Aging & Long Term Support

WACs 388-112A-1240 & 388-112A-1250

WAC 388-112A-1240 What are the minimum qualifications for an instructor for core basic, population specific, on-the-job, residential care administrator, nurse delegation core, and specialized diabetes trainings? and 388-112A-1250 What are the minimum qualifications for community instructors for adult education training using DSHS curriculum? The proposed changes do not affect the separate Department of Social and Health Services (department) contract required to be a nurse delegator, and all other instructor requirements for nurse delegation and adult education are maintained.

WACs 388-101-3020 & 388-101-30201

This rule making is necessary to help the regulated community comply with the rules by providing clear language about Certified Community Residential Services and Supports (CCRSS) compliance and infection control practices.

WACs 388-71-0503, 388-106-0010, 388-106-0060 & 388-115-0516

The Department of Social and Health Services (department) is proposing to amend the following WAC 388-71-0503 - What definitions apply to WAC 388-71-0500 through 388-71-05640, 388-106-0010 - What definitions apply to this chapter?, 388-106-0060 - Who must perform the assessment?, and 388-115-0516 - What are the responsibilities of the consumer-directed employer when providing care to a client?. WAC 388-106-0010 was filed as a part of a CR-101 on 6/17/24 with WSR 24-13-075. That rule making will be placed on hold for this rule making to proceed. The department may amend other related rules as required. The department is allowed to contract with a federally recognized Indian tribe to determine eligibility including assessments and reassessments, authorize and reauthorize services, and perform case management functions for Medicaid long-term services and supports clients within the tribe’s authority.
 

WAC 388-76-10490

WAC 388-76-10490-Medication disposal-Written policy-Required. The proposed rule supports and protects residents by adding timeframes to existing WAC requirements and adding clarifying language. The proposed rule does this by requiring AFHs to dispose of expired and discontinued medications within a specific timeframe and developing a policy to address the transfer of medications when residents permanently leave the home. Residents are less likely to receive expired or unused medications and those who leave the AFH will receive support to ensure they take their medications with them. *Updated text corrected 12.9.24*
 

WACs 388-76-10031, 388-76-10225 & 388-76-10530

This proposal updates chapter 388-76 WAC - adult family home minimum licensing requirements, amending the following sections: 388-76-10031 license requirements—seven or eight bed adult family homes—licensure, 388-76-10225 reporting requirement, and 388-76-10530 resident rights—notice of rights and services.

WAC 388-76-10780

This proposal would update Chapter 388-76 WAC - Adult Family Home Minimum Licensing Requirements, amending section 388-76-10780- Toilets and bathing facilities.

WAC 388-106-1021

WAC 388-106-1021 Private Duty Nurse Holiday Pay. The proposed rule clarifying holiday pay for contracted private duty nurses.

Chapters 388-71 & 388-115 WAC

The Department is planning to amend the following WAC sections related to training and continuing education rules due to SB 5811 (chapter 322 laws of 2024) 388-71-0523, 388-71-0839, 388-71-0875, 388-71-0880, 388-71-0888, 388-71-0890, 388-71-0971, 388-71-0977, 388-71-0991, 388-71-1001, 388-115-0523, and to repeal 388-71-0990.

Chapter 388-106 WAC

The department is proposing new rules to implement the establishment of a state-funded Guardianship and Conservatorship Assistance Program by adding new sections in chapter 388-106 WAC. Services have been provided since 2022 under a pilot project status. The purpose of the proposed rules is to convert from pilot to program. The new sections include: WAC 388-106-2100 – What is the home and community services guardianship and conservatorship assistance program?, 388-106-2105 – Definitions., 388-106-2110 - Eligibility criteria., 388-106-2115 – Referral process., 388-106-2120 - Acceptance into the program., 388-106-2125 – Reconsideration of acceptance determination., 388-106-2130 – Notice of department decisions., 388-106-2135 – Appeal of acceptance determination or discontinuation of program participation., 388-106-2140 – Overpayment., 388-106-2145- Program hold and reinstatement or forfeiture of program participation., 388-106-2150 - Estate recovery., 388-106-2155 - Exception to rule (ETR)., 388-106-2160 - Personal needs allowance increase or participation reduction, and 388-106-2165- Split appointment.

Chapter 388-106 WAC

The department is proposing new rules to implement provisions of Engrossed Second Substitute Senate Bill 5440, (chapter 453, laws of 2023) by adding new sections in chapter 388-106 WAC. The new sections include: WAC 388-106-2000 What definitions apply to the civil transitions program?, 388-106-2005 Who is eligible to apply to receive services under the civil transitions program?, 388-106-2010 What services may I receive under the civil transitions program if I am not functionally or financially eligible for long-term services and supports?, 388-106-2015 What services may I receive under the civil transitions program if I am functionally and financially eligible for long-term services and supports?, 388-106-2020 What conditional services may I receive under the civil transitions program?, 388-106-2025 Who can provide long term services and supports when I am eligible for the civil transitions program conditional services?, 388-106-2030 Where can I receive civil transitions program conditional services?, 388-106-2035 When will the department authorize my civil transitions program conditional services?, 388-106-2040 When will my civil transitions program conditional services end?, 388-106-2045 Do I have a right to an administrative hearing on civil transitions program conditional services?, and 388-106-2050 Can an exception to the rule (ETR) be granted for civil transitions program conditional services?

WAC 388-106-0336

The department added a new service, Community Stability Supports, under the Residential Support Waiver amendment WA.1086.R01.10. WAC 388-106-0336 – What services may I receive under the residential support waiver? Minor language changes are made to this WAC for consistency in service language.
 

Chapter 388-97 WAC

The department is proposing amendments to: WAC 388-97-0300, Clinical records for residents in medicare and medicaid certified facilities; and adoption of a new section related to nursing facilities providing clinical records to residents and their representatives during the COVID-19 pandemic; 388-97-0920, Resident and family groups; 388-97-1000, Resident Assessment; and adoption of a new section related to resident assessment during the COVID-19 pandemic; 388-97-1020, Comprehensive Plan of Care; and adoption of a new section related to care plans during the COVID-19 pandemic; 388-97-1260, Physician services for residents in medicare and medicaid certified facilities; and adoption of a new section related to physician delegation of tasks and visits in nursing homes during the COVID-19 pandemic; 388-97-1380, Tuberculosis – testing required; 388-97-1580, Tuberculosis – Reporting – Required; and adoption of two new sections related to tuberculosis (TB) testing requirements and COVID-19 vaccinations during the COVID-19 pandemic; 388-97-1740: Disaster and emergency preparedness; 388-97-1760: Quality assessment and assurance; 388-97-2400: Resident rooms; and the adoption of three new related sections during the COVID-19 pandemic. The department is proposing to adopt rules to identify the requirements in place during the COVID-19 pandemic in Washington state. The purpose of the rule change is to ensure consistent implementation and enforcement of rule requirements in effect during the COVID-19 pandemic in Washington state.

Preproposal notices filed as WSR 20-17-005, 20-17-133, 20-19-009, 20-21-034 and 21-11-061;

Proposed rule filed as WSR 23-06-063;

Supplemental proposed rule filed as WSR 24-01-015;        

Hearing Date: February 6, 2024

WAC 388-112A-0800

The department is planning to amend WAC 388-112A-0800 related to adult family home administrator training certification. Rules on this subject are needed due to the lack of alignment between WAC 388-112A-0800 and RCW 70.128.120. Currently, the WAC and the law have conflicting information related to the number of hours of training needed for required adult family home administrator training. This conflict is causing concerns during the adult family home application process because older certificates with fewer hours, while valid, do not meet the hours required in the current rule. The change will ensure that older certificates, provided they were received through an approved community college program, will be accepted.

Chapters 388-71, 388-112A & 388-115 WAC

The department of social and health services (department) is planning to amend WAC sections 388-71-0523, 388-71-0836, 388-71-0837, 388-71-0839, 388-71-0875, 388-71-0880, 388-71-0888, 388-71-0893, 388-71-0975, 388-71-0977, 388-71-0980, 388-71-1001, 388-112A-0010, 388-112A-0110, 388-112A-0115, 388-115-0503, 388-115-0505, 388-115-0520, 388-115-0523, 388-115-0540, 388-115-05410, and repeal section 388-112A-0130 in response and in compliance to E2SHB 1694 (chapter 424, Laws of 2023) passed during the 2023 legislative session. The changes included the definition of “date of hire”, clarification on when the date of hire may be re-set, and additional family relationships related to long-term care worker training and continuing education requirements. Changes to law related to training and continuing education affect all long-term care workers, and those that fall into newly added familial relationships. The department is also taking this opportunity to make necessary changes related to numerical representation, consistency regarding the Consumer Direct Employer relationship to individual providers, and inclusive language.

WACs 388-71-0876, 388-71-0992, 388-112A-0081 & 388-112A-0613

The department is proposing to amend the following sections WAC 388-71-0876, When must long-term care workers who were working or hired during the COVID-19 public health emergency complete training, including specialty training?, 388-71-0992, When must continuing education be completed when public health emergency waivers are lifted, and what continuing education credit is granted to long-term care workers employed during the pandemic?, 388-112A-0081, When must long-term care workers who were working or hired during the COVID-19 public health emergency complete training, including required specialty training?, and 388-112A-0613, When must continuing education be completed when public health emergency waivers are lifted, and what continuing education credit is granted to long-term care workers employed during the pandemic?. The amendments will finalize training, certification, and continuing education pandemic extensions and deadlines, and set a date for repeal of those sections as required by RCW 74.39A.074 and 74.39A.341.

WAC 388-96-918

Wage equity funding. Rules establishing department procedures for reviewing the spending of wage equity funding for nursing facilities. New rule. Legislature directed the department to implement rules outlining the procedure to review the spending of wage equity funding by nursing facilities and recoup funding as necessary.

Chapter 388-106 WAC

The department is adding a new section in chapter 388-106 WAC describing Long-Term Services and Supports (LTSS) Presumptive Eligibility (PE) and functional eligibility criteria for clients who are discharging from acute care hospitals or diverting from community psychiatric facilities into an in-home setting with home and community based (HCB) services. LTSS PE is included in the 1115 Waiver amendment currently under review by CMS. The Health Care Authority will also be filing rules amending chapter 182-513 WAC and chapter 182-515 WAC to define financial eligibility for LTSS Presumptive Eligibility.

WACs 388-106-1900 & 388-106-1915

The Department of Social and Health Services (department) is proposing to amend WAC 388-106-1900, What definitions apply to Medicaid Alternative Care (MAC) and Tailored Support for Older Adults (TSOA) services? and 388-106-1915, What services may I receive in MAC and TSOA? The department is not proceeding with amendments to other sections listed on the CR 101 preproposal at this time. The department determined they did not need to be amended for this proposal. The proposed rules clarify definitions and amend services provided to MAC and TSOA recipients. The department is amending chapter 388-106 WAC to update definition language, add additional services that are included in the 1115 Medicaid Transformation Waiver Renewal, and clarifying eligibility and updating language.

WACs 388-106-0010 & 388-106-0130

The department is planning to amend WAC 388-106-0010 “What definitions apply to this chapter?” and 388-106-0130 “How does the department determine the number of hours I may receive for in-home care?” The purpose of the proposal is to amend rules that are a result of the department’s efforts to modernize the Comprehensive Assessment and Reporting Evaluation (CARE) assessment tool. Most of the changes in this proposal were intended to be a part of WSR 20-23-124 and went through most of the rule-making review process but had to be pulled in order to prioritize other rule-making priorities. There have been no changes that affect how the department determines eligibility or benefit level using the CARE tool. In addition, in WAC 388-106-0010, “Turning and repositioning program”, “Passive range of motion,” “Active range of motion,” and “Bowel program” definitions are being added. A couple of definitions that are no longer relevant are being removed. Section (6)(c) is being removed because it is being added to 388-106-0010, “Informal support” (3) definition in this rule-making effort. Also, updates to terminology were made due to CARE Modernization.

WACs 388-76-10350, 388-76-10351, 388-78A-2100, 388-78A-2101, 388-107-0080 & 388-107-0081

The department is proposing to amend WAC 388-76-10350 Assessment-Updates required,388-78A-2100 On-going Assessments, 388-107-0080 On-going Comprehensive Assessment, and adding a new rule to chapters 388-76, 388-78A, and 388-107 to codify the timeline for emergency rules in place due to the COVID-19 public emergency. The department is proposing to adopt rules to identify the requirements in place during the COVID-19 pandemic in Washington state. The purpose of the rule change is to ensure consistent implementation and enforcement of rule requirements in effect during the COVID-19 pandemic in Washington state. This rulemaking will provide clarity for regulated facilities and department inspection and investigation staff related to requirements in place during the COVID-19 pandemic.

Chapter 388-112B WAC

New chapter 388-112B WAC Behavioral Health Workers-Facility Based Workers-Geriatric Behavioral Health Worker Training and Curriculum Requirements. The department is planning to add a new chapter 388-112B WAC relating to curricula for persons in long-term care facilities with behavioral health needs. This new rule will set competencies and standards to be used by nursing home facilities to create the curriculum required by RCW 74.39A.078 and set rules for approval of the curriculum by the department. During the 2017 legislative session, House Bill 1548 was codified as RCW 74.39A.078. This law requires the Department of Social and Health Services to adopt rules to establish minimum competencies and standards for the approval of curricula for facility-based workers serving persons with behavioral health needs and geriatric behavioral health workers. The curricula must include at least 30 hours of training specific to the diagnosis, care, and crisis management of residents with a mental health disorder, traumatic brain injury, or dementia. The curricula must be outcome-based, and the effectiveness measured by demonstrated competency in the core specialty areas through the use of a competency test. By eliminating the requirement for a social work degree through this training, the number of individuals who fall within the definition of Geriatric Behavioral Health worker can be expanded, which consequently allows the work performed by these individuals to be used to satisfy the nursing home's, direct care service, minimum requirements.

WACs 388-97-0300, 388-97-03001, 388-97-0920, 388-97-1000, 388-97-10001, 388-97-1020, 388-97-10201, 388-97-1260, 388-97-12601, 388-97-1380, 388-97-13801, 388-97-1580, 388-97-15801, 388-97-1740, 388-97-17401, 388-97-1760, 388-97-17601, 388-97-2400 & 388-97-24001

The department is proposing amendments to: WAC 388-97-0300, Clinical records for residents in medicare and medicaid certified facilities, and adoption of a new section related to nursing facilities providing clinical records to residents in and their representatives during the COVID-19 pandemic, 388-97-0920, Resident and family groups, 388-97-1000, Resident Assessment; and adoption of a new section related to resident assessment during the COVID-19 pandemic, 388-97-1020, Comprehensive Plan of Care; and adoption of a new section related to care plans during the COVID-19 pandemic, 388-97-1260, Physician services for residents in medicare and medicaid certified facilities, and adoption of a new section related to physician delegation of tasks and visits in nursing homes during the COVID-19 pandemic, 388-97-1380, Tuberculosis – testing required, 388-97-1580, Tuberculosis – Reporting – Required, and adoption of two new sections related to tuberculosis (TB) testing requirements and COVID-19 vaccinations during the COVID-19 pandemic, 388-97-1740: Disaster and emergency preparedness, 388-97-1760: Quality assessment and assurance, 388-97-2400: Resident rooms; and the adoption of three new sections during the COVID-19 pandemic.

WACs 388-106-0270 & 388-106-0274

The department is proposing amending sections of two Community First Choice (CFC) rules related to Assistive Technology - WAC 388-106-0270(5) "What services are available under community first choice (CFC)?", and 388-106-0274(1) and (3) "Are there limits to the assistive technology I may receive?" The purpose of the proposed amendments is to provide further clarification to our stakeholders on what is CFC assistive technology, what are examples of CFC assistive technology, what are examples of items that are not covered as CFC assistive technology, and what a treating professional providing a written recommendation should know about the assistive technology item and address related to the individual requesting the assistive technology. The anticipated effects of these proposed amendments are to assist case managers and CFC clients to have a clearer idea of what CFC assistive technology is.