H05-027– Information

April 5, 2005
TO: / Home and Community Services (HCS) Regional Administrators
Area Agency on Aging (AAA) Directors
Division of Developmental Disabilities Regional Administrators
FROM: / Penny Black, Director, Home and Community Services Division
Linda Rolfe, Director, Division of Developmental Disabilities
SUBJECT: /
CARE ADH Screen (Version 2.2.2)
Purpose: / To assist social workers/case managersin determining eligibility for Adult Day Health services.
Background: / Determination of eligibility for Adult Day Health services transferred from ADH providers to department/AAA staff with implementation of the revised Adult Day Services WAC in October, 2003. To assist in determining eligibility for ADH, social workers/case managers will respond to a list of questions in CARE on the ADH screen. Responses to those questions will assist social workers/case managers in determining whether the client is eligible for an ADH program.
What’s new, changed, or
Clarified / In order to determine eligibility for ADH, social workers/case managers will need to:
  1. Perform a CARE assessment
  2. Complete a list of questions. Answers to these questions will assist in the determination of whether the client is eligible for an ADH program. (See attached Screen Shot titled ADH. This screen is located in CARE in the Medical folder between the Treatment and Pain screens).
  3. Follow additional instructions for completing this screen as outlined in the (F1) ADH Help Screen.

ACTION: / Social workers/case managers will perform a CARE assessment to assist in determining eligibility for ADH.
  1. When will this screen be completed?
Social worker/case managers will complete the required ADH screen for new Initial, Annual, Significant Change, IRR and Interim Assessments. The screen also contains a skip pattern question; “Are you considering client for ADH/” yes/no. If “no” is chosen, the rest of the questions on this screen will remain disabled.
  1. What are the eligibility questions?
The questions listed on the ADH screen reflect the eligibility criteria for ADH in WAC 388-71-0710 (soon to be adopted as WAC 388-106-0815). Thesemust all be answered “yes”for the client to meet eligibility criteria.
The qualifying criteria are:
  • Enrolled in CNP, CNP-QMB, GA-X, or ADATSA; and
  • Has an unmet need for Skilled Nursing or Skilled Rehabilitative Therapy Services; and
  • Skilled services will improve, restore, maintain, or slow the decline of the client’s health status or ease related pain or suffering; and
  • Client is at risk of deterioration or institutionalization without these skilled services being provided; and
  • Client is not able to manage their home care needs safely due to physical, cognitive, or other impairments; and
  • Has a need for personal care or other core services, whether or not those needs are being met.
3. Clarifications of drop down choices in the bucket “Client is not eligible for”:
You must also identify whether a client is not eligible for ADH by selecting any of the following applicable choices:
  • Need(s) exceed the scope of ADH. Clients may have a skilled need that exceeds the scope of services or supervision available in the ADH setting and their needs cannot be safely or adequately met.
  • Need(s) already met. The client has the skilled services being provided by another health care provider or entity and ADH would be a duplication of service.
  • No need for nurse/therapist. The client has care needs that do not need to be provided or supervised by a licensed nurse or therapist. These care needs can be provided by another paid or unpaid caregiver.
  • Less structured care setting can meet needs. The care needs required by the client can be met in a less structured setting in their own home or residence, and does not require the skilled interventions provided at ADH.
  • Is in NF or where skilled services exist. The specific skilled service the client needs exists in the setting. For example, a client residing in an AFH or BH with a nurse available may still need skilled services from a rehabilitative therapist.
  • Not able to participate safely. The client is not capable of participating safely in a group setting.
  • None of these. The client preference may be to not attend ADH or to receive their care in another setting.
  1. Additional Instructions on when/how to complete the Care Plan screen?
  • To authorize ADH only – Select ADH in the Client is eligible for dropdown on the Care Plan screenif the client is receiving ADH only. Also select ADH for the Recommended/Planned settings.
  • To authorize COPES services and ADH – If this is a COPES client who will also receive ADH, select COPES in the Client is eligible for dropdown on the Care Plan screen.
  • For all clients receiving ADH services, be sure you have selected Adult Day Health on the Treatment screen in the Treatment List. This must be selected so that you can assign treatments to the ADH provider on the Supports screen, and to be available on the Care Plan screen.

Related
REFERENCES: / WAC 388-71-0702 through 0776; MB H05-026 New Steps and Information Related to Adult Day Health (ADH) Assessment, Referral and Authorization; CARE Version 2.2.2, User Instructions
ATTACHMENT(S): / CARE ADH Screen Shot

CONTACT(S): / Regarding Adult Day Services:
Candace (Candy) Goehring,Program Manager
360-725-2562;
Regarding HCS/AAA CARE assessment instructions:
Terry Rupp, Program Manager
360-725-2353 or
Regarding DDD CARE assessment instructions:
Debbie Johnson, Program Manager
360-725-3525 or