Medical Device Use in Adult Family Homes

The Department of Social and Health Services (DSHS) recently issued a Dear Provider Letter providing clarification on the use of medical devices in Adult Family Homes (AFHs). The guidance reminds providers that residents may use medical devices to meet assessed care needs, but providers must understand the difference between a medical device and a restraint and ensure devices are used safely and appropriately.

Because providers had questions regarding who may complete medical device assessments and the specific requirements for bed rails, the Adult Family Home Council (AFHC) requested additional clarification from DSHS.

Medical Device Assessments and Qualified Assessors

The Dear Provider Letter references WAC 388-76-10150, which requires assessments involving medical devices to be completed by an individual who meets the qualifications of an assessor.

DSHS clarified that authorized department case managers already perform resident assessments for Medicaid clients through the CARE assessment process. Under WAC 388-76-10150(1), an authorized department case manager is included as an exception to the assessor qualification requirements listed for other individuals completing assessments.

For AFH providers, this means that department case managers may complete assessments within their scope of responsibility for residents receiving Medicaid services. Providers should continue to ensure that medical device use is supported by the required assessment, documentation, and care planning requirements.

Bed Rails and Therapy Evaluations

AFHC also requested clarification regarding assessments for bed rails, as providers have received questions about whether a Physical Therapist (PT) or Occupational Therapist (OT) evaluation is required.

DSHS clarified that when a resident is requesting Medicaid coverage for a bed rail or positioning device, Home and Community Services (HCS) requires completion of the Therapy Evaluation for Bed Transfer/Positioning Devices (DSHS Form 13-906) by a qualified Physical Therapist or Occupational Therapist. This requirement is an HCS policy and is separate from the Adult Family Home licensing regulations.

If an AFH provider receives a citation related to the assessment requirements for a bed rail, DSHS recommends discussing the specific circumstances with their Field Manager to determine how the regulations apply.

Requirements for Safe Use of Medical Devices

AFH providers remain responsible for ensuring that medical devices are used safely and are not being used as restraints. Under WAC 388-76-10650, providers must ensure:

• The medical device is used to address an assessed resident need and is not used for staff convenience or as a restraint.
• The resident has an assessment that addresses the resident’s ability to safely use the device.
• The resident and their family member or legal representative are informed of the risks and benefits of the device so they can make an informed decision.
• The resident’s Negotiated Care Plan (NCP) documents how the medical device will be used.
• The device is properly installed and maintained.

Providers should continue reviewing their medical device policies and procedures to ensure they align with current regulations and that staff understand the difference between appropriate medical device use and the use of restraints.

For questions about medical device requirements or specific situations involving a resident, providers should work with their DSHS Field Manager.