Helpful Hints
Understanding the Assessment
REQUESTING PERSONAL CARE
Clients who are eligible to receive Medicaid may also request an assessment to determine if they meet functional eligibility requirements to receive personal care services. Personal care services refers to physical and verbal assistance provided to a client who requires supports with Activities of Daily Living (ADLs) (ex. Bathing, Eating, Toileting, and Transfers) and Instrumental Activities of Daily Living (IADLs) (ex. Shopping, Meals, Housework).
ASSESSMENT
Washington State must conduct an assessment to evaluate the client’s abilities and support needs. This information is then used to determine the amount of personal care hours a client is authorized to receive. This assessment must be conducted at least once a year or when a significant change is reported in the client’s support needs.
Chapter 388-106 WAC contains information about the algorithm governing how assessment scores are used to determine a service classification level and number of hours a client is eligible to receive each month.
Upon completion of the assessment, the case manager reviews assessment results with the client and their legal representative/guardian, if they have one.The assessment for service happens at your first innitial intake and after that a yearly review
Levels and Hours
WAC 388-106-0125 How does CARE use criteria to place me in a classification group for in-home care? CARE uses the criteria of cognitive performance score as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behavior and behavior point score as determined under WAC 388-106-0100, ADLS as determined under WAC 388-106-0105, and exceptional care as determined under WAC 388-106-0110 to place you into one of the following seventeen in-home groups.
CARE classification is determined first by meeting criteria to be placed into a group, then you are further classified based on ADL score or behavior point score into a classification sub-group following a classification path of highest possible base hours to lowest qualifying base hours. Each classification group is assigned a number of base hours as described below based upon the level of funding provided by the legislature for personal care services, and based upon the related level of functional disability of persons in each classification group as compared to persons in other classification groups.
GROUP E
(1) If you meet the criteria for exceptional care, then CARE will place you in Group E. CARE then further classifies you into: (a) Group E High with 393 base hours if you have an ADL score of 26-28; or (b) Group E Medium with ((346)) 327 base hours if you have an ADL score of 22-25.
GROUP D
(2) If you meet the criteria for clinical complexity and have cognitive performance score of 4-6 or you have cognitive performance score of 5-6, then you are classified in Group D regardless of your mood and behavior qualification or behavior points.
CARE then further classifies you into: (a) Group D High with 260 base hours if you have an ADL score of 25-28; or (b) Group D Medium-High with 215 base hours if you have an ADL score of 18-24; or (c) Group D Medium with 168 base hours if you have an ADL score of 13-17; or (d) Group D Low with 120 base hours if you have an ADL score of 2-12.
GROUP C
(3) If you meet the criteria for clinical complexity and have a CPS score of less than 4, then you are classified in Group C regardless of your mood and behavior qualification or behavior points. CARE then further classifies you into: (a) Group C High with ((194)) 176 base hours if you have an ADL score of 25-28; or (b) Group C Medium-High with 158 base hours if you have an ADL score of 18-24; or (c) Group C Medium with 115 base hours if you have an ADL score of 9-17; or (d) Group C Low with 73 base hours if you have an ADL [ 2 ] SHS-4262.4 score of 2-8.
GROUP B
(4) If you meet the criteria for mood and behavior qualification and do not meet the classification for C, D, or E groups, then you are classified into Group B. CARE further classifies you into: (a) Group B High with 129 base hours if you have an ADL score of 15-28; or (b) Group B Medium with 69 base hours if you have an ADL score of 5-14; or (c) Group B Low with 39 base hours if you have an ADL score of 0-4; or
(5) If you meet the criteria for behavior points and have a CPS score of greater than 2 and your ADL score is greater than 1, and do not meet the classification for C, D, or E groups, then you are classified in Group B. CARE further classifies you into: (a) Group B High with 129 base hours if you have a behavior point score 12 or greater; or (b) Group B Medium-High with 84 base hours if you have a behavior point score greater than 6; or (c) Group B Medium with 69 base hours if you have a behavior point score greater than 4; or (d) Group B Low with 39 base hours if you have a behavior point score greater than 1.
GROUP A
(6) If you are not clinically complex and your CPS score is less than 5 and you do not qualify under either mood and behavior criteria, then you are classified in Group A. CARE further classifies you into: (a) Group A High with 59 base hours if you have an ADL score of 10-28; or (b) Group A Medium with 47 base hours if you have an ADL score of 5-9; or (c) Group A Low with 22 base hours if you have an ADL score of 0-4.