WSR 04-19-022

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed September 7, 2004, 3:07 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 04-13-106.

Title of Rule and Other Identifying Information: Chapter 388-820 WAC, Community residential services and support, and other related sections.

Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on October 26, 2004, at 10:00 a.m.

Date of Intended Adoption: Not earlier than October 27, 2004.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., October 26, 2004.

Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by October 22, 2004, TTY (360) 664-6178 or (360) 664-6097.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of amending these rules is to reflect the correct administrative names as well as correct language changes due to the new HCBS waiver. In addition, the proposed rules will clarify procedures and requirements.


WAC # Subject of Amendment
388-820-020 Adds definitions of ADSA, HCBS, POC and RCS; updates correct administrative names; deletes the definition of community alternatives program.
388-820-030 Adds minimal rights guaranteed to residents of CRS.
388-820-040, 388-820-090, 388-820-140, 388-820-180, 388-820-200, 388-820-240, 388-820-290, 388-820-360, 388-820-880, 388-820-890, 388-820-900, 388-820-910, and 388-820-920 Updates correct administrative names.
388-820-150 Updates correct administrative names and clarifies DDD's role of initial certification.
388-820-160 Updates correct administrative names and clarifies the roles of DDD/RCS and the application procedures of initial certification.
388-820-190 Updates correct administrative names and adds principles and procedures of RCS.
388-820-210 Updates correct administrative names; clarifies intent of review and evaluation, deletion of needed draft copy of the report (subsection (5)(e)) and clarifies procedures and requirements.
388-820-220 Updates correct administrative names and deletion of receipt of the draft (subsection (1)(b)).
388-820-230 Updates correct administrative names and adds "must" in subsection (3)(b).
388-820-250 Updates correct administrative names and adds "client health and safety."
388-820-260 Addition of health and safety policies and procedures; deletes DDD required approval of administrative documents and adds subsection (4) other requirements.
388-820-310 Change "directly" to " continuously;" new subsection (5) states an existing requirement for boarding homes and adult family homes.
388-820-330 Updates correct administrative names; correct language changes due to the new HCBS waiver; and adds staff training with regards to ISP/POC.
388-820-400, 388-820-520, 388-820-530, 388-820-540, 388-820-550, 388-820-560, 388-820-630, and 388-820-720 Correct language changes due to the new HCBS waiver.
388-820-405 Corrects grammatical error.
388-820-430 Deletes reference to the contract.
388-820-440 Deletion of "DSHS approved" and adds "state law."
388-820-650 Clarifies previous intent of the WAC.
388-820-930 Updates correct administrative names and clarifies new procedure to the ETR (exception to rule) process.

Reasons Supporting Proposal: See above.

Statutory Authority for Adoption: RCW 71A.12.030 and 71A.12.080.

Statute Being Implemented: Chapter 71A.12 RCW.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of Social and Health Services, ADSA, RCS, governmental.

Name of Agency Personnel Responsible for Drafting: Jill Young, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-3210; Implementation and Enforcement: Pat Lashway, Director, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2401.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rules and determined that they will not result in more than minor costs to small businesses or nonprofits required to comply with the rules. A comprehensive small business economic impact statement is not required.

A cost-benefit analysis is not required under RCW 34.05.328. The proposed rules do not meet the definition of a significant legislative rule under RCW 34.05.328 (5)(c)(iii). A cost benefit is not required. The proposed rule clarify existing requirements, update names of DSHS units responsible for administering these rules, update names of DSHS programs and WAC cross references, and correct grammatical errors.

September 1, 2004

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3459.5
AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-020   What definitions apply to this chapter?   "Agency" ((means)) refers to an entity interested in becoming a service provider that offers residential instruction and support services to clients.

"ADSA" refers to aging and disability services administration at DSHS. Residential care services and the division of developmental disabilities are divisions under aging and disability services.

"Certification" ((means)) refers to the determination by ((DSHS)) RCS that an agency or service provider has satisfactorily complied with the requirements outlined in this chapter and in the department contract.

"Client" ((means)) refers to a person who has a developmental disability and is eligible under RCW 71A.10.020. (For eligibility criteria, see chapter 388-825 WAC and WAC 388-820-060.)

"Client services" ((means)) refers to instruction and support activities that benefit clients, as specified under WAC 388-820-450 through 388-820-510.

(("Community alternatives program (CAP)" means a Title XIX Medicaid waiver program that serves a specific number of individuals. This waiver is for particular home- and community-based services not covered under the Medicaid state plan. (See WAC 388-825-170 for more details.)))

"Community protection services" (Community Protection Intensive Supported Living Services, or CP-ISLS) ((means)) refers to intensive supported living services provided to clients who meet the criteria of "Individual with Community Protection Issues."

"Crisis diversion services (CDS)" ((means)) refers to DDD-authorized crisis residential services and supports offered to clients on a temporary basis. These clients show a serious decline in mental functioning, making the client at risk for psychiatric hospitalization (see WAC 388-820-050 and 388-820-085 for details).

"Crisis service plan" refers to a document that identifies needs and services a client will receive while placed in crisis diversion services.

"DDD" refers to the division of developmental disabilities ((at DSHS)) of aging and disability services administration (ADSA).

"DSHS" refers to the department of social and health services of Washington state.

"Exceptions" ((means DSHS')) refers to residential care services' (RCS) approval of a written request for an exception to a rule in this chapter. (There are no exceptions to RCWs.)

"Group home" ((means)) refers to residential services provided in a dwelling that is:

(1) Owned, leased, or rented by an entity other than the client;

(2) Licensed by the applicable state authority; and

(3) Operated by a provider.

(See WAC 388-820-090 for further details.)

"Group training home" ((means)) refers to a certified nonprofit residential facility that provides full-time care, treatment, training, and maintenance for clients, as defined under RCW 71A.22.020(2).

"HCBS" refers to home and community based services waivers. This is a Title XIX Medicaid waiver program that serves a specific number of individuals. This waiver is for particular home and community based services not covered under the Medicaid state plan. (See WAC 388-825-170 for more details.)

"IFP" refers to individual financial plan. (See WAC 388-820-620.)

"IISP" refers to the individual instruction and support plan for clients. (See WAC 388-820-560 through 388-820-580.)

"Individual with community protection issues" ((means)) refers to a client identified by DDD as needing one or more of the following criteria:

(1) The person has been convicted of or charged with a crime of sexual violence as defined in chapter 71.09 RCW, including, but not limited to, rape, statutory rape, rape of a child, and child molestation;

(2) The person has been convicted of or charged with acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization;

(3) The person has been convicted of or charged with a sexually violent offense and/or predatory act, and may constitute a future danger;

(4) The person has not been convicted and/or charged, but has a history of stalking, sexually violent, predatory, and/or opportunistic behavior which demonstrates a likelihood to commit a sexually violent and/or predatory act based on current behaviors that may escalate to violence;

(5) The person has committed one or more violent crimes, such as murder, attempted murder, arson, first degree assault, kidnapping, or use of a weapon to commit a crime.

"Initial assessment" ((means)) refers to a written evaluation that identifies a client's needs upon entry into crisis diversion services.

"Instruction" ((means)) refers to goal-oriented teaching that is designed for acquiring and enhancing skills.

"ISP" refers to the individual service plan for clients. (See WAC 388-820-520 through 388-820-550.)

"Nursing assistant" ((means)) refers to a person who is registered or certified by department of health under chapter 18.88A RCW. A nursing assistant performs certain nursing care tasks that are delegated by a registered nurse for a specific client in authorized settings. (See chapter 246-841 WAC for more details.)

"POC" refers to the plan of care for clients based on the criteria of the home and community based waivers. (See WAC 388-820-520 through 388-820-550.)

"RCS" refers to residential care services of aging and disability services (ADSA).

"Regional support network (RSN)" ((means)) refers to a county, combination of counties or other member entities under contract with DSHS mental health division (MHD). These RSNs administer all mental health service activities within their jurisdiction, using available resources. (See WAC 388-865-200 for details.)

"Reprisal" ((means)) refers to any negative action taken as retaliation against an employee.

"Residential service" ((means)) refers to client services offered by certified service providers.

"Secretary" ((means)) refers to the secretary of the department of social and health services or the secretary's designee.

"Service provider" ((means)) refers to an agency RCS has certified ((by)) and DDD has contracted ((with DDD)) to provide residential services to clients. Also refers to state operated living alternative (SOLA) program.

"Severity" ((means)) refers to the seriousness of an incident. This is determined by the extent to which a client's physical, mental, or psychosocial well-being is or may be compromised or threatened.

"SSP" (state supplemental payment) ((means)) refers to DDD administered state paid cash assistance program for certain clients of DDD. (See chapter 388-827 WAC for details.)

"Support" ((means)) refers to assistance as requested or needed by a client, based on their abilities, needs, and goals.

"Supported living" ((means)) refers to residential services provided to clients living in their own homes, which are owned, rented, or leased by the clients or their legal representatives. (See WAC 388-820-080 for more details.)

"Trust account" ((means)) refers to a bank account containing two or more clients' funds where the service provider has the authority to make deposits and withdrawals.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-020, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-020, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as 388-820-020, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-020, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 86-08-003 (Order 2349), 275-26-020, filed 3/20/86; 83-05-017 (Order 1945), 275-26-020, filed 2/9/83.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-030   What are residential services?   Residential services are instructions and supports provided to eligible clients by service providers to enable clients to live in their community. These may include:

(1) Supported living services;

(2) Group home services; or

(3) Services provided in the group training home.

Residential services must follow the requirements outlined in this chapter. The client rights set forth in this chapter are the minimal rights guaranteed to all clients of certified residential services, and are not intended to diminish rights set forth in other state or federal laws that may contain additional rights.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-030, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-030, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as 388-820-030, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-022, filed 8/9/91, effective 9/9/91. Statutory Authority: RCW 34.05.220 (1)(a) and 71.12.030 [71A.12.030]. 90-04-074 (Order 2997), 275-26-022, filed 2/5/90, effective 3/1/90. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-022, filed 2/9/83.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-040   Who certifies residential services?   Residential services are certified by ((DDD to support eligible clients)) RCS.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-040, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as 388-820-040, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), 275-26-050, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), 275-26-050, filed 2/9/83.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-090   What are group homes?   (1) Group homes are residences that are licensed as either a boarding home or an adult family home by ((aging and disability services administration in DSHS)) RCS, under chapters 388-78A and 388-76 WAC, respectively.

(2) Group homes must have a contract with DDD.

(3) The service provider must ensure that group homes comply with all applicable licensing regulations.

(4) Group homes provide residential services to two or more clients who are unrelated to the provider.

(5) Clients who live in group homes pay costs of room and board from their own financial resources. (See WAC 388-820-120 for additional information.)

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-090, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-090, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as 388-820-090, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapters 18.88A and 71A.12 RCW. 96-10-076 (Order 3978), 275-26-076, filed 5/1/96, effective 6/1/96.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-140   What are the different types of certification?   There are three different types of certification that ((DDD)) RCS approves for residential services:

(1) Initial certification;

(2) Regular certification; and

(3) Provisional certification.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-140, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-150   When may ((DDD)) RCS grant initial certification to an agency?   (1) Before RCS begins the certification process, the interested agency must submit a budget forecast, verification of financial stability, and staff coverage schedule to DDD.

(2) An interested agency must apply to ((DDD)) RCS to be certified.

(((2) DDD))

(3) RCS may grant initial certifications to agencies that meet the requirements outlined in this chapter.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-150, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-160   How does an agency apply for initial certification?   To apply for initial certification, an agency must go through the following application ((procedure.

(1) An agency's completed application must be submitted to the regional DDD office for initial certification in that region. The application must include:

(a) A letter of intent;

(b) A mission statement;

(c) A statement of assurance stating that the service provider will not discriminate against a client or employee (see WAC 388-820-280);

(d) Verification of financial stability;

(e) A budget forecast;

(f) A staff-coverage schedule;

(g) A staff in-service training plan;

(h) The agency's policies and procedures;

(i) Relevant experience and qualifications of the agency;

(j) A minimum of two professional references;

(k) A copy of the license if applying for a group home;

(l) The administrator's resume; and

(m) A list of the agency board of directors and affiliations, if applicable.

(2) DSHS must provide the county with a copy of the agency's application.

(3) The county may submit written recommendations about the application to DSHS within thirty calendar days after receiving the application. DSHS reviews the county's recommendations.

(4) An agency must comply within one hundred and eighty days of the certification's effective date with:

(a) Relevant federal, state, and local laws and ordinances; and

(b) Department-established requirements.

(5) DDD notifies the agency in writing that all documentation has been received and approves or denies initial certification)) procedures.

(1) DDD will review:

(a) Verification of financial stability;

(b) A budget forecast; and

(c) A staff-coverage schedule.

(2) After reviewing, DDD will send a letter of suggestion to RCS.

(3) The interested agency will submit to RCS:

(a) A letter of intent;

(b) Relevant experience and qualifications of the agency;

(c) A minimum of two professional references;

(d) The administrator's resume;

(e) A list of the agency board of directors and affiliations, if applicable;

(f) Policies, principles and procedures regarding health and safety and;

(g) Methods on the prevention and reporting of abuse, neglect, exploitation and mistreatment to clients according to state law.

RCS may request additional information as needed to complete the application process.

(4) Before applying to RCS, the interested agency will keep in their records the following:

(a) A letter of intent;

(b) A mission statement;

(c) A statement of assurance stating that the service provider will not discriminate against a client or employee (see WAC 388-820-280);

(d) Verification of financial stability;

(e) A budget forecast;

(f) A staff coverage;

(g) A staff in-service training plan;

(h) The agency's policies and procedures;

(i) Relevant experience and qualifications of the agency;

(j) A minimum of two professional references;

(k) A copy of the license if applying for a group home;

(l) The administrator's resume; and

(m) A list of the agency board of directors and affiliations, if applicable.

(5) RCS must provide the county with a copy of the agency's letter of intent.

(6) The county may submit written recommendations about the application to RCS within thirty calendar days after receiving the letter of intent. RCS reviews the county's recommendations.

(7) An agency must comply within one hundred and eighty days of the certification's effective date with:

(a) Relevant federal, state, and local laws and ordinances; and

(b) RCS/DDD established requirements.

(8) After receiving all materials requested, a determination will be made on initial certification based on the information received. RCS notifies the agency in writing that all documentation has been received and determines if the agency meets the minimal requirements for initial certification.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-160, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-180   May initial certification be extended for a service provider?   If the initial certification expires before ((DDD)) RCS conducts a formal review and evaluation of a service provider, ((DDD)) RCS may extend the initial certification up to one hundred and eighty days.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-180, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-190   How does a service provider receive regular certification?   (1) ((DSHS)) RCS uses a formal review and evaluation process to determine whether a service provider has complied with certification requirements outlined in this chapter, principles and procedures established by RCS, and the ((department)) DSHS/DDD contract.

(2) The county may submit recommendations about a service provider to ((DSHS)) RCS.

(3) After determining that a service provider has complied with requirements, ((DSHS)) RCS may approve a service provider for regular certification.

(a) This certification allows a service provider to continue to receive referrals and provide instruction and support to clients.

(b) Regular certification may be granted to service providers for up to two years.

(4) Regular certification may be extended for a period up to one hundred and eighty days.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-190, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-200   How often are reviews and evaluations done for service providers?   (1) ((DSHS)) RCS must review and/or evaluate each service provider's services at least every two years.

(2) ((DSHS)) RCS may review a client's records and activities at any time to see if the service provider continues to address the clients' needs for instruction and support activities.

(3) DSHS may conduct additional evaluations or audits of any service provider at its discretion.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-200, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-210   What occurs during review and evaluation?   (1) Service providers are evaluated, using this chapter, principles and procedures established by RCS, and the DSHS/DDD contract requirements.

(2) To gather information, evaluators use a sample of clients that the service provider supports. Ways to gather information for evaluation must include:

(a) ((Review of records)) Observation of staff and client interactions;

(b) Interview of clients, legal representatives, and others with the client's consent; and

(c) ((Observation of staff and client interactions)) Review of records.

(3) Information may also be gathered by conducting:

(a) Interviews with other entities contracted with DSHS; and

(b) Interviews with DSHS staff.

(4) The state-contracted evaluators ((conduct meetings)) discuss with the service provider ((and DDD to discuss)) their preliminary findings and request additional information and clarification.

(5) Evaluators conduct an exit conference to present the ((evaluation)) draft report to the service providers and ((DSHS)) DDD. The service provider's administrator or designee must be present at this exit conference. A copy of the draft report with preliminary findings are sent to RCS.

(a) The evaluation report will include the service provider's operation history.

(b) If the service provider has not complied with certification requirements or with its contract with DSHS/DDD, the evaluator will note the findings in the draft report.

(c) The ((report)) service provider must ((specify the)) draft a corrective action ((plan. The corrective action plan and)) plan(s) with specific time frames ((are negotiated between the service provider and DSHS)) and submit it to RCS for approval.

(d) At the conclusion of the exit conference, the service provider ((may request a copy of part or all of the)) will receive a draft copy of the report ((from the evaluator)) including the corrective action plan(s) and the evaluator(s) will submit the draft copy to RCS.

(e) The final report, including corrective action plan(s), will be finalized by RCS and sent to the service provider ((may also submit a letter requesting a draft copy of the report to DDD headquarters within fourteen days of the exit conference)).

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-210, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-220   May service providers disagree with evaluation findings?   (1) If service providers disagree with evaluation findings, they must submit in writing documentation supporting their position within ((fourteen calendar)) ten working days after((:

(a))) the exit conference((; or

(b) Receipt of the draft of the evaluation report)).

(2) After receiving the service provider's documentation, ((DDD)) RCS must send written notification of its decision to the service provider within ((fourteen calendar)) ten working days.

(3) The service provider's documentation and ((DDD's)) RCS' decision must become part of the final evaluation report.

(4) ((DDD)) RCS must file a final report of the evaluation results and send a copy to the service provider. At this time, the evaluation report is considered to be a public document.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-220, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-230   May a service provider receive provisional certification?   (1) A service provider that does not comply with requirements of this chapter may receive provisional certification by ((DSHS)) RCS.

(2) Provisional certification may not exceed one hundred eighty days.

(3) At the end of provisional certification:

(a) If the service provider has complied with certification requirements, ((DSHS)) RCS may approve the service provider for regular certification.

(b) If the service provider has not complied with all certification requirements, ((DSHS)) RCS must revoke the service provider's certification and DSHS/DDD must terminate the contract.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-230, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-230, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-240   When may ((DSHS)) RCS decertify a service provider?   If a service provider does not comply with certification requirements, ((DSHS)) RCS may decertify a service provider under chapter 43.20A RCW. Upon decertification, ((DSHS terminates)) DSHS/DDD must terminate the contract ((and stops all payments)).

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-240, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-250   What are administrators of service providers required to do?   ((DSHS)) RCS requires administrators of service providers to oversee all aspects of services delivered to clients, consistent with the DSHS/DDD contract. This includes:

(1) Overseeing all aspects of staff development, such as recruitment and staff training;

(2) Preparing and maintaining policies and procedures related to client services, personnel, and financial records; and

(3) Securely storing client, personnel, and financial records.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-250, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-260   ((Must service providers')) What type of administrative documents ((be approved by DDD)) are service providers required to have?   ((Service providers must have DDD approval for several types of administrative documents.))

(1) Service providers must have these written statements ((approved by DDD)):

(a) A mission statement;

(b) Program description ((and admission criteria));

(c) An organizational chart and description showing all supervisory relationships; and

(d) Definition of staff roles and responsibilities, including the person designated to act in the absence of the administrator.

(2) Service providers must also have these policies and procedures ((approved by DDD)):

(a) Admission criteria;

(b) Client rights, including a client's right to file a complaint or suggestion without interference;

(((b))) (c) Client grievance procedures;

(((c))) and

(d) Methods used for soliciting client input and feedback on services and support received.

(3) Service providers must have health and safety policies and procedures including:

(a) Information on how to report suspected abuse, neglect, exploitation, and mistreatment;

(((d))) (b) Plans for responding to missing persons; client emergencies, including access to medical, mental health, and law enforcement resources; and natural or other disasters;

(((e))) and

(c) Notification of client's guardian and/or relatives in case of emergency((; and

(f) Methods used for soliciting client input and feedback on services and support received)).

(4) In addition to other required documents, service providers must keep all documents, policies and procedures as required by the Centers for Medicare and Medicaid Services and any other applicable state or federal laws and have them readily available to DSHS.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-260, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-260, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-290   What staffing requirements must service providers meet?   (1) A service provider must have a designated administrator.

(2) Clients must have immediate access to staff, or the means to contact staff, at all times: Twenty-four hours a day, seven days a week.

(3) A service provider must provide adequate staff within contracted hours to administer the program and meet the needs of the clients.

(4) ((A service provider must have other staff available, as specified by the service provider's contract with DSHS.

(5))) Each group home must maintain staffing that complies with:

(a) Boarding home or adult family home licensing requirements under chapter 388-78A or 388-76 WAC, respectively; and

(b) Contract requirements with the division of developmental disabilities.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-290, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-290, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-310   Who needs background checks?   (1) Service providers must obtain background checks from DSHS for all administrators, employees, volunteers and subcontractors showing that there are no disqualifying records to prevent individuals from working with clients.

(2) Before administrators, employees, volunteers or subcontractors may have unsupervised access to clients, the service provider must have a background check report from DSHS. This report must indicate that the individual has no disqualifying records that prevent him or her from working with clients.

(3) In certain situations, administrators, employees, volunteers, or subcontractors ((must not)) can only work ((alone)) with clients ((unless)) when they are directly observed by staff authorized to have unsupervised access to clients. These situations are:

(a) The service provider has not yet received a DSHS response for a background check request;

(b) DSHS has disqualified the individual based on background check information; or

(c) The individual is awaiting FBI clearance and does not have provisional clearance from their employer under WAC 388-06-0500 through 388-06-0540.

(4) Background checks must be renewed at least every thirty-six months for each administrator, employee, volunteer or subcontractor of a contracted service provider.

(5) Licensed boarding homes or licensed adult family homes must adhere to the current regulations set forth in this chapter and in the applicable licensing laws.

(6) Service providers must follow the requirements of RCW 43.43.830 and 74.15.030.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-310, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-310, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-330   What staff training is required?   The service provider must give specific training to staff. Within the first six months, staff must receive a minimum of thirty-two total hours of training that meet the following requirements.

(1) Before the employee works alone with clients, the service provider must explain the following to the employee:

(a) The current instruction and support plans of the clients with whom the employee works;

(b) Emergency procedures for clients;

(c) The ((DSHS-approved policy)) state law on abuse and neglect; and

(d) Client confidentiality.

(2) Within the first four weeks of employing a staff person, the service provider must provide training that includes:

(a) The service provider's mission statement;

(b) Policies and procedures; and

(c) On-the-job training.

(3) Additional training within the first six months must include:

(a) First aid/CPR;

(b) Bloodborne pathogens with HIV/AIDS information; and

(c) Client services.

(4) Each employee must keep first aid/CPR certification and bloodborne pathogens training current.

(5) The service provider must document orientation and training activities.

(6) Group homes must also meet the training requirements mandated by the licensing requirements specified in chapter 388-78A WAC.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-330, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-330, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-360   What happens when a service provider's ownership changes?   (1) A service provider must inform ((DSHS)) RCS and DDD in writing sixty days before a change of ownership occurs.

(2) On the effective date of a change of ownership, ((DSHS)) RCS must terminate the department's certification and DSHS/DDD must terminate the contract with the previous service provider.

(3) ((DSHS)) DDD must withhold final payment to the previous service provider until that service provider submits and DSHS accepts all reports and required documents.

(4) ((DSHS)) DDD is under no obligation to contract with the new owner entity.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-360, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-400   What information do service providers need to keep in client records?   (1) Crisis diversion service providers are exempt from the client record requirements specified in this section. Instead, they must follow requirements outlined in WAC 388-820-405.

(2) Service providers must keep certain information in client records to fulfill DSHS requirements. The client's records must include, but not be limited to, the following:

(a) The client's name, address, and Social Security number.

(b) The name, address, and telephone number of the client's relative, guardian or legal representative.

(c) Copies of legal guardianship papers, if any.

(d) Client health records, including:

(i) The name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other health care service provider;

(ii) Health care service providers' instructions about health care needed, including appointment dates and date of next appointment if appropriate;

(iii) Written documentation that the health care service providers' instructions have been followed; and

(iv) A record of major health events and surgeries when known.

(e) A copy of the client's most recent individual service plan or plan of care (ISP/POC).

(f) The client's individual instruction and support plan (IISP), including:

(i) Instruction and support activities for each client as a basis for review and evaluation of client's progress;

(ii) Semiannual review of the IISP;

(iii) Consultation with other service providers and other interested persons;

(iv) IISP revisions and changes; and

(v) Other activities relevant to the client that the client wants included.

(g) Progress notes and incident reports on clients.

(h) The client's financial records for funds managed by the service provider, including:

(i) Receipts, ledgers and records of the client's financial transactions; and

(ii) Client's related bankbooks, checkbooks, bank registers, tax records and bank statements.

(i) Burial plans and wills.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-400, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-400, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-405   What information do crisis diversion service providers need to keep in client records?   (1) All crisis diversion service providers must keep the following information in client records:

(a) The client's name, address, and Social Security number.

(b) The name, address, and telephone number of the client's relative, guardian or legal representative.

(c) Progress notes and incident reports on clients.

(2) Crisis diversion service providers other than those offering services in a client's own home have additional requirements. These service providers also must keep the following information in client records:

(a) An initial assessment;

(b) ((An)) A crisis service plan;

(c) Copies of legal guardianship papers, if any;

(d) Client health records, including:

(i) The name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other health care service provider;

(ii) Health care service providers' instructions about health care needed, including appointment dates and date of next appointment if appropriate;

(iii) Written documentation that the health care service providers' instructions have been followed; and

(iv) A record of major health events and surgeries when known.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-405, filed 1/29/04, effective 2/29/04.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-430   Who must service providers notify in emergencies?   In emergencies, a service provider must:

(1) Notify the client's guardian or legal representative as soon as possible;

(2) Immediately report to DSHS about a serious incident or emergency((, as specified in the contract)); and

(3) Submit a written incident report to DSHS, as required by law or policy.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-430, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-440   What abuse and neglect reporting requirements must service providers meet?   (1) Under chapter 74.34 RCW, all administrators, owners, staff and volunteers are mandated to report instances of suspected client abuse, neglect, exploitation, or mistreatment.

(2) Reports must be made to one of two different areas at DSHS:

(a) Service providers giving supported living services must report to adult protective services (APS); and

(b) Service providers giving services through group homes must report to residential care services (RCS).

(3) Reports must be made to law enforcement agencies, when appropriate.

(4) Service providers must have ((DSHS-approved)) policies and procedures complying with state law that specify reporting requirements for client abuse, neglect, exploitation, or mistreatment.

(5) Each administrator, owner, staff person, and volunteer must read and sign ((this)) the policy about reporting requirements. The service provider must ((place)) retain the signed policy ((in the personnel file)) for staff ((or)) and volunteers.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-440, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-520   What is an individual service plan/plan of care (ISP/POC) for clients?   An individual service plan or plan of care (ISP/POC) is required for each client. The ISP/POC outlines the support needs and interests of the client. The plan identifies the responsibilities of the service provider and other entities in supporting the client. Examples of other entities are: Vocational provider, therapists, nurses, and advocates. (See RCW 71A.18.010.)

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-520, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-530   Who is responsible for completing and overseeing a client's ISP/POC?   The client's DDD case resource manager is responsible for completing and overseeing a client's individual service plan or plan of care (ISP/POC).

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-530, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-540   Who may participate in creating a client's ISP/POC?   (1) The case resource manager must have face-to-face contact with the client in developing the individual service plan or plan of care (ISP/POC).

(2) The case resource manager must also involve the client's guardian or legal representative and the service provider.

(3) In creating a client's individual service plan or plan of care (ISP/POC), under RCW 71A.18.010, the client and DDD case resource manager may involve:

(a) Department staff; and

(b) Other interested persons invited by the client.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-540, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-550   How often must the ISP/POC be reviewed?   (1) ((The DDD case resource manager must review the ISP with the client at least every twelve months.

(2) In addition,)) An ISP/POC meeting must be held and a new ISP/POC developed with the client at least every ((two years)) twelve months, under RCW 71A.18.010. The meeting must be held in the client's home unless requested otherwise by the client.

(((3))) (2) A client may request a review of the ISP/POC at any time.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-550, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-550, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-560   What is an individual instruction and support plan (IISP) for clients?   (1) An individual instruction and support plan (IISP) outlines the specific goals for carrying out the residential services portion outlined in the individual service plan or plan of care (ISP/POC). The IISP also must describe the methods of instruction and/or support needed to reach the client's goal.

(2) The IISP must be based on the goals of the individual service plan or plan of care (ISP/POC), reflect the client's preferences, and have the client's agreement.

(3) The IISP identifies activities and opportunities that promote one or more of the following client services:

(a) Health and safety;

(b) Personal power and choice;

(c) Positive recognition by self and others;

(d) Integration in the physical and social life of the community;

(e) Positive relationships; and

(f) Competence and self-reliance.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-560, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-560, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-630   What information must the IFP include?   This plan must include all of the following items:

(1) The part of the client's funds and income that will be managed by the service provider;

(2) The part of client funds and income that will be managed by the client or legal representative;

(3) The type of accounts used;

(4) A budget process;

(5) Asset management, such as personal property, burial plan, retirement funds, stock, and vehicles;

(6) Cash management;

(7) Money management instruction and/or support;

(8) An explanation of which purchases require receipts;

(9) Contingency plan for expenditures if a client's resources exceed the ((CAP)) home and community based services (HCBS) wavier limit; and

(10) A signature of the client and the client's guardian, if any.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-630, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 04-04-043, filed 1/29/04, effective 2/29/04)

WAC 388-820-650   What documentation must service providers keep to protect a client's financial interests?   Service providers must keep certain documentation for the part of funds they manage for clients. This protects clients' financial interests.

(1) Documentation for bank and cash accounts must include a monthly reconciliation ((of bank and cash accounts that are verified and initialed by a second party)) and verification of the reconciliation. The reconciliation and/or verification must be completed by a person who did not make or assist in ((the)) any financial transaction.

(2) Other documentation that a service provider must keep for client financial transactions include:

(a) Monthly bank statements and reconciliation;

(b) Checkbook registers and bankbooks;

(c) Deposit receipts;

(d) Receipts for purchases over twenty-five dollars;

(e) Any itemized subsidiary ledgers showing deposits, withdrawals, and interest payments to individual clients; and

(f) A control journal for trust accounts.

(3) Other documentation that a service provider must keep for client cash transactions include:

(a) A detailed ledger signed by the person who withdrew any of the client's money;

(b) Monthly reconciliation to the cash amount;

(c) Detailed accounting of the money received on behalf of the client, such as cash received from writing checks over the purchase amount, and a list of where the money was spent; and

(d) Receipts for purchases over twenty-five dollars where service provider staff withdrew the money.

(4) Service providers must notify DSHS when the client:

(a) Receives services under a ((CAP (community alternative program))) home and community based services (HCBS) waiver; and

(b) Has an account that reaches three hundred dollars less than the maximum amount allowed by federal or state law.

Note: CAP-waiver is defined under WAC 388-825-170.

[Statutory Authority: RCW 71A.12.030 and chapter 71A.12 RCW. 04-04-043, 388-820-650, filed 1/29/04, effective 2/29/04. Statutory Authority: Title 71A RCW. 01-22-020, 388-820-650, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-720   How must the service provider be involved with a client's transportation needs?   (1) The service provider must provide transportation or ensure that clients have a way to get to:

(a) Emergency medical care;

(b) Medical appointments; and

(c) Therapies.

(2) Within available resources, the service provider must provide necessary assistance with transportation to and from:

(a) Work, school or other publicly funded services;

(b) Leisure or recreation activities;

(c) Client-requested activities; and

(d) ISP/POC- or IISP-related activities.

(3) A vehicle that the service provider uses to transport clients must be:

(a) In safe operating condition; and

(b) Properly insured for its usage.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-720, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-880   May an agency or service provider contest a ((DSHS)) RCS decision?   (1) An agency or service provider may contest a ((DSHS)) RCS decision about certification within twenty-eight days of being notified of the decision.

(2) Within this twenty-eight day period, the agency or service provider must request in writing that the ((DDD)) RCS director or designee review the decision. The agency or service provider must:

(a) Sign the request;

(b) Identify the challenged decision and the date it was made;

(c) State specifically the issues and regulations involved and the grounds for the service provider's disagreement; and

(d) Include with the request copies of any supporting documentation for the service provider's position.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-880, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-890   When does an administrative review conference occur?   (1) After receiving the agency or service provider's timely written request to review a decision, ((DSHS)) RCS has twenty-eight days to contact the service provider to schedule an administrative review conference at a mutually convenient time.

(2) Exception: The agency or service provider and ((DSHS)) RCS may agree in writing to a specific later date for the conference.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-890, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-900   May an administrative review conference be conducted by telephone?   (1) The administrative review conference between ((DSHS)) RCS and an agency or service provider may be conducted by telephone.

(2) Exception: If either ((the department)) RCS, or the agency or service provider requests in writing that the conference be held in person, the conference may not be conducted by telephone.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-900, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-910   What happens during the administrative review conference?   (1) The agency or service provider requesting an administrative review conference and appropriate ((DSHS)) RCS representatives must attend the conference.

(2) The agency or service provider must bring to the conference, or give to ((DSHS)) RCS before the conference, any supporting documentation for the service provider's position.

(3) The parties must clarify and attempt to resolve the issues at the conference.

(4) If additional documentation is needed to resolve issues, a second session of the conference must be scheduled. The second conference must be scheduled no later than twenty-eight days after the initial session unless both parties agree in writing to a specific later date.

(5) The director ((of the division of developmental disabilities)) or designee of RCS must give a written decision to the service provider after the end of the conference.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-910, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-920   May an agency or service provider contest the decision from the administrative review conference?   At the administrative review conference, an agency or service provider may contest a decision made by the director ((of the division of developmental disabilities)) or designee of RCS. To contest a decision, the agency or service provider may request a hearing. The hearing procedure follows the requirements under chapter 388-02 WAC.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-920, filed 10/26/01, effective 1/1/02.]


AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-930   Does ((DSHS)) RCS make exceptions to the requirements in this chapter?   ((DSHS)) RCS may grant service providers exceptions to the requirements specified in this chapter as long as the following conditions are met:

(1) The service provider must submit a written request for an exception to the DDD regional administrator of the region where the contract is held.

(2) ((DSHS)) DDD must evaluate requests for exceptions, considering:

(a) The health and safety of the clients;

(b) The quality of the services;

(c) Supervision; and

(d) The impact on client services.

(3) ((DSHS)) DDD will send their recommendations of the exceptions of the requirements to RCS.

(4) RCS must send a copy of ((those)) the requests that have significant impacts on client services to the client(s) involved. ((DSHS)) RCS must then give the client an opportunity to comment before granting an exception.

(((4) The DDD))

(5) The RCS director or designee must approve or deny the request in writing within sixty calendar days after receiving the request from the service provider.

(((5))) (6) Any exception granted must be in line with the legislative intent of Title 71A RCW.

(((6))) (7) Service providers must retain a copy of each ((DSHS)) RCS-approved exception.

(((7))) (8) Service providers do not have hearing rights when they receive a denial from ((DSHS)) RCS for an exception to the rules in this chapter.

[Statutory Authority: Title 71A RCW. 01-22-020, 388-820-930, filed 10/26/01, effective 1/1/02.]

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