RCW 74.42.455
Transitional care management.
(1) Nursing facilities may provide telephone or web-based transitional care management services to persons discharged from the facility to home for up to thirty days postdischarge.
(2) When a nursing facility provides transitional care management services, the facility must coordinate postdischarge care and service needs with in-home agencies licensed under chapter 70.127 RCW, and other authorized care providers, to promote evidence-based transition care planning. In-home service agencies and other authorized care providers, including the department, shall, when appropriate, determine resident eligibility for postdischarge care and services and coordinate with nursing facilities to plan a safe transition of the client to the home setting. When a resident is discharged to home and is without in-home care or services due to the resident's refusal of care or their ineligibility for care, the nursing facility may provide telephone or web-based transitional care management services. These services may include care coordination services, review of the discharge plan, instructions to promote compliance with the discharge plan, reminders or assistance with scheduling follow-up appointments with other health care professionals consistent with the discharge plan, and promotion of self-management of the client's health condition. Web-based transition care services may include patient education and the provision of services described in this section. They are not intended to include telehealth monitoring.
(3) If the nursing facility identifies concerns in client care that result from telephone or web-based transitional care management services, the nursing facility will notify the client's primary care physician. The nursing facility will also discuss with the client options for care or other services which may include in-home services provided by agencies licensed under chapter 70.127 RCW.
[ 2011 c 366 § 7.]
NOTES:
Findings—Purpose—Conflict with federal requirements—2011 c 366: See notes following RCW 18.20.020.
Structure Revised Code of Washington
Chapter 74.42 - Nursing Homes—Resident Care, Operating Standards.
74.42.020 - Minimum standards.
74.42.030 - Resident to receive statement of rights, rules, services, and charges.
74.42.040 - Resident's rights regarding medical condition, care, and treatment.
74.42.050 - Residents to be treated with consideration, respect—Complaints.
74.42.055 - Discrimination against medicaid recipients prohibited.
74.42.056 - Department assessment of medicaid eligible individuals—Requirements.
74.42.057 - Notification regarding resident likely to become medicaid eligible.
74.42.058 - Department case management services.
74.42.060 - Management of residents' financial affairs.
74.42.080 - Confidentiality of records.
74.42.090 - Work tasks by residents.
74.42.110 - Freedom of association—Limits.
74.42.120 - Personal possessions.
74.42.130 - Individual financial records.
74.42.140 - Prescribed plan of care—Treatment, medication, diet services.
74.42.150 - Plan of care—Goals—Program—Responsibilities—Review.
74.42.170 - Rehabilitative services.
74.42.190 - Activities program—Recreation areas, equipment.
74.42.200 - Supervision of health care by physician—When required.
74.42.210 - Pharmacist services.
74.42.220 - Contracts for professional services from outside the agency.
74.42.225 - Self-medication programs for residents—Educational program—Implementation.
74.42.240 - Administering medication.
74.42.250 - Medication stop orders—Procedure for persons with developmental disabilities.
74.42.260 - Drug storage, security, inventory.
74.42.280 - Adverse drug reaction.
74.42.285 - Immunizations—Rules.
74.42.290 - Meal intervals—Food handling—Utensils—Disposal.
74.42.300 - Nutritionist—Menus, special diets.
74.42.310 - Staff duties at meals.
74.42.320 - Sanitary procedures for food preparation.
74.42.340 - Administrative support—Purchasing—Inventory control.
74.42.350 - Organization chart.
74.42.360 - Adequate staff—Minimum staffing standards—Exceptions—Definition.
74.42.370 - Licensed administrator.
74.42.380 - Director of nursing services.
74.42.390 - Communication system.
74.42.400 - Engineering and maintenance personnel.
74.42.420 - Resident record system.
74.42.430 - Written policy guidelines.
74.42.440 - Facility rated capacity not to be exceeded.
74.42.455 - Transitional care management.
74.42.460 - Organization plan and procedures.
74.42.470 - Infected employees.
74.42.490 - Room requirements—Waiver.
74.42.500 - Toilet and bathing facilities.
74.42.510 - Room for dining, recreation, social activities—Waiver.
74.42.540 - Building requirements.
74.42.560 - Emergency lighting for facilities housing persons with developmental disabilities.
74.42.570 - Health and safety requirements.
74.42.580 - Penalties for violation of standards.
74.42.620 - Departmental rules.
74.42.630 - Conflict with federal requirements.
74.42.640 - Quality assurance committee.
74.42.910 - Construction—Conflict with federal requirements.
74.42.920 - Chapter 74.42 RCW suspended—Effective date delayed until January 1, 1981.