Washington State In-Home Services Rules

This content discusses the basics of Washington State In-Home Services Rules as of February 2021, covering topics such as learning objectives, statutory differences, resources for regulatory issues, and the importance of knowing and adhering to regulations. It emphasizes the significance of complying with regulations and provides insights into Revised Code of Washington (RCW), WA State In-Home Services Rules, licensing requirements, and the role of WACs in guiding state surveyors.

• Washington State
• Regulations
• In-Home Services
• Compliance
• Licensing

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1. Regulatory Roundup 1 KNOW THE BASICS WASHINGTON STATE IN-HOME SERVICES RULES FEBRUARY, 2021

2. Speaker Bio 2 Donna Goodwin Clinical Director Home Care Association of WA 509-991-1001 goodwndr@aol.com

3. Know the Basics 3 Learning Objectives: Be able to access and navigate the WA State In- Home Services law and rules Understand the difference between statute and rule. Find resources for your toughest regulatory and survey issues.

4. What we wont tackle today 4 This presentation is not about Medicare Conditions of Participation (only pertains if you are Medicare certified) This presentation is not about accrediting body standards (Example, Joint Commission)

5. Why is this information important to you? 5 This presentation covers the basics as minimum standards As the licensee, you are responsible for knowing these regulations It s not unusual to work in the In-home Services industry and not refer back to the regulations Generally speaking the higher standard is the one you will be held to.

6. Revised Code of Washington (RCW) 6 70.127 RCW Statute or Law RCW contains language that assigns a state agency to develop rules Department of Health https://apps.leg.wa.gov/RCW/default.aspx?cite=70. 127

7. WA State In-Home Services Rules 7 In-home services WAC Washington Administrative Code WACs are administrative rules that implement a statute or law. Chapter 246-335 WAC https://app.leg.wa.gov/wac/default.aspx?cite=246- 335

8. Why is this important? 8 State surveyors use the WAC to guide how they approach surveys and how they write citations. Outlines the licensure process for agencies. Spells out what must be in the patient Bill of Rights Protects the patients who use our services Represents minimum standards Spells out how licensure fees are calculated (FTEs or beds)

9. Who must be licensed? 9 WAC 246-335-315 License required. A person must possess a current In-Home Service license issued by the department before advertising, operating, managing, conducting, opening or maintaining an in-home services agency unless exempt under RCW 70.127.040 or 70.127.050. Any person who employs or contracts with two or more individuals to provide any one or combination of in-home services as defined by chapter 70.127 RCW and this chapter is subject to licensure.

10. Survey and Investigation 10 WAC 246-335-340 Survey and investigation. The department may: (1) Conduct unannounced surveys at any time and at least once during a licensure period. (2) Survey a licensee at any time if the department has reason to believe the licensee is providing unsafe, insufficient, inadequate or inappropriate client or patient care;. (3) Investigate any person suspected of advertising, operating, managing, conducting, opening or maintaining an in-home services agency or providing in-home services, including hospice care center services, without a license unless exempt from licensure (4) Investigate complaints against in-home services licensees that allege noncompliance with statute and rule. (5) Investigate allegations of noncompliance with RCW 43.43.830 through 43.43.842 (Abuse & Neglect/Background Checks), and, when necessary, in consultation with law enforcement personnel; and (6) Require the licensee to complete additional criminal history background checks and disclosure statements for an individual associated with the licensee or having direct contact with children under sixteen years of age, people with developmental disabilities, or vulnerable persons.

11. Statement of Deficiencies; POC; Enforcement 11 WAC 246-335-345 Statement of Deficiencies SOD: Outlines which WAC/RCW that was not followed. Uses term agency failed in the SOD. Plan of Correction POC: Completed by the agency with specific timelines. Enforcement Dept can suspend, curtail or revoke a license.

12. In-home Services WAC Delivery of Services 12 WAC 246-335-420 - Home Care Agencies WAC 246-335-520 Home Health Agencies WAC 246-335-620 Hospice Agencies WAC 246-335-605 Hospice Care Centers All require a written policy regarding admissions, transfers, discharges and referrals. Your written policy must reflect the details in WAC for your provider type. You must have a way to assure your staff know the policy.

13. Plan of Operation 13 WAC 246-335-415 Home Care WAC 246-335-515 - Home Health WAC 246-335-615 Hospice Must have job descriptions, org chart, how you will manage client/patient care throughout service area, what services are provided, days and hours of operation, how staff will access policies, emergency preparedness. READ THIS SECTION ! Chapter 246-335 WAC:

14. Complaint Hotline - Patient Rights 14 WAC 246-335-435 (Home Care) (18) Be informed of the department's complaint hotline number to report complaints about the licensed agency or credentialed health care professionals; and (19) Be informed of the DSHS end harm hotline number to report suspected abuse of children or vulnerable adults. WAC 246-335-535 (Home Health) WAC 246-335-635 (Hospice)

15. Required Numbers 15 State Complaint Hotline: 1-800-633-6828 End-Harm Hotline: 1-866-END-HARM (1-866-363-4276)

16. Personnel, contractor, and volunteer records 16 WAC 246-335-430 (Home Care) WAC 246-335-530 (Home Health) WAC 246-335-630 (Hospice)

17. Personnel, contractor, and volunteer records. 17 What you must have in your records: Current practice certification, credential or licensure, as applicable; https://www.doh.wa.gov/LicensesPermitsandCertificates/Pro viderCredentialSearch Documentation of references Documentation of orientation to agency policies and procedures Written contracts if using contractors Verification of skills or training re: patient care Evidence of initial and subsequent criminal history background checks and disclosure statements according to RCW 43.43.830 through 43.43.842 and this chapter;

18. Personnel, contractor, and volunteer records 18 Training on current and revised agency policies and procedures, including patient care issues; Current CPR training for direct care staff Documentation of current food worker cards or equivalent training if preparing food for the patient Communicable disease testing and vaccination according to state and federal recommendations. Documentation of performance evaluations for direct care staff Annually to include observation of direct patient care

19. Supervision of Services 19 246-335-445 Home Care Services 246-335-545 Home Health Services 246-335-645 Hospice Services

20. Supervision of Services Home Care Agency 20 Must have a supervisor and alternate Supervisor is responsible for overall coordination and update to the Plan of Care Must have documentation of at least 10hrs of training annually. Must document contact with the client by phone or in person visit at least once every 6 months. Read more at: https://app.leg.wa.gov/wac/default.aspx?cite=246-335- 445

21. Supervision of Services Home Health Agency 21 Must employ a Director of Clinical services and an alternate. Same 10 hrs of training required Supervises all care provided and assures agency policies are followed. Monthly supervisory visits for acute patients. (acute=not medically stable) Every 6 months for maintenance patients (maintenance=stable and predictable). https://app.leg.wa.gov/wac/default.aspx?cite=246-335- 545

22. Supervision of Services Hospice Agency 22 Must have a Director of Clinical services and an Alternate Must have 10 hrs of training annually. Once a month in home supervisory visit if receiving aide services. https://app.leg.wa.gov/wac/default.aspx?cite=246- 335-645

23. Plan of Care Home Care 23 Assure a written plan of care is developed with input from the client/family Assure that the written plan of care is updated at least annually or more often with condition changes and signed by the client/family. https://app.leg.wa.gov/wac/default.aspx?cite=246- 335-440

24. Plan of Care Home Health 24 Assure the plan of care is developed to meet client needs. Plan of Care must be updated every 2 months if acute. Plan of Care updated every 6 months if maintenance. Plan of Care updated annually if only providing DME. Plan of Care must be signed and returned within 60 days. https://app.leg.wa.gov/wac/default.aspx?cite=246- 335-540

25. Plan of Care - Hospice 25 Develop a Plan of Care that is signed by the provider and returned within 60 days. Assure that the IDT reviewed the Plan of Care within one week of admission and every two weeks there after. https://app.leg.wa.gov/wac/default.aspx?cite=246- 335-640

26. Quality improvement program 26 WAC 246-335-455 Home Care WAC 246-335-555 - Home Health WAC 246-335-655 - Hospice

27. Quality improvement program 27 Every licensee must establish and implement a quality improvement program to ensure the quality of care and services provided throughout all approved service areas that includes, at a minimum: (1) A complaint process that includes a procedure for the receipt, investigation, and disposition of complaints regarding services provided; (2) A method to identify, monitor, evaluate, and correct problems identified by patients, families, personnel, contractors, or volunteers; and (3) A system to assess patient satisfaction with the overall services provided by the agency

28. Licensure Fees 28 WAC 246-335-990 Fees are specific for initial licenses; addition of a license type and for annual renewals. $$ Fees are based on number of Full Time Equivalents (FTE) for renewals.

29. Review Learning Objectives 29 Learning Objectives: Be able to access and navigate the WA State In- Home Services law and rules Understand the difference between statute and rule. Find resources for your toughest regulatory and survey issues.

30. Links 30 RCW 70.127 https://apps.leg.wa.gov/RCW/default.aspx?cite=70.12 7 WAC 246-335 https://app.leg.wa.gov/wac/default.aspx?cite=246- 335

31. Questions? 31

32. 32 Donna Goodwin Clinical Director Home Care Association of Washington goodwndr@aol.com 509-991-1001 HCAW.org Call me .

33. Resources 33 John Hilger, MSW Facilities Program Manager Office of Community Health Systes Health Systems Quality Assurance Washington State Department of Health john.hilger@doh.wa.gov 360-236-2929