WAC 388-106-0500
What services may I receive under
medically needy in-home waiver (MNIW)? You may be eligible to
receive only the following medically needy in-home waiver
(MNIW) services in your own home:
(1) Personal care services as defined in WAC 388-106-0010
in your own home and, as applicable, while you are out of the
home accessing community resources or working.
(2) Adult day care if you meet the eligibility
requirements under WAC 388-106-0805.
(3) Environmental modifications, if the minor physical
adaptations to your home:
(a) Are necessary to ensure your health, welfare and
safety;
(b) Enable you to function with greater independence in
the home;
(c) Directly benefit you medically or remedially;
(d) Meet applicable state or local codes; and
(e) Are not adaptations or improvements, which are of
general utility or add to the total square footage.
(4) Home delivered meals, providing nutritional balanced
meals, limited to one meal per day, if:
(a) You are homebound and live in your own home;
(b) You are unable to prepare the meal;
(c) You don't have a caregiver (paid or unpaid) available
to prepare this meal; and
(d) Receiving this meal is more cost-effective than
having a paid caregiver.
(5) Home health aide service, if the service tasks:
(a) Include assistance with ambulation, exercise,
self-administered medications and hands on personal care;
(b) Are beyond the amount, duration or scope of medicaid
reimbursed home health services (WAC 388-551-2120) and are in
addition to those available services;
(c) Are health-related. Note: Incidental services such
as meal preparation may be performed in conjunction with a
health-related task as long as it is not the sole purpose of
the aide's visit; and
(d) Do not replace medicare home health services.
(6)(a) Personal emergency response system (PERS), if the
service is necessary to enable you to secure help in the event
of an emergency and if:
(i) You live alone in your own home;
(ii) You are alone, in your own home, for significant
parts of the day and have no regular provider for extended
periods of time; or
(iii) No one in your home, including you, can secure help
in an emergency.
(b) A medication reminder if you:
(i) Are eligible for a PERS unit;
(ii) Do not have a caregiver available to provide the
service; and
(iii) Are able to use the reminder to take your
medications.
(7) Skilled nursing, if the service is:
(a) Provided by a registered nurse or licensed practical
nurse under the supervision of a registered nurse; and
(b) Beyond the amount, duration or scope of
medicaid-reimbursed home health services as provided under WAC 388-551-2120.
(8) Specialized durable and nondurable medical equipment
and supplies under WAC 388-543-1000, if the items are:
(a) Medically necessary under WAC 388-500-0005;
(b) Necessary: For life support; to increase your
ability to perform activities of daily living; or to perceive,
control, or communicate with the environment in which you
live;
(c) Directly medically or remedially beneficial to you;
and
(d) In addition to and do not replace any medical
equipment and/or supplies otherwise provided under medicaid
and/or medicare.
(9) Training needs identified in CARE or in a
professional evaluation, which meet a therapeutic goal such
as:
(a) Adjusting to a serious impairment;
(b) Managing personal care needs; or
(c) Developing necessary skills to deal with care
providers.
(10) Transportation services if you live in your own
home, when the service:
(a) Provides access to community services and resources
to meet a therapeutic goal;
(b) Is not diverting in nature;
(c) Is in addition to and does not replace the
medicaid-brokered transportation or transportation services
available in the community.
(11) Nurse delegation services when:
(a) You are receiving personal care from a registered or
certified nursing assistant who has completed nurse delegation
core training;
(b) Your medical condition is considered stable and
predictable by the delegating nurse; and
(c) Services are provided in compliance with WAC 246-840-930.
(12) Nursing services, when you are not already receiving
this type of service from another resource. A registered
nurse may visit you and perform any of the following
activities. The frequency and scope of the nursing services
is based on your individual need as determined by your CARE
assessment and any collateral contact information obtained by
your case manager.
(a) Nursing assessment/reassessment;
(b) Instruction to you and your providers;
(c) Care coordination and referral to other health care
providers;
(d) Skilled treatment, only in the event of an emergency.
A skilled treatment is care that would require authorization,
prescription, and supervision by an authorized practitioner
prior to its provision by a nurse, for example, medication
administration or wound care such as debridement. In
nonemergency situations, the nurse will refer the need for any
skilled medical or nursing treatments to a health care
provider, a home health agency or other appropriate resource;
(e) File review; and/or
(f) Evaluation of health-related care needs affecting
service planning and delivery.
(13) Community transition services, if you are being
discharged from the nursing facility or hospital and if
services are necessary for you to set up your own home.
Services:
(a) May include: Safety deposits, utility set up fees or
deposits, health and safety assurances such as pest
eradication, allergen control or one time cleaning prior to
occupancy, moving fees, furniture, essential furnishings, and
basic items essential for basic living outside the
institution.
(b) Do not include rent, recreational or diverting items
such as TV, cable or VCRs.
[Statutory Authority: RCW 74.08.090, 74.09.520. 07-24-026, §
388-106-0500, filed 11/28/07, effective 1/1/08. Statutory
Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-106-0500, filed 2/6/06,
effective 3/9/06. Statutory Authority: RCW 74.08.090,
74.09.520. 05-11-082, § 388-106-0500, filed 5/17/05,
effective 6/17/05.]