Hospice Agencies

Updated Rules – Information, Resources and Guidance

The in-home services licensing rules, chapter 246-335 WAC, have been updated and took effect April 6, 2018. This page offers applicants and licensees various resources and guidance pertaining to the updated rules.

CR-103 – filed on March 6, 2018

The filing of the CR-103 (WSR 18-06-093) (PDF) signifies the conclusion of the department's in-home services rule updating activities. The CR-103 form identifies new sections added to the rules, old sections that have been repealed, and amended sections. The updated rules are attached to the CR-103, page 4 through 78.

Significant rule changes

The department has created a “significant rule changes” document (PDF) that highlights the more substantial in-home services rule changes for applicants and licensees. In addition to these changes, there are many other updates throughout the rules. We encourage applicants and licensees to read the revised rules thoroughly.

Survey grace period ended on October 6, 2018

The department provided in-home services licensees a six-month survey-related grace period, which ended October 6, 2018, in order to perform necessary administrative updates and to become familiar with the various new and revised rule requirements in chapter 246-335 WAC. Any licensee surveyed after October 6, 2018, is expected to be in compliance with the updated rules.

New orientation class requirement for applicants

WAC 246-335-320(1) requires applicants to complete an in-home services orientation class before submitting a licensing application. The class's purpose is to provide prospective applicants an overview of the state licensing process, explain the differences between home care, home health, and hospice service categories, and describe department expectations of licensees providing care to vulnerable persons. This half-day orientation class is free of charge and offered at the department's Tumwater campus. Applications submitted without an orientation class certificate of completion will not be processed. For class registration information and dates, see our Orientation Class webpage.

Note: The orientation class isn't required for change of ownership applications, agencies adding a service category to their license, or Medicare-certified agencies that choose to establish a new state license for a recently approved county through Certificate of Need.

New Full-time Equivalent (FTE) Worksheet

WAC 246-335-320(2)(c) and 246-335-325(3) requires applicants and licensees to complete, sign and submit a Full-time Equivalent Worksheet (PDF) along with their initial and renewal applications. The worksheet is designed to assist agencies in calculating their FTEs. The FTEs noted on initial and renewal applications should match the FTEs on the worksheet. A separate FTE worksheet is required for each services category (e.g., home care, home health, and hospice). Agency administrators must sign the completed form, attesting that the information is accurate. For your convenience, here are two examples of completed FTE worksheets:

New criminal history background check requirements

WAC 246-335-425(6), 246-335-525(6), and 246-335-625(6) requires home care, home health, and hospice agencies to request criminal history background checks and disclosure statements for the administrator, supervisor of direct care services, director of clinical services, and all employees who provide care to clients and patients. Background checks are required upon hire and then every two years. The department supports client and patient safety by requiring agencies to periodically re-run background checks on their workers to verify that no disqualifying charges or convictions have taken place since their previous check.

Home health and hospice agencies must process initial and subsequent background checks through the Washington State Patrol (WSP). Home care agencies must process initial hiring background checks through the Washington State Department of Social and Health Services Background Check Central Unit (DSHS BCCU) and subsequent two-year checks through WSP. Processing background checks through the BCCU satisfies the requirement in WAC 246-335-425(6). BCCU is required to provide only initial background checks for long-term care workers and certified home care aides at no charge to the home care agency.

Note 1: DSHS-contracted home care agencies are required by their contract to process all background checks, initial and subsequent, through the BCCU system.

New character, competency, and suitability determination requirement

WAC 246-335-425(7), 246-335-525(7), and 246-335-625(7) requires home care, home health, and hospice agencies to develop policies and procedures for conducting a character, competence, and suitability (CCS) determination for personnel, contractors, volunteers, and students whose background check results reveal non-disqualifying convictions, pending charges, or negative actions. Agencies are required to process Washington State Patrol (WSP) criminal history background checks upon hire and then every two years. The WSP background check results will either indicate “No Record Found” or “Record Found.” If the results say “Record,” agencies must review the crimes listed to determine if there are any disqualifying crimes per RCW 43.43.830. If there are no disqualifying crimes, but other non-disqualifying crimes, pending charges, or negative actions are listed, agencies must conduct a CCS review to determine if the person should have unsupervised access to vulnerable adults or children.

Guidance on using the Tuberculosis (TB) Risk Assessment form

WAC 246-335-425(13), 246-335-525(16), and 246-335-625(15) requires home care, home health, and hospice agencies to conduct TB risk assessments for new employees and annually for all employees. Agencies must use the department's Adult TB Risk Assessment form (PDF) and conduct TB testing if any of the three boxes are checked.

The department recognizes that agencies have limited resources and complying with these new regulations translates into increased costs. If agencies with limited fiscal resources are unable to test all employees who indicate they are foreign-born, the risk assessment form contains an option to focus testing efforts on higher risk persons who have identified they also have one or more medical risks. Persons who were born in countries that have elevated TB rates have an increased risk of TB infection. These persons who also have certain medical risks have an even higher risk of progressing to TB disease. Focusing testing and treatment efforts on higher-risk employees will allow agencies with limited resources to provide the most protection to public health.

Here is an example of a completed risk assessment form (PDF) and one way that agencies can document that their foreign-born employee will not be tested because they don't have additional medical risks.

Note 1: If the “Immunosuppression” or “Close contact” boxes are checked, testing is required.

Note 2: Medicare-certified home health and hospice agencies and hospice care centers may have additional requirements in their conditions of participation related to TB testing.

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