DDA Nursing Services
Nursing Services Unit Manager
Erika Parada, MSN RN
360-448-7079
DDANursingServices@dshs.wa.gov
DDA Nursing Services offers a wide array of professional health services for adults and children, eligible for the DDA. Services may include:
- Waivered Skilled Nursing
- Nurse Delegation
- Medically Intensive Childrens' Program, for Fee for Service participants
- Private Duty Nursing
- Skin Observation Protocol
- Nurse Consultation
Waiver Skilled Nursing
Waivered Skilled Nursing is a DDA specific contract with Licensed Practice Nurses, Registered Nursing, and Home Health Agencies. The contracted provider is authorized to provide a service through a DDA Prior Approval. Skilled Nursing Services provided under this contract include long-term, intermittent, and hourly nursing tasks, which are not covered by private insurance, Medicare, or Medicaid state plan benefits. A denial is needed to proceed with a Prior Approval for the service.
Examples of tasks commonly referred:
- Indwelling catheter insertion
- Injections
- Complex wound care
- Skilled nursing respite
- Skilled nursing assessments
Resources:
For information on becoming a DDA contracted provider, please email:
DDANursingServices@dshs.wa.gov
Nurse Delegation
Nurse Delegation is a service option which provides training for Long-Term Care Workers, to perform nursing tasks in a community based residential setting. Delegation of nursing tasks is performed by a contracted Registered Nurse Delegator (RND). The RND will decide is the client is stable and predictable, thus eligible for nurse delegation. If a client is deemed stable and predictable for delegation, the RND will train the LTCW’s on specific nursing tasks and provide routine oversight (every 90 days) of the client and LTCW’s. The RND is not responsible for care planning, discharge planning, development of plan of care or providing hands on nursing tasks. The RND is responsible to train and supervisor the LTCW’s on specific nursing tasks and assessment of a client’s condition, as it relates to the delegation. The rules for Community Based Nurse Delegation are written by Department of Health, Board of Nursing, to ensure public safety.
Examples of commonly delegated nursing tasks:
- Oral medication administration
- G-tube feeds
- Seizure rescue medications
- In and out catheterization
- Nebulizer treatments
- Simple wound care
- Blood glucose monitoring
- Insulin administration
The following tasks are prohibited from being delegated to LTCW’s:
- Administration of medications by injection; other than insulin
- Sterile procedures
- Central line maintenance
- Acts which require nursing judgement
Nurse Delegation is appropriate in the following settings:
- In home
- DDA community residential setting
- Adult Family Home
- Assisted Living Facility
Resources:
Find a DSHS Contracted Nurse Delegator
How to Become a Contracted Nurse Delegator
DOH Provider Credential Search
Medically Intensive Children’s Program
Medically Intensive Children’s Program (MICP) is private duty nursing for children. The MICP program provides continuous skilled nursing services to children birth through 17 years of age. DDA administers the MICP program for DDA Fee for Service Children. If a family or legal representative requests an MICP assessment, an MICP application (DSHS 15-398) and documentation must be submitted to the DDA Nursing Services Unit Manager, prior to assigning the case to a DDA Nursing Care Consultant for review. Children enrolled in a managed care program will receive a nursing assessment and eligibility determination through their MCO. The MICP program is designed to support clients and their families who must assume a portion of the client’s care.
A client may qualify for MICP if:
- They are 17 years old or younger.
- Have complex medical needs requiring continuous skilled nursing care, which are not delegable (tracheostomy, ventilator dependency, complex respiratory treatments, medications/feedings through an IV or central line, etc.)
- Eligible for DDA
- Enrolled in Medicaid Fee for Service
- Require at least four hours of continuous skilled nursing care per day.
PDN hours are determined by the DDA Nursing Care Consultant (NCC), up to 16 hours per day.
Children may receive MICP in the following settings:
- Family home
- Foster home
- Group Care Facilities for medically fragile children
- Staffed residential home
MICP may be provided by an entity with an in-home services license with the state or Washington and a contract with DSHS to provide Private Duty Nursing.
Resources:
Find a DSHS Contracted Private Duty Nurse
Medically Intensive Children’s Program WAC
Private Duty Nursing Billing Guide
Private Duty Nursing Fee Schedule (Health Care Authority)
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) rules
For information on becoming a DDA contracted provider, please email: DDANursingServices@dshs.wa.gov
Private Duty Nursing
Private Duty Nursing (PDN) is a program which provides continuous skilled nursing services to adults age 18 years of age or older. DDA administers the PDN program for DDA clients. The PDN program is designed to support clients and their families who must assume a portion of the client’s care. PDN is an alternative to institutional care.
A client may qualify for PDN if:
- They are 18 years old or older
- Have complex medical needs requiring continuous skilled nursing care, which are not delegable (tracheostomy, ventilator dependency, complex respiratory treatments, medications/feedings through an IV or central line, etc.)
- Eligible for DDA
- Enrolled in Medicaid
- Require at least four hours of continuous skilled nursing care per day.
PDN hours are determined by the DDA Nursing Care Consultant (NCC), up to 16 hours per day.
Clients may receive PDN in the following settings:
- Family home
- Adult Family Home with PDN Specialty contract
- Staffed residential home with PDN Specialty contract
Resources:
Find a DSHS Contracted Private Duty Nurse
How to Become a Contracted Private Duty Nurse
Private Duty Nursing Skilled Nursing Task Log (15-344)
Skin Observation Protocol
Skin Observation Protocol (SOP) is a mandatory nursing-related referral, triggered by the DDA Assessment algorithm. The algorithm is intended to identify individuals at risk of having or developing a pressure injury. If a client triggers in their DDA Assessment for Skin Observation Protocol, the DDA Case Manager must alert the client or legal representative of the SOP trigger and refer the client to a DSHS contracted provider to complete an in-person skin assessment.
The contracted nursing provider will complete a basic skin assessment for all referred clients and a pressure injury assessment and documentation form for each pressure injury. The contracted nursing provider will describe the skin status and any recommendations. During the in person visit, the contracted nursing provider will provide education on healthy skin and prevention strategies to the client, family, legal representative, or Long-Term Care Worker (LTCW) present.
The SOP referral must be completed in 10 business days.
Who are DDA contracted nursing providers?
- Area Agency on Aging
- Home Health Agency with Nurse Consultation contract
- Nurse Delegators
- DDA contracted Skilled Nurses
Resources:
Pressure Injury Assessment and Documentation Form
Pressure Injury Pamphlet
For information on becoming a DDA contracted provider, please email: DDANursingServices@dshs.wa.gov
Nurse Consultation
Nurse Consultation is provided by DDA Nursing Care Consultants (NCC), for clients enrolled in Enhanced Case Management, Transitional Care Management, and client with high medical acuity. The goal of nurse consultation is to promote health, safety, independence, and equal access to nursing assessment and consultation for DDA clients. Referrals for Nurse Consultation are submitted by the DDA Case Manager.
Nurse consultation may include:
- Nursing assessment or home visit
- Nurse consultation with the DDA Case Manager, client, family, legal representative, and health care provider
- Home evaluation
- Clarification of health care instructions
- Assessment of medication regimen
- Assessment of nutritional status
- Assessment of mobility
Health Home
Health Home is a network of services that provide coordination of primary, mental health and long-term services and supports. Health home is focused on serving individuals with one or more chronic health condition who have been determined as frequent utilizers of emergency services and hospitalization, thus identified as high-risk/high-cost Medicaid clients.
The Health Home program helps clients:
- Develop a person-centered health action plan
- Improve self-management of chronic conditions
- Ensure care coordination and care transitions
The Health Home program provides the following specific services:
- Comprehensive care management
- Care coordination
- Health promotion
- Comprehensive transitional care
- Individual and family support
- Referral to community and social support services
For more information contact healthhomes@hca.wa.gov or visit the Health Home website
Care Coordination
Care Coordination is a benefit to Managed Care participants. Care Coordination may not be assigned at time of enrollment, and is based on a clients level of need. Care coordination may include support from a social worker, nurse, or mental health professional. Care coordination focuses on individual care needs and preferences. Delivery of services focuses on safe, appropriate, and effective care. If you or an individual you support would like more information on accessing care coordination, please reach out to the assigned Managed Care Organization (MCO).
- Wellpoint (Formerly Amerigroup)
- Community Health Plan of Washington (CHPW)
- Coordinated Care of Washington (CCW)
- Molina Healthcare of Washington, Inc (MHW)
- UnitedHealthcare Community Plan (UHC)
Resources
- DDA Provider Bulletins
- DDA Management Bulletins
- DDA Fact Sheets
- Mary Bridge Children’s Hospital
- Seattle Children’s Hospital
- Providence Sacred Heart Hospital
- DSHS Office Locator – addresses and maps
- Aging and Long Term Supports Administration