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Chapter 388-106 WAC

|Show DispositionsLast Update: 7/30/24

LONG-TERM CARE SERVICES

WAC Sections

SCOPE AND DEFINITIONS
HTMLPDF388-106-0005What is the purpose and scope of this chapter?
HTMLPDF388-106-0010What definitions apply to this chapter?
APPLYING FOR SERVICES
HTMLPDF388-106-0015What long-term care services does the department provide?
HTMLPDF388-106-0020Under the MPC, CFC, COPES, and chore programs, what services are not covered?
HTMLPDF388-106-0025How do I apply for long-term care services?
HTMLPDF388-106-0030Where can I receive services?
HTMLPDF388-106-0033When may I receive services in a facility contracted to provide specialized dementia care services?
HTMLPDF388-106-0035May I receive personal care services through any of the long-term care programs when I am out of the state of Washington?
HTMLPDF388-106-0040Who can provide long-term care services?
HTMLPDF388-106-0045When will the department authorize my long-term care services?
HTMLPDF388-106-0047When can the department terminate or deny long-term care services to me?
COMPREHENSIVE ASSESSMENT REPORTING EVALUATION (CARE) ASSESSMENT
HTMLPDF388-106-0050What is an assessment?
HTMLPDF388-106-0055What is the purpose of an assessment?
HTMLPDF388-106-0060Who must perform the assessment?
HTMLPDF388-106-0065What is the process for conducting an assessment?
HTMLPDF388-106-0070Will I be assessed in CARE?
HTMLPDF388-106-0075How is my need for personal care services assessed in CARE?
CARE CLASSIFICATION
HTMLPDF388-106-0080How is the amount of long-term care services I can receive in my own home or in a residential facility determined?
HTMLPDF388-106-0085What criteria does the CARE tool use to place me in one of the classification groups?
HTMLPDF388-106-0090How does the CARE tool measure cognitive performance?
HTMLPDF388-106-0095How does the CARE tool measure clinical complexity?
HTMLPDF388-106-0100How does the CARE tool measure mood and behaviors?
HTMLPDF388-106-0105How does the CARE tool measure activities of daily living (ADLs)?
HTMLPDF388-106-0110How does the CARE tool evaluate me for the exceptional care classification of the E Group?
HTMLPDF388-106-0115How does CARE use criteria to place me in a classification group for residential facilities?
HTMLPDF388-106-0120What is the payment rate that the department will pay the provider if I receive personal care services in a residential facility?
HTMLPDF388-106-0125How does CARE use criteria to place me in a classification group for in-home care?
HTMLPDF388-106-0130How does the department determine the number of hours I may receive for in-home care?
HTMLPDF388-106-0135What is the maximum number of hours of personal care services that I can receive for in-home services?
HTMLPDF388-106-0136What if I disagree with the result of the limitation extension decision regarding personal care?
HTMLPDF388-106-0140What may change the maximum number of hours that I can receive for in-home personal care services?
HTMLPDF388-106-0145What may change the maximum payment rate that will be paid for residential personal care services provided to me?
MEDICAID PERSONAL CARE (MPC)
HTMLPDF388-106-0200What services may I receive under medicaid personal care (MPC)?
HTMLPDF388-106-0210Am I eligible for medicaid personal care (MPC) funded services?
HTMLPDF388-106-0215When do MPC services start?
HTMLPDF388-106-0220How do I remain eligible for MPC?
HTMLPDF388-106-0225How do I pay for medicaid personal care?
HTMLPDF388-106-0230Can I be employed and receive MPC?
HTMLPDF388-106-0235Are there waiting lists for MPC?
ROADS TO COMMUNITY LIVING
HTMLPDF388-106-0250What is the roads to community living (RCL) demonstration project and who is eligible?
HTMLPDF388-106-0255What services may I receive under RCL?
HTMLPDF388-106-0256When do RCL services start?
HTMLPDF388-106-0257How do I remain eligible for RCL?
HTMLPDF388-106-0260How do I pay for RCL services?
HTMLPDF388-106-0261How does the department determine the number of hours or the payment rate for my personal care in RCL?
HTMLPDF388-106-0262What may change the number of hours or payment rate for my personal care in RCL?
HTMLPDF388-106-0265Do I have the right to an administrative hearing while receiving RCL services?
COMMUNITY FIRST CHOICE
HTMLPDF388-106-0270What services are available under community first choice (CFC)?
HTMLPDF388-106-0271Are there limits to the skills acquisition training I may receive?
HTMLPDF388-106-0272Who are qualified providers for skills acquisition training?
HTMLPDF388-106-0273May I receive additional personal emergency response services?
HTMLPDF388-106-0274Are there limits to the assistive technology I may receive?
HTMLPDF388-106-0275Are there limits to the community transition services I may receive?
HTMLPDF388-106-0276Where can I receive CFC services?
HTMLPDF388-106-0277Am I eligible for CFC services?
HTMLPDF388-106-0280When do CFC services begin?
HTMLPDF388-106-0283How do I remain eligible for CFC services?
HTMLPDF388-106-0285What do I pay for if I receive CFC services?
HTMLPDF388-106-0290What does the department pay towards the cost of care when you are receiving CFC services and live in a residential facility?
HTMLPDF388-106-0295May I be employed and receive CFC services?
COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES)
HTMLPDF388-106-0300What services may I receive under community options program entry system (COPES) when I live in my own home?
HTMLPDF388-106-0305What services may I receive under COPES if I live in a residential facility?
HTMLPDF388-106-0310Am I eligible for COPES-funded services?
HTMLPDF388-106-0315When do COPES services start?
HTMLPDF388-106-0320How do I remain eligible for COPES?
HTMLPDF388-106-0325How do I pay for COPES services?
HTMLPDF388-106-0330Can I be employed and receive COPES?
HTMLPDF388-106-0335Are there waiting lists for COPES?
RESIDENTIAL SUPPORT
HTMLPDF388-106-0336What services may I receive under the residential support waiver?
HTMLPDF388-106-0337When are you not eligible for adult day health services?
HTMLPDF388-106-0338Am I eligible for services funded by the residential support waiver?
HTMLPDF388-106-0340When do services from the residential support waiver start?
HTMLPDF388-106-0342How do I remain eligible for residential support waiver services?
HTMLPDF388-106-0344How do I pay for residential support waiver services?
HTMLPDF388-106-0346Can I be employed and receive residential support waiver services?
HTMLPDF388-106-0348Are there waiting lists for the residential support waiver services?
NURSING FACILITY CARE SERVICES
HTMLPDF388-106-0350What are nursing facility care services?
HTMLPDF388-106-0355Am I eligible for nursing facility care services?
HTMLPDF388-106-0360How do I pay for nursing facility care services?
CHORE
HTMLPDF388-106-0600What services may I receive under chore?
HTMLPDF388-106-0610Am I eligible for chore-funded services?
HTMLPDF388-106-0615When do chore services start?
HTMLPDF388-106-0620How do I remain eligible for chore?
HTMLPDF388-106-0625How do I pay for chore?
HTMLPDF388-106-0630Can I be employed and receive chore?
VOLUNTEER CHORE
HTMLPDF388-106-0650What is the volunteer services program?
HTMLPDF388-106-0655Am I eligible to receive assistance through volunteer services?
HTMLPDF388-106-0660What types of services may be offered through volunteer services?
HTMLPDF388-106-0665How are volunteers qualified to provide volunteer services?
HTMLPDF388-106-0670When may volunteer services not be available or offered?
HTMLPDF388-106-0675What if I disagree with a decision made by the contracted volunteer services provider(s) related to volunteer services?
PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
HTMLPDF388-106-0700What services may I receive under PACE?
HTMLPDF388-106-0705Am I eligible for PACE services?
HTMLPDF388-106-0710How do I pay for PACE services?
HTMLPDF388-106-0715How do I end my enrollment in the PACE program?
ADULT DAY SERVICES
HTMLPDF388-106-0800What adult day care services may I receive?
HTMLPDF388-106-0805Am I eligible for adult day care?
HTMLPDF388-106-0810What adult day health services may I receive?
HTMLPDF388-106-0815Am I eligible for adult day health?
GAU-FUNDED RESIDENTIAL CARE
HTMLPDF388-106-0900What services may I receive under medical care services?
HTMLPDF388-106-0905Am I eligible to receive medical care services (MCS) residential care services?
COMMUNITY TRANSITION OR SUSTAINABILITY SERVICES
HTMLPDF388-106-0950What services may I receive under community transition or sustainability services?
HTMLPDF388-106-0955Am I eligible for community transition or sustainability services?
HTMLPDF388-106-0960Are there limits to the community transition or sustainability services I may receive?
HTMLPDF388-106-0965Are there waiting lists for community transition or sustainability services?
PRIVATE DUTY NURSING
HTMLPDF388-106-1000What is the intent of WAC 388-106-1000 through 388-106-1055?
HTMLPDF388-106-1005What services may I receive under private duty nursing (PDN)?
HTMLPDF388-106-1010Am I eligible for medicaid-funded private duty nursing services?
HTMLPDF388-106-1020How do I pay for my PDN services?
HTMLPDF388-106-1025Who can provide my PDN services?
HTMLPDF388-106-1030Are there limitations or other requirements for PDN?
HTMLPDF388-106-1035What requirements must a home health agency meet in order to provide and be paid for my PDN?
HTMLPDF388-106-1040What requirements must an RN, or LPN under the supervision of an RN, meet in order to provide and get paid for my PDN services?
HTMLPDF388-106-1045When may I receive private duty nursing (PDN) services in a contracted PDN adult family home (AFH)?
HTMLPDF388-106-1046When may an adult family home (AFH) be paid an all-inclusive daily rate for private duty nursing (PDN) services?
HTMLPDF388-106-1047What is included in the all-inclusive daily rate payment to the adult family home (AFH) providing private duty nursing (PDN) services?
HTMLPDF388-106-1050May I receive other long-term care services in addition to PDN?
HTMLPDF388-106-1055Can I choose to self-direct my care if I receive PDN services?
SENIOR CITIZENS' SERVICES
HTMLPDF388-106-1100What services can I receive under the Senior Citizens' Services Act (SCSA) fund?
HTMLPDF388-106-1105How do I apply for SCSA-funded services?
HTMLPDF388-106-1110Am I eligible for SCSA-funded services at no cost?
HTMLPDF388-106-1115What income and resources are exempt when determining eligibility?
HTMLPDF388-106-1120What if I am not eligible to receive SCSA-funded services at no cost?
RESPITE CARE SERVICES
HTMLPDF388-106-1200What definitions apply to respite care services through the family caregiver support program?
HTMLPDF388-106-1205What are respite care services?
HTMLPDF388-106-1210Who is eligible to receive respite care services through the family caregiver support program?
HTMLPDF388-106-1215Who may provide respite care services through the family caregiver support program?
HTMLPDF388-106-1220How are respite care providers reimbursed for their services through the family caregiver support program?
HTMLPDF388-106-1225Are participants required to pay for the cost of their respite care services through the family caregiver support program?
HTMLPDF388-106-1230What determines emergent and nonemergent respite care services through the family caregiver support program?
CLIENT RIGHTS
HTMLPDF388-106-1300What rights do I have as a client of the department?
HTMLPDF388-106-1303What responsibilities do I have as a client of the department?
HTMLPDF388-106-1305What if I disagree with the result of the CARE assessment and/or other eligibility decisions made by the department?
HTMLPDF388-106-1310When I request a fair hearing on my CARE assessment and another CARE assessment(s) is done between my fair hearing request and the fair hearing, which CARE assessment must the administrative law judge review?
HTMLPDF388-106-1315Do I have a right to an administrative hearing if my total in-home personal care hours or New Freedom budget approved as an exception to rule are reduced or terminated or if my increased residential payment rate approved as an exception to rule is reduced or terminated?
NEW FREEDOM CONSUMER DIRECTED SERVICES (NFCDS)
HTMLPDF388-106-1400What services may I receive under New Freedom consumer directed services (NFCDS)?
HTMLPDF388-106-1405What services are not covered under New Freedom consumer directed services (NFCDS)?
HTMLPDF388-106-1410Am I eligible for New Freedom consumer directed services (NFCDS)-funded services?
HTMLPDF388-106-1415When do New Freedom consumer directed services (NFCDS) start?
HTMLPDF388-106-1420How do I remain eligible for New Freedom consumer directed services (NFCDS)?
HTMLPDF388-106-1422What happens to my New Freedom service dollar budget if I am temporarily hospitalized, placed in a nursing facility, or intermediate care facilities for intellectual disability (ICF/ID)?
HTMLPDF388-106-1425How do I pay for New Freedom consumer directed services (NFCDS)?
HTMLPDF388-106-1430Can I be employed and receive New Freedom consumer directed services (NFCDS)?
HTMLPDF388-106-1435Who can direct New Freedom consumer directed services (NFCDS)?
HTMLPDF388-106-1440What is an individual budget?
HTMLPDF388-106-1445How is the amount of the individual budget determined?
HTMLPDF388-106-1450Is the individual budget intended to fully meet all of my needs?
HTMLPDF388-106-1455What happens to individual budget funds when I don't use them?
HTMLPDF388-106-1458How do I create and use my spending plan?
HTMLPDF388-106-1460When can my New Freedom spending plan (NFSP) be denied?
HTMLPDF388-106-1465Who can deny my New Freedom spending plan (NFSP)?
HTMLPDF388-106-1470Are there waiting lists for New Freedom consumer directed services (NFCDS)?
HTMLPDF388-106-1475How do I end enrollment in New Freedom consumer directed services (NFCDS)?
HTMLPDF388-106-1480What are my hearing rights to appeal New Freedom consumer directed services (NFCDS) assessment and eligibility actions?
NURSING FACILITY CERTIFICATE OF NEED
HTMLPDF388-106-1600What definitions apply to the nursing facility certificate of need?
HTMLPDF388-106-1610What is the purpose of determining nursing facility comparable home and community-based long-term capacity?
HTMLPDF388-106-1620What methodology does the department use to determine statewide or county specific nursing home comparable home and community-based long-term services availability?
SUPPORTIVE HOUSING
HTMLPDF388-106-1700What definitions apply to supportive housing?
HTMLPDF388-106-1705What services may I receive under supportive housing?
HTMLPDF388-106-1710Where may I receive supportive housing services?
HTMLPDF388-106-1715Who may provide supportive housing services?
HTMLPDF388-106-1720Am I eligible for supportive housing funded services?
HTMLPDF388-106-1725When do supportive housing services begin?
HTMLPDF388-106-1730How do I remain eligible for supportive housing?
HTMLPDF388-106-1735Do I have to pay for my supportive housing services?
HTMLPDF388-106-1740What are my rights when I receive supportive housing services in a setting owned by a service provider?
HTMLPDF388-106-1745May I be employed and receive supportive housing services?
HTMLPDF388-106-1750Are there limits to the supportive housing services I receive?
HTMLPDF388-106-1755Are there waiting lists for supportive housing?
HTMLPDF388-106-1760Do I have the right to an administrative hearing regarding supportive housing services?
HTMLPDF388-106-1765When may the department terminate or deny supportive housing services?
LONG-TERM SERVICES AND SUPPORTS (LTSS) PRESUMPTIVE ELIGIBILITY (PE)
HTMLPDF388-106-1800What definitions apply to LTSS PE?
HTMLPDF388-106-1805Am I eligible for LTSS NFLOC PE services?
HTMLPDF388-106-1810What services may I receive under LTSS NFLOC PE?
HTMLPDF388-106-1815Am I eligible for LTSS MPC PE services?
HTMLPDF388-106-1820What services may I receive under LTSS MPC PE?
HTMLPDF388-106-1825Who can provide long-term care services when I am eligible for LTSS NFLOC or LTSS MPC PE services?
HTMLPDF388-106-1830When will the department authorize my LTSS NFLOC or LTSS MPC PE services?
HTMLPDF388-106-1835When do LTSS NFLOC PE or LTSS MPC PE services end?
HTMLPDF388-106-1840Where can I receive LTSS NFLOC PE or LTSS MPC PE services?
HTMLPDF388-106-1845What do I pay for if I receive LTSS NFLOC PE or LTSS MPC PE services?
HTMLPDF388-106-1850Do I have a right to an administrative hearing on LTSS NFLOC PE or LTSS MPC PE determinations?
HTMLPDF388-106-1855Can an exception to rule (ETR) be granted for eligibility or service determinations?
MAC AND TSOA SERVICES
HTMLPDF388-106-1900What definitions apply to MAC and TSOA services?
HTMLPDF388-106-1905Am I eligible for MAC services?
HTMLPDF388-106-1910Am I eligible for TSOA services?
HTMLPDF388-106-1915What services may I receive in MAC and TSOA?
HTMLPDF388-106-1920What is the maximum amount of step three services I may receive a month?
HTMLPDF388-106-1921How does the TCARE assessment determine what step three services are recommended to my caregiver?
HTMLPDF388-106-1925What are the goals in TCARE?
HTMLPDF388-106-1930What is the purpose of the TCARE assessment?
HTMLPDF388-106-1931What are the TCARE screening measures?
HTMLPDF388-106-1932How is the TCARE screening scored to determine if my caregiver is eligible for a TCARE assessment and related step three services?
HTMLPDF388-106-1933How is the GetCare screening scored to determine if I am eligible for a GetCare assessment and related step three services?
HTMLPDF388-106-1935Where may I receive MAC and TSOA services?
HTMLPDF388-106-1940When will my MAC or TSOA services be authorized?
HTMLPDF388-106-1945When do my MAC or TSOA services begin?
HTMLPDF388-106-1950How do I remain eligible for MAC and TSOA services?
HTMLPDF388-106-1955What do I pay for if I receive MAC or TSOA services?
HTMLPDF388-106-1960May I be employed and receive MAC or TSOA services?
HTMLPDF388-106-1965Are there limits to the services I may receive?
HTMLPDF388-106-1970Who may provide MAC and TSOA services?
HTMLPDF388-106-1975Will there be a waitlist for MAC and TSOA?
HTMLPDF388-106-1980When may the department terminate or deny MAC or TSOA services?
HTMLPDF388-106-1985Do I have the right to an administrative hearing regarding MAC or TSOA services?
HTMLPDF388-106-1990May I choose to receive traditional medicaid long-term services and supports instead of services under the MAC program?
HTMLPDF388-106-2000What definitions apply to the civil transitions program?
HTMLPDF388-106-2005Who is eligible to apply to receive services under the civil transitions program?
HTMLPDF388-106-2010What services may I receive under the civil transitions program if I am not functionally and financially eligible for long-term services and supports?
HTMLPDF388-106-2015What services may I receive under the civil transitions program if I am functionally and financially eligible for long-term services and supports?
HTMLPDF388-106-2020What conditional services may I receive under the civil transitions program?
HTMLPDF388-106-2025Who can provide long-term services and supports when I am eligible for the civil transitions program conditional services?
HTMLPDF388-106-2030Where can I receive civil transitions program conditional services?
HTMLPDF388-106-2035When will the department authorize my civil transitions program conditional services?
HTMLPDF388-106-2040When will my civil transitions program conditional services end?
HTMLPDF388-106-2045Do I have a right to an administrative hearing on civil transitions program conditional services?
HTMLPDF388-106-2050Can an exception to rule (ETR) be granted for civil transitions program conditional services?
HTMLPDF388-106-2100What is the home and community services guardianship and conservatorship assistance program?
HTMLPDF388-106-2105Definitions.
HTMLPDF388-106-2110Eligibility criteria.
HTMLPDF388-106-2115Referral process.
HTMLPDF388-106-2120Acceptance into the program.
HTMLPDF388-106-2125Reconsideration of acceptance determination.
HTMLPDF388-106-2130Notice of department decisions.
HTMLPDF388-106-2135Appeal of acceptance determination or discontinuation of program participation.
HTMLPDF388-106-2140Overpayment.
HTMLPDF388-106-2145Program hold and reinstatement or forfeiture of program participation.
HTMLPDF388-106-2150Estate recovery.
HTMLPDF388-106-2155Exception to rule (ETR).
HTMLPDF388-106-2160Personal needs allowance increase or participation reduction.
HTMLPDF388-106-2165Split appointment.
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