Chapter 388-71 WAC

SOCIAL SERVICES FOR ADULTS

Last Update: 6/29/01


WAC

ADULT PROTECTIVE SERVICES

388-71-0100 What are the statutory references for WAC 388-71-0100 through 388-71-0155?
388-71-0105 What definitions apply to adult protective services and the personal aide registry?
388-71-0110 What is the purpose of an adult protective services investigation?
388-71-0115 When is an investigation conducted?
388-71-0120 What adjunct services are provided?

PERSONAL AIDE STATE REGISTRY

388-71-0150 When is the name of a personal aide placed on a registry?
388-71-0155 Prior to placing his or her name on the registry is the personal aide notified?

HOME AND COMMUNITY PROGRAMS

388-71-0400 What is the intent of the department's home and community programs?
388-71-0405 What are the home and community programs?
388-71-0410 What services may I receive under HCP?
388-71-0415 What other services may I receive under the COPES program?
388-71-0420 What services are not covered under HCP?
388-71-0425 Who can provide HCP services?
388-71-0430 Am I eligible for one of the HCP programs?
388-71-0435 Am I eligible for COPES-funded services?
388-71-0440 Am I eligible for MPC-funded services?
388-71-0445 Am I eligible for Chore-funded services?
388-71-0450 How do I remain eligible for services?
388-71-0455 Can my services be terminated if eligibility requirements for HCP change?
388-71-0460 Are there limitations to HCP services I can receive?
388-71-0465 Are there waiting lists for HCP services?
388-71-0470 Who pays for HCP services?
388-71-0480 If I am employed, can I still receive HCP services?

INDIVIDUAL PROVIDER AND HOME CARE AGENCY PROVIDER QUALIFICATIONS

388-71-0500 What is the purpose of WAC 388-71-0500 through 388-71-0580?
388-71-0505 How does a client hire an individual provider?
388-71-0510 How does a person become an individual provider?
388-71-0513 Is a background check required of a home care agency provider?
388-71-0515 What are the responsibilities of an individual provider or home care agency provider when employed to provide care to a client?
388-71-0520 Are there educational requirements for an individual provider or a home care agency provider of an adult client?
388-71-0525 Are there any exemptions from the training requirements?
388-71-0530 Are there special rules about training for parents who are the individual providers of division of developmental disabilities (DDD) adult children?
388-71-0535 Are there special rules about training for parents who are the individual providers of non-DDD adult children?
388-71-0540 When will the department or AAA deny payment for services of an individual provider or home care agency provider?
388-71-0546 When can the department or AAA reject the client's choice of an individual provider?
388-71-0551 When can the department or AAA terminate or summarily suspend an individual provider's contract?
388-71-0556 When can the department or AAA otherwise terminate an individual provider's contract?
388-71-0560 What are the client's rights if the department denies, terminates, or summarily suspends an individual provider's contract?
388-71-0580 Self-directed care -- Who must direct self-directed care?

RESIDENTIAL CARE SERVICES

388-71-0600 What are residential services?
388-71-0605 Am I eligible for residential services?
388-71-0610 Who pays for residential care?
388-71-0613 For what days will the department pay the residential care facility?
388-71-0615 If I leave a hospital, residential facility, or nursing facility, are there resources available to help me find a place to live?
388-71-0620 Am I eligible for a residential discharge allowance?

NURSING FACILITY CARE AND PAYMENT

388-71-0700 What are the requirements for nursing facility eligibility, assessment, and payment?

PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)

388-71-0800 What is PACE?
388-71-0805 What services does PACE cover?
388-71-0810 Who provides these services?
388-71-0815 Where are these services provided?
388-71-0820 How do I qualify for Medicaid-funded PACE services?
388-71-0825 What are my appeal rights?
388-71-0830 Who pays the PACE provider?
388-71-0835 How do I enroll into the PACE program?
388-71-0840 How do I disenroll from the PACE program?
388-71-0845 What are my rights as a PACE participant?

PRIVATE DUTY NURSING

388-71-0900 What is the intent of WAC 388-71-0900 through 388-71-0960?
388-71-0905 What is private duty nursing (PDN) for adults?
388-71-0910 Am I financially eligible for Medicaid-funded private duty nursing services?
388-71-0915 Am I medically eligible to receive private duty nursing services?
388-71-0920 How is my eligibility determined?
388-71-0925 Am I required to pay participation toward PDN services?
388-71-0930 Are PDN costs subject to estate recovery?
388-71-0935 Who can provide my PDN services?
388-71-0940 Are there limitations or other requirements for PDN?
388-71-0945 What requirements must a home health agency meet in order to provide and get paid for my PDN?
388-71-0950 What requirements must a private RN or LPN meet in order to provide and get paid for my PDN services?
388-71-0955 Can I receive PDN in a licensed adult family home (AFH)?
388-71-0960 Can I receive services in addition to PDN?
388-71-0965 Can I choose to self-direct my care if I receive PDN?

SENIOR CITIZEN'S SERVICES

388-71-1000 What is the Senior Citizens Services Act?
388-71-1005 Who administers the Senior Citizens Services Act funds?
388-71-1010 What services does the SCSA fund?
388-71-1015 How do I apply for SCSA-funded services?
388-71-1020 Am I eligible for SCSA-funded services at no cost?
388-71-1025 What income and resources are exempt when determining eligibility?
388-71-1030 What if I am not eligible to receive SCSA-funded services at no cost?
388-71-1035 What are my rights under SCSA?

RESPITE CARE SERVICES

388-71-1065 What is the purpose of the respite care program?
388-71-1070 What definitions apply to respite care services?
388-71-1075 Who is eligible to receive respite care services?
388-71-1080 Who may provide respite care services?
388-71-1085 How are respite care providers reimbursed for their services?
388-71-1090 Are participants required to pay for the cost of their services?
388-71-1095 Are respite care services always available?

VOLUNTEER CHORE

388-71-1100 What is volunteer chore services (VCS)?
388-71-1105 Am I eligible to receive volunteer chore services?
388-71-1110 How do I receive information on applying for volunteer chore services?

DISPOSITIONS OF SECTIONS FORMERLY CODIFIED IN THIS CHAPTER
388-71-0545 Under what conditions will the department/AAA deny payment to or terminate the contract of an individual provider, or deny payment to a home care agency provider? 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. 00-03-043, § 388-71-0545, filed 1/13/00, effective 2/13/00.  Repealed by 01-11-019, filed 5/4/01, effective 6/4/01. 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, 74.39.095. 
388-71-0550 Are there other conditions under which the department/AAA may deny payment, or deny or terminate a contract to an individual provider? 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. 00-03-043, § 388-71-0550, filed 1/13/00, effective 2/13/00.  Repealed by 01-11-019, filed 5/4/01, effective 6/4/01. 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, 74.39.095. 
388-71-0555 When can the department/AAA summarily suspend an individual provider's contract? 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. 00-03-043, § 388-71-0555, filed 1/13/00, effective 2/13/00.  Repealed by 01-11-019, filed 5/4/01, effective 6/4/01. 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, 74.39.095. 

WAC 388-71-0100   What are the statutory references for WAC 388-71-0100 through 388-71-0155?  The statutory references for WAC 388-71-0100 through WAC 388-71-0155 are:
     (1) Chapter 74.34 RCW;
     (2) Chapter 74.39A. RCW; and
     (3) Chapter 74.39 RCW.

[Statutory Authority: RCW 74.08.090, 74.34.165, and 74.39A.050(9). 00-03-029, § 388-71-0100, filed 1/11/00, effective 2/11/00.]

WAC 388-71-0105   What definitions apply to adult protective services and the personal aide registry?  In addition to the definitions found in chapter 74.34 RCW, the following definitions apply:
     "Basic necessities of life" means food, water, shelter, clothing, and medically necessary health care, including but not limited to health-related treatment or activities, hygiene, oxygen, and medication.
     "Legal representative" means a guardian appointed under chapter 11.88 RCW or individual named in a durable power of attorney as the attorney-in-fact as defined under chapter 11.94 RCW.
     "Person or entity with a duty of care" includes, but is not limited to, the following:
     (1) A guardian appointed under chapter 11.88 RCW; or
     (2) A person or entity providing the basic necessities of life to vulnerable adults where:
     (a) The person or entity is employed by or on behalf of the vulnerable adult; or
     (b) The person or entity voluntarily agrees to provide, or has been providing, the basic necessities of life to the vulnerable adult on a continuing basis.
     "Personal aide" as found in RCW 74.39.007.
     "Self-directed care" as found in RCW 74.39.007.

[Statutory Authority: RCW 74.08.090, 74.34.165, and 74.39A.050(9). 00-03-029, § 388-71-0105, filed 1/11/00, effective 2/11/00.]

WAC 388-71-0110   What is the purpose of an adult protective services investigation?  The purpose of an adult protective services investigation is to:
     (1) Determine if allegations of abandonment, abuse, financial exploitation, neglect, or self-neglect are valid.
     (2) Provide protective services on valid reports with the consent of the vulnerable adult or his or her legal representative.
     (3) Determine if other vulnerable adults are at risk of being harmed by individual who has abused, neglected, abandoned or financially exploited the vulnerable adult.
     (4) Inform the program or facility providing care for the vulnerable adult that the reported incident of abandonment, abuse, financial exploitation, or neglect occurred. The information provided to the facility or program is required to be consistent with confidentiality requirements concerning the vulnerable adult, witnesses, and complainants.

[Statutory Authority: RCW 74.08.090, 74.34.165, and 74.39A.050(9). 00-03-029, § 388-71-0110, filed 1/11/00, effective 2/11/00.]

WAC 388-71-0115   When is an investigation conducted?  The department determines when an investigation is required. The following criteria must be met:
     (1) The reported circumstances fit the definition of abandonment, abuse, financial exploitation, neglect, or self-neglect found in chapter 74.34 RCW; and
     (2) The victim is a vulnerable adult defined in chapter 74.34 RCW.

[Statutory Authority: RCW 74.08.090, 74.34.165, and 74.39A.050(9). 00-03-029, § 388-71-0115, filed 1/11/00, effective 2/11/00.]

WAC 388-71-0120   What adjunct services are provided?  Chore personal care services and placement into a licensed and contracted adult family home or state funded adult residential care facility are provided without regard to income only:
     (1) When the services are essential to, and a subordinate part of, the adult protective services plan; and
     (2) For a period not to exceed ninety days during any twelve-month period of time.

[Statutory Authority: RCW 74.08.090, 74.34.165, and 74.39A.050(9). 00-03-029, § 388-71-0120, filed 1/11/00, effective 2/11/00.]

WAC 388-71-0150   When is the name of a personal aide placed on a registry?  The name of a personal aide providing self-directed care for a vulnerable adult is placed on the registry when:
     (1) An incident of abandonment, abuse, financial exploitation, or neglect of the vulnerable adult has been substantiated by the department; and
     (2) The personal aide has either waived his or her right to a fair hearing or the hearing process results in upholding the finding of abandonment, abuse, financial exploitation, or neglect.

[Statutory Authority: RCW 74.08.090, 74.34.165, and 74.39A.050(9). 00-03-029, § 388-71-0150, filed 1/11/00, effective 2/11/00.]

WAC 388-71-0155   Prior to placing his or her name on the registry is the personal aide notified?  The following information must be sent to the personal aide prior to placing his or her name on the registry:
     (1) Nature and date of the alleged abandonment, abuse, financial exploitation, or neglect.
     (2) Right to a fair hearing, as described in chapters 34.05 RCW and 388-08 WAC.
     (3) Intent to place identifying information about the personal care aide on a registry.
     (4) That the personal aide's failure to request a fair hearing within thirty days will result in his or her name being placed on the registry.
     (5) That the name of the personal aide will be placed on the registry if the hearing process results in upholding the department's finding of abandonment, abuse, financial exploitation, or neglect.
     (6) That the personal aide has a right to be represented at a fair hearing at his or her own expense.
     (7) That, upon request of any person, the department will disclose the substantiated finding of abandonment, abuse, financial exploitation, or neglect and the identifying information regarding a personal aide whose name appears on a registry.

[Statutory Authority: RCW 74.08.090, 74.34.165, and 74.39A.050(9). 00-03-029, § 388-71-0155, filed 1/11/00, effective 2/11/00.]

WAC 388-71-0400   What is the intent of the department's home and community programs?  The department offers home and community programs (HCP) as an alternative to nursing facility care so that eligible persons may remain in, or return to, their own homes or community residences with the provision of supportive services. Some of these services may be administered by home and community services (HCS), division of developmental disabilities (DDD), area agency on aging (AAA) or division of children and family services (DCFS).

[Statutory Authority: 74.39A.130, 74.09.520, 74.08.090. 00-04-056, § 388-71-0400, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0405   What are the home and community programs?  The HCP are in-home and community residential services funded by:
     (1) Community options program entry system (COPES), codified under subsection 1915(c) of the Social Security Act and 42 C.F.R. 441.300 and 310.
     (2) Medicaid personal care services (MPC), found under RCW 74.09.520 and in the Medicaid state plan.
     (3) Chore personal care services, a state-only funded program authorized under RCW 74.08.090, 74.09.520, and 74.08.570.

[Statutory Authority: RCW 74.09.520, 74.08.090, 74.39A.130. 00-04-056, § 388-71-0405, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0410   What services may I receive under HCP?  You may receive the following HCP services:
     (1) Assistance with personal care tasks and household tasks in your own home, as defined in 388-15-202(38); and
     (2) Assistance with personal care tasks and household tasks in a residential setting, as described in WAC 388-71-0600. Note: Household tasks are included as part of the board and room rate. You may receive, under MPC:
     (a) Up to thirty hours of personal care services in an adult residential care facility; or
     (b) Up to sixty hours of personal care services in an adult family home.

[Statutory Authority: RCW 74.08.090, 74.39.010, 74.09.520. 00-04-056, § 388-71-0410, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0415   What other services may I receive under the COPES program?  In addition to the services listed in WAC 388-71-0410, you may be eligible for other services under the COPES program. You may be eligible to receive:
     (1) Adult day services, in an adult day care or adult day health center if you:
     (a) Are ineligible for Medicaid state plan covered adult day health services;
     (b) Are chronically ill or disabled, socially isolated and/or confused or have mild to moderate dementia; and
     (c) Meet eligibility requirements for adult day services as required in:
     (i) WAC 388-15-652, Eligibility for adult day care; or
     (ii) WAC 388-15-653, Eligibility for adult day health.
     (2) Environmental modifications, if the minor physical adaptations to your home:
     (a) Are necessary to ensure your health, welfare and safety;
     (b) Enable you to function with greater independence in the home;
     (c) Directly benefit you medically or remedially;
     (d) Meet applicable state or local codes.
     (3) Home delivered meals, limited to one meal per day, if:
     (a) You are homebound;
     (b) You are unable to prepare the meal;
     (c) You don't have a caregiver (paid or unpaid) available to prepare this meal; and
     (d) Receiving this meal is more cost-effective than having a paid caregiver.
     (4) Home health aide service tasks, if the service tasks:
     (a) Include assistance with ambulation, exercise, self-administered medications and hands on personal care;
     (b) Are beyond the amount, duration or scope of Medicaid reimbursed home health services (WAC 388-551-2100) and are in addition to those available services; and
     (c) Are health-related. Note: Incidental services such as meal preparation may be performed in conjunction with a health-related task as long as it is not the sole purpose of the aide's visit.
     (5) Personal emergency response system (PERS), if the service is necessary to enable you to secure help in the event of an emergency and if you:
     (a) Live alone; or
     (b) Are alone for significant parts of the day and have no regular provider for extended periods of time.
     (6) Skilled nursing, if the service is:
     (a) Provided by a registered nurse or licensed practical nurse under the supervision of a registered nurse; and
     (b) Beyond the amount, duration or scope of Medicaid-reimbursed home health services as provided under WAC 388-551-2100.
     (7) Specialized medical equipment and supplies, if the items are:
     (a) Necessary for life support;
     (b) Necessary to increase your ability to perform activities of daily living; or
     (c) Necessary for you to perceive, control, or communicate with the environment in which you live; and
     (d) Directly medically or remedially beneficial to you; and
     (e) In addition to any medical equipment and supplies provided under the state plan.
     (8) Training, if you need to meet a therapeutic goal such as:
     (a) Adjusting to a serious impairment;
     (b) Managing personal care needs; or
     (c) Developing necessary skills to deal with care providers.
     (9) Transportation services, if the service:
     (a) Provides the client access to community services and resources provided in accordance with a therapeutic goal;
     (b) Is not merely diversional in nature;
     (c) Is in addition to Medicaid brokered transportation to medical services; and
     (d) Does not replace the Medicaid-brokered transportation.

[Statutory Authority: RCW 74.08.090, 74.39.020. 00-04-056, § 388-71-0415, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0420   What services are not covered under HCP?  HCP does not cover the following services:
     (1) For chore personal care and MPC:
     (a) Teaching, including teaching how to perform personal care tasks;
     (b) Development of social, behavioral, recreational, communication, or other types of community living skills;
     (c) Nursing care.
     (2) Services provided outside of your residence, unless they are authorized in your written service plan.
     (3) Child care;
     (4) Sterile procedures, administration of medications, or other tasks requiring a licensed health professional, unless authorized as an approved nursing delegation task, client self-directed care task, or provided by a family member;
     (5) Services provided over the telephone;
     (6) Services provided outside the state of Washington if COPES or chore personal care;
     (7) Services to assist other household members not eligible for services;
     (8) Yard care.

[Statutory Authority: RCW 74.09.520, 74.08.090, 74.39A.130. 00-04-056, § 388-71-0420, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0425   Who can provide HCP services?  The following types of providers may provide COPES, MPC, or chore services:
     (1) Individual in-home providers, who must meet the requirements outlined in WAC 388-71-0500 through 388-71-0580;
     (2) Home care agencies, which must be licensed under chapters 70.127 RCW and 246-336 WAC, or home health agencies, licensed under chapters 70.127 RCW and 246-327 WAC;
     (3) Licensed adult family home and boarding home providers who are contracted with DSHS (see WAC 388-71-0600); and
     (4) Service providers who have contracted with the AAA to perform COPES services listed in WAC 388-71-0415.

[Statutory Authority: 1999 c 175, chapters 70.126, 70.127 RCW, RCW 74.08.044. 00-04-056, § 388-71-0425, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0430   Am I eligible for one of the HCP programs?  You are eligible to receive HCP services if you meet the functional and financial eligibility requirements in WAC 388-71-0435 for COPES, WAC 388-71-0440 for MPC, or WAC 388-71-0445 for Chore. Your eligibility begins upon the date of the department's service authorization.

[Statutory Authority: RCW 74.39A.030. 00-13-077, § 388-71-0430, filed 6/19/00, effective 7/20/00. Statutory Authority: RCW 74.39.010, 74.08.090, 74.39A.110, 74.09.520. 00-04-056, § 388-71-0430, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0435   Am I eligible for COPES-funded services?  You are eligible for COPES-funded services if you meet all of the following criteria. The department or its designee must assess your needs and determine that:
     (1) You are age:
     (a) Eighteen or older and blind or disabled, as defined in WAC 388-511-1105; or
     (b) Sixty-five or older.
     (2) You meet financial eligibility requirements. This means the department will assess your finances and determine if your income and resources fall within the limits set in WAC 388-515-1505, Community options program entry system (COPES).
     (3) You:
     (a) Are not eligible for Medicaid personal care services; or
     (b) Are eligible for Medicaid personal care services, but the department determines that the amount, duration, or scope of your needs is beyond what Medicaid personal care can provide.
     (4) Your comprehensive assessment shows you need the level of care provided in a nursing facility (or will likely need the level of care within thirty days unless COPES services are provided) which means one of the following applies. You:
     (a) Require care provided by or under the supervision of a registered nurse or a licensed practical nurse on a daily basis;
     (b) Have an unmet need requiring substantial or total assistance with at least two or more of the following activities of daily living (ADLS) as defined in WAC 388-15-202 and 388-15-203:
     (i) Eating,
     (ii) Toileting,
     (iii) Ambulation,
     (iv) Transfer,
     (v) Positioning,
     (vi) Bathing, and
     (vii) Self-medication.
     (c) Have an unmet need requiring minimal, substantial or total assistance in three or more of the ADLS listed in subsection (4)(b)(i) through (vii) of this section; or
     (d) Have:
     (i) A cognitive impairment and require supervision due to one or more of the following: disorientation, memory impairment, impaired judgment, or wandering; and
     (ii) An unmet need requiring substantial or total assistance with one or more of the ADLS listed in subsection (4)(b)(i) through (vii) of this section.
     (5) You have a completed service plan, per WAC 388-15-205.

[Statutory Authority: RCW 74.39A.030. 00-13-077, § 388-71-0435, filed 6/19/00, effective 7/20/00.]

WAC 388-71-0440   Am I eligible for MPC-funded services?  To be eligible for MPC-funded services you must:
     (1) Have unmet need for assistance with at least one unmet direct personal care task listed in WAC 388-15-202(17); and
     (2) Be certified as Title 19 categorically needy, as defined in WAC 388-500-0005.
     (3) Be assessed by department staff or designee using a department approved comprehensive assessment and have a determination of unmet needs for HCP services.

[Statutory Authority: RCW 74.09.520. 00-04-056, § 388-71-0440, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0445   Am I eligible for Chore-funded services?  To be eligible for Chore-funded services, you must:
     (1) Be eighteen years of age or older;
     (2) Require assistance with at least one of the direct personal care tasks listed in WAC 388-15-202(17);
     (3) Not be eligible for MPC or COPES, Medicare home health or other programs if these programs can meet your needs;
     (4) Have net household income (as described in WAC 388-450-0005, 388-450-0020, 388-450-0040, and 388-511-1130) not exceeding:
     (a) The sum of the cost of your chore services, and
     (b) One-hundred percent of the FPL adjusted for family size.
     (5) Have resources, as described in chapter 388-470 WAC, which does not exceed ten thousand dollars for a one-person family or fifteen thousand dollars for a two-person family. (Note: One thousand dollars for each additional family member may be added to these limits.)
     (6) Not transfer assets on or after November 1, 1995 for less than fair market value as described in WAC 388-513-1365.

[Statutory Authority: 74.39A.110, 74.39A.150. 01-02-051, § 388-71-0445, filed 12/28/00, effective 1/28/01. Statutory Authority: RCW 74.09.520, 74.09.530, 74.39A.110, [74.39A.120,[74.39A.130 , and 1998 c 346 § 205 (1)(c), and RCW 74.39A.030. 00-18-099, § 388-71-0445, filed 9/5/00, effective 10/6/00. Statutory Authority: RCW 74.39A.110, 74.39A.150. 00-04-056, § 388-71-0445, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0450   How do I remain eligible for services?  In order to remain eligible for services, you must have and be found still in need of HCP services through a reassessment. The reassessment must be conducted:
     (1) Face-to-face.
     (2) In your own home. Note: A case manager may request the interview be conducted in private.
     (3) At least annually or more often if your functional, financial, or other significant circumstances change.

[Statutory Authority: 42 C.F.R. 441.302, RCW 74.09.520. 00-04-056, § 388-71-0450, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0455   Can my services be terminated if eligibility requirements for HCP change?  The department has the right to terminate your services if eligibility requirements for HCP change.

[Statutory Authority: RCW 74.09.510, 74.09.520. 00-04-056, § 388-71-0455, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0460   Are there limitations to HCP services I can receive?  The following are limitations to HCP services you can receive:
     (1) HCP services may not replace other available resources, both paid and unpaid.
     (2) AASA published rates and program rules establish your total hours and how much the department pays toward the cost of your services.
     (3) The department will adjust payments to a personal care provider who is doing household tasks at the same time (e.g., essential shopping, meal preparation, laundry, and supervision due to impaired judgement) for:
     (a) More than one client living in the same household; or
     (b) A client in a shared living arrangement (MPC).

[Statutory Authority: RCW 74.09.520. 00-04-056, § 388-71-0460, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0465   Are there waiting lists for HCP services?  If you are receiving:
     (1) COPES services, a waiting list may be created if:
     (a) The caseload or expenditures exceed the legislative funding, or
     (b) HCFA or the legislature imposes caseload limits.
     (2) Chore services, a waiting list may be created to maintain the monthly expenditures within the legislative appropriation. You receive priority if you:
     (a) Have received chore as of June 30, 1995; or
     (b) Need chore:
     (i) To return to the community from a nursing home,
     (ii) To prevent unnecessary nursing home placement, or
     (iii) For protection based on referral from an APS investigation.
     (3) MPC, there is no waiting list. Note: Instead of waiting lists, the department may be required to revise HCP rules to reduce caseload size, hours, rates, or payments in order to stay within the legislative appropriation.

[Statutory Authority: RCW 74.39.010, 74.39A.120. 00-04-056, § 388-71-0465, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0470   Who pays for HCP services?  Depending on your income and resources, you may be required to pay participation toward the cost of your care. The department determines exactly what amount, if any, you pay. If you are receiving:
     (1) COPES in-home or residential,
     (a) You participate income per rules in WAC 388-515-1505;
     (b) If you have nonexempt income that exceeds the cost of COPES services, you may retain the difference.
     (2) MPC in-home services, you do not participate toward the cost of your personal care services.
     (3) MPC services in a residential setting and you are:
     (a) An SSI beneficiary who receives only SSI income, you only pay for board and room. You are allowed to keep a personal allowance of at least thirty-eight dollars and eighty-four cents.
     (b) An SSI beneficiary who receives SSI and SSA benefits, you only pay for board and room. You are allowed to keep a personal allowance of at least fifty-eight dollars and eighty-four cents.
     (c) An SSI-related person per WAC 388-511-1105, you may be required to participate towards the cost of your personal care services in addition to your board and room if your financial eligibility is based on the facility's state contracted rate plus add-on hours. You will receive a personal allowance of fifty-eight dollars and eighty-four cents.
     (d) A GA-X client in a residential care facility, you are allowed to keep a personal allowance of thirty-eight dollars and eighty-four cents only. The remainder of your grant must be paid to the facility.
     (4) Chore services, you may retain an amount equal to one hundred percent of the federal poverty level, adjusted for family size, as the home maintenance allowance and pay the difference between the FPL and your nonexempt income. Exempt income includes:
     (a) Income listed in WAC 388-513-1340;
     (b) Spousal income allocated and actually paid as participation in the cost of the spouse's community options program entry system (COPES) services;
     (c) Amounts paid for medical expenses not subject to third party payment;
     (d) Health insurance premiums, coinsurance or deductible charges; and
     (e) If applicable, those work expense deductions listed as WAC 388-71-480(2).

[Statutory Authority: RCW 74.09.520, 74.09.530, 74.39A.110,[74.39A.120 , [74.39A.130, and 1998 c 346 § 205 (1)(c), and RCW 74.39A.030. 00-18-099, § 388-71-0470, filed 9/5/00, effective 10/6/00. Statutory Authority: RCW 74.39A.120, 74.39.010, 74.39.020. 00-04-056, § 388-71-0470, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0475   What is the maximum amount that the department pays per month for your COPES care?  Total expenditures are limited to the department's published rates and authorized payments. These costs are not to exceed ninety percent of the statewide average monthly Medicaid nursing home reimbursement rate. The total cost of care includes the COPES maintenance allowance as well as all Medicaid costs associated with the COPES individual's paid services including but not limited to the following list of services:
     (1) Personal care,
     (2) Residential care services,
     (3) Adult day care,
     (4) Adult day health,
     (5) Environmental modifications,
     (6) Home delivered meals,
     (7) Home health aide visits,
     (8) Personal emergency response,
     (9) Skilled nursing visits,
     (10) Specialized medical equipment and supplies,
     (11) Adult companion services,
     (12) Client training,
     (13) Transportation services,
     (14) Hospitalization, and
     (15) Nursing facility care.

[Statutory Authority: RCW 74.08.090. 00-04-056, § 388-71-0475, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0480   If I am employed, can I still receive HCP services?  If you are disabled, as determined under WAC 388-511-1105, you may be employed and still be eligible to receive HCP services.
     (1) If you remain Medicaid eligible under the categorically needy program, you are financially eligible for MPC services.
     (2) If you are not Medicaid eligible due to your earned income and resources, you may be eligible to receive chore personal care services.
     (a) You may be required to pay participation per WAC 388-71-0470(4) for any earned income above one hundred percent of the federal poverty level.
     (b) The department will exempt fifty percent of your earned income after work expense deductions. Work expense deductions are:
     (i) Personal work expenses in the form of self-employment taxes (FICA); and income taxes when paid;
     (ii) Payroll deductions required by law or as a condition of employment in the amounts actually withheld;
     (iii) The necessary cost of transportation to and from the place of employment by the most economical means, except rental cars;
     (iv) Expenses necessary for continued employment such as tools, materials, union dues, transportation to service customers is not furnished by the employer; and
     (v) Uniforms needed on the job and not suitable for wear away from the job.

[Statutory Authority: RCW 74.09.520, 74.09.530, 74.39A.110,[74.39A.120 , [74.39A.130, and 1998 c 346 § 205 (1)(c), and RCW 74.39A.030. 00-18-099, § 388-71-0480, filed 9/5/00, effective 10/6/00. Statutory Authority: RCW 74.39A.140, 74.39A.150. 00-04-056, § 388-71-0480, filed 1/28/00, effective 2/28/00.]

WAC 388-71-0500   What is the purpose of WAC 388-71-0500 through 388-71-0580?  A client/legal representative may choose an individual provider or a home care agency provider. The intent of WAC 388-71-0500 through 388-71-0580 is to describe the:
     (1) Qualifications of an individual provider, as defined in WAC 388-15-202 (25) and (26);
     (2) Qualifications of a home care agency provider, as defined in WAC 388-15-202(2) and chapter 246-336 WAC;
     (3) Conditions under which the department or the area agency on aging (AAA) will pay for the services of an individual provider or a home care agency provider.

[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, 74.39.095. 01-11-019, § 388-71-0500, filed 5/4/01, effective 6/4/01. 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. 00-03-043, § 388-71-0500, filed 1/13/00, effective 2/13/00.]

WAC 388-71-0505   How does a client hire an individual provider?  The client, or legal representative:
     (1) Has the primary responsibility for locating, screening, hiring, supervising, and terminating an individual provider;
     (2) Establishes an employer/employee relationship with the provider; and
     (3) May receive assistance from the social worker/case manager or other resources in this process.

[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, 74.39.095. 01-11-019, § 388-71-0505, filed 5/4/01, effective 6/4/01. 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. 00-03-043, § 388-71-0505, filed 1/13/00, effective 2/13/00.]

WAC 388-71-0510   How does a person become an individual provider?  In order to become an individual provider, a person must:
     (1) Be eighteen years of age or older;
     (2) Provide the social worker/case manager/designee with:
     (a) Picture identification; and
     (b) A Social Security card; or
     (c) Authorization to work in the United States.
     (3) Complete and submit to the social worker/case manager/designee the department's criminal conviction background inquiry application, unless the provider is also the parent of the adult DDD client and exempted, per chapter 74.15 RCW;
     (a) Preliminary results may require a thumb print for identification purposes;
     (b) An FBI fingerprint-based background check is required if the person has lived in the state of Washington less than three years.
     (4) Sign a home and community-based service provider contract/agreement to provide services to a COPES or Medicaid personal care client.

[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, 74.39.095. 01-11-019, § 388-71-0510, filed 5/4/01, effective 6/4/01. 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. 00-03-043, § 388-71-0510, filed 1/13/00, effective 2/13/00.]

WAC 388-71-0513   Is a background check required of a home care agency provider?  In order to be a home care agency provider, a person must complete the department's criminal conviction background inquiry application, which is submitted by the agency to the department. This includes an FBI fingerprint-based background check if the home care agency provider has lived in the state of Washington less than three years.

[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, 74.39.095. 01-11-019, § 388-71-0513, filed 5/4/01, effective 6/4/01.]

WAC 388-71-0515   What are the responsibilities of an individual provider or home care agency provider when employed to provide care to a client?  An individual provider or home care agency provider must:
     (1) Understand the client's service plan that is signed by the client or legal representative and social worker/case manager, and translated or interpreted, as necessary, for the client and the provider;
     (2) Provide the services as outlined on the client's service plan, within the scope of practice in WAC 388-15-202(38) and 388-15-203;
     (3) Accommodate client's individual preferences and differences in providing care, within the scope of the service plan;
     (4) Contact the client's representative and case manager when there are changes which affect the personal care and other tasks listed on the service plan;
     (5) Observe the client for change(s) in health, take appropriate action, and respond to emergencies;
     (6) Notify the case manager immediately when the client enters a hospital, or moves to another setting;
     (7) Notify the case manager immediately if the client dies;
     (8) Notify the department or AAA immediately when unable to staff/serve the client; and
     (9) Notify the department/AAA when the individual provider or home care agency will no longer provide services. Notification to the client/legal guardian must:
     (a) Give at least two weeks' notice, and
     (b) Be in writing.
     (10) Complete and keep accurate time sheets that are accessible to the social worker/case manager; and
     (11) Comply with all applicable laws and regulations.

[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, 74.39.095. 01-11-019, § 388-71-0515, filed 5/4/01, effective 6/4/01. 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. 00-03-043, § 388-71-0515, filed 1/13/00, effective 2/13/00.]

WAC 388-71-0520   Are there educational requirements for an individual provider or a home care agency provider of an adult client?  There are educational requirements for an individual provider or a home care agency employee. They must:
     (1) Possess a certificate of successfully completing department-designated fundamentals of caregiving training within one hundred and twenty days after beginning employment;
     (2) Complete a minimum of ten hours of continuing education credits each calendar year following the year in which the fundamentals of caregiving training is taken. One hour of completed instruction equals one hour of credit on topics that pertain to services provided in an in-home setting including, but not limited to:
     (a) Client's rights;
     (b) Personal care (such as transfers or skin care);
     (c) Mental illness;
     (d) Dementia;
     (e) Depression;
     (f) Medication assistance;
     (g) Communication skills;
     (h) Alternatives to restraints;
     (i) Activities for clients; and
     (3) Provide the department/AAA with proof of completion of continuing education credits.

[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. 00-03-043, § 388-71-0520, filed 1/13/00, effective 2/13/00.]

WAC 388-71-0525   Are there any exemptions from the training requirements?  In lieu of the fundamentals of caregiving training, an individual provider or home care agency provider can:
     (1) Pass the department's challenge test for the required class. This test can be taken only once;
     (2) Complete the department designated modified fundamentals of caregiving training and be a:
     (a) Registered or licensed practical nurse;
     (b) Physical or occupational therapist;
     (c) Certified nursing assistant; or
     (d) Medicare-certified home health aide; or
     (3) Complete the required division of developmental disabilities' (DDD) staff training if they are employed by, and continue to work for, a DDD-contracted and certified residential agency.

[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. 00-03-043, § 388-71-0525, filed 1/13/00, effective 2/13/00.]

WAC 388-71-0530   Are there special rules about training for parents who are the individual providers of division of developmental disabilities (DDD) adult children?  Natural, step, or adoptive parents of adult DDD children:
     (1) Must possess a certificate of successfully completing a six-hour DDD-approved training or a specially designed department-approved training within one hundred eighty days after beginning employment;
     (2) Are exempt from continuing education requirements; and
     (3) Are exempt from the fundamentals of caregiving training if they provide care only for their own adult DDD child.

[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. 00-03-043, § 388-71-0530, filed 1/13/00, effective 2/13/00.]

WAC 388-71-0535   Are there special rules about training for parents who are the individual providers of non-DDD adult children?  Natural, step, or adoptive parents of adult non-DDD children must:
     (1) Possess a certificate of successfully completing the modified fundamentals of caregiving training within one hundred eighty days after beginning employment and have documentation that they have completed individualized or other specific instruction on the care of their adult child; or
     (2) Pass the department's challenge test; or
     (3) Possess a certificate of successfully completing the fundamentals of caregiving.
     (4) Are exempt from continuing education requirements described in WAC 388-71-0520(2) if they provide care only for their adult child.

[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. 00-03-043, § 388-71-0535, filed 1/13/00, effective 2/13/00.]

WAC 388-71-0540   When will the department or AAA deny payment for services of an individual provider or home care agency provider?  The department or AAA will deny payment for the services of an individual provider or home care agency provider who:
     (1) Is the client's spouse, per 42 C.F.R 441.360(g), except in the case of an individual provider for a Chore services client. Note: For Chore spousal providers, the department pays a rate not to exceed the amount of a one-person standard for a continuing general assistance grant, per WAC 388-478-0030;
     (2) Is the natural/step/adoptive parent of a minor client aged seventeen or younger receiving services under this chapter;
     (3) Has been convicted of a disqualifying crime, under RCW 43.43.830 and 43.43.842 or of a crime relating to drugs as defined in RCW 43.43.830;
     (4) Has abused, neglected, abandoned, or exploited a minor or vulnerable adult, as defined in chapter 74.34 RCW;
     (5) Has had a license, certification, or a contract for the care of children or vulnerable adults denied, suspended, revoked, or terminated for noncompliance with state and/or federal regulations;
     (6) Does not successfully complete the training requirements within the time limits required in WAC 388-71-0520;
     (7) Is already meeting the client's needs on an informal basis, and the client's assessment or reassessment does not identify any unmet need; and/or
     (8) Is terminated by the client (in the case of an individual provider) or by the home care agency (in the case of an agency provider).
     (9) In addition, the department or AAA may deny payment to or terminate the contract of an individual provider as provided under WAC 388-71-0546, 388-71-0551, and 388-71-0556.

[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, 74.39.095. 01-11-019, § 388-71-0540, filed 5/4/01, effective 6/4/01. 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. 00-03-043, § 388-71-0540, filed 1/13/00, effective 2/13/00.]

WAC 388-71-0546   When can the department or AAA reject the client's choice of an individual provider?  The department or AAA may reject a client's request to have a family member or other person serve as his or her individual provider if the case manager has a reasonable, good faith belief that the person will be unable to appropriately meet the client's needs. Examples of circumstances indicating an inability to meet the client's needs could include, without limitation:
     (1) Evidence of alcohol or drug abuse;
     (2) A reported history of domestic violence, no-contact orders, or criminal conduct (whether or not the conduct is disqualifying under RCW 43.43.830 and 43.43.842;
     (3) A report from the client's health care provider or other knowledgeable person that the requested provider lacks the ability or willingness to provide adequate care;
     (4) Other employment or responsibilities that prevent or interfere with the provision of required services;
     (5) Excessive commuting distance that would make it impractical to provide services as they are needed and outlined in the client's service plan.

[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, 74.39.095. 01-11-019, § 388-71-0546, filed 5/4/01, effective 6/4/01.]

WAC 388-71-0551   When can the department or AAA terminate or summarily suspend an individual provider's contract?  The department or AAA may take action to terminate an individual provider's contract if the provider's inadequate performance or inability to deliver quality care is jeopardizing the client's health, safety, or well-being. The department or AAA may summarily suspend the contract pending a hearing based on a reasonable, good faith belief that the client's health, safety, or well-being is in imminent jeopardy. Examples of circumstances indicating jeopardy to the client could include, without limitation:
     (1) Domestic violence or abuse, neglect, abandonment, or exploitation of a minor or vulnerable adult;
     (2) Using or being under the influence of alcohol or illegal drugs during working hours;
     (3) Other behavior directed toward the client or other persons involved in the client's life that places the client at risk of harm;
     (4) A report from the client's health care provider that the client's health is negatively affected by inadequate care;
     (5) A complaint from the client or client's representative that the client is not receiving adequate care;
     (6) The absence of essential interventions identified in the service plan, such as medications or medical supplies; and/or
     (7) Failure to respond appropriately to emergencies.

[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, 74.39.095. 01-11-019, § 388-71-0551, filed 5/4/01, effective 6/4/01.]

WAC 388-71-0556   When can the department or AAA otherwise terminate an individual provider's contract?  The department or AAA may otherwise terminate the individual provider's contract for default or convenience in accordance with the terms of the contract and to the extent that those terms are not inconsistent with these rules.

[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, 74.39.095. 01-11-019, § 388-71-0556, filed 5/4/01, effective 6/4/01.]

WAC 388-71-0560   What are the client's rights if the department denies, terminates, or summarily suspends an individual provider's contract?  If the department denies, terminates, or summarily suspends the individual provider's contract, the client has the right to:
     (1) A fair hearing to appeal the decision, per chapter 388-02 WAC, and
     (2) Receive services from another currently contracted individual provider or home care agency provider, or other options the client is eligible for, if a contract is summarily suspended.
     (3) The hearing rights afforded under this section are those of the client, not the individual provider.

[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, 74.39.095. 01-11-019, § 388-71-0560, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050,