LABOR AND INDUSTRIES
Preproposal statement of inquiry was filed as WSR 05-12-113.
Title of Rule and Other Identifying Information: Industrial insurance, chapter 296-14 WAC, Residence modification.
Other Identifying information: New sections WAC 296-14-6200 What is a residence modification?, 296-14-6202 What is the residence modification benefit?, 296-14-6204 Which workers may be eligible to receive benefits for residence modifications?, 296-14-6206 Which residences may be eligible to be modified?, 296-14-6208 When may the worker request residence modification benefits?, 296-14-6210 What is the maximum amount of the residence modification benefit?, 296-14-6212 Can the worker receive additional modification benefits for the same residence?, 296-14-6214 Can a worker receive residence modification benefits for more than one house?, 296-14-6216 How can a worker begin the process of requesting residence modification benefits?, 296-14-6218 How does the department or self-insured employer determine the worker's residence for purposes of residence modification?, 296-14-6220 What type of residence may the department or self-insured employer modify?, 296-14-6222 What is a residence modification consultant, and how are they involved in the process of residence modification?, 296-14-6223 Will the department pay for professional services needed to design a residence modification?, 296-14-6224 What must the worker submit to the department in a completed request for a residence modification?, 296-14-6226 What other information must be submitted to the department in a completed application for a residence modification?, 296-14-6228 Who will approve or deny a request for residence modification?, 296-14-6230 What will the supervisor consider when approving or denying a residence modification request?, 296-14-6232 What happens if the residence modification costs exceed the maximum benefit?, 296-14-6234 Can a worker apply the residence modification benefit to the cost of building a new residence?, 296-14-6236 How is a worker advised that the supervisor has approved or denied the request for residence modification benefits?, and 296-14-6238 Who receives payment from the department?
Hearing Location(s): Red Lion Hotel Yakima Center, Veranda Room, 607 East Yakima Avenue, Yakima, WA 98901-2548,
(509) 452-6511, on December 6, 2005, at 11:00 a.m.; and at the Department of Labor and Industries, Tukwila Office Training Room, 12806 Gateway Drive, Tukwila, WA 98168-3311, (206) 835-1000, on December 9, 2005, at 11:00 a.m.
Date of Intended Adoption: February 28, 2006.
Submit Written Comments to: Keith Klinger, Department of Labor and Industries, P.O. Box 44329, Olympia, WA 98504-4329, (360) 902-6362, e-mail KLIN235@LNI.WA.GOV, fax (360) 902-6706, by December 15, 2005.
Assistance for Persons with Disabilities: Contact Keith Klinger by November 30, 2005.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Pursuant to chapter 411, Laws of 2005 (EHB 2185), L&I was directed to implement rules that will establish guidelines and processes for providing residence modification assistance to workers who have sustained catastrophic injury.
Reasons Supporting Proposal: The proposed rules will reduce inconsistent interpretation and application of the law and potentially unnecessary litigation.
Statutory Authority for Adoption: RCW 51.04.010, 51.04.020, 51.32.240, and chapter 411, Laws of 2005 (EHB 2185).
Statute Being Implemented: RCW 51.36.022.
Rule is not necessitated by federal law, federal or state court decision.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: The proposed rules will provide a consistent means for implementing the statutory change, thus reducing inconsistent interpretation and application of the law and potentially unnecessary litigation.
Name of Proponent: Department of Labor and Industries, governmental.
Name of Agency Personnel Responsible for Drafting and Implementation: Rich Wilson, P.O. Box 44324, Olympia, WA 98504-4324, (360) 902-6361; Enforcement: Sandy Dziedzic, (360) 902-4300, and Jean Vanek, (360) 902-6907, P.O. Box 44890, Olympia, WA 98504-4890.
No small business economic impact statement has been prepared under chapter 19.85 RCW. No small business economic impact statement was prepared because the content of these rules are specifically dictated by RCW 34.05.310 (4)(e).
A cost-benefit analysis is not required under RCW 34.05.328. No cost-benefit analysis was prepared because the content of these rules are specifically dictated by RCW 34.05.328 (5)(b)(v).
November 1, 2005
WAC 296-14-6200 What is a residence modification? A residence modification is a permanent change to an existing residence or a repair of a modification previously approved and paid for by the department or self-insured employer, or a modification made when constructing a new residence.
Household appliances such as refrigerators, washers, and dryers, are generally not residence modifications and the department or self-insured employer will approve them only under unique circumstances as approved by the supervisor.
(1) The residence must be structurally sound and free of obvious structural defects. The department may request a safety inspection. The department or self-insured employer will not pay for a residence to be brought up to state and local code.
(2) The residence can be adapted to be suitable for the worker's needs for purposes of daily living.
(3) In the opinion of the worker's health care providers, the worker can live in the residence after modification.
The department or self-insured employer will only authorize modification of manufactured/mobile residences when the factory assembled structures division of the department reviews and approves the plans in advance.
The department or self-insured employer will not approve modification of commercial coaches.
The department or self-insured employer will not approve modification of recreational vehicles or recreational park trailers used as permanent residences, unless the local jurisdiction allows recreational vehicles or recreational park trailers to be used as a dwelling, and the factory assembled structures division of the department reviews and approves the plans in advance.
A residence modification consultant must be either a licensed physical or occupational therapist, or licensed nurse, and must be trained or experienced in both rehabilitation of catastrophic injuries and in modifying residences. The residence modification consultant must have a provider number with the department. The department or self-insured employer will pay for the services of the residence modification consultant pursuant to department provider rules.
The residence modification consultant will assist the worker, the contractor and the worker's health providers to determine what modifications will be requested and submit a written report to the department or self-insured employer and the worker. If modifications are approved, the residence modification consultant may assist the worker and the contractor if requested by the department or self-insured employer.
If approved, the cost of architectural, engineering, predesign and planning services will be included in the residential modification benefit. The cost for services should be included in the residence modification request.
(1) Documentation of residence ownership. If the worker does not own the residence, he or she must submit the actual owner's proof of ownership and written legal permission signed by the actual owner to modify the residence as indicated in the proposed plan; and
(2) A report signed by the residence modification consultant for all necessary modifications; and
(3) Competing and detailed bids from two licensed, registered and bonded contractors.
|Exceptions:||If it is not possible to obtain two bids, a written explanation of the circumstances must be provided.|
|If family or friends will perform free labor, they need not be licensed, registered and bonded, but must still submit a bid for the cost of materials.|
(2) The residence modification consultant must submit an evaluation, based on an in-home inspection, of the worker's needs for safety, mobility and activities of daily living. This evaluation must be in the form of a written report with pictures or drawings.
(3) Any additional information requested by the department or self-insured employer that might be needed to evaluate a specific request.
In order to determine what is reasonable and necessary, the supervisor will review the completed application and will consider at least the following:
(1) Whether the worker is eligible to receive a residence modification benefit; and
(2) The needs and preferences of the individual worker, based on information provided by the injured worker; and
(3) Whether the proposed residence is appropriate for modification; and
(4) Whether the proposed modifications are appropriate for the style, nature and condition of the residence; and
(5) The attending health care provider's opinions of the medical condition, physical needs of the worker and whether the worker can reside in the residence after the modifications are complete; and
(6) The residence modification consultant's evaluation of whether the proposed modification is necessary to meet the worker's current need for safety, mobility and activities of daily living; and
(7) Whether the contractor's proposed plan will satisfy the necessary modification; and
(8) Whether the proposed plans submitted by the contractors are consistent with state guidelines for specially adapted residential housing, if any; and
(9) The contractor's proposed modification plan is consistent with the guidelines established by the United States Department of Veterans Affairs in their publication entitled "Handbook for Design: Specially Adapted Housing," or the recommendations published in "The Accessible Housing Design File" by Barrier Free Environments, Inc.; and
(10) Whether the proposed modifications are being provided at the least cost while maintaining quality; and
(11) Whether there are additional funds available to the worker based on the maximum amount for residence modification at the time of the request less the cost of any modifications already provided.
If the costs of the proposed modifications of an existing residence exceed the benefit, the worker is responsible for payment of the balance of the costs. The worker must choose one of the following options:
(1) Adjust their request for modifications to remain within the benefit; or
(2) Obtain additional financing. If the worker chooses to obtain additional financing, he or she must submit to the department written verification of the additional financing from the funding source. The supervisor will deny the residence modification if the worker is unable to cover the additional costs.
(1) A signed letter of satisfaction from the worker; and
(2) A positive report of a final inspection from the appropriate inspection authorities, if required; and
(3) A report of an inspection from the residence modification consultant if requested by the department; and
(4) A release of lien form signed by the contractors or subcontractors or both.