Wash. Admin. Code § 296-23-246

Current through Register Vol. 24-21, November 1, 2024

Section 296-23-246 - Attendant services

(1)What are attendant services? Attendant services are proper and necessary personal care services provided to maintain the injured worker in his or her residence.

(2)Who may receive attendant services? Workers who are temporarily or permanently totally disabled and rendered physically helpless by the nature of their industrial injury or occupational disease may receive attendant services.

(3)Is prior authorization required for attendant services? Yes. To be covered by the department, attendant services must be requested by the attending physician and authorized by the department before care begins.

(4)What attendant services does the department cover? The department covers proper and necessary attendant services that are provided consistent with the injured worker's needs, abilities and safety. Only attendant services that are necessary due to the physical restrictions caused by the accepted industrial injury or occupational disease are covered.

The following are examples of attendant services that may be covered:

Bathing and personal hygiene;

Dressing;

Administration of medications;

Specialized skin care, including changing or caring for dressings or ostomies;

Tube feeding;

Feeding assistance (not meal preparation);

Mobility assistance, including walking, toileting and other transfers;

Turning and positioning;

Bowel and incontinent care; and

Assistance with basic range of motion exercises.

Services the department considers everyday environmental needs, unrelated to the medical care of the worker are not covered. The following chore services are examples of services that are not covered: Housecleaning, laundry, shopping, meal planning and preparation, transportation of the injured worker, errands for the injured worker, recreational activities, yard work, and child care.

(5)Who may provide attendant services? Attendant services provided on or after June 1, 2002, must be provided through an agency licensed, certified or registered to provide home care or home health services.

EXCEPTION:

A worker who received department approved attendant services from a spouse prior to October 1, 2001, may continue to receive attendant services from that spouse as long as all of the following criteria are met.

The attendant service spouse provider:

(a) Had an active provider account with the department on September 30, 2001; and

(b) Maintains an active provider account with the department; and

(d) Allows the department or its designee to perform periodic independent nursing evaluations in the worker's residence.

(6)What are the treatment limits for attendant services? The department will determine the maximum hours of authorized attendant care services based on an independent nursing assessment of the worker's care needs.

Spouses eligible to provide attendant services are limited to a maximum of seventy hours of attendant services per week or to the maximum hours authorized for the worker, whichever is less. Workers who are receiving attendant services from spouses and whose care needs exceed seventy hours per week must receive attendant services in excess of seventy hours from an agency eligible to provide attendant services.

EXCEPTION:

The department may exempt a spouse from the seventy-hour limit if, after review by the department and based on independent nursing assessment:

(a) The injured worker is receiving proper and necessary care; and

(b) The worker's care needs exceed seventy hours per week; and

(7)Will the department review attendant services? Yes. The department or its designee will perform periodic independent nursing evaluations of attendant services. Evaluations may include, but are not limited to, on-site review of the injured worker and review of medical records.

Wash. Admin. Code § 296-23-246

Statutory Authority: RCW 51.04.020. 03-21-069, recodified as § 296-23-246, filed 10/14/03, effective 12/1/03. Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.060, 51.32.072, and 7.68.070. 01-18-041, § 296-20-303, filed 8/29/01, effective 10/1/01.