Washington Department of Social and Health Services

Transcription

1 Washington Department of Social and Health Services Aging and Disabilities Services Administration Eligibility & Rates f Long Term Care Services Release Date: September 0, 2003

2 TABLE OF CONTENTS I Introduction...I-. Purpose...I- 2. Audience...I-2 3. Contact Infmation...I-2 II Definitions...II- III Eligibility... III-. Eligibility f Long Term Care Services... III-3. COPES / Medically Needy Residential Waiver Eligibility Requirements... III-5.2 Medicaid Personal Care (MPC) Program... III-7.3 CHORE Eligibility... III-24 IV Washington State Resource Use Classification Model...IV-. Criteria f Clinically Complex...IV-5 2. Criteria f Mood & Behavi...IV-8 3. Cognitive Perfmance Scale...IV- 4. Activities of Daily Living... IV-3 5. Exceptional Care Group... IV-5 V Rates... V-6. Introduction... V-2 2. In-Home Methodology... V-3 3. Residential Payment System... V-0 VI Nursing Referrals...VI-. Nursing Referral Algithm...VI-2 VII ICD-9 Codes...VII-. Introduction...VII- 2. ICD-9 Codes in CARE...VII-3 VIII WAC Reference... VIII- IX CARE Screen Shots...IX-. Psych/Social...IX-. Mini Mental Status Exam Screen...IX-2.2 Memy Screen...IX-7.3 Behavi Screen...IX-8.4 Decision Making Screen...IX-9 2. Activities f Daily Living... IX-0 2. Medications: Medication Management Screen... IX Locomotion in Room... IX- 2.3 Locomotion Outside Room... IX Walk in Room... IX Bed Mobility... IX Transfers... IX Bladder/Bowel... IX Toileting... IX-7 Washington Department of Social and Health Services Released 09/0/03 Table of Contents

3 2.9 Eating... IX Hygiene... IX-9 2. Bathing... IX Dressing... IX Personal Hygiene...IX Telephone Use... IX Household Tasks... IX Transptation... IX Essential Shopping... IX Wood Supply... IX Housewk... IX Finances... IX Skin... IX Medical... IX Diagnosis... IX Treatments... IX Pain... IX Nutrition/Oral... IX Care Plan... IX Nursing Referral... IX-36 Washington Department of Social and Health Services Released 09/0/03 Table of Contents

4 I Introduction. Purpose Washington State s Department of Social and Health Services (DSHS) Aging and Disabilities Services Administration (ADSA) must comply with state and federal regulations f assessing clients and providing service plans. The Legislature has required that ADSA consistently apply assessments and service plans to clients. DSHS/ADSA ganized a Quality Assurance Unit whose purpose is to ensure the quality and consistency of client assessments and care plans. The Quality Assurance Unit s wk will reduce future holdbacks, liabilities, and penalties because they provide a proactive service to the agency to make sure assessments and service plans confm to regulations. To ensure assessments and service plans confm to regulations ADSA is implementing a new Comprehensive Assessment Repting Evaluation (CARE) tool, which is an automated system used to collect demographic data, assess functional needs and abilities, health, and medical infmation, determine eligibility f services, develop a care plan, and authize services f clients on requesting long-term care services. The implementation of CARE will: Assure the quality, consistency, and completeness of the CARE assessment and service plans, as required by the Legislature. Ensure that ADSA complies with Center f Medicare & Medicaid Services (CMS) protocols and regulations. Provide consistency in the application of policies and procedures. Provides diminished exposure to liability f the agency. The purpose of this document is to provide ADSA with a single source that clearly describes how eligibility, rates, and nursing referral criteria are determined f long term care services. Included in this document are source materials, algithms, and codes used in the development of the CARE software. Page I-

5 2. Audience This document is written f an external, non-technical audience to understand how eligibility, rates, and nursing referrals are determined by ADSA s CARE system. Users of this document may include federal and state oversight agencies who monit services to ensure that ADSA meets all federal and state regulations in assessing clients and distributing services in a fair and equitable manner, nursing home and residential providers who provide direct services to clients; and ADSA management who has the responsibility of ensuring the quality of services delivered to ADSA clients, the consistent application of unifm standards and policies, and the diminished exposure to liability. The materials contained within this document assume the reader has some basic familiarity with ADSA services. 3. Contact Infmation F me infmation about the CARE project about the infmation contained within this document contact: Brooke Buckingham Program Manager Home & Community Programs Department of Social and Health Services Aging and Adult Services Administration Management Services Division 640 Woodland Square Loop SE PO Box Olympia, Washington (360) FAX (360) TTY (360) ADSA Hotline buckibe@dshs.wa.gov Page I-2

6 II Definitions The following table provides definitions f acronyms used throughout this document: Acronym ADL ADSA AFH AL ALS APS ARC AROM CARE CC CMS COPD COPES CPS DSHS EARC HCS IADL ICD-9 ICD-9-CM MMSE MNRW MPC MSA Non-MSA PROM PSA SOB SSPS TBI Definition Activities f Daily Living Adult Family Home Assisted Living Amyotrophic Lateral Sclerosis (Lou Gehrig s disease) Adult Protective Service Adult Residential Care Facility Active Range of Motion Comprehensive Assessment Repting Evaluation (software tool) Clinically Complex Center f Medicare & Medicaid Services Chronic Obstructive Pulmonary Disease Community Options Program Entry System Cognitive Perfmance Scale Washington State s Department of Social and Health Services Enhanced Adult Residential Care Facility Home and Community Services Instrumental Activities of Daily Living International Classification of Diseases (ICD) statistical classification system. Clinical Modification of the International Classification of Diseases (ICD) statistical classification system. Mini Mental Status Exam Medically Needy Residential Waiver Medicaid Personal Care Metropolitan Service Area Non-Metropolitan Service Area Passive Range of Motion Planning and Service Area Shtness of Breath Social Service Payment System Traumatic Brain Injury Page II-

7 III Eligibility Introduction (ADSA) offers a wide range of services. The agency assists elderly adults individuals with developmental disabilities who need help with personal care health-related problems. ADSA also monits care and services to assure their quality. Often the first contact a client has is with a casewker (social wker nurse) who makes an inperson visit to assess the client s needs, preferences, and resources. The casewker helps to identify services that will suppt the client in the most independent living arrangement possible. With this infmation services are provided that assists the client with Activities f Daily Living (ADL s) and Instrumental Activities of Daily Living (IADL s). The CARE system provides a tool f casewkers to complete assessments, determine eligibility, and to create service plans f those clients requesting services from ADSA. Once considered eligible, clients may choose to receive services in one of these settings: In Home the client lives in and receives personal care services in a private home. Services may be received by an individual provider home care agency. Adult Family Home the client lives in and receives personal care services in residential homes licensed to care f two to six residents. They provide room, board, laundry, necessary supervision, and personal care tasks. Boarding Home the client resides in and receives personal care services in a Boarding Home. These facilities provide room, board, and some supervision. Boarding Homes include the following: Adult Residential Care Facility (ARC) the client resides in and receives personal care services in a residential care facility that provides limited nursing services. The level of nursing services differentiates between an ARC and EARC. Enhanced Adult Residential Care Facility (EARC) the client resides in and receives personal care services in a residential care facility that provides limited nursing services. The level of nursing services differentiates between an ARC and EARC. Assisted Living Facility (AL) the client lives in a private apartment-like room, with its own bathroom and limited kitchen area. Limited nursing services are available. Nursing Home the client resides in and receives personal care services in a Nursing Home. Nursing Homes provide 24-hour supervised nursing services, personal care, Page III-

8 therapy, supervised nutrition, ganized activities, social services, room, board, and laundry. F me infmation about eligibility f aging and disabilities services about the infmation contained within this section contact: Brooke Buckingham Program Manager Home & Community Programs Department of Social and Health Services Aging and Adult Services Administration Management Services Division 640 Woodland Square Loop SE PO Box Olympia, Washington (360) FAX (360) TTY (360) ADSA Hotline buckibe@dshs.wa.gov See Also: Section VIII. WAC Reference: ADL and IADL descriptions Page III-2

9 . Eligibility f Long Term Care Services Business Description Funding f client services is available from a variety of sources: Community Options Program Entry System (COPES) -A program that pays f personal care and other services f people in their own homes. COPES also pays f care in Adult Family Homes (AFH), Enhanced Adult Residential Care facilities (EARC), and Assisted Living facilities (AL). It is designed to help people who, without COPES, would need to be in nursing homes. COPES is one of the Medicaid programs. It is administered by the Washington State Department of Social and Health Services (DSHS). The financial eligibility rules f COPES are very similar to the rules f the Medicaid program f nursing home care. Medicaid Personal Care (MPC) provides personal care suppt f people who need long term care in their own homes, Adult Family Homes (AFH), Adult Residential Care facilities (ARC). Medically Needy Residential Waiver (MNRW) This program pays f personal care and other services f aged, blind, disabled individuals residing in Adult Family Homes (AFH), Assisted Living (AL), and Enhanced Adult Residential Care facilities (EARC). It is designed to help people who are not eligible f other programs such as COPES MPC due to their income, but who would need to be in a nursing home without the services provided under MNRW. A maximum of 600 participants can be served during any waiver year. CHORE is state-funded and provides in-home personal care services to non-medicaid eligible, low-income, disabled very frail adults who still live in their own homes. This group includes all contracted agency and individual provider services as well as provider meal reimbursements and travel costs. CHORE program is frozen, except f the addition of Adult Protective Service (APS) clients. This is because there was no budget appropriation f new additions to the CHORE program. Page III-3

10 Funding is provided based on the type of care setting: Payment Source In AL ARC EARC AFH Home COPES X X X X CHORE X MPC X X X MNRW X X X X Page III-4

11 . COPES / Medically Needy Residential Waiver Eligibility Requirements To meet COPES / Medically Needy Residential Waiver eligibility, a client must meet one of the four criteria as listed below. An algithm is a computerized fmula that makes a determination from infmation gathered in the CARE tool, f example: eligibility, classification, and nursing referral. Treatment Provider Key Frequency Key 5 Home Health Agency QD Once Daily 6 Hospice 2 BID Two Times Daily 9 Clinic/Practitioner s Office 3 TID Three Times Daily 0 Private Duty Nurse 4 QID Four Times Daily Nurse Delegation 5 5 me/24 Hours 2 Facility RN/LPN These values can be found on the CARE Treatment Screens. Treatment/Skin Problems/Skin Care COPES ELIGIBILITY ALGORITHM Received Treatment Frequency Need Provider Sce. WAC A-0055 (4) (a) You require care provided by under the supervision of a registered nurse a licensed practical nurse on a daily basis. One of the following must be met: Wound/Skin care Need 05, 06, 09, 0, 2 Ulcer Care Need 05, 06, 09, 0, 2 Dialysis Need 05, 06, 09, 0, 2 Management of IV Need 05, 06, 09, 0, Lines 2 Moniting of an Need 05, 06, 09, 0, acute condition by a 2 licensed nurse 0, 02, 03, 04, 05 0, 02, 03, 04, 05 0, 02, 03, 04, 05 0, 02, 03, 04, 05 0, 02, 03, 04, 05 Nebulizer Need 05, 06, 09, 0,, 2 0, 02, 03, 04, 05 Oxygen Therapy Need 05, 06, 09, 0, 0, 02, 03,, 2 04, 05 Radiation Need 09 0, 02, 03, 04, 05 Suctioning Need 05, 06, 09, 0, 0, 02, 03,, 2 04, 05 Page III-5

12 Treatment/Skin Problems/Skin Care COPES ELIGIBILITY ALGORITHM Received Treatment Frequency Need Provider Tracheostomy Care Need 05, 06, 09, 0, 2 Transfusions Need 05, 06, 09, 0, 2 0, 02, 03, 04, 05 0, 02, 03, 04, 05 Sce Tube Feedings Need 05, 06, 09, 0,, 2 0, 02, 03, 04, 05 Ventilat Respirat Need 05, 06, 09, 0, 2 0, 02, 03, 04, 05 Application of Dressing Need 05, 06, 09, 0, 2 0, 02, 03, 04, 05 Application of medication Need 05, 06, 09, 0, 2 0, 02, 03, 04, 05 Bowel Program Need 05, 06, 09, 0, 2 Enemas/Irrigation Need 05, 06, 09, 0, 2 Intermittent Need 05, 06, 09, 0, Catheter 2 0, 02, 03, 04, 05 0, 02, 03, 04, 05 0, 02, 03, 04, 05 Intravenous Medications Need 05, 06, 09, 0, 2 0, 02, 03, 04, 05 IV Nutritional Suppt Need 05, 06, 09, 0, 2 0, 02, 03, 04, 05 Urinary Catheter Care Need 05, 06, 09, 0,, 2 0, 02, 03, 04, 05 Blood Glucose Moniting Need 05, 06, 09, 0,, 2 0, 02, 03, 04, 05 Chemotherapy Need 05, 06, 09, 0, 2 Injections Need 05, 06, 09, 0, 2 0, 02, 03, 04, 05 0, 02, 03, 04, 05 Page III-6

13 Treatment/Skin Problems/Skin Care COPES ELIGIBILITY ALGORITHM Received Treatment Frequency Need Provider Ostomy Care Need 05, 06, 09, 0,, 2 Routine Lab Wk Need 05, 06, 09, 0, 2 0, 02, 03, 04, 05 0, 02, 03, 04, 05 Sce COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce 2. WAC A-0055-(4) (b) You have an unmet partially met need the activity did not occur (because you were unable no provider was available) with at least three me of the following, as defined in WAC A At least one of the following tasks must be unmet partially met (i.e., cannot have all declines) f the ADLs that contribute to the client s eligibility. Bed Mobility Limited Assistance Supervision Extensive Assistance Total Dependency Set up help only One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Transfer Supervision Limited Assistance Extensive Assistance Total Dependence Set up help only One person physical assist Two plus persons physical assist Did not occur, no provider Did not occur Page III-7

14 COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Did not occur, client unable Did not occur N/A Toileting Supervision Limited Assistance Extensive Assistance Total Dependence No set up Set up help only One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Bathing Supervision Physical Help/Transfer only Physical Help/part of bathing Total Dependence No set up Set up help only One person physical assist Two plus persons physical assist Did not occur, no provider Did not occur Did not occur, client unable Did not occur N/A Ambulation = Walk in Room Locomotion in Room Locomotion Supervision Limited Assistance Extensive Assistance Total Dependence Set up help only One person physical assist Two plus persons physical assist Page III-8

15 COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Outside Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Eating Independent Supervision Limited Assistance Extensive Assistance Total Dependence Set up help only One person physical assist Two plus persons physical assist No help from Caregiver Set up help only One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Medication Management Self-direct medication assistance Must be administered Assistance Required Page III-9

16 COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce 3. WAC (4) (c) You have an unmet partially met need with at least two me of the following, as defined in WAC A At least one of the following tasks must be unmet partially met (i.e., cannot have all declines) f the ADLs that contribute to the client s eligibility. Bed Mobility & Skin Limited Assistance Extensive Assistance Total Dependence Did not occur, client unable One person physical assist Two plus persons physical assist and Skin care item turning/repositioning program is marked as received need. Did not occur and Skin care item turning/repositioning program is marked as received need. N/A Did not occur, no provider Did not occur and Skin care item turning/repositioning program is marked as received need. Transfer Extensive Assistance Total Dependence One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Page III-0

17 COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Toileting Extensive Assistance Total Dependence One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Bathing Physical Help/Part of bathing Total Dependence One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Ambulation = Walk in Room Locomotion in Room Locomotion Outside Extensive Assistance Total Dependence Did not occur, client unable One person physical assist Two plus persons physical assist Did not occur N/A Did not occur, no provider Did not occur Page III-

18 COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Eating Supervision One person physical Limited Assistance Extensive Assistance Total Dependence assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Medication Management Self-directed medication assistance Must be administered Assistance required Medications must be administered Frequency code f any Frequency code must be daily Frequency code f any Page III-2

19 COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce 4. WAC A-0055 (d) You have a cognitive impairment and require supervision due to one me of the following: disientation, memy impairment, impaired decision making, wandering and have an unmet partially met need with at least one me of the following, as defined in WAC A One of the following must be met: Orientation to Person is No (Memy) Sce 3 me No s on Orientation to Place (MMSE/Orientation) Sce 3 me No s on Orientation to Time (MMSE/Orientation) Sht Term Memy is a Problem (Memy) Delayed recall after interface is impaired Have at least one No (MMSE/Recall Screen) Long Term Memy is a problem (Memy) Wandering within the residence is current (Behavi) Wandering inside and is exit seeking is current (Behavi) Cognitive Skills f Daily Decision making is Moderately impaired Severely impaired (Decision Making) then Only one () of the following ADL s must be present and At least one of the following tasks must be unmet partially met (i.e. cannot have all declines) f the ADLs that contribute to the client s eligibility. Bed Mobility Limited Assistance Extensive Assistance Total Dependency One person physical assist Two plus persons physical assist and Skin care item turning/repositioning program is marked as received need. Page III-3

20 COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Did not occur, no provider Did not occur and Skin care item turning/repositioning program is marked as received need. Did not occur, client unable Did not occur and Skin care item turning/repositioning program is marked as received need. N/A Eating Supervision Limited Assistance Extensive Assistance Total Dependence Did not occur, client One person physical assist Two plus persons physical assist Did not occur N/A unable Did not occur, no provider Did not occur Transfer Extensive Assistance Total Dependence One person physical assist Two plus persons physical assist Did not occur, no provider Did not occur Page III-4

21 COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Did not occur, client unable Did not occur N/A Toileting Extensive Assistance Total Dependence One person physical assist Two plus persons physical assist Did not occur, no provider Did not occur Did not occur, client unable Did not occur N/A Bathing Physical help in part of bathing activity Total Dependence One person physical assist Two plus persons physical assist Did not occur, no provider Did not occur, client unable One person physical assist Two plus persons physical assist Did not occur Did not occur N/A Ambulation = Walk in Room Locomotion in Room Extensive Assistance Total Dependence One person physical assist Two plus persons physical assist Page III-5

22 COPES ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Locomotion Outside Did not occur, no provider Did not occur Did not occur, client unable Did not occur N/A Medication Management Self-direct medication assistance Must be administered Frequency code can be any of the options Assistance required Frequency code must be daily Page III-6

23 .2 Medicaid Personal Care (MPC) Program To meet Medicaid Personal Care (MPC) eligibility, a client must meet one of the two criteria as listed below. MPC ELIGIBILITY ALGORITHM. MPC A-0060 (2): Have an unmet partially met need the activity did not occur (because client was unable no provider was available) in at least three me of the following, as defined in WAC A At least one of the following tasks must be unmet partially met (i.e., cannot have all declines) f the ADLs that contribute to the client s eligibility. ADL (screen) Self Perfmance Suppt Provided Status Sce Ambulation = Walk in Room Locomotion in Room Locomotion Outside Supervision Limited Assistance Extensive Assistance Total Dependence Set up only One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur Did not occur, no provider Did not occur Bathing Supervision Physical Help Limited Physical Help in Part Total Dependence No set up Set up only One person physical assist Two plus persons physical assist Did not occur, no provider Did not occur Did not occur, client unable Did not occur N/A Page III-7

24 MPC ELIGIBILITY ALGORITHM Dressing Supervision Limited Assistance Extensive Assistance Total Dependence Any Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Eating Independent Set up only One person physical assist Two plus persons physical assist Supervision Limited Assistance Extensive Assistance Total Dependence No set up Set up only One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Page III-8

25 Personal Hygiene MPC ELIGIBILITY ALGORITHM Any Supervision Limited Assistance Extensive Assistance Total Dependence Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Bed Mobility Supervision Limited Assistance Extensive Assistance Total Dependence Set up only One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Medication Management Self-directed medication assistance Must be administered Assistance Required Frequency code can be any of the options Page III-9

26 Toileting MPC ELIGIBILITY ALGORITHM Any of the options Supervision Limited Assistance Extensive Assistance Total Dependence Did not occur, no provider Did not occur Did not occur, client unable Did not occur N/A Transfer Supervision Limited Assistance Extensive Assistance Total Dependence Set up only One person physical assist Two plus persons physical assist Did not occur, no provider Did not occur Did not occur, client unable Did not occur N/A Body Care Treatment Screen and Skin Care and Foot Care Application ointment/lotion (Foot Care) Nails Trimmed (Foot Care) Dry bandage change (Foot Care) Application ointment/lotion (Skin Care) Dry Bandage Change (Skin Care) Page III-20 N/A Needs Needs and Receives

27 MPC ELIGIBILITY ALGORITHM Range of Motion (passive) in Rehabilitation/Restative Care (Treatments). MPC ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce 2. MPC A-0060 (3): You have an unmet partially met need the activity did not occur (because you were unable no provider was available) with at least one me of the following, as defined in WAC A At least one of the following tasks must be unmet partially met (i.e., cannot have all declines) f the ADLs that contribute to the client s eligibility. Bed Mobility & Skin Limited Assistance Extensive Assistance Total Dependence Did not occur, client unable One person physical assist Two plus persons physical assist and Skin care item turning/repositioning program is marked as received need. Did not occur and Skin care item turning/repositioning program is marked as received need. N/A Did not occur, no provider Did not occur and Skin care item turning/repositioning program is marked as received need. Transfer Extensive Assistance Total Dependence One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Page III-2

28 MPC ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Did not occur, no provider Did not occur Toileting Extensive Assistance Total Dependence One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Bathing Physical Help/Part of bathing Total Dependence One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Ambulation = Walk in Room Locomotion in Room Locomotion Outside Extensive Assistance Total Dependence One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Page III-22

29 MPC ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Did not occur, no provider Did not occur Eating Supervision Limited Assistance Extensive Assistance Total Dependence One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Medication Management Self-directed medication assistance Must be administered Assistance required Medications must be administered Frequency code f any Frequency code must be daily Frequency code f any Personal Hygiene Extensive Total Frequency code f any Did not occur, client unable Did not occur N/A Page III-23

30 MPC ELIGIBILITY ALGORITHM ADL (Screen) Self Perfmance Suppt Provided Status Sce Did not occur, no provider Did not occur Dressing Extensive Frequency code f any Total Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Body Care Treatment Screen and Skin Care and Foot Care Application ointment/lotion (Foot Care) Nails Trimmed (Foot Care) Dry bandage change (Foot Care) Application ointment/lotion (Skin Care) Dry Bandage Change (Skin Care) Range of Motion (passive) in Rehabilitation/Restative Care (Treatments). N/A Needs Needs and Receives.3 CHORE Eligibility To be eligible CHORE A-0065 (2): Have an unmet partially met need the activity did not occur (because client was unable no provider was available) in at least one me of the following, as defined in WAC A Need one of the following and at least one of the following tasks must be unmet partially met (i.e., cannot have all declines) f the ADLs that contribute to the client s eligibility: Page III-24

31 CHORE ELIGIBILITY ALGORITHM New ADL Self Perfmance Suppt Provided Status Sce Supervision Limited Assistance Extensive Assistance Total Dependence Set up only One person physical assist Two plus persons physical assist Ambulation = Walk in Room Locomotion in Room Locomotion Outside Did not occur, client unable Did not occur, no provider Did not occur Did not occur Bathing Supervision Physical Help Limited Physical Help in Part Total Dependence Did not occur, no provider Did not occur, client unable No set up Set up only One person physical assist Two plus persons physical assist Did not occur Did not occur N/A Dressing Supervision Limited Assistance Extensive Assistance Total Dependence Any Page III-25

32 CHORE ELIGIBILITY ALGORITHM New ADL Self Perfmance Suppt Provided Status Sce Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Eating Independent Set up only One person physical assist Two plus persons physical assist Supervision Limited Assistance Extensive Assistance Total Dependence No set up Set up only One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur, no provider Did not occur N/A Did not occur Personal Hygiene Supervision Limited Assistance Extensive Assistance Total Dependence Any Page III-26

33 CHORE ELIGIBILITY ALGORITHM New ADL Self Perfmance Suppt Provided Status Sce Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Bed Mobility Supervision Limited Assistance Extensive Assistance Total Dependence Set up only One person physical assist Two plus persons physical assist Did not occur, client unable Did not occur N/A Did not occur, no provider Did not occur Medication Management Self-directed medication assistance Must be administered Assistance Required Frequency code can be any of the options Toileting Supervision Limited Assistance Extensive Assistance Total Dependence Any of the options Page III-27

34 CHORE ELIGIBILITY ALGORITHM New ADL Self Perfmance Suppt Provided Status Sce Did not occur, no provider Did not occur Did not occur, client unable Did not occur N/A Transfer Supervision Limited Assistance Extensive Assistance Total Dependence Set up only One person physical assist Two plus persons physical assist Did not occur, no provider Did not occur, client unable Did not occur Did not occur N/A Body Care Treatment Screen and Skin Care and Foot Care Application ointment/lotion (Foot Care) Nails Trimmed (Foot Care) Dry bandage change (Foot Care) Application ointment/lotion (Skin Care) Dry Bandage Change (Skin Care) Range of Motion (passive) in Page III-28 N/A Needs Needs and Receives

35 CHORE ELIGIBILITY ALGORITHM New ADL Self Perfmance Suppt Provided Status Sce Rehabilitation/Restative Care (Treatments). Related CARE Screen(s) CARE - Treatment Screen CARE ADL Screens Bed Mobility Transfer Toileting Bathing Walk in Room Locomotion in Room Locomotion Outside Dressing Personal Hygiene Treatment Skin Foot Care Eating Medication Management See Also Section VIII. WAC Reference: CARE Eligibility Section IX. CARE Screen Shots Page III-29

36 IV Washington State Resource Use Classification Model Business Description Criteria are used to classify ADSA home and community clients into clinical categies. The Washington State Resource Use Classification Model on the following two pages show the criteria used to determine the clinical classifications. The criteria f the classification model are determined by the following clinical characteristics: Clinically Complex Mood & Behavi Cognitive Perfmance Activities of Daily Living Once determined eligible f services, clients are placed into a Classification Group. Criteria are used to classify clients into twelve (2) main clinical categies f all residential care settings (Adult Family Homes, Assisted Living, ARC s, and EARC s). There are two additional groups f clients that receive in-home services(see Criteria f Exceptional Care Group). In addition, in-home clients with a Cognitive Perfmance Sce of 5 6 (equating to severely impaired cognition) will be placed in classification groups 0, 2 depending upon their activities of daily living sce. This section provides source materials, algithms, and codes used f the determination of classification groups within the CARE software. F me infmation regarding the development of the Classification Model: Washington State Residential Time Study Rept see DSHS website at: Page IV-

37 Washington State Resource Use Residential Classification Model Classification ADL Sce Group Severely Impaired Cognition (CPS 4-6) ADL Sce and ADL Sce 3-20 Clinically Complex ADL Sce Cognition Intact-Moderately Impaired (CPS 0-3) ADL Sce and ADL Sce Clinically Complex ADL Sce Mood & Behavi Yes ADL Sce Not Clinically Complex CPS = 0-6 ADL Sce ADL Sce Mood & Behavi No ADL Sce Not Clinically Complex CPS = 0-6 ADL Sce ADL Sce 0-4 Page IV-2

38 Washington State Resource Use In-Home Classification Model Classification ADL Sce Group Exceptional Care Group (in home only) Diagnosis + ADL >=22 + Treatment +Programs ADL Sce ADL Sce Severely Impaired Cognition ADL Sce (CPS 4-6) and Clinically Complex OR ADL Sce 3-20 Severely Impaired Cognition (CPS 5 6) ADL Sce Cognition Intact-Moderately Impaired (CPS 0-3) ADL Sce and ADL Sce Clinically Complex ADL Sce Mood & Behavi Yes ADL Sce Not Clinically Complex CPS = 0-4 ADL Sce ADL Sce Mood & Behavi No ADL Sce Not Clinically Complex CPS = 0-4 ADL Sce ADL Sce 0-4 See Also Page IV-3

39 Section IV. Washington State Resource Use Classification Model. Criteria f Clinically Complex Section IV. Washington State Resource Use Classification Model 2. Criteria f Mood & Behavi Section IV. Washington State Resource Use Classification Model 3. Cognitive Perfmance Scale Section IV. Washington State Resource Use Classification Model 4. Exceptional Care Group Section VIII. WAC Reference: Classification f In-Home and Residential Care Page IV-4

40 . Criteria f Clinically Complex Business Description To be considered Clinically Complex a client must be assessed as having any one of the following conditions: Condition AND an ADL Sce of ALS (Lou Gehrig s disease) >4 * Aphasia (Expressive and/ Receptive) >=2 Cerebral Palsy >4 * Diabetes Mellitus (Insulin Dependent) >4 Diabetes Mellitus (Non-Insulin Dependent) >4 Emphysema & (SOB [at rest exertion] Dizziness/Vertigo) >0 COPD & (SOB [at rest exertion] Dizziness/Vertigo) >0 Explicit Terminal Prognosis >4 Hemiplegia >4 Multiple Sclerosis >4 * Parkinson Disease >4 * Pathological Bone Fracture >4 * Pressure Ulcers, areas of persistent skin redness OR * Pressure Ulcers, partial loss of skin layers OR * Pressure Ulcers, a full thickness lost OR * Skin Problem, skin desensitized to pain/pressure OR * Skin Problem, open lesions OR Skin Problem, stasis ulcers AND >=2 Receives Ulcer Care OR * [Received] [Needs and Received] [Need Met] Pressure Relieving Device OR * [Received] [Needs and Received] [Need Met] Turning/Reposition Program OR Receives Application of Dressing OR * Receives Wound/Skin Care * Quadriplegia >4 * Rheumatoid Arthritis >4 * Skin Problem, Burns and receives application of dressings OR >=2 Receives Wound/Skin Care * Frequently Incontinent, Bladder OR >0 Page IV-5

41 Condition Incontinent All Most of the Time, Bladder ORFrequently Incontinent, Bowel OR Incontinent All Most of the Time, Bowel AND an ADL Sce of AND Uses, Has Leakage, Needs Assistance Does Not Use, Has Leakage Any Scheduled Toileting Plan OR OR * Current Swallowing Problem and Not Independent in Eating >0 * Edema >4 * Pain Daily >4 * Bowel program Receives and Needs >0 Dialysis, Needs >0 IV Nutritional Suppt, Needs OR * Tube Feedings, Needs AND Total Calies Received per IV Tube was greater than 50% >=2 OR Total Calies per IV Tube was 25-50% AND fluid intake greater than 2 cups * Hospice Care, Needs >4 Injections, Needs >4 Intravenous Medications, Needs >0 Management of IV lines, Needs >0 * Ostomy Care, Needs >=2 * Oxygen Therapy, Needs >0 Radiation, Needs >0 * Range of Motion, Passive, Receives and Needs >0 * Walking, Training, Receives and Needs >0 * Suction, Needs >=2 Tracheostomy Care, Needs >0 Ventilat/Respirat, Needs >0 Page IV-6

42 Rules & Exceptions The ADL sce range is Items marked with asterisks are suppted by the Washington State Time Study data (i.e., people with the condition used statistically significantly me direct care time than those without the condition). Items not marked with asterisks were recommended by the Clinical Resource Group Related CARE Screen(s) Treatment Diagnosis Nutrition/Oral Skin Pain Bowel/Bladder See Also Section IV. Washington State Resource Use Classification Model Section IX. CARE Screen Shots Page IV-7

43 2. Criteria f Mood & Behavi Business Description To be considered as having Mood and Behavial problems a client must be assessed as demonstrating any one of the following: Behavi Status * Assaultive Current * Combative during Personal Care Current * Combative during Personal Care, In Past Addressed with current interventions * Crying Tearfulness Current, Frequency 4 me days per week Delusions In past, Addressed with current interventions * Depression Sce >4 * Disrobes in Public Not Easily Altered * Easily Irritable/Agitated Not Easily Altered * Eats Non-Edible Substances Current * Eats Non-Edible Substances In past, Addressed with current interventions * Hallucinations Current * Hiding Items In past, Addressed with current interventions * Hoarding/Collecting In past, Addressed with current interventions * Mental health Therapy/Program Need * Repetitive Complaints/Questions Current, Daily * Repetitive Complaints/Questions In past, Addressed with current interventions * Repetitive Movement/Pacing Current, Daily * Resistive to Care Current * Resistive to Care In past, Addressed with current interventions * Sexual Acting Out Current * Sexual Acting Out In past, Addressed with current interventions * Spitting Not Easily Altered * Spitting In past, Addressed with current interventions * Breaks/Throws Items Current Page IV-8

44 Behavi Status * Unsafe Smoking Not Easily Altered * Up at Night Requires Intervention * Wanders Exit Seeking Current * Wanders Exit Seeking In past, Addressed with current interventions * Wanders Not Exit Seeking Current Wanders Not Exit Seeking In past, Addressed with current interventions * Yelling/Screaming Current, Frequency 4 me days per week Rules & Exceptions Items marked with an asterisk (*) are suppted by the Washington State Time Study data (i.e., people with the condition used statistically significantly me direct care time than those without the condition). Items not marked with asterisks were recommended by the Clinical Resource Group (CRG). A maj guiding principle in the Washington development process was that the groups categies make clinical sense. To ensure that end, a group of clinical experts was convened to wk with the time study team. The CRG included boarding home and adult family home representatives, nurse practitioners, social wkers and other industry professionals. The members of the CRG were chosen f their knowledge about the: Levels of complexity, severity, and instability characterizing HCS residents clinical conditions; Special therapies high-tech services that are provided; and Cognitive impairments, behavial characteristics, and environmental conditions that affect the amount and type of care HCS residents require. The CRS group was to provide feedback about:. Whether the groups derived from the statistical analysis make clinical sense; 2. What other data elements could be combined with them so that they did make clinical sense; and 3. What incentives can be built into the system to ensure that certain types of specialized care are provided (e.g. should we pay me f certain services such as restative nursing)? Related CARE Screen(s) Behavi Depression Treatment Page IV-9

45 See Also Section IV. Washington State Resource Use Classification Model Section IX. CARE Screen Shots Page IV-0

46 3. Cognitive Perfmance Scale Business Description The diagram below shows how a client s Cognitive Perfmance Scale (CPS) sce is achieved: Impairment Count (Number of the following): Decision Making: Not Independent = -2 Understood: Not Independent = -3 Sht-Term Memy: Not OK = All Residents Severe Impairment Count (Number of the following): Decision Making: Mod. Impaired = 2 Understood: Sometimes/Never = 2-3 No (0) Coma? Yes () Not Severely Impaired (0-2) Decision - Making Severely Impaired (3) 0 Impairment Count? 2 3 Total Dependent Eating? Yes (4) This sce pertains to the number of criteria met under the impairment count. 0 Severe Impairment Count 2 No (0-3) This sce pertains to the number of criteria met under the severe impairment count. (0) Intact 24.9 () Bderline Intact Average mini mental sce in field trial where 30 is best and 0 is wst. (2) Mild Impairment (3) Moderate Impairment (4) Mod. Severe Impairment (5) Severe Impairment (6) Very Severe Impairment 0.4 Reference: Mris, JN, Fries, BF, et.al. MDS Perfmance Scale. J. Gerontology 994; 49, m74-m82 Page IV-

47 . Comatose (Is client comatose; Diagnosis screen) No (0) Yes () 2. Decision Making (Rate how client makes decision; Decision Making screen). Independent (0) Modified Independence () Moderately Impaired (2) Severely Impaired (3) 3. Able to make self understood (By others client is; Speech/Hearing screen) Understood (0) Usually Understood () Sometimes Understood (2) Rarely/Never Understood (3) 4. Sht-term memy. Note: Sht-term Memy Not OK if either of the following is met: (Response to sht term memy question; Memy screen): Recent memy Problem () OR (Ask three wds ; MMSE/Recall Tab): Have at least one No () 5. Total Dependent Eating? (Self perfmance; Eating screen) Independent (0) Supervision () Limited Assistance (2) Extensive Assistance (3) Total Dependence (4) Related CARE Screen(s) Diagnosis Decision Making Speech/Hearing Memy MMSE/Recall Tab Eating See Also Section IV. Washington State Resource Use Classification Model Section IX. CARE Screen Shots Page IV-2

48 4. Activities of Daily Living The values f scing the following Activities of Daily Living (ADL) are shown in the ADL Scing Chart: Personal Hygiene Bed Mobility Transfers Eating Toilet Use Dressing ADL Scing Chart If Self Perfmance is: Sce Equals Independent 0 Supervision Limited Assistance 2 Extensive Assistance 3 Total Dependence 4 Did Not Occur/No Provider 4 Did Not Occur/Client Not Able 4 Did Not Occur/Client Declined 0 The ADL Scing Chart is also used to calculate the sce f the following Activities of Daily Living, but only the highest of the three sces is used in the Total ADL Sce (see example below): Locomotion in Room Locomotion Outside Room Walk in Room Example ADL Self Perfmance Sce Total Sce Personal Hygiene Independent 0 0 Bed Mobility Supervision Transfers Extensive Assistance 3 3 Eating Independent 0 0 Toilet Use Total Dependence 4 4 Dressing Limited Assistance 2 2 Locomotion in Room Extensive Assistance 3 Locomotion Outside Did Not Occur/Client 0 Room Declined Walk in Room Did Not Occur/Client Not Able 4 Choose the highest of these three sces 4 Total ADL Sce 4 Page IV-3

49 Related CARE Screen(s) Personal Hygiene Bed Mobility Transfers Eating Dressing Locomotion in Room Locomotion Outside Room Walk in Room See Also Section VIII. WAC Reference: ADL & IADL Descriptions Section IX. CARE Screen Shots Page IV-4

50 5. Exceptional Care Group Business Description The following criteria are used to determine if an in-home client qualifies f the Exceptional Care Group. The client must meet all of the criteria in either the First Second Criterion List. First Criterion List The client must have a diagnosis of: Quadriplegia Paraplegia ALS (Amyotrophic Lateral Sclerosis) Parkinson s Disease Multiple Sclerosis Comatose Muscular Dystrophy Cerebral Palsy Post Polio Syndrome TBI (Traumatic Brain Injury) AND ADL sce of greater than equal to 22 [Needs] [Needs and Received] [Need Met] Turning/Repositioning Program External catheter Intermittent catheter Indwelling catheter care Bowel Program Ostomy Care OR OR OR OR OR OR OR OR OR AND AND AND AND Needs Active Range of Motion (AROM) Needs Passive Range of Motion (PROM) with provider code of: 03 = Individual Provider Agency Provider 04 = Self-Directed Care (individual provider only) 0 = Private Duty Nurse Page IV-5

51 Second Criterion List The client must have: ADL sce greater than equal to 22 [Needs] [Needs and Received] [Need Met] Turning/Repositioning Program Need f AROM OR need f PROM and Provider Code of: 03 = Individual Provider Agency Provider 04 = Self-Directed Care (individual provider only) 0 = Private Duty Nurse IV nutrition suppt OR tube feeding and Total calies received per IV tube was greater than 50% and Fluid intake greater than 2 cups AND AND AND AND Needs dialysis (with provider code of 03, 04, 0) Needs ventilat/respirat (with provider code of 03, 04, 0) ADL Split Both criterion will have two ADL groups: ADL sce of 22 to 25 f Group 3 will be one level ADL sce of 26 to 28 f Group 4 will be second level Related CARE Screen(s) Diagnosis Treatment Skin Nutrition/Oral Bowel/Bladder See Also Section IV. Washington State Resource Use Classification Model Section IX. CARE Screen Shots V Rates Page V-6

52 . Introduction Once the client s Classification Group is determined, the number of hours f In-Home clients the Daily Rate f Residential clients is calculated. An hourly rate, based on appropriations by the Washington Legislature, is paid f clients living in and receiving personal care services in a private home. A Daily Rate is paid f clients living in and receiving personal care services in a Boarding Home (AL/ARC/EARC) Adult Family Home. A fact in determining the daily rates is the Residential Service Area (RSA) where the provider is located. There are three (3) RSA s: King County, Metropolitan (MC), and Non-Metropolitan (NMC). Residential care rates can be viewed on the DSHS web-site at: F me infmation about Rates f Aging and Disabilities Services about the infmation contained within this section contact: Patricia Draleau Rates Analyst Home & Community Rates Section Office of Rates Management Department of Social and Health Services Aging and Adult Services Administration Management Services Division 640 Woodland Square Loop SE PO Box Olympia, Washington (360) FAX (360) TTY (360) dralepc@dshs.wa.gov Jon Ihli Long Term Care Data & Fiscal Analyst Home & Community Rates Section Office of Rates Management Department of Social and Health Services Aging and Adult Services Administration Management Services Division 640 Woodland Square Loop SE PO Box Olympia, Washington (360) FAX (360) TTY (360) ihlijd@dshs.wa.gov Page V-2

53 2. In-Home Methodology Business Description The following chart provides the CARE methodology used to calculate the Distribution of Hours f In-Home clients. The results of this calculation are displayed on the Care Plan screen. Once the maximum number of hours available f distribution is calculated (Column 6) the client and the case manager will decide how the hours will be distributed. The hours may be used to authize: Personal Care Services, Home Delivered Meals, Adult Day Care, Adult Day Health, and a Home Health Aide. Classification Categy Exceptional Care Group (in-home only) ADL Sce Classification Group Base hours ADL = Diagnosis + ADL>=22 + Treatment +Program ADL = Adjustment f needs met by non-adsa paid sources% Base hour adjusted by needs met by non-adsa paid sources Adjustment to hours Maximum Hours available f distribution % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 Severely Impaired Cognition ADL = (CPS = 4-6) and ADL = Clinically Complex Severely Impaired Cognition (CPS = 5 6) ADL = Cognition Intact- Moderately Impaired (CPS = 0-3) and Clinically Complex Setting decision IN-HOME ADL = ADL = ADL = % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 Mood & Behavi Yes Not Clinically Complex (CPS = 0-4) ADL = ADL = ADL = % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 Mood & Behavi - No Not Clinically Complex (CPS = 0-4) ADL = ADL = ADL = % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 % adjustment 2 X 3 = 4 + hours = 6 Page V-3

54 Calculation Key f In-Home Methodology Column Column 2 Column 3 Care setting decision = In-Home. Base Hours f Classification Group. Non-ADSA paid sources include, but are not limited to: family, neighbs, friends, home, church, community, etc. The system will calculate this value based on a percentage of unmet needs f selected ADLs and IADLs. See chart on next page labeled Column 3 Explanation Column 4 Column 5 Base hour adjusted by needs met by non-adsa paid sources. (Column 2 x Column 3) Adjustment to hours include increases f off-site laundry facilities, wood supply (if only source of heat), client is >45 minutes away from essential shopping services (not medical transpt). See chart on page V-7 labeled Column 5 Explanation Column 6 Maximum hours available f distribution. (Column 4 + Column 5) Page V-4

55 Column 3 Explanation The value f Column 3 Adjustment f Needs Met by Non-ADSA Paid Sources is determined as follows:. F each separate ADL and IADL listed below, the case wker determines the amount of met need. 2. If need is met if a client declines assistance f a specific ADL/IADL it is assigned 0%, if need is totally unmet 00% is assigned. 3. A percentage is assigned to the varying degrees of partially met needs. The higher amount of need met, the lower the percentage. 4. The met need percentages will be weighted differently f each ADL/IADL depending upon how significant the ADL/IADL. F example, >3/4 partially met need f dinary housewk will receive a lower percentage than >3/4 partially met need f toilet use. 5. The percentage assigned to each specified ADL/IADL is carried two decimal places, summed and divided by 3 (the total number of selected ADLs/IADLs). 6. This percentage is subtracted from. The result is divided by 3. The result of the division is then added to the iginal percentage. The sum of the iginal percentage and the result of the division are then multiplied by the base hours assigned to the client s classification group. Medications Self-Administration of medications Status Assistance Available Value Percentage N/A Met N/A 0 N/A 0 < /4 time 0.9 Partially Met between /4 - /2 time 0.7 between /2 and 3/4 time 0.5 > 3/4 time 0.3 otherwise Page V-5

56 Unscheduled ADLs Unscheduled ADLs are activities that cannot be perfmed on a schedule. Assistance with these activities is needed on demand. Bed mobility Transfer Walk in room Eating Toilet use Status Assistance Available Value Percentage N/A Met N/A 0 N/A 0 < /4 time 0.9 between /4 - /2 time 0.7 Partially Met between /2 and 3/4 time 0.5 > 3/4 time 0.3 otherwise Scheduled ADLs Scheduled ADLs are activities that can be perfmed and assisted with on a schedule. Dressing Personal hygiene Bathing Status Assistance Available Value Percentage N/A Met N/A 0 N/A 0 < /4 time 0.75 between /4 - /2 time 0.55 Partially Met between /2 and 3/4 time 0.35 > 3/4 time 0.5 otherwise Meal preparation Ordinary housewk Essential shopping IADLs Status Assistance Available Value Percentage N/A Met N/A 0 N/A 0 < /4 time 0.3 between /4 - /2 time 0.2 Partially Met between /2 and 3/4 time 0. > 3/4 time 0.05 otherwise Page V-6

57 IADLs Travel to medical Status Assistance Available Value Percentage N/A Met N/A 0 N/A 0 < /4 time 0.9 between /4 - /2 time 0.7 Partially Met between /2 and 3/4 time 0.5 > 3/4 time 0.3 otherwise Example: Task Assistance Available Value Percentage. Self-Administration of </4 time 0.9 Medications 2. Bed Mobility.0 3. Transfer Met Walk in room Did not occur Client Eating Between ½ and ¾ time Toilet Use > ¾ time Dressing Did not occur Client.0 8. Personal Hygiene Between ½ and ¾ time Bathing > ¾ time Meal Preparation.0. Ordinary Housewk Between ½ and ¾ time Essential Shopping > ¾ time Travel to Medical > ¾ time 0.3 SUM 5.65 The total 5.65 is divided by 3 (the total number of ADLs/IADLs) =.4346 (.4346)/3 = = % This percentage is inserted in Column 3. The value inserted in Column 3 (62.3%) is then multiplied by the client s Base Hours (Column 2) to arrive at the Base Hour Adjusted by Needs Met by Non-ADSA Paid Sources (Column 4). Page V-7

58 Column 5 Explanation The value f Column 5 Adjustment to Hours is determined as follows: Condition Assessment Status Assistance Available Add On Hours Off Site Laundry Facilities If Yes, add on assigned hours 8 Condition Assessment Status Assistance Available Add On Hours Client is > 45 If Yes, then the N/A 5 minutes from assistance available f essential services this task is assessed by < /4 time 5 the response to Essential Shopping. between /4 - /2 time 4 Partially Met between /2 and 3/4 time 2 > 3/4 time 2 Condition Assessment Status Assistance Available Add On Hours Wood supply only source of heat If Yes Met Partially Met N/A 8 N/A 0 N/A 0 < /4 time 8 between /4 - /2 time 6 between /2 and 3/4 time 4 > 3/4 time 2 Sum of Add On Hours Column is value entered in Column 5 Total Add On Hours Related CARE Screen(s) Wood Supply Housewk Transptation Medication ADLs IADLs Care Plan Screen Page V-8

59 See Also Section VIII. WAC Reference: Payment Methodology f In-Home Services Section IX. CARE Screen Shots DSHS web-site at: Page V-9

60 3. Residential Payment System Business Description This section describes how Residential Rates f client services are determined in the CARE system. The Washington State Resource Use Classification Model algithm determines the client s Classification Group (-2, f residential settings). The client s rate is based on the Classification Group, care setting (AL, EARC, ARC, AFH) and service area. There are three (3) types of Service Areas: King County Metropolitan (MSA) Non-Metropolitan (Non-MSA). The following chart shows the Service Area f each county: County Number COUNTY/SERVICE AREA County Name Service Area Adams Non-MSA 2 Asotin Non-MSA 3 Benton MSA 4 Chelan Non-MSA 5 Challam Non-MSA 6 Clark MSA 7 Columbia Non-MSA 8 Cowlitz Non-MSA 9 Douglas Non-MSA 0 Ferry Non-MSA Franklin MSA 2 Garfield Non-MSA 3 Grant Non-MSA 4 Grays Harb Non-MSA 5 Island MSA 6 Jefferson Non-MSA 7 King King 8 Kitsap MSA 9 Kittitas Non-MSA 20 Klickitat Non-MSA 2 Lewis Non-MSA 22 Lincoln Non-MSA 23 Mason Non-MSA 24 Okanogan Non-MSA Page V-0

61 County Number COUNTY/SERVICE AREA County Name Service Area 25 Pacific Non-MSA 26 Pend Oreille Non-MSA 27 Pierce MSA 28 San Juan Non-MSA 29 Skagit Non-MSA 30 Skamania Non-MSA 3 Snohomish MSA 32 Spokane MSA 33 Stevens Non-MSA 34 Thurston MSA 35 Wahkiakum Non-MSA 36 Walla Walla Non-MSA 37 Watcom MSA 38 Whitman Non-MSA 39 Yakima MSA 40 King King Residential rates can be viewed on the DSHS web-site at: The residential rate is comprised of four component pieces. Direct Care, Group and Suppt, Administration and Operations, and Property. The Direct Care ption of the rate is based on the direct care time recded in the Washington State Time Study compiled by wker type multiplied by the Bureau Lab Statistics wage data. The Group and Suppt ption is the time recded in the Washington State Time Study of wkers not spent on direct care, using wker type multiplied by the Bureau Lab Statistics wage data. The Administration and Operations ption are figures taken from the Medicaid Nursing Facility cost rept at the 5 th percentile. The Property Rate is developed as a rental rate based on Marshall Swift Valuation Services. Assessed land values are based on a survey of 25 facilities in each of the three service areas. Moveable equipment costs are from the Nursing Facility cost repts. Related CARE Screen(s) Care Plan Screen Page V-

62 See Also Section IV. Washington State Resource Use Classification Model Section VIII. WAC Reference: Home & Community Payment Rates Section IX. CARE Screen Shots DSHS web-site at: Page V-2

63 VI Nursing Referrals Introduction If certain data elements combination of data elements are selected in the CARE system, they will trigger a critical indicat, which means that a referral to Nursing Services is recommended. This infmation will be displayed on the Nursing Referral screen, where staff will determine whether a referral to Nursing Services is necessary. Referrals are not required if the client is already receiving nursing care other health-related care. In addition to considering referrals to Nursing Services, staff will be required to follow the Skin Protocol if CARE indicates that the client appears to be at imminent risk related to skin breakdown over pressure points. F me infmation about the Nursing Referral section of CARE about the infmation contained within this section contact: Candace Goehring Program Manager Home & Community Programs Department of Social and Health Services Aging and Adult Services Administration Management Services Division 640 Woodland Square Loop SE PO Box Olympia, Washington (360) FAX (360) TTY (360) ADSA Hotline goehringc@dshs.wa.gov Page VI-

64 . Nursing Referral Algithm Business Description The chart below shows the algithm used in CARE to notify the casewker of a need to refer the client to Nursing Service staff. A referral to the Nursing Service staff is displayed on the Care Plan screen. Critical Indicat Data Element Value (Weight) CARE Screen Diagnosis of insulin dependent diabetes mellitus quadriplegia; Diagnosis. Presence of any one combination of diagnoses that are unstable, changing as evidenced by the affect on service planning f the functional cognitive care needs of the client. Any one combination of diagnoses that are poly managed unstable as evidenced by affect on current ADL status, histy of po compliance with health care recommendations, required frequent medical intervention; and Client has a recent change in condition as evidenced by shtness of breath, dizziness, syncope, histy of recurrent infections, physical mental function fluctuates. Diagnosis Me than one hospitalization in the last six months Me than one emergency room visit in the last six months; Indicated in CARE the client has (a) pain daily (b) pain scale rating greater than 4 (5 to 0) and (c) pain impact is limiting activity, sleep is disturbed pain treatment is ineffective CARE indicates that overall self-sufficiency has deteriated since the last assessment related to an unmet health care need. Indicats Pain Functional Status Page VI-2

65 Critical Indicat Data Element Value (Weight) CARE Screen 2. Caregiver training needed to suppt the requirements of the client s service plan. Indicated in CARE that medication level is must be administered to person Client declines assist with medications and Cognitive Perfmance Scale is greater than 3 Mood behavi sce is 3 greater. Medications Management Psych/Social Behavi 3. Presence of a medication regimen that has an affect Client has SOB, dizziness (fall risk), syncope (fall risk), vomiting, recurrent infections Indicated in CARE client needing treatments related to: tracheotomy tube, indwelling catheter, routine lab wk (e.g. pro-time), injections, wound/skin care, blood glucose moniting, tube feedings; Passive ROM Indicated that the client has a mood symptom that is a barrier to the caregiver providing care to the client is not adequately treated with psychoactive medication as evidenced by a sce of: Frequency must be either 4-6 days out of 7 occur daily and behavi not easily altered Indicated in CARE that medication level is must be administered to person Diagnosis Treatment Mood Symptoms included are: Crying, tearfulness Easily irritable /agitated Repetitive physical movement /pacing, hand wringing, fidgeting Delusions Hallucinations Manic symptoms Medication Management Page VI-3

66 Critical Indicat Data Element Value (Weight) CARE Screen on client assessment, service planning, and delivery. Client declines assist with medications and Cognitive Perfmance Scale sce is 3 greater Mood Behavi sce is 3 greater Medication Management Psych/Social Behavi 4. Nutritional status weight concerns affecting service planning and delivery. Limitations Drop Down: Indicated that the client assessed as: choking/gagging on medications, medication regimen is complex, Client mixes alcohol with prescription drugs Client does not take medications as dered Client is unaware of dosages Client has multiple pharmacies and multiple providers. Indication of al problems al hygiene and dental problems as evidenced by limitations: chewing problem current swallowing problem non compliant with diet Po appetite Appetite change and Weight loss gain Nutritional approaches that includes Enteral Parenteral dietary supplement Mechanically altered therapeutic diet. Medication Management Eating Screen Eating Screen Nutritional /Oral Screen Indicats Treatment Screen Nutritional /Oral Page VI-4

67 Critical Indicat Data Element Value (Weight) CARE Screen 5. Client is bedbound, has care needs related to immobility that affect service planning and delivery. Identified in CARE in rehab/restative care and training skill practice (drop down) the client assessed as needing ROM passive ROM active splint brace assistance amputation/prostheses care bed mobility transfer walking and Provider Code is 0 to 04 Treatment Screen Care Plan indicates that client is frequently incontinent incontinent with multiple daily episodes of bladder bowel ADL self-perfmance code is extensive Total and ADL suppt code is one person two person in the following ADL s Bed mobility Transfer Walk in room, hallway and rest of immediate living environment Locomotion in room and immediate living environment Client is assessed f fall risk as indicated by fell in last 30 days, fell in past 3-80 days, hip fracture in last 80 days, other fracture in the last 80 days. Bladder/Bowel Self Perfmance: extensive total and (b) Suppt Provided: One person Two person Falls Screen: When: Last 30 days -6 months Consequence: Hip fracture Other functions Page VI-5

68 Critical Indicat Data Element Value (Weight) CARE Screen 6. Presence Indicated in CARE that client has one of the following Skin Screen histy skin breakdown affecting service planning. skin problems not related to pressure: Abrasions, skin tears, cuts and status is non-healing deteriating Burns and status is non-healing deteriating Open lesions and status is non-healing deteriating Rashes and status is non-healing Skin folds/perineal rash and status is non-healing deteriating Surgical wounds and status is non-healing deteriating Stasis ulcers and status is non-healing deteriating Skin care need including: Pressure relieving device f chair bed Turning/repositioning program Nutrition hydration intervention to manage skin problems Other preventative protective skin care treatment need Skin Screen Indicated as treatment needing including: Application of dressing (with without topical dressing) Application of ointments, wound/skin care indicated Surgical wound care and provider code is 0 to 04. Treatments Screen Problems and care need is indicated and the problem is non-healing deteriating Indicated as treatment needed including application of dressing to feet and provider code is 0 to 04 Foot Screen Treatment Provider: Client Family IP/Agency Self Directed Page VI-6

69 Critical Indicat Data Element Value (Weight) CARE Screen Indicated in CARE that the client has pressure ulcer Skin Screen ranging from any area of persistent skin redness to unable to see ulcer due to scab CARE indicated that client had an ulcer that was resolved Skin Screen cured over the last year 7. Other health Not an algithm f CARE. A referral to Nursing Service Client may related care need may occur related to any assessment service planning present with a not identified in a concern. risk fact critical indicat requiring nursing services f client assessment service planning. care need not identified in the referral critical indicats. This risk fact may require an RN f assessment 8. Indicats f skin breakdown over pressure points. One of the following: a. Current Pressure Ulcer b. Quadriplegia c. Paraplegia d. Total Dependency in Bed Mobility e. Comatose Persistent Vegetative State f. Histy of pressure ulcer within one year One of the following:. Bedfast and/ chairfast, and cognition problems 2. Bedfast and/ chairfast, and incontinent of bladder bowel 3. Hemiplegia, and cognition problems, and incontinent of bladder bowel 4. Bedfast and/ chairfast, and Insulin Dependent Diabetes Mellitus (IDDM) Bladder incontinence is defined as (a) multiple daily episodes of the individual being wet, (b) even with the use of appliances programs used to manage this. Bowel incontinence is defined as (a) inadequate control all almost all of the time, (b) even with the use of appliances programs to manage this. Note: Cognitive impairment is defined by a sce of 3 higher on the Cognitive Perfmance Scale. and intervention. Skin Diagnosis Bed Mobility Bladder/Bowel Page VI-7

70 Related CARE Screen(s) Behavi Bladder/Bowel Diagnosis Bed Mobility Eating Foot Functional Status Indicats Medications Management Mood Nutritional /Oral Pain Psych/Social Skin Treatment See Also IV. Washington State Resource Use Classification Model 3. Cognitive Perfmance Scale IX. CARE Screen Shots Page VI-8

71 VII ICD-9 Codes. Introduction The International Classification of Diseases (ICD-9) coding is a statistical classification system that arranges diseases and injuries into groups accding to established criteria. ICD-9 is designed f the classification of mbidity and mtality infmation f statistical purposes, and f the indexing of hospital recds by disease and operations, f data stage and retrieval. The histical background of the International Classification of Diseases may be found in the Introduction to ICD-9 (Manual of the International Classification of Diseases, Injuries, and Causes of Death, Wld Health Organization, Geneva, Switzerland, 977). ICD-9-CM is a clinical modification of the Wld Health Organization's International Classification of Diseases, 9th Revision (ICD-9). The term "clinical" is used to emphasize the modification's intent: to serve as a useful tool in the area of classification of mbidity data f indexing of medical recds, medical care review, and ambulaty and other medical care programs, as well as f basic health statistics. To describe the clinical picture of the patient, the codes are me precise than those needed only f statistical groupings and trend analysis. The ICD-9-CM is recommended f use in all clinical settings but is required f repting diagnoses and diseases to all U.S. Public Health Service and Health Care Financing Administration programs. Characteristics of ICD-9 Codes Most ICD-9 codes are numeric and consist of three, four, five numbers and a description. F example, an ICD-9 code f a broken arm is fractured radius, In addition, injuries are also coded accding to their location on the body. So, the code f the broken arm would indicate whether it was the left, right, bilateral (both) arms. In addition, an injury site may be listed if necessary. Site locations apply to injuries to the fingers, teeth and toes. Since ICD-9 codes identify the type and nature of the injury, they are also used to determine appropriate medical treatment. In addition, when medical providers use ICD-9 codes f services, they list the ICD-9 on the billing fms. Characteristics of ICD-9-CM ICD-9-CM far exceeds its predecesss in the number of codes provided. The disease classification has been expanded to include health-related conditions and to provide greater specificity at the fifthdigit level of detail. These fifth digits are not optional; they are intended f use in recding the infmation substantiated in the clinical recd. ICD-9-CM is totally compatible with its parent system, ICD-9, thus meeting the need f comparability of mbidity and mtality statistics at the international level. A few fourth-digit codes were created in existing three-digit rubrics only when the necessary detail could not be accommodated by the use of a fifth-digit sub-classification. Page VII-

72 Questions regarding the use and interpretation of the International Classification of Diseases, 9th Revision, Clinical Modification can be directed to any of the ganizations listed below. Central Clearinghouse f ICD-9-CM American Hospital Association Chicago, Illinois 606 Wld Health Organization Collabating Center f Classification of Diseases f Nth America National Center f Health Statistics Department of Health and Human Services 6525 Belcrest Road Hyattsville, Maryland Mbidity Classification Branch Division of Health Care Statistics Office of Vital and Health Statistics Systems National Center f Health Statistics Department of Health and Human Services 6525 Belcrest Road Hyattsville, Maryland Page VII-2

73 2. ICD-9 Codes in CARE The Diagnosis Screen of CARE contains a drop-down menu providing users with a sht list of ICD-9 Codes used in the Classification and Nursing Referrals algithms. Users of the CARE system have the option of searching f a generic list of diagnosis to use an advanced list f uncommon diagnoses. ICD-9 Codes Used in the Classification and Nursing Referrals Algithm in CARE Generic Name ICD-9 Codes ICD-9 Name Diabetes/Non-insulin dependent DMII WO CMP NT ST UNCNTR ALS Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) AMYOTROPHIC SCLEROSIS Hemiplegia 342 HEMIPLEGIA Quadriplegia QUADRIPLEGIA, UNSPECIFD Arthritis, Rheumatoid 74.0 RHEUMATOID ARTHRITIS Aphasia (expressive and/ receptive) APHASIA Cerebral Palsy 343 INFANTILE CEREBRAL PALSY* Emphysema 492 EMPHYSEMA* Explicit terminal prognosis EXC.02 Explicit terminal prognosis Diabetes/Insulin dependent DMI WO CMP NT ST UNCNTRL Multiple Sclerosis 340 MULTIPLE SCLEROSIS Muscular dystrophy 359 MUSCULAR DYSTROPHIES* Paraplegia 344. PARAPLEGIA NOS Parkinson s 332 PARKINSON'S DISEASE* Fracture, Pathological 733. PATHOLOGICAL FRACTURE* Polio/post syndrome 38 LATE EFFECT ACUTE POLIO Traumatic brain injury (TBI) 853 OTH TRAUMATIC BRAIN HEM* Chronic Obstructive Pulmonary Disease (COPD) 496 CHR AIRWAY OBSTRUCT NEC Page VII-3

74 The following table provides a complete list of ICD-9 codes. Users of the CARE system can search f the complete list of ICD-9 codes by using the Advanced Search feature on the Diagnosis screen. Complete List Of ICD-9 Codes Sted by Generic Name ICD-9 Generic Name Codes ICD9 Names Allergies ALLERGY, UNSPECIFIED ALS Amyotrophic Lateral Sclerosis (Lou Gehrig s Disease) AMYOTROPHIC SCLEROSIS Alzheimer s disease 33.0 ALZHEIMER'S DISEASE Amputation of lower limb V49.70 STATUS AMPUT LWR LMB NOS Amputation of upper limb V49.60 STATUS AMPUT UP LMB NOS Anemia ANEMIA NOS Angina 43.9 ANGINA PECTORIS NEC/NOS Anxiety disder ANXIETY STATE NOS Aphasia (expressive and/ receptive) APHASIA Arteriosclerotic heart disease (ASHD) ASCVD Asthma 493 ASTHMA Autism INFANTILE AUTISM-RESID Bipolar disder BIPOLAR AFFECTIVE NOS Cancer 99. MALIGNANT NEOPLASM NOS Cardiac dysrhythmias CARDIAC DYSRHYTHMIA NOS Cataracts CATARACT NOS Cerebral Palsy 343 INFANTILE CEREBRAL PALSY Stroke 436 CVA Bronchitis, Chronic 49 CHRONIC BRONCHITIS* Chronic Obstructive Pulmonary Disease (COPD) 496 CHR AIRWAY OBSTRUCT NEC Congestive heart failure CONGESTIVE HEART FAILURE Crohn s Disease 555 REGIONAL ENTERITIS* Decubitus ulcer DECUBITUS ULCER Deep vein thrombosis 45.2 THROMBOPHLEBITIS LEG NOS Dementia other than Alzheimer s disease SENILE DEMENTIA UNCOMP Depression DEPRESS PSYCHOSIS-UNSPEC Diabetic retinopathy DIABETIC RETINOPATHY Emphysema 492 EMPHYSEMA* Explicit terminal prognosis EXC.02 Explicit terminal prognosis (Internal to CARE) Fibromyalgia 729. MYALGIA AND MYOSITIS NOS Gastroesophygeal reflux disease (GERD) ESOPHAGEAL REFLUX Gastrointestinal ulcers 53 GASTRIC ULCER Glaucoma 365 GLAUCOMA Gout GOUT NOS Hemiplegia 342 HEMIPLEGIA Hepatitis 070 VIRAL HEPATITIS Fracture, Hip FX NECK OF FEMUR NOS-CL Hypertension 40 ESSENTIAL HYPERTENSION Hyperthyroidism THYROTOXICOSIS NOS Hypotension 458 HYPOTENSION Page VII-4

75 Complete List Of ICD-9 Codes Sted by Generic Name ICD-9 Generic Name Codes ICD9 Names Hypothyroidism HYPOTHYROIDISM NOS Impairment of central nervous system EXC.0 Impairment of central nervous system (Internal to CARE) Diabetes/Insulin dependent DMI WO CMP NT ST UNCNTRL Irritable bowel syndrome 564. IRRITABLE BOWEL SYNDROME Macular degeneration DEGENERATION OF MACULA Mental retardation 37 MILD MENTAL RETARDATION Multiple sclerosis 340 MULTIPLE SCLEROSIS Muscular dystrophy 359 MUSCULAR DYSTROPHIES Neuropathy DIA W NEUROLOGIC MANIF Diabetes/Non-insulin dependent DMII WO COMP NT ST UNCNTR Obesity OBESITY NOS Arthritis, Osteoarthritis 75.0 GENERAL OSTEOARTHROSIS Osteoposis OSTEOPOROSIS NOS Cardiovascular disease, other HEART DISEASE NOS Paraplegia 344. PARAPLEGIA NOS Parkinson s 332 PARKINSON'S DISEASE Fracture, Pathological 733. PATHOLOGICAL FRACTURE Peripheral vascular disease PERIPH VASCULAR DIS NOS Personality disder 30.9 PERSONALITY DISORDER NOS Pneumonia 486 PNEUMONIA, ORGANISM NOS Polio/post syndrome 38 LATE EFFECT ACUTE POLIO PTSD (post traumatic stress disder) ACUTE STRESS REACT NEC Quadriplegia QUADRIPLEGIA, UNSPECIFD Renal failure 586 RENAL FAILURE NOS Arthritis, Rheumatoid 74.0 RHEUMATOID ARTHRITIS Schizophrenia 295 SCHIZOPHRENIC DISORDERS Seizure disder CONVULSIONS NEC Sleep apnea OTH UNSPCF SLEEP APNEA Transient ischemic attack (TIA) TRANS CEREB ISCHEMIA NOS Traumatic brain injury (TBI) 853 OTH TRAUMATIC BRAIN HEM Tuberculosis 0.00 TB LUNG INFILTR-UNSPEC Ulcerative colitis 556 IDIOPATHIC PROCTOCOLITIS Urinary tract infection (UTI) URIN TRACT INFECTION NOS Fracture, other 829 FRACTURE NOS Down's Syndrome DOWN'S SYNDROME Page VII-5

76 VIII WAC Reference The Washington Administrative Code (WAC) contains the rules and regulation by which the state agency uses to determine eligibility, payment rates, etc. To be a valid regulation, the state agency must have followed the Administrative Procedures Act (APA) found in Chapter of the Revised Code of Washington (RCW). The Aging and Disability Services Administration (ADSA) followed the APA in adopting the new regulation contained in chapter A WAC, Comprehensive Assessment and Repting Evaluation Tool. These rules implement the new Comprehensive Assessment Repting Evaluation (CARE) tool, an automated system used to collect demographic data, assess functional needs and abilities, health, and medical infmation, determine eligibility f services, develop a care plan, and authize services f clients on requesting long-term care services. NEW SECTION Chapter A WAC COMPREHENSIVE ASSESSMENT REPORTING EVALUATION (CARE) TOOL APPLICATION WAC A-0005 When do the rules in chapter A WAC apply to me? The rules in chapter A WAC apply when the department designee uses the comprehensive assessment repting evaluation (CARE) tool f your: () Initial assessment; (2) Annual reassessment; (3) Assessment due to a significant change in condition. [] NEW SECTION WAC A-000 Does chapter WAC apply to me? Yes. Chapter WAC applies with the exception of the following: WAC , , , , , and [] NEW SECTION WAC A-005 If the department did not use the CARE tool f my last assessment, may I have my assessments done on the assessment fm used f my last assessment? You may not have assessments done on the last assessment fm once you've been assessed under CARE. The CARE tool replaces all assessment fms previously used by the department to determine your eligibility and service payment level f home and community programs. Page VIII-

77 [] ASSESSMENT AND SERVICE PLANNING NEW SECTION WAC A-0020 What is an assessment? Assessment is defined in WAC [] NEW SECTION WAC A-0025 What is the process f conducting an assessment? The department staff designees will: () Assess your abilities and needs using a department-prescribed assessment tool, called the comprehensive assessment repting evaluation (CARE); and (2) Perfm the assessment based on an in-person interview with you in your own home other place of residence, which is defined in WAC A case manager may request the assessment be conducted in private. [] NEW SECTION WAC A-0030 What is the purpose of an assessment? Department staff designees will perfm an assessment using CARE to: () Determine eligibility f department-paid home and community programs; (2) Identify your strengths; (3) Evaluate your living situation and environment; (4) Evaluate your physical health, functional and cognitive abilities, social resources, income and financial resources, and emotional and social functioning f service planning purposes; (5) Identify your values and preferences f effective service planning based on your lifestyle; (6) Determine availability of alternative resources including family, neighbs, friends, community programs, volunteers, and other service delivery options that will provide needed assistance; (7) Determine risk of and program eligibility f nursing facility placement; and (8) Determine need f case management activities. [] NEW SECTION Page VIII-2

78 WAC A-0035 What are personal care services? Personal care services means physical verbal assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL). Assistance means verbal physical assistance with ADL and IADL. Assistance is evaluated with use of assistive devices. () Activities of daily living consist of the following care tasks that are directly related to your disabling condition: (a) Bathing, how you take a full-body bath/shower, sponge bath, and transfer in/out of tub/shower; (b) Bed mobility, how you move to and from a lying position, turn side to side, and position your body while in bed; (c) Body care, how you perfm with passive range of motion, applications of dressings and ointments lotions to the body and pedicure to trim toenails and apply lotion to feet. In adult family homes in licensed boarding homes contracting with DSHS to provide assisted living services, dressing changes using clean technique and topical ointments must be delegated by a registered nurse in accdance with chapter WAC. Body care excludes: (i) Foot care f clients who are diabetic have po circulation; (ii) Changing bandages dressings when sterile procedures are required. (d) Dressing, how you put on, fasten, and take off all items of clothing, including donning/removing prosthesis; (e) Eating, how you eat and drink, regardless of skill. Eating includes any method of receiving nutrition, e.g., by mouth, tube through a vein; (f) Locomotion in room and immediate living environment, how you move between locations in your room and immediate living environment. If you are in a wheelchair, locomotion includes how self-sufficient you are once in your wheelchair; (g) Locomotion outside of immediate living environment including outdos, how you move to and return from me distant areas. If you are living in boarding home nursing facility (NF), this includes areas set aside f dining, activities, etc. If you are living in your own home in an adult family home, locomotion outside immediate living environment including outdos includes how you move to and return from a patio pch, backyard, to the mailbox, to see the next-do neighb, etc; (h) Walk in room, hallway and rest of immediate living environment, how you walk between locations in your room and immediate living environment; (i) Medication management, describes the amount of assistance, if any, required to receive medications, over the counter preparations herbal supplements; (j) Toilet use, how you use the toilet room, commode, bedpan, urinal, transfer on/off toilet, cleanse, change pad, manage ostomy catheter, and adjust clothes; Page VIII-3

79 (k) Transfer, how you move between surfaces, i.e., to/from bed, chair, wheelchair, standing position. Transfer does not include how you move to/from the bath toilet; and (l) Personal hygiene, how you maintain personal hygiene, including combing hair, brushing teeth, applying makeup, washing/drying face hands, menses care, and perineum. This does not include personal hygiene in baths and showers. (2) Instrumental activities of daily living (IADL) consist of the following routine activities perfmed around the home in the community. (a) Meal preparation, how meals are prepared (e.g., planning meals, cooking, assembling ingredients, setting out food, utensils, and cleaning up after meals). NOTE: This task may not be authized to just plan meals clean up after meals. You must need assistance with actual meal preparation; (b) Ordinary housewk, how dinary wk around the house is perfmed (e.g., doing dishes, dusting, making bed, tidying up, laundry); (c) Essential shopping, how shopping is completed to meet your health and nutritional needs (e.g., selecting items). Shopping is limited to brief, occasional trips in the local area to shop f food, medical necessities and household items required specifically f your health, maintenance wellbeing. This includes shopping with f you; (d) Wood supply, how wood is supplied (e.g., splitting, stacking, carrying wood) when you use wood as the sole source of fuel f heating and/ cooking; (e) Travel to medical services, how you travel by vehicle to a physician's office clinic in the local area to obtain medical diagnosis treatmentincludes driving vehicle yourself, traveling as a passenger in a car, bus, taxi; (f) Managing finances, how bills are paid, checkbook is balanced, household expenses are managed. The department cannot pay f any assistance with managing finances; and (g) Telephone use, how telephone calls are made received (with assistive devices such as large numbers on telephone, amplification as needed). [] NEW SECTION WAC A-0040 What infmation does the assess gather? () The case manager gathers infmation from you, your caregivers, family members, and other sources to determine whether you have unmet partially met needs f assistance with ADL's and IADL's. (2) F each ADL, except as otherwise provided f bathing, body care, and medication management, the case manager assesses the level of your ability to self-perfm the ADL and the level of suppt provided by others. (a) F each ADL, the case manager measures your level of self-perfmance by determining what you actually did within the last seven days, not what you might be capable of doing. If you: Page VIII-4

80 (i) Received no help oversight, if you needed help oversight only once twice, you are assessed as being independent; (ii) Received oversight (moniting standby), encouragement, cueing three me times, needed physical assistance in addition to supervision only once twice, you are assessed as needing supervision; (iii) Were: (A) Highly involved in the activity, (B) Given physical help in guided maneuvering of limbs other nonweight bearing assistance on three me occasions, (C) Given weight bearing assistance but only one two times, you are assessed as needing limited assistance. (iv) Perfmed part of the activity, but on three me occasions, you needed weight bearing suppt you received full perfmance of the activity during part, but not all, of the activity from others, you were assessed as needing extensive assistance; (v) Received full caregiver perfmance of the activity and all subtasks during the entire seven-day period from others, you are assessed as having total dependence. Total dependence means complete nonparticipation by you in all aspects of the ADL; (vi) Or others do not perfm an ADL over the last seven days befe your assessment, your assessment will indicate that the activity did not occur during the entire seven-day period. The activity may not have occurred because: (A) You were not able (e.g., walking, if paralyzed; (B) No provider was available to assist; (C) You declined assistance with the task. (b) F each ADL, the case manager also determines the level of suppt provided, which means the highest level of suppt provided by others over the last seven days, even if that level of suppt occurred only once. F each ADL, the assessment will indicate one of the following levels of suppt provided: (i) No set-up physical help provided by others; (ii) Set-up help only provided, which is the type of help characterized by providing you with articles, devices, preparation necessary f greater self-perfmance of the activity (such as giving holding out an item that you take from others); (iii) One-person physical assist provided; (iv) Two- me person physical assist provided; (v) Activity did not occur during entire seven-day period. Page VIII-5

81 (3) The activity of bathing is assessed in the same way as other ADL's under subsection (2) of this section, except you are assessed as needing: (a) Limited assistance with bathing if physical help is limited to transfer only. (b) Extensive assistance with bathing if you needed physical help with part of the activity (other than transfer). (4) The activity of body care is assessed to determine whether you need assistance. You are assessed as needing assistance if you require: (a) Application of ointment lotions; (b) Trimming of toenails; (c) Dry bandage changes; (d) Passive range of motion treatment. (5) The activity of medication management is assessed to determine whether you need assistance managing your medications. If you: (a) Remember to take medications as prescribed and manage your medications without assistance, you are assessed as being independent with medical management. (b) Need assistance from a nonlicensed provider to facilitate your selfadministration of a prescribed, over the counter, herbal medication, you are assessed as needing assistance with medication management. Assistance required includes reminding coaching you, handing you the medication container, opening the container, using an enabler to assist you in getting the medication into your mouth, and placing the medication in your hand. This does not include assistance with intravenous injectable medications. You must be aware that you are taking medications. (c) Are a person with a functional disability who is capable of and who chooses to self-direct your medication assistance/administration, you are assessed as needing self-directed medication assistance/administration. (d) Must have medications placed in your mouth applied to your skin mucus membrane by a licensed professional as delegated by a registered nurse (RN) to: a provider who is not a RN a licensed practical nurse (LPN) in an adult family home boarding home following nurse delegation protocols in chapter WAC, by a family member unpaid caregiver, you are assessed as needing medications administered to you. Intravenous injectable medications must be administered by a licensed health care professional, family member, unpaid caregiver. (6) F each IADL, the case manager assesses the level of your ability to self-perfm the IADL and how difficult it is ( would be) f you to perfm the activity on your own. (a) The case manager measures the level of your ability to self-perfm the activity by determining what you actually did within the last thirty days, not what you might be capable of doing. If you: Page VIII-6

82 (i) Received no help, set-up help, supervision, you are assessed as being independent; (ii) Received set-up help arrangements only, you are assessed as needing supervision; (iii) Sometimes perfmed the activity yourself and other times needed assistance, you are assessed as needing limited assistance; (iv) Were involved in perfming the activity, but required cueing/supervision partial assistance at all times, you are assessed as needing extensive assistance; (v) Needed the activity fully perfmed by others, you are assessed as having total dependence; (vi) Others did not perfm the activity within the assessment period, the assessment will indicate that the activity did not occur. (b) F each IADL, the case manager determines how difficult it is would be f you to perfm the activity. The assessment will determine whether you have would have: (i) No difficulty in perfming the activity; (ii) Some difficulty in perfming the activity (e.g., you need some help, are very slow, fatigue easily); (iii) Great difficulty in perfming the activity (e.g., little no involvement in the activity is possible). [] NEW SECTION WAC A-0045 How will the department plan to meet my care needs? Department staff designees will: () Authize services to crespond with your assessed need, per WAC A- 0040; (2) Develop a service plan with you that identifies: (a) Your specific abilities and needs; (b) A plan f meeting each need f which you want assistance; (c) Ways to meet your needs with the most appropriate services, both fmal and infmal; (d) Who is responsible f carrying out each part of the plan; (e) Anticipated outcomes; (f) Dates and changes to the plan; Page VIII-7

83 (g) Dates of referral, service initiation, follow-up reviews; (h) Those needs that you do not want assistance with at this time; and (i) Agreement to the service plan by you your representative. [] NEW SECTION WAC A-0050 What if I disagree with the result of the assessment the decisions about what services I may receive? You have a right to contest a denial reduction of services. The department the department's designee will notify you of the right to contest a denial reduction of services and provide you with the address to which you can write to request a hearing on the denial reduction. [] Page VIII-8

84 CARE ELIGIBILITY NEW SECTION WAC A-0055 Am I eligible f COPES-funded services? You are eligible f COPES-funded services if you meet all of the following criteria. The department its designee must assess your needs and determine that: () You are age: (a) Eighteen older and blind disabled, as defined in WAC ; (b) Sixty-five older. (2) You meet financial eligibility requirements. This means the department will assess your finances and determine if your income and resources fall within the limits set in WAC , Community options program entry system (COPES); (3) You: (a) Are not eligible f Medicaid personal care services (MPC); (b) Are eligible f MPC services, but the department determines that the amount, duration, scope of your needs is beyond what MPC can provide. (4) Your comprehensive assessment shows you need the level of care provided in a nursing facility ( will likely need the level of care within thirty days unless COPES services are provided) which means one of the following applies. (a) You require care provided by under the supervision of a registered nurse a licensed practical nurse on a daily basis, : (b) You have an unmet partially met need the activity did not occur (because you were unable no provider was available) with at least three me of the following, as defined in WAC A-0040: (i) Setup in eating (e.g., cutting meat and opening containers at meals; giving one food categy at a time); (ii) Supervision in toileting; (iii) Supervision in bathing; (iv) Supervision plus setup in transfer; (v) Supervision plus setup in bed mobility; (vi) Supervision plus set up help in one of the following three tasks: (A) Walk in room, hallway and rest of immediate living environment; (B) Locomotion in room and immediate living environment; Page VIII-9

85 (C) Locomotion outside of immediate living environment including outdos. (vii) Assistance required in medication management; (c) You have an unmet partially met need with at least two me of the following, as defined in WAC A-0040: (i) Extensive assistance plus one person physical assistance in toileting; (ii) Extensive assistance plus one person physical assistance in one of the following three tasks: (A) Walk in room, hallway and rest of immediate living environment; (B) Locomotion in room and immediate living environment; (C) Locomotion outside of immediate living environment including outdos. (iii) Extensive assistance plus one person physical assistance in transfer; (iv) Limited assistance plus one person physical assistance in bed mobility and need turning/repositioning; (v) Physical help limited to transfer plus one person physical assist in bathing; (vi) Supervision plus one person physical assist in eating; (vii) Daily assistance required in medication management; (d) You have a cognitive impairment and require supervision due to one me of the following: disientation, memy impairment, impaired decision making, wandering and have an unmet partially met need with at least one me of the following, as defined in WAC A-0040: (i) Extensive assistance plus one person physical assistance in toileting; (ii) Extensive assistance plus one person physical assistance in one of the following three tasks: (A) Walk in room, hallway and rest of immediate living environment; (B) Locomotion in room and immediate living environment; (C) Locomotion outside of immediate living environment including outdos. (iii) Extensive assistance plus one person physical assistance in transfer; (iv) Limited assistance plus one person physical assistance in bed mobility; (v) Physical help limited to transfer plus one person physical assist in bathing; (vi) Supervision plus one person physical assist in eating; Page VIII-0

86 (vii) Daily assistance required in medication management. [] NEW SECTION WAC A-0060 Am I eligible f MPC-funded services? You are eligible f MPC-funded services when the department its designee assesses your needs and determines that you meet all of the following criteria: () Are certified as Title XIX categically needy, as defined in WAC (2) Have an unmet partially met need the activity did not occur (because you were unable no provider was available) in at least ((one)) three me of the following, as defined in WAC A-0040: (a) Help/oversight one two times during the last seven days plus setup in eating; (b) Supervision in toileting; (c) Supervision in bathing; (d) Supervision in dressing; (e) Supervision plus setup in transfer; (f) Supervision plus setup in bed mobility; (g) Supervision plus set up help in one of the following three tasks: (i) Walk in room, hallway and rest of immediate living environment; (ii) Locomotion in room and immediate living environment; (iii) Locomotion outside of immediate living environment including outdos. (h) Assistance required in medication management; (i) Supervision in personal hygiene; (j) Assistance with body care, which means you need: (i) Application of ointment lotions; Page VIII-

87 (ii) Your toenails trimmed; (iii) Dry bandage changes; (iv) Passive range of motion treatment. (3) You have an unmet partially met need the activity did not occur (because you were unable no provider was available) with at least one me of the following, as defined in WAC A-0040: (a) Extensive assistance plus one person physical assistance in toileting; (b) Extensive assistance plus one person physical assistance in one of the following three tasks: (i) Walk in room, hallway and rest of immediate living environment; (ii) Locomotion in room and immediate living environment; (iii) Locomotion outside of immediate living environment including outdos. (c) Extensive assistance plus one person physical assistance in transfer; (d) Limited assistance plus one person physical assistance in bed mobility and need turning/repositioning; (e) Physical help limited to transfer plus one person physical assist in bathing; (f) Supervision plus one person physical assist in eating; (g) Daily assistance required in medication management; (h) Assistance with body care, which means you need: (i) Application of ointment lotions; (ii) Your toenails trimmed; (iii) Dry bandage changes; (iv) Passive range of motion treatment. (i) Extensive assistance plus one person physical assistance in dressing. Page VIII-2

88 (j) Extensive assistance plus one person physical assistance in personal hygiene. [] NEW SECTION WAC A-0065 Am I eligible f Che-funded services? To be eligible f Che-funded services, you must: () Be eighteen years of age older; (2) Have an unmet partially met need the activity did not occur (because you were unable no provider was available) in at least one me of the following, as defined in WAC A-0040: (a) Help/oversight one two times during the last seven days plus setup in eating; (b) Supervision in toileting; (c) Supervision in bathing; (d) Supervision in dressing; (e) Supervision plus setup in transfer; (f) Supervision plus setup in bed mobility; (g) Supervision plus set up help in one of the following three tasks: (i) Walk in room, hallway and rest of immediate living environment; (ii) Locomotion in room and immediate living environment; (iii) Locomotion outside of immediate living environment including outdos. (h) Assistance required in medication management; (i) Supervision in personal hygiene; (j) Assistance with body care, which means you need: (i) Application of ointment lotions; (ii) Your toenails trimmed; (iii) Dry bandage changes; (iv) Passive range of motion treatment. (3) Currently be on the Che program and not be eligible f MPC COPES, Medicare home health other programs if these programs can meet your needs; Page VIII-3

89 (4) Have net household income (as described in WAC , , , and ) not exceeding: (a) The sum of the cost of your che services; and (b) One-hundred percent of the Federal Poverty Level (FPL) adjusted f family size. (5) Have resources, as described in chapter WAC, which does not exceed ten thousand dollars f a one-person family fifteen thousand dollars f a two-person family. (Note: One thousand dollars f each additional family member may be added to these limits.) (6) Not transfer assets on after November, 995 f less than fair market value as described in WAC [] Page VIII-4

90 CLASSIFICATION FOR IN-HOME AND RESIDENTIAL CARE NEW SECTION WAC A-0070 What are the in-home hours and residential rate based on? The department employs a client classification methodology consisting of fourteen care groups. The department uses an automated assessment tool known as the comprehensive assessment repting evaluation (CARE) tool to assess client characteristics. [] NEW SECTION WAC A-0075 What does the CARE computerized assessment tool do with the client infmation entered by department staff? The CARE software program evaluates the infmation about the client using the following criteria: () Cognitive perfmance; (2) Clinical complexity, e.g., medical conditions; (3) Mood/behavis; and (4) Activities of daily living (ADL). [] NEW SECTION WAC A-0080 What are the elements that the CARE tool evaluates f each of the criteria in WAC A-0075? The CARE tool evaluates f: () Cognitive perfmance (a) Sht term memy; (b) Self-perfmance in eating; (c) Ability to make self understood; (d) Ability to make decisions regarding ADLs; and (e) Comatose in a persistent vegetative state. (2) Clinical complexity (a) Diagnoses requiring me than average care time and/ special care; (b) Skin problems receiving treatment; (c) Unstable clinical conditions; and (d) Skilled nursing needs. Page VIII-5

91 (3) Mood/behavis the assessment data evaluated may include, but is not limited to the following: (a) Assaulting care givers; (b) Resisting care; (c) Wandering; and (d) Depression. (4) Activities of daily living (ADLs), the amount of assistance the client needs to perfm ADLs. [] NEW SECTION WAC A-0085 How does the CARE tool evaluate the criteria elements? The CARE tool evaluates the criteria elements f: () Cognitive perfmance by using the cognitive perfmance scale (CPS) and assigning a sce. The sce assigns ranges from zero to six with six being very severely impaired; (2) Clinical complexity by determining whether your medical conditions take me less time and/ require special care; (3) Mood/behavi by determining whether your mood/behavi symptoms take me less time; (4) ADLs by scing the assistance needed to perfm ADLs. [] Page VIII-6

92 PAYMENT METHODOLOGY FOR IN-HOME SERVICES NEW SECTION WAC A-0090 What are the maximum hours that I can receive f in-home services? The maximum hours that you can receive f in-home services is determined through the CARE tool. These hours are based on criteria outlined in WAC A [] NEW SECTION WAC A-0095 How are the number of hours I can receive f in-home services determined? () In addition to criteria defined in WAC A-0075, A-0080, and A-0085, CARE will take into account your: (a) Assistance available to meet your needs. This is defined as: (i) Met; (ii) ; (iii). NOTE: Home and community programs (HCP) services may not replace other available resources the department identified when completing CARE. The hours will be adjusted to account f tasks that are either fully partially met by other available resources. These resources may be unpaid paid f by other state community sources. (b) Environment, such as whether you: (i) Have laundry facilities out of home; and/ (ii) Use wood as a primary source of heat and/; (iii) The time it takes to access essential shopping services. (c) Living arrangement. The department will adjust payments to a personal care provider who is doing household tasks at the same time (e.g., essential shopping, meal preparation, laundry, and wood supply) if: (i) There is me than one client living in the same household; (ii) You and your paid provider live in the same household. (2) The CARE tool will provide a maximum number of hours that can be used to develop your care plan. The assess must take into account cost effectiveness, client health and safety, and program limits in determining how hours can be used to meet identified client needs. (3) Within the limits of subsection (2) of this section, you and your case manager will wk to determine what services you choose to receive if you are eligible. The hours may be used to authize: Page VIII-7

93 (a) Personal care services (per WAC A-0055, A-0060, A- 0065); (b) Home delivered meals (per WAC A-0055); (c) Adult day care (per WAC A ); (d) Adult day health (per WAC A ); (c) A home health aide (per WAC A-0055). [] NEW SECTION WAC A-000 Are there other in-home services I may be eligible to receive in addition to those described in WAC A-0095(3)? Yes. If you meet the eligibility criteria outlined in WAC and A-0055 you may also receive the following services: () Environmental modifications; (2) Personal response system (PERS); (3) Skilled nursing; (4) Specialized medical equipment; (5) Training; (6) Transptation services. [] NEW SECTION WAC A-005 What would cause a change in the maximum hours authized? Hours you are eligible to receive may be adjusted if you have had a change in any criteria listed in WAC A [] Page VIII-8

94 HOME AND COMMUNITY PAYMENT RATES NEW SECTION WAC A-00 How much will the department pay f my care? The department publishes rates and/ adopts rules to establish how much the department pays toward the cost of your care in a residential care facility f in-home services. [] Page VIII-9

95 IX CARE Screen Shots The following are screen shots from the CARE system referenced throughout this document. The screens shown in this section are ones that affect eligibility, rates, and nursing referrals. A screen shot is a picture of the computer screen seen by the case manager when he/she is completing an assessment.. Psych/Social The screens in the Psych/Social folder are used to document the client s current psychological and social situation, and to document memy and behavi. Psych/Social Folder Psych/Social (Folder Level) Page IX-

96 . Mini Mental Status Exam Screen The MMSE screen is a multi-tab screen used to administer the Mini Mental Status Exam (MMSE). MMSE Screen Tabs within the MMSE screen MMSE Tab Page IX-2

97 Orientation Tab Registration Tab Page IX-3

98 Attention/Calculation Tab Recall Tab Page IX-4

99 Language Tab Command Tab Page IX-5

100 Other Tab Page IX-6

101 .2 Memy Screen The Memy Screen is used to document memy problems and possible assistance needed with memy. Memy Screen Page IX-7

102 .3 Behavi Screen The Behavi Screen is used to document and assess the various behavis of the client. Behavi Screen Page IX-8

103 .4 Decision Making Screen The Decision Making screen is used to document the client ability to make decisions and to supervise Caregivers. Decision Making Screen Page IX-9

104 2. Activities f Daily Living The following screens are used to assess the client s ability to perfm various Activities f Daily Living (ADL s). 2. Medications: Medication Management Screen The Medication Management Screen, found in the Medical folder, is used to document the client s ability to self administer medications. Medical Folder Page IX-0

105 2.2 Locomotion in Room The Locomotion in Room screen, found in the Mobility folder, is used to assess the client s ability to move about in their immediate living environment. Mobility Folder Page IX-

106 2.3 Locomotion Outside Room The Locomotion Outside Room screen, found in the Mobility folder, is used to assess the client s ability to move about outside of their immediate living environment. Page IX-2

107 2.4 Walk in Room The Walk in Room screen, found in the Mobility folder, is used to assess the client s ability to walk about in their immediate living environment. Page IX-3

108 2.5 Bed Mobility The Bed Mobility screen, found in the Mobility folder, is used to assess the client s ability to move and change positions while in bed. Page IX-4

109 2.6 Transfers The Transfers screen, found in the Mobility folder, is used to assess the client s ability to transfer from one position location to another. Page IX-5

110 2.7 Bladder/Bowel The Bladder/Bowel Screen, found in the Toileting Folder, is used to document the frequency with which the client is wet and dry during the 4-day assessment period which includes the entire 24 hours each day. Toileting Folder Page IX-6

111 2.8 Toileting The Toilet Use Screen, found in the Toileting Folder, is used to document the client s abilities regarding toilet use. Page IX-7

112 2.9 Eating The Eating screen, found in the Eating folder, is used to document how the client eats and drinks, regardless of skill. Eating Folder Page IX-8

113 2.0 Hygiene The Hygiene folder is used to gather infmation about the client s personal hygiene habits and abilities. Hygiene Folder Page IX-9

114 2. Bathing The Bathing screen, found in the Hygiene folder, is used to document the client s abilities and preferences regarding bathing. Page IX-20

115 2.2 Dressing The Dressing screen, found in the Hygiene folder, is used to document the client s abilities and preferences regarding their clothing. Page IX-2

116 2.3 Personal Hygiene The Personal Hygiene screen, found in the Hygiene folder, is used to document how the client maintains personal hygiene. Personal hygiene includes combing hair, brushing teeth, shaving, applying makeup, washing/drying face, hands, and perineum (excludes baths and showers). Page IX-22

117 3. Telephone Use The Telephone screen, found in the Communication folder, is used to document how the client makes and receives telephone calls. Communication Folder Page IX-23

118 4. Household Tasks The Household Tasks folder is used to document how the client perfms basic household tasks such as transptation, shopping, housewk, finances, and pet care. 4. Transptation The Transptation screen, found in the Household Tasks folder, is used to document how the client gets to places by vehicle (beyond walking). Household Tasks Folder Page IX-24

119 4.2 Essential Shopping The Essential Shopping screen, found in the Household Tasks folder, is used to document how the client does shopping f essential goods. Page IX-25

120 4.3 Wood Supply The Wood Supply screen, found in the Household Tasks folder, is used to document if the client s source of heat is by wood; and how their supply of wood is obtained and maintained. Page IX-26

121 4.4 Housewk The Housewk screen, found in the Household Tasks folder, is used to document how basic housewk ches are perfmed in the client s living space. Page IX-27

122 4.5 Finances The Finances screen, found in the Household Tasks folder, is used to document the client s ability to pay their bills and to maintain their own finances. Page IX-28

123 5. Skin The Skin screen, found in the Indicats folder (used to document critical indicats), is used to document problems, care, and turning/repositioning issues as they relate to the client s skin. Indicats Folder Page IX-29

124 6. Medical The Medical folder contains various screens used to document medical infmation about the client. 6. Diagnosis The Diagnosis screen, found in the Medical folder, is used to search f and to document the diagnoses related to the client s current daily living status and medical treatments. Medical Folder Click on the [+] button to open the Search Diagnosis dialog box (see next page) Page IX-30

125 The user can perfm a Generic Advanced search f diagnoses Search Diagnosis Dialogue Box The Search Diagnosis dialogue box is used to search f and document diagnoses specific to the client. The user can search f Generic diagnoses Advanced diagnoses. Choosing an Advanced search will provide a complete list of ICD9 Codes. Page IX-3

126 6.2 Treatments The Treatments screen, found in the Medical folder, is used to document the treatments the client is currently receiving. Page IX-32

127 6.3 Pain The Pain screen, found in the Medical folder, is used to document aspects related to the client s pain including: amount, frequency, management, and impact. Page IX-33

128 7. Nutrition/Oral The Nutrition/Oral screen, found in the Eating folder, is used to document specific nutritional and/ al/dental problems the client has experienced during the last 7 days. Eating Folder Page IX-34

129 8. Care Plan The classification level, the residential rate, and the amount of hours provided f a client s care plan will be established automatically by CARE based on the selections made by the user in the CARE assessment screens. Infmation from these screens determines what appears in the Care Plan f the client. The Care Plan screens are also used to document infmation on referrals and provider suppt. Care Plan Folder The Client is Eligible f drop down list will display all of the programs f which the client is functionally eligible, based on the CARE eligibility algithms. The selections made in the Living Situation Planned field will determine the Daily Rate Monthly Hours (Choosing In Home will determine number of hours. Choosing a Facility will determine the daily rate). Page IX-35

130 8. Nursing Referral The Nursing Referral screen will automatically list up to eight (8) Critical Indicats depending on the choices made by the user during the assessment. These Critical Indicats are responses to certain CARE items. F example, certain skin ADL choices will automatically trigger a nursing referral. Page IX-36