Date of Adoption: January 13, 2000.

Purpose: Rules repeal WAC 388-15-196 through 388-15-19680 and 388-15-198, and move them to WAC 388-71-0500 through 388-71-0580. These rules implement provisions of RCW 74.39A.095, 74.39A.090, and 74.39A.050 relating to individual provider qualifications. Describes when the department/AAA may contract with and authorize payment to an individual provider and when they may deny payment or terminate a contract, and when they may deny payment to a home care agency provider. Requires persons who are performing health-related tasks directed by their client employers to meet quality assurance requirements the department establishes.

Citation of Existing Rules Affected by this Order: Repealing WAC 388-15-196, 388-15-19610, 388-15-19620, 388-15-19630, 388-15-19640, 388-15-19650, 388-15-19660, 388-15-19670, and 388-15-19680.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842.

Other Authority: RCW 74.39A.090, 43.20A.710, 74.39.050, 43.43.830.

Adopted under notice filed as WSR 99-23-078 on November 16, 1999.

Changes Other than Editing from Proposed to Adopted Version:

•	WAC 388-71-0510(3), clarified exclusion of DDD parent providers, per chapter 74.15 RCW;
•	WAC 388-71-0540 (5) and (6) were deleted; WAC 388-71-0540(7) was deleted because a rule with this criteria already exists in WAC 388-825-272(3);
•	WAC 388-71-0540, new, adds language to preclude contracting with an individual provider who the department/AAA determines to be unable to appropriately meet the client's needs, per RCW 74.39A.095 (7) or (8);
•	WAC 388-71-0545(4), is moved to WAC 388-71-0550; WAC 388-71-0550, deletes "including relatives" and adds "deny payment," to clarify that payment can be denied without termination of a contract; and
•	WAC 388-71-0550(5), removes the second sentence regarding the caregiver strain index.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 7, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 14, Amended 0, Repealed 11.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 14, Amended 0, Repealed 11. Effective Date of Rule: Thirty-one days after filing.

January 13, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

An adult client/legal guardian 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/area agency on aging (AAA) will pay an individual provider; and

(4) Conditions under which the department/AAA may deny a contract to an individual provider or terminate payment to an individual provider or a home care agency provider.

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The adult client, or legal guardian, as defined in chapter 11.88 RCW:

(1) Has the primary responsibility for locating, screening, hiring, 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.

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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. Preliminary results may require a thumb print or an interstate background check; and

(4) Sign a home and community-based service provider contract/agreement to provide services to a COPES or Medicaid personal care client, or other department contract or agreement.

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An individual provider or home care agency provider must:

(1) Understand the client's service plan, which is written in clear language, 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/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) In addition to the above requirements, the individual provider and home care agency provider must:

(a) Complete and keep accurate time sheets that are accessible to the social worker/case manager; and

(b) Maintain certain employment standards, which include:

(i) Maintaining a drug/alcohol-free work place;

(ii) Absence of criminal activity; and

(iii) Skills, knowledge, ability, and willingness to provide services.

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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.

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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.

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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.

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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.

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The department/AAA cannot contract or pay an individual provider who:

(1) Is the client's spouse, per 42 C.F.R 441.360(g), unless the client is on the chore personal care program;

(2) Has been convicted of a disqualifying crime, as listed in RCW 43.43.830 and 43.43.842;

(3) Has abused, neglected, abandoned, or exploited a minor or vulnerable adult, as per chapter 74.34 RCW or RCW 74.39A.050(8);

(4) 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; and/or

(5) Is determined by the department/AAA to be unable to appropriately meet the client's needs, per RCW 74.39A.095 (7) or (8).

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The department/AAA will deny payment and terminate the individual provider's contract, or deny payment to a home care agency provider when either provider:

(1) Does not successfully complete the training requirements within the time limits described in WAC 388-71-0520 and 388-71-0525;

(2) Does not meet the conditions of the contract;

(3) Has been terminated by the department for cause;

(4) Demonstrates an unwillingness or inability to provide quality care and services as outlined on the service plan, which is jeopardizing the health, safety, or well-being of the client;

(5) Is terminated by the client/employer; and/or

(6) Has not met the conditions described in WAC 388-71-0510 through WAC 388-71-0540.

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The department/AAA may deny or terminate a contract to an individual provider when the individual provider:

(1) Has other employment which prevents the provision of authorized services, as outlined on the client's service plan;

(2) Is unable to appropriately meet the client's care needs, per RCW 74.39A.090;

(3) Is already providing the personal care tasks the client requires per the comprehensive assessment and service plan on an informal basis, and the assessment or reassessment does not identify any unmet need;

(4) Has abused, neglected, abandoned, or financially exploited a minor or vulnerable adult;

(5) Has stress and strain in providing care which interferes with meeting the client's needs;

(6) Lives too far from the client, which prevents the provision of services as they are needed and outlined on the client's service plan;

(7) Places the health, safety, or well-being of the client at risk;

(8) Is reported by the client's health care providers and others with direct knowledge as unable to meet the client's needs, and the report is substantiated by the department/AAA; and/or

(9) Has not met the conditions described in WAC 388-71-0515.

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The department/AAA may summarily suspend an individual provider's contract when it has a reasonable, good faith belief that the health, safety, or well-being of the client is in imminent jeopardy because of the individual provider's inadequate performance or inability to deliver quality care, as evidenced by, but not limited to:

(1) The absence of, withholding of, or refusal to use essential interventions identified on the service plan for the client which could cause immediate harm, such as essential medications or other medical supplies;

(2) Evidence of alcohol/drug abuse by the individual provider during hours of employment;

(3) Failure to respond to emergencies;

(4) Abuse, neglect, abandonment, and/or financial exploitation;

(5) Other behavior directed toward the client and other persons involved in the client's life which places the client at risk of harm;

(6) A report(s)from health care providers seeing the client that the health of the client is seriously affected by poor care; and/or

(7) Conditions or a combination of conditions found in WAC 388-71-0515, 388-71-0520, 388-71-0525, 388-71-0540, 388-71-0545, and 388-71-0550 that imminently affect the health, safety or well-being of the client.

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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 388-08 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.

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Self-directed care under chapter 74.39 RCW must be directed by the adult client for whom the health-related tasks are provided. The adult client is responsible to train the individual provider in the health-related tasks which the client self-directs.

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     The following sections of the Washington Administrative Code are repealed:

WAC 388-15-196	Individual providers and home care agency providers.
WAC 388-15-19600	How do I apply to be an individual provider of an adult client?
WAC 388-15-19610	What requirements must an adult client's individual provider or a home care agency provider meet?
WAC 388-15-19620	How do I get paid as an individual provider?
WAC 388-15-19630	Under what conditions will the department deny payment to an individual provider or a home care agency provider?
WAC 388-15-19640	Does the individual provider or the home care agency provider have responsibilities in addition to the service plan?
WAC 388-15-19650	What are the educational requirements for an individual provider or a home care agency provider?
WAC 388-15-19660	Do all individual providers or home care agency providers have to take the fundamentals of caregiving training?
WAC 388-15-19670	Are there special rules about training for parents who are the individual providers of division of developmental disabilities (DDD) adult children?
WAC 388-15-19680	Are there special rules about training for parents who are the individual providers of non-DDD adult children?
WAC 388-15-198	Home and community services--Client and provider responsibilities.

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