Wash. Rev. Code § 74.39A.095

Case management services — Agency on aging oversight — Plan of care — Termination of contract — Rejection of individual provider

Area agencies on aging that provide case management services pursuant to an agreement with the department of social and health services, must oversee the provision of care. Such oversight should include:

•       Verifying the provider’s training qualifications.
•       Monitoring whether the consumer’s plan of care meets their needs.
•       “Reassessing and reauthorizing services.”
•       Monitoring provider performance.
•       Conducting employee background checks.

Case managers must collaborate with consumers to create a plan of care that ensures coordination of health and long-term care services that meet the consumer’s needs.  The plan must include, at minimum, the following items:

•         The case manager’s name and telephone number as well as a description about how to reach the manager if concerns regarding the consumer’s health or “adequacy of care” arise.
•         The names and telephone numbers of the consumer’s primary care provider and other providers that frequently care for the consumer.
•         Description of the roles and responsibilities of both the case manager and consumer.
•         Duties and tasks to be performed by the case manager and consumer.        Information regarding the type and amount of in-home services authorized.
•        Provider compensation terms.
•         A provider’s statement that they are able and willing to comply with the plan of care.
•         A statement that, except for services relating to reassessment, reauthorization, and verification, the consumer has the right to waive case management services.
•         A statement that the patient has waived case management services.

Area agencies on aging must keep records regarding the waiver of case management services.

Consumers have the right to participate in the development of their plan of care.

The plan of care must be given to the consumer’s primary care provider and any other providers that the consumer authorizes.

If the department or area agency reasonably believes that a provider has placed the health or life of a consumer in danger, then the department or agency may suspend the contract between the provider and the department and initiate a hearing on the matter. The department may terminate the contract upon a finding that the provider has placed the life or health of a consumer in danger.

A consumer may request that a family member or other person serve as their individual provider, but the department or area agency may deny such request upon a reasonable belief that the identified individual will not meet the consumer’s needs.