AGING AND DISABILITY SERVICES ADMINISTRATION

October 8, 2001

AASA No. 01-021

Re:?Exceptional Therapy Care Program ? Designated Facility

Dear Nursing Home Administrator:

In 1999, the legislature authorized DSHS to adopt rules implementing a system of exceptional therapy care payments.? The department will make exceptional therapy care payments for a Medicaid resident under age sixty-five and intensive therapy will enable the resident to achieve significant progress in their functional status.? Intensive therapy is at least two hours a day, five days a week in duration.? Also, the resident must not be eligible for Medicare.

The number of facilities eligible for exceptional therapy care payment is limited to no more than twelve.? Each designated facility must have a demonstrated history of excellence in therapy care.? Although not a requirement to participate in the exceptional therapy care program, a facility accredited by the Commission for Accreditation of Rehabilitation Facilities (CARF) is deemed to meet the criteria for demonstrated excellence in therapy care.?

In January of 2000, the department designated twelve facilities to participate in the exceptional therapy care program.? Currently, there are only eight facilities participating.? Aging and Disability Services Administration (AASA) is now accepting applications from additional facilities that would like to participate in the exceptional therapy care program.? AASA will review applications and determine whether the applicant qualifies for one of the four vacancies.

An interested facility should submit a written request to the department, separate from all other requests.? The facility should document, to the extent possible, compliance with the following criteria that AASA will use to evaluate applicants:

• Established system for determining changes in resident outcome measures between admission, transition, and/or discharge status;
• Method to measure improvement toward accomplishment of functional goals;
• Measurable criteria for initiation and termination of specific rehabilitation treatment;
• Substantial experience in serving residents who are under age sixty-five, not eligible for Medicare, and are able to achieve significant progress in functional status when provided with intensive therapy care services;
• Treatment to a sufficient volume of residents to ensure an environment of peer support for residents;
• Medical rehabilitation case management system utilized;
• Rehabilitation services provided by staff that are licensed, registered, or certified;
• In-house or contracted rehabilitation staff must be available for treatment indicated in the rehabilitation plan; and
• Occupational therapy, physical therapy, speech/language therapy, and mental health services i.e., neuropsychological services, clinical psychological services, and substance abuse counseling must be provided when indicated in the rehabilitation plan.

For facilities that are CARF accredited, the facility must provide documentation detailing current accreditation status.? If the NF has been CARF accredited and accreditation status was lost, the NF must provide documentation detailing the findings that led to the changed accreditation status.

If you want to apply for designation as an exceptional therapy care facility, please send a letter of interest and documentation of your qualifications for this status by October 26, 2001 to:

Jim Lochner
Office of Rates Management
PO Box 45600
Olympia, WA 98504-5600

If you have any questions regarding this letter, please call Marlene Black at (360) 725-2529.

Sincerely,

Tom Kearns. Chief

Office of Rates Management