§ 1396n(c)(1); 42 C.F.R. §§ 435.217, 441.302(c); see also, e.g., Wash. Admin. Code § 388-106-0310(4) (participants in Community Options Program Entry Services ("COPES") waiver program must "need the level of care provided in a nursing facility"); id. §§ 388-106-0410(4), 388-106-0510(4) (same with respect to participants in Medically Needy Residential Waiver ("MNRW") and Medically Needy In-Home Waiver ("MNIW") programs); id. § 388-845-0030(2) (developmentally disabled participants [*8] in Home and Community-Based Services ("HCBS") waiver programs must need the level of care provided in an intermediate care facility for the mentally retarded).
DSHS determines the number of hours of in-home personal services care to which a Medicaid beneficiary is entitled through the Comprehensive Reporting Evaluation ("CARE"). SeeWash. Admin. Code § 388-106-0050 to -0145. The Washington Supreme Court has described CARE as follows:
In the initial stage of a CARE evaluation, the individual is scored on factors such as an individual's ability to perform daily activities and an individual's mental status. The individual is then assigned to 1 of 17 classification groups, each group having a set number of base . . . hours associated with it. Once these base hours are established, an assessor individually considers the recipient's self-performance and the amount of informal support available for the recipient's activities of daily living (ADL) and instrumental activities of daily living (IADL). The recipient's level of informal support for each ADL and IADL then reduces the base hours allocated to that recipient by a predetermined percentage.
Samantha A. v. Dep't of Soc. & Health Servs., 171 Wn.2d 623, 256 P.3d 1138, 1140 (Wash. 2011) [*9] (en banc) (internal citation omitted); see also, e.g., Jenkins v. Wash. Dep't of Soc. & Health Servs., 160 Wn.2d 287, 157 P.3d 388, 389-90 (Wash. 2007) (en banc). DSHS sets the base monthly hours associated with each classification group by regulation. Wash. Admin. Code § 388-106-0125. DSHS conducts CARE reassessments at least annually, or whenever a beneficiary's ability to care for himself changes. Id.