reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › CARE CLASSIFICATION › Section 388-106-0120 - What is the payment rate that the department will pay the provider if I receive personal care services in a residential facility?

Current through Register Vol. 24-14, July 15, 2024
The department publishes rates and/or adopts rules to
					 establish how much the department pays toward the cost of your care in a
					 residential facility.
(1) For CFC,
				  COPES, MPC, medical care services, RCL, and new freedom programs, the
				  department assigns payment rates to the CARE classification group. Under these
				  programs, payment for care in a residential facility corresponds to the payment
				  rate assigned to the classification group in which the CARE tool has placed
				  you.
(2)The enhanced services
				  facility rate is determined by legislative action and appropriation.
(3) The rate for adult family homes with a
				  specialized behavior support contract is based on the CARE classification group
				  and an add-on amount, which is negotiated through the collective bargaining
				  process.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0120, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › CARE CLASSIFICATION › Section 388-106-0125 - How does CARE use criteria to place me in a classification group for in-home care?

Current through Register Vol. 24-14, July 15, 2024
CARE uses the criteria of cognitive performance score as
					 determined under WAC
					 388-106-0090, clinical complexity
					 as determined under WAC
					 388-106-0095, mood/behavior and
					 behavior point score as determined under WAC
					 388-106-0100, ADLs as determined
					 under WAC
					 388-106-0105, and exceptional
					 care as determined under WAC
					 388-106-0110 to place you into
					 one of the following seventeen in-home groups. CARE classification is
					 determined first by meeting criteria to be placed into a group, then you are
					 further classified based on ADL score or behavior point score into a
					 classification sub-group following a classification path of highest possible
					 base hours to lowest qualifying base hours. Each classification group is
					 assigned a number of base hours as described below based upon the level of
					 funding provided by the legislature for personal care services, and based upon
					 the relative level of functional disability of persons in each classification
					 group as compared to persons in other classification groups.
(1) If you meet the criteria for exceptional
				  care, then CARE will place you in
Group E.
CARE then further
				  classifies you into:
(a)
Group E
				  High
with 393 base hours if you have an ADL score of 26-28; or
(b)
Group E Medium
with 327 base
				  hours if you have an ADL score of 22-25.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › CARE CLASSIFICATION › Section 388-106-0135 - What are the maximum hours that I can receive for in-home services?

Current through Register Vol. 24-14, July 15, 2024
(1) If you are age
				  21 or older, the maximum number of hours that you may receive is the base hours
				  assigned to your classification group and adjusted per WAC
				  388-106-0130, unless additional
				  hours are authorized through an exception to rule per WAC
				  388-440-0001. For chore program
				  clients, the maximum personal care hours per month the department will
				  authorize is one hundred sixteen (116).
(2) If you are under age twenty-one:
(a) The maximum number of hours that you may
				  receive will be the base hours assigned to your classification group and
				  adjusted per WAC
				  388-106-0130, unless additional
				  hours are authorized under parts (2)(b) or (3) below.
(b) Additional hours may be authorized at the
				  department's discretion through an exception to rule per WAC
				  388-440-0001. You may request
				  additional hours of personal care services through an exception to rule by
				  contacting your case manager and explaining why you do not believe the
				  authorized hours provide adequate assistance with your personal care tasks. The
				  case manager will document your request and forward the request for review per
				  WAC 388-440-0001. You will be
				  notified in writing of the decision.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › CARE CLASSIFICATION › Section 388-106-0136 - What if I disagree with the result of the limitation extension decision regarding personal care?

Current through Register Vol. 24-14, July 15, 2024
(1) In
				  addition to your right to contest the result of your CARE assessment under WAC
				  388-106-1305, if you are under
				  the age of twenty-one you have the right to an administrative hearing to
				  contest the number of personal care hours authorized pursuant to WAC
				  388-106-0135(3).
(2) The department will notify you in writing
				  of your right to an administrative hearing under sub-section (1) and will
				  provide you with information about how to request a hearing.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › CARE CLASSIFICATION › Section 388-106-0140 - What may change the maximum number of hours that I can receive for in-home personal care services?

Current through Register Vol. 24-14, July 15, 2024
The maximum number of in-home personal care hours you can
					 receive may change:
(1) When you have
				  a change in any of the criteria listed in WAC
				  388-106-0125 and/or 388-106-0130;
				  or
(2) Because you meet the
				  criteria in WAC
				  388-440-0001, an exception to
				  rule is approved by the department for in-home personal care hours in excess of
				  the amount determined to be available to you by the CARE tool.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520, chapters 74.39 and
						74.39A RCW. 07-01-046, § 388-106-0140, filed 12/14/06, effective 1/14/07.
						Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0140, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › CARE CLASSIFICATION › Section 388-106-0145 - What may change the maximum payment rate that will be paid for residential personal care services provided to me?

Current through Register Vol. 24-14, July 15, 2024
The maximum payment rate that will be paid for residential
					 personal care services provided to you may change:
(1) When you have a change in any of the
				  criteria listed in WAC
				  388-106-0115 and/or 388-106-0120;
				  or
(2) Because you meet the
				  criteria in WAC
				  388-440-0001, an exception to
				  rule is approved by the department for a payment rate for your residential
				  personal care services in excess of the rate determined to be applicable to you
				  by the CARE tool.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520, chapters 74.39 and
						74.39A RCW. 07-01-046, § 388-106-0145, filed 12/14/06, effective
						1/14/07.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › MEDICAID PERSONAL CARE (MPC) › Section 388-106-0200 - What services may I receive under medicaid personal care (MPC)?

Current through Register Vol. 24-14, July 15, 2024
You may be eligible to receive only the following services
					 under medicaid personal care (MPC):
(1) Personal care services, as defined in WAC
				  388-106-0010, in your own home
				  and, as applicable, assistance with personal care tasks while you are out of
				  the home accessing community resources or working.
(2) Personal care services in one of the
				  following residential care facilities:
(a)
				  Adult family homes; or
(b) A
				  licensed assisted living facility that has contracted with the department to
				  provide adult residential care services.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › MEDICAID PERSONAL CARE (MPC) › Section 388-106-0215 - When do MPC services start?

Current through Register Vol. 24-14, July 15, 2024
Your eligibility for MPC begins the date the department
					 authorizes services.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.39A.010 and
						74.39A.020. 06-05-022, §
						388-106-0215, filed 2/6/06, effective
						3/9/06.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › MEDICAID PERSONAL CARE (MPC) › Section 388-106-0220 - How do I remain eligible for MPC?

Current through Register Vol. 24-14, July 15, 2024
(1)
				  In order to remain eligible for MPC, you must be in need of services in
				  accordance with WAC
				  388-106-0210 as determined
				  through a CARE assessment. The assessment in CARE must be at least annually or
				  more often when there are significant changes in your functional or financial
				  circumstances.
(2) When eligibility
				  statutes, regulations, and/or rules for MPC change, irrespective of whether
				  your functional or financial circumstances have changed, if you do not meet the
				  changed eligibility requirements, the department will terminate your MPC
				  services.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0220, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › MEDICAID PERSONAL CARE (MPC) › Section 388-106-0225 - How do I pay for medicaid personal care?

Current through Register Vol. 24-14, July 15, 2024
You pay for medicaid personal care (MPC) as
					 follows:
(1) If you live in your own
				  home, you do not share in the cost of your personal care services.
(2) If you live in a residential facility,
				  you:
(a) Keep a personal needs allowance as
				  described in WAC
				  182-513-1105;
(b) Pay for room and board as described in
				  WAC 182-513-1105; and
(c) May be required to share in the cost of
				  your personal care under WAC
				  182-513-1205.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › MEDICAID PERSONAL CARE (MPC) › Section 388-106-0230 - Can I be employed and receive MPC?

Current through Register Vol. 24-14, July 15, 2024
You can be employed and receive MPC services if you remain
					 medicaid eligible under the noninstitutional categorically needy
					 program.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0230, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › MEDICAID PERSONAL CARE (MPC) › Section 388-106-0235 - Are there waiting lists for MPC?

Current through Register Vol. 24-14, July 15, 2024
There are no waiting lists for MPC. Instead of waiting
					 lists, the department may revise rules to reduce caseload size, hours, rates,
					 or payments in order to stay within the legislative
					 appropriation.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0235, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › ROADS TO COMMUNITY LIVING › Section 388-106-0250 - What is the roads to community living (RCL) demonstration project and who is eligible?

Current through Register Vol. 24-14, July 15, 2024
(1) Roads to
				  community living (RCL) is a demonstration project, funded by a "money follows
				  the person" grant originally authorized under section 6071 of the Deficit
				  Reduction Act of 2005 (
				  P.L.
				  109-171 ) and extended through the Patient
				  Affordable Care Act (
				  P.L.
				  111-148 ). It is designed to test services and
				  supports which help customers move from institutional settings into the
				  community if they wish to.
(2) To
				  be eligible, the department must assess your needs in CARE per chapter 388-106
				  or 388-845 WAC and you must:
(a) Have a
				  continuous stay of at least sixty days in a qualified institutional setting
				  (hospital, nursing home, residential habilitation center);
(i) Any days you were solely receiving
				  medicare-paid, short term rehabilitation services are excluded from the sixty
				  days.
(ii) If you are discharging
				  from a state psychiatric hospital and meet the length of stay criteria, you
				  must be under age twenty-two, or age sixty-five and older.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › ROADS TO COMMUNITY LIVING › Section 388-106-0255 - What services may I receive under RCL?

Current through Register Vol. 24-14, July 15, 2024
Following eligibility and case management criteria
					 outlined in chapters 388-106 or 388-845 WAC:
(1) The state plan or medicaid waiver
				  services for which you would otherwise be eligible;
(2) You may receive additional RCL
				  demonstration services; and
(3)
				  When you are discharged to a qualified community setting, you are eligible for
				  continuous medicaid coverage until your RCL services end.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and Deficit Reduction
						Act of 2005 ( P.L.
						109-171 ). 08-18-046, § 388-106-0255, filed
						8/29/08, effective 9/29/08.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › ROADS TO COMMUNITY LIVING › Section 388-106-0256 - When do RCL services start?

Current through Register Vol. 24-14, July 15, 2024
(1)
				  RCL services to prepare for your discharge may begin while you are in the
				  institution.
(2) After discharge,
				  roads to community living (RCL) can be authorized for no longer than three
				  hundred sixty-five days in a qualified community setting. Day one of the
				  demonstration year is the day you move from the institutional setting into the
				  qualified community setting. Day three hundred sixty-five is the last day you
				  can receive demonstration services.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › ROADS TO COMMUNITY LIVING › Section 388-106-0257 - How do I remain eligible for RCL?

Current through Register Vol. 24-14, July 15, 2024
You remain eligible for RCL until any of the following
					 occur:
(1) Reach the end of your
				  demonstration year;
(2) Return to
				  an institution for longer than 30 days (you can re-enroll later);
(3) Move out of state; or
(4) No longer want the service.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › ROADS TO COMMUNITY LIVING › Section 388-106-0260 - How do I pay for RCL services?

Current through Register Vol. 24-14, July 15, 2024
Depending on your income and resources, you may be required
					 to participate toward the cost of the services you receive under RCL, including
					 personal care and demonstration services, as outlined in chapters 388-515 or
					 388-106 WAC.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and Deficit Reduction
						Act of 2005 ( P.L.
						109-171 ). 08-18-046, § 388-106-0260, filed
						8/29/08, effective 9/29/08.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › ROADS TO COMMUNITY LIVING › Section 388-106-0261 - How does the department determine the number of hours or the payment rate for my personal care in RCL?

Current through Register Vol. 24-14, July 15, 2024
(1)
				  The number of personal care hours you receive is determined by the CARE
				  assessment as outlined in chapter 388-106 WAC.
(2) The payment rate structure for
				  residential personal care received in a residential facility is outlined in
				  chapter 388-106 WAC.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › ROADS TO COMMUNITY LIVING › Section 388-106-0262 - What may change the number of hours or payment rate for my personal care in RCL?

Current through Register Vol. 24-14, July 15, 2024
The maximum number of in-home personal care hours or
					 payment rate you can receive may change:
(1) When you have a change in any of the
				  criteria listed in WAC
				  388-106-0125,
				  388-106-0115,
				  388-106-0120 and/or 388-106-0130;
				  or
(2) Because you meet the
				  criteria in WAC
				  388-440-0001, an exception to
				  rule is approved by the department.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › ROADS TO COMMUNITY LIVING › Section 388-106-0265 - Do I have the right to an administrative hearing while receiving RCL services?

Current through Register Vol. 24-14, July 15, 2024
Yes, you may request an administrative hearing based on the
					 rules outlined in WAC
					 388-106-1305 to contest
					 eligibility decisions made by the department. Once your three hundred
					 sixty-five days of roads to community living (RCL) eligibility end, per WAC
					 388-106-0256, you may not request
					 an administrative hearing to contest the conclusion of RCL services or to
					 request an extension.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and Deficit Reduction
						Act of 2005 ( P.L.
						109-171 ). 08-18-046, § 388-106-0265, filed
						8/29/08, effective 9/29/08.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0270 - What services are available under community first choice (CFC)?

Current through Register Vol. 24-14, July 15, 2024
The services you may receive under the community first
					 choice program include:
(1) Personal
				  care services as defined in WAC
				  388-106-0010.
(2) Relief care, which is personal care
				  services by a second individual or agency provider as a back-up to your primary
				  paid personal care provider.
(3)
				  Skills acquisition training, which is training that allows you to acquire,
				  maintain, and enhance skills necessary to accomplish ADLs, IADLs, or health
				  related tasks more independently. Health related tasks are specific tasks
				  related to the needs of an individual that under state law licensed health
				  professionals can delegate or assign to a qualified health care
				  practitioner.
(4) Personal
				  emergency response systems (PERS), which are basic electronic devices that
				  enable you to secure help in an emergency when:
(a) You live alone in your own
				  home;
(b) You are alone in your own
				  home for significant parts of the day and have no provider for extended periods
				  of time; or
(c) No one in your
				  home, including you, is able to secure help in an emergency.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0271 - Are there limits to the skills acquisition training I may receive?

Current through Register Vol. 24-14, July 15, 2024
Skills acquisition training:
(1) Shall not replace any training or therapy
				  otherwise provided under medicaid, medicare, or any private
				  insurance;
(2) Does not include
				  therapy or nursing services that must be performed by a licensed therapist or
				  nurse, but may be used to complement therapy or nursing goals coordinated
				  through the care plan;
(3) For
				  children, must be related to the child's disability and will not be provided
				  for tasks that are determined to be age appropriate as described in WAC
				  388-106-0130(7);
				  and
(4)In combination with
				  assistive technology purchases, is limited to a yearly amount determined by the
				  department per fiscal year.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0272 - Who are qualified providers for skills acquisition training?

Current through Register Vol. 24-14, July 15, 2024
(1) Long term care
				  workers, who must only provide skills acquisition training on IADLs and the
				  following ADL tasks: dressing, application of deodorant, washing hands and
				  face, hair washing, hair combing and styling, application of make-up, menses
				  care, shaving with an electric razor, tooth brushing or denture care, and
				  bathing tasks excluding any transfers in or out of the bathing area;
				  and
(2) Contracted home health
				  agencies, which may provide skills acquisition training on ADLs, IADLs or
				  health related tasks that are within the profession's scope of
				  practice.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0273 - May I receive additional personal emergency response services?

Current through Register Vol. 24-14, July 15, 2024
Under the assistive technology benefit, you may be
					 eligible to receive:
(1)A fall
				  detection system, if:
(a)You are eligible for
				  a standard PERS unit; and
(b)You
				  have a recent documented history of falls.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0274 - Are there limits to the assistive technology I may receive?

Current through Register Vol. 24-14, July 15, 2024
(1) There are
				  limits to the assistive technology you may receive. Assistive technology
				  excludes:
(a) Any purchase solely for
				  recreational purposes;
(b) Items of
				  general utility, meaning they are used by people in the absence of illness,
				  injury, or disability, such as a wood splitter, facial wipes, menstrual
				  supplies, or a slow cooker;
(c)
				  Subscriptions, data plan charges, and ongoing recurring fees;
(d) Educational software, game applications,
				  or gift cards for educational/game applications;
(e) Medical supplies and medical equipment,
				  items available as specialized equipment and supplies, or durable medical
				  equipment;
(f) Specialized clothing
				  or slip-on shoes that are for convenience and not adaptive in nature;
(g) Exercise equipment;
(h) Home/environmental
				  modifications;
(i) Medically
				  necessary items, including but not limited to compression socks/stockings,
				  orthotics, hearing aids, and eyeglasses; and
(j) Any item that would otherwise be covered
				  under any other payment source, including but not limited to medicare,
				  medicaid, private insurance, or another resource.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0275 - Are there limits to the community transition services I may receive?

Current through Register Vol. 24-14, July 15, 2024
Community transition services:
(1) Do not include recreational or diverting
				  items, such as a television, cable or VCR;
(2) Do not include room and board;
(3) Do not include residential unit
				  furnishings, as outlined in WAC
				  388-78A-3011
				  for assisted living facilities and WAC
				  388-76-10685 for adult
				  family homes;
(4) Do not include
				  items that would otherwise be covered under other payment sources, including
				  but not limited to, medicare, medicaid, and private insurance; and
(5) May not exceed twenty-five hundred
				  dollars per discharge for items and services.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0276 - Where can I receive CFC services?

Current through Register Vol. 24-14, July 15, 2024
You may receive CFC services;
(1)In your own home; or
(2)In a residential facility, which include
				  licensed and contracted:
(a)Adult family
				  homes, as defined in
				  RCW
				  70.128.010; or
(b) Assisted living facilities as defined in
				  RCW
				  18.20.020.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0277 - Am I eligible for CFC services?

Current through Register Vol. 24-14, July 15, 2024
You are eligible for CFC services if you meet the following
					 criteria:
(1)Your CARE assessment shows
				  you need the level of care provided in a hospital, nursing facility,
				  intermediate care facility for the intellectually disabled (ICF/ID),
				  institution providing psychiatric services for individuals under age
				  twenty-one, or an institution for mental diseases for individuals age
				  sixty-five or over (or will likely need the level of care within thirty days
				  unless CFC services are provided); and
(2)You are eligible for a categorically needy
				  (CN) or the alternative benefit plan (ABP) Washington apple health program.
				  Financial eligibility rules for CFC are described in WAC 182-513-1210 through
				  WAC 182-513-1220; or
(3)If you are
				  not financially eligible for a non-institutional CN or ABP program, but are
				  financially eligible for a home and community based waiver, you are eligible
				  for CFC as long as you continue to receive at least one monthly waiver
				  service.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0283 - How do I remain eligible for CFC services?

Current through Register Vol. 24-14, July 15, 2024
(1) In order to remain eligible for CFC, you
				  must remain financially eligible and be in need of services in accordance with
				  WAC 388-106-0310 as determined
				  through a CARE assessment. The assessment in CARE must be completed at least
				  annually or more often when there are significant changes in your functional or
				  financial circumstances; or
(2) If
				  you receive services through DDA, you must remain financially eligible and
				  eligible for ICF/ID or nursing facility level of care as described in WAC
				  388-828-4400,
				  388-828-3080 and
				  388-106-0355.
(3)When your eligibility is dependent on your
				  eligibility for a home and community based waiver, you must receive at least
				  one waiver service every month. If you do not receive a waiver service for more
				  than thirty calendar days, you will no longer be eligible for CFC and the
				  department will terminate your CFC services.
(4) If eligibility laws, regulations, or
				  rules for CFC change, and if you do not meet the changed eligibility
				  requirements, the department will terminate your CFC services, even if your
				  functional or financial circumstances have not changed.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0285 - What do I pay for if I receive CFC services?

Current through Register Vol. 24-14, July 15, 2024
(1) If you are receiving services through CFC
				  only, you may be required to pay toward the cost of your care as outlined in
				  WAC 182-513-1215. If you are receiving services in:
(a)Your own home, you will not have to pay
				  toward the cost of your care.
(b) A
				  residential facility, you must pay for your room and board. You are allowed to
				  keep some of your income for personal needs allowance (PNA). Depending on your
				  financial eligibility group and income, you may also be responsible to pay an
				  additional amount towards the cost of your care.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0290 - What does the department pay towards the cost of care when you are receiving CFC services and live in a residential facility?

Current through Register Vol. 24-14, July 15, 2024
When you receive CFC services and live in a residential
					 facility, the department pays the facility the difference between what you are
					 required to pay the facility and the department-set rate for the facility. The
					 department pays the residential facility from the first day of service through
					 the:
(1)The day before your discharge
				  date; or
(2)The last day of service
				  if you die while living at the facility.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY FIRST CHOICE › Section 388-106-0295 - May I be employed and receive CFC services?

Current through Register Vol. 24-14, July 15, 2024
You may be employed and continue to receive CFC services
					 as long as you remain medicaid eligible under the categorically needy (CN) or
					 alternative benefit plan (ABP) program.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES) › Section 388-106-0300 - What services may I receive under community options program entry system (COPES) when I live in my own home?

Current through Register Vol. 24-14, July 15, 2024
When you live in your own home, you may be eligible to
					 receive the following services under COPES:
(1) Adult day care if you meet the
				  eligibility requirements under WAC
				  388-106-0805;
(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;
				  and
(e) Are not adaptations or
				  improvements, which are of general utility or add to the total square
				  footage;
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES) › Section 388-106-0305 - What services may I receive under COPES if I live in a residential facility?

Current through Register Vol. 24-14, July 15, 2024
If you live in one of the following residential facilities:
					 A licensed assisted living facility contracted with the department to provide
					 assisted living, enhanced adult residential care, enhanced adult residential
					 care-specialized dementia care, or an adult family home, you may be eligible to
					 receive only the following services under COPES:
(1) Specialized medical equipment and
				  supplies under WAC
				  182-543-1000, when
				  the items :
(a) Are necessary for:
(i) Life support;
(ii) To increase your ability to perform
				  activities of daily living; or
(iii) To perceive, control, or communicate
				  with the environment in which you live; or
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES) › Section 388-106-0310 - Am I eligible for COPES-funded services?

Current through Register Vol. 24-14, July 15, 2024
You are eligible for COPES-funded services if you meet all
					 of the following criteria. The department must assess your needs in CARE and
					 determine that:
(1) You are age:
(a) Eighteen or older and blind or have a
				  disability, as defined in WAC
				  182-512-0050; or
(b) Sixty-five or older.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES) › Section 388-106-0315 - When do COPES services start?

Current through Register Vol. 24-14, July 15, 2024
Your eligibility for COPES begins the date the department
					 authorizes services.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0315, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES) › Section 388-106-0320 - How do I remain eligible for COPES?

Current through Register Vol. 24-14, July 15, 2024
(1) In order to remain eligible for COPES,
				  you must be in need of services in accordance with WAC
				  388-106-0310 as determined
				  through a CARE assessment. The assessment in CARE must be at least annually or
				  more often when there are significant changes in your functional or financial
				  circumstances.
(2) When eligibility
				  statutes, regulations, and/or rules for COPES change, irrespective of whether
				  your functional or financial circumstances have changed, if you do not meet the
				  changed eligibility requirements, the department will terminate your COPES
				  services.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0320, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES) › Section 388-106-0325 - How do I pay for COPES services?

Current through Register Vol. 24-14, July 15, 2024
Depending on your income and resources, you may be
					 required to pay participation toward the cost of your care, as outlined in WAC
					 182-515-1505. If you have
					 nonexempt income that exceeds the cost of COPES services, you may retain the
					 difference. If you are receiving services in:
(1) Your own home, you are allowed to keep
				  some of your income for a maintenance allowance.
(2) In a residential facility, you must use
				  your income to pay for your room and board and services. You are allowed to
				  keep some of your income for personal needs allowance (PNA). The department
				  determines the amount of PNA that you may keep. The department pays the
				  facility for the difference between what you pay and the department-set rate
				  for the facility. The department pays the residential care facility from the
				  first day of service through the:
(a) Last day
				  of service when the medicaid resident dies in the facility; or
(b) Day of service before the day the
				  medicaid resident is discharged.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES) › Section 388-106-0330 - Can I be employed and receive COPES?

Current through Register Vol. 24-14, July 15, 2024
You can be employed and receive COPES, per WAC
					 182-515-1505.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0330, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES) › Section 388-106-0335 - Are there waiting lists for COPES?

Current through Register Vol. 24-14, July 15, 2024
The department will create a waiting list in accordance
					 with caseload limits determined by legislative funding. Wait listed clients
					 will gain access in the following manner:
(1) Nursing home residents wanting COPES
				  waiver services will be ranked first on the wait list by date of application
				  for services;
(2) Then clients
				  living in the community with a higher level of need, as determined by the CARE
				  assessment, will be ranked higher on the wait list over clients with a lower
				  level of need; and
(3) When two or
				  more clients in the community have equal need levels, the client with the
				  earlier application for services will have priority over later applications for
				  services.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0335, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › RESIDENTIAL SUPPORT › Section 388-106-0336 - What services may I receive under the residential support waiver?

Current through Register Vol. 24-14, July 15, 2024
You may receive the following services under the
					 residential support waiver:
(1) Adult
				  family homes and assisted living facilities with an expanded community services
				  contract that will provide:
(a) Personal
				  care;
(b) 24-hour on-site support
				  and response staff;
(c) The
				  development and implementation of an individualized behavior support plan to
				  prevent and respond to crises;
(d)
				  Medication management; and
(e)
				  Coordination and collaboration with a contracted behavior support
				  provider;
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › RESIDENTIAL SUPPORT › Section 388-106-0337 - When are you not eligible for adult day health services?

Current through Register Vol. 24-14, July 15, 2024
You are not eligible for adult day health if you:
(1) Can independently perform or obtain the
				  services provided in an adult day health center; or
(2) Have referred care needs that:
(a) Exceed the scope of authorized services
				  that the adult day health center is able to provide;
(b) Do not need to be provided or supervised
				  by a licensed nurse or therapist;
(c) Can be met in a less structured care
				  setting;
(d) In the case of skilled
				  care needs, are being met by paid or unpaid providers;
(e) Live in a nursing home or other
				  institutional facility; or
(f) Are
				  not capable of participating safely in a group care setting.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › RESIDENTIAL SUPPORT › Section 388-106-0338 - Am I eligible for services funded by the residential support waiver?

Current through Register Vol. 24-14, July 15, 2024
(1) You are
				  eligible for services funded by the residential support waiver if the
				  department, based on its assessment of your needs in CARE , determines you meet
				  all of the following criteria:
(a) You are at
				  least eighteen years old and blind or have a disability as defined in WAC
				  182-512-0050, or are age
				  sixty-five or older;
(b) Your
				  income and resources fall within the limits set in WAC
				  182-515-1505 and meet the income
				  and resource criteria for home and community based waiver programs and hospice
				  clients;
(c) Your CARE assessment
				  shows you need the level of care provided in a nursing facility or that you
				  will likely need this level of care within thirty days unless you receive
				  residential support waiver services as defined in WAC
				  388-106-0355(1);
(d) You have been assessed as medically and
				  psychiatrically stable and one ore more of the following applies:
(i) You currently reside at a state mental
				  hospital or the psychiatric unit of a hospital and the hospital has found you
				  are ready for discharge to the community;
(ii) You have a history of frequent or
				  protracted psychiatric hospitalizations; or
(iii) You have a history of an inability to
				  remain medically or behaviorally stable for more than six months and you;
(A) Have exhibited serious challenging
				  behaviors within the last year; or
(B) Have had problems managing your
				  medication which has affected your ability to live in the community;
(e) Because of the
				  protracted nature of your behavior and clinical complexity, you have no other
				  placement options and have found no community placement with a qualified
				  community provider;
(f) You have
				  behavioral or clinical complexity that requires staffing supports available
				  only in the qualified community settings provided through the residential
				  support waiver; and
(g) You require
				  caregiving staff with specific training in providing personal care,
				  supervision, and behavioral supports to adults with challenging
				  behaviors.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › RESIDENTIAL SUPPORT › Section 388-106-0340 - When do services from the residential support waiver start?

Current through Register Vol. 24-14, July 15, 2024
Your eligibility for Residential Support begins the date
					 the department authorizes services.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › RESIDENTIAL SUPPORT › Section 388-106-0342 - How do I remain eligible for residential support waiver services?

Current through Register Vol. 24-14, July 15, 2024
(1) In order to
				  remain eligible for residential support waiver services, you must be in need of
				  services as determined through a CARE assessment and as determined by the
				  department. Your CARE assessment must show your need for the level of care
				  provided in a nursing facility, as defined in WAC
				  388-106-0355(1).
				  The assessment in CARE must be completed at least annually or more often when
				  there are significant changes in your functional or financial
				  circumstances.
(2) When eligibility
				  statutes, regulations and/or rules for the residential support waiver change,
				  irrespective of whether your functional or financial circumstances have
				  changed, if you do not meet the changed eligibility requirements, the
				  department will terminate your Residential Support services.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › RESIDENTIAL SUPPORT › Section 388-106-0344 - How do I pay for residential support waiver services?

Current through Register Vol. 24-14, July 15, 2024
Depending on your income and resources, you may be
					 required to pay participation toward the cost of your care, as outlined in WAC
					 182-515-1505. If you have
					 nonexempt income that exceeds the cost of residential support services, you may
					 retain the difference. If you are receiving services under the residential
					 support waiver you must use your income to pay for your room and board and
					 services. You are allowed to keep some of your income for personal needs
					 allowance (PNA). The department determines the amount of PNA that you may keep.
					 The department pays the facility for the difference between what you pay and
					 the department-set rate for the facility. The department pays the residential
					 care facility from the first day of service through the:
(1) Last day of service when the medicaid
				  resident dies in the facility; or
(2) Day of service before the day the
				  medicaid resident is discharged.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › RESIDENTIAL SUPPORT › Section 388-106-0346 - Can I be employed and receive residential support waiver services?

Current through Register Vol. 24-14, July 15, 2024
You can be employed and receive residential support
					 services, per WAC
					 182-515-1505.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › RESIDENTIAL SUPPORT › Section 388-106-0348 - Are there waiting lists for the residential support waiver services?

Current through Register Vol. 24-14, July 15, 2024
The department will create a waiting list in accordance
					 with caseload limits determined by legislative funding. Wait listed clients
					 will gain access in the following manner:
(1) Length of time since the participant
				  requested placement;
(2) Continued
				  functional and financial eligibility;
(3) Geographical preferences; and
(4) Choice of provider, setting, and
				  roommate.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › NURSING FACILITY CARE SERVICES › Section 388-106-0350 - What are nursing facility care services?

Current through Register Vol. 24-14, July 15, 2024
You may receive care in a nursing facility, as outlined in
					 chapter 388-97 WAC.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0350, filed 5/17/05, effective
						6/17/05.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › NURSING FACILITY CARE SERVICES › Section 388-106-0360 - How do I pay for nursing facility care services?

Current through Register Vol. 24-14, July 15, 2024
(1) If you are medicaid eligible and the
				  nursing facility admits you without a request for assessment from the
				  department, the nursing facility will not:
(a) Be reimbursed by the department;
				  or
(b) Be allowed to collect
				  payment, including a deposit or minimum stay fee, from you or your
				  family/representative for any care provided before the date of request for
				  assessment.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › CHORE › Section 388-106-0600 - What services may I receive under chore?

Current through Register Vol. 24-14, July 15, 2024
You may receive personal care services in your own home
					 and, as applicable, assistance with personal care tasks while you are out of
					 the home accessing community resources or working.
Statutory Authority:
						RCW
						74.08.090,
						74.09.520. 05-11-082, §
						388-106-0600, filed 5/17/05, effective
						6/17/05.