clearly identified. It shall also be appealing and protective to participants and others.
     (h) When necessary, arrangements shall be made with local authorities to provide safety zones for those arriving by motor vehicle and adequate traffic signals for people entering and exiting the facility.
     (i) A telephone shall be available for participant use.
     (3) Safety and sanitation.
     (a) The facility and grounds shall be safe, clean, and accessible to all participants. It shall be designed, constructed, and maintained in compliance with all applicable local, state, and federal health and safety regulations.
     (b) There shall be an area for labeled medication, secured and stored apart from participant activity areas. If medications need to be refrigerated, they should be in a locked box - if not in their own refrigerator.
     (c) Safe and sanitary handling, storing, preparation, and serving of food shall be assured. If meals are prepared on the premises, kitchen appliances, food preparation area, and equipment must meet state and local requirements.
     (d) Toxic substances, whether for activities or cleaning, shall be stored in an area not accessible to participants. They must be clearly marked, the contents identified, and stored in original containers.
     (e) At least two well-identified exits shall be available. Nonslip surfaces or bacteria-resistant carpets shall be provided on stairs, ramps, and interior floors.
     (f) Alarm/warning systems are necessary to ensure the safety of the participants in the facility in order to alert staff to potentially dangerous situations. It is recommended that call bells be installed or placed in the rest areas, restroom stalls, and showers.
     (g) An evacuation plan shall be strategically posted in each facility.
     (h) The facility shall be free of hazards, such as high steps, steep grades, and exposed electrical cords. Steps and curbs shall be painted and the edges of stairs marked appropriately to highlight them. All stairs, curb cuts, ramps, and bathrooms accessible to those with disabilities shall be equipped with properly anchored handrails.
     (i) Procedures for fire safety as approved by the local fire authority shall be adopted and posted, including provisions for fire drills, inspection and maintenance of fire extinguishers, periodic inspection, and training by fire department personnel. The program shall conduct and document quarterly fire drills and keep reports of drills on file. Improvements shall be made based on the fire drill evaluation. Smoke detectors shall also be used.
     (j) Emergency first-aid kits shall be visible and accessible to staff. Contents of the kits shall be replenished after use and reviewed as needed. A nurse or personnel trained in first aid and CPR shall be on hand whenever participants are present. Infection control procedures shall be followed by all staff. All staff shall be trained in and use Universal Precautions.
     (k) There shall be sufficient maintenance and housekeeping personnel to assure that the facility is clean, sanitary, and safe at all times. Maintenance and housekeeping shall be carried out on a regular schedule and in conformity with generally accepted sanitation standards, without interfering with the program.
     (l) If smoking is permitted, an adequately ventilated special area away from the main program area shall be provided and supervised.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-659, filed 5/27/99, effective 6/27/99.]

WAC 388-15-660   Coordination of services.  The need for coordination of care shall be considered for each participant. If the person is a client of another agency and/or receiving services from the department, the plan of care shall be developed in conjunction with the services provided by the other agencies or the department.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-660, filed 5/27/99, effective 6/27/99.]

WAC 388-15-661   Clients in residential care or nursing facility care settings.  Residential clients may receive adult day health level II services when the service is an approved part of the service plan developed by AASA staff. Clients receiving nursing facility care shall not be authorized adult day health services. Clients who reside in enhanced adult residential care, adult residential care, assisted living or adult family homes shall not be authorized COPES funded adult day care.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-661, filed 5/27/99, effective 6/27/99.]

WAC 388-15-662   Expenditures not to exceed.  If program expenditures exceed the budget appropriations, the department shall have the authority to limit services by setting forth alternative ways of determining eligibility such as:
     (1) Authorizing service to only those clients with the greatest care needs.
     (2) Department staff shall assess and authorize all adult day health services.
     (3) Limit the number of days a client may receive services.
     (4) The department shall comply with established rules and procedures for client notification should action in this section become necessary.

[Statutory Authority: RCW 74.39A.007 and 74.08.090. 99-12-072, § 388-15-662, filed 5/27/99, effective 6/27/99.]