WSR 06-01-024

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed December 13, 2005, 11:39 a.m. , effective January 13, 2006 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: The division of developmental disabilities has received initial approval from the federal Centers for Medicare and Medicaid Services (CMS) to implement four home and community based service (HCBS) waivers, which replaced the community alternatives program (CAP) waiver. These rules will clarify eligibility, service array, utilization, provider qualifications, client appeal rights and access to services. This filing includes a new chapter 388-845 WAC. When effective, these rules replace the emergency rules filed as WSR 05-19-044.

Statutory Authority for Adoption: RCW 71A.12.030, 71A.12.12 [71A.12.120].

Other Authority: Chapter 71A.12 RCW.

Adopted under notice filed as WSR 05-17-055 on August 9, 2005.

Changes Other than Editing from Proposed to Adopted Version: The wording in WAC 388-845-0035, 388-845-0040 and 388-845-0045 has been changed to read "enrolled in a waiver."

WAC 388-845-0050 has been changed to reflect that all requests for enrollment in a waiver are documented in a DDD database.

WAC 388-845-0051 has been expanded to clarify that notice will be sent for a denial of a request to be enrolled in a waiver.

WAC 388-845-0050(2) has been changed to read: "When there is capacity to enroll additional people in a waiver, WAC 388-845-0045 describes how DDD will determine who will be enrolled."

WAC 388-845-0065(2) has been changed to read: "Your eligibility for nonwaiver state-only funded DDD services..."

A cross-reference to WAC 388-845-1500 has been added to WAC 388-845-0710.

Cross-reference to WAC 388-845-1505 and 388-845-1510 have been added to WAC 388-845-0750.

WAC 388-845-3080 (1)(a) and 388-845-3085 (1)(a) have been changed to read: "Identify more available natural supports."

WAC 388-845-3080(4) and 388-845-3085(3) have been changed to read: "... you will remain eligible for nonwaiver DDD services but access to state-only funded DDD services is limited by the availability of funding ..."

A final cost-benefit analysis is available by contacting Steve Brink, P.O. Box 5310, Olympia, WA 98507-5310, phone (360) 725-3416, fax (360) 407-0955, e-mail brinksc@dshs.wa.gov. There are no changes to the preliminary cost-benefit analysis.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 131, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 131, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.

Date Adopted: December 9, 2005.

Andy Fernando, Manager

Rules and Policies Assistance Unit

3373.17
Chapter 388-845 WAC

DDD HOME AND COMMUNITY BASED SERVICES WAIVERS


NEW SECTION
WAC 388-845-0001   Definitions.   "ADSA" means the aging and disability services administration, an administration within the department of social and health services.

"Aggregate Services" means a combination of services subject to the dollar limitations in the Basic and Basic Plus waivers.

"CAP waiver" means the Community Alternatives Program waiver.

"CARE" means the Comprehensive Assessment and Reporting Evaluation.

"DDD" means the division of developmental disabilities, a division within the aging and disability services administration of the department of social and health services.

"Department" means the department of social and health services.

"Employment/Day Program Services" means community access, person-to-person, prevocational services or supported employment services subject to the dollar limitations in the Basic and Basic Plus waivers.

"HCBS Waivers" means home and community based services waivers.

"ICF/MR" means an Intermediate Care Facility for the Mentally Retarded.

"Plan of Care (POC)" means the primary tool DDD uses to determine and document your needs and to identify services to meet those needs.

"Providers" means an individual or agency who is licensed, certified and/or contracted to provide services to you.

"Respite Assessment" means a series of questions about you and your caregiver used to determine the amount of respite care available to you.

"SSI" means Supplemental Security Income, an assistance program administered by the federal Social Security Administration for blind, disabled and aged individuals.

"SSP" means State Supplementary Payment, a benefit administered by the department intended to augment an individual's SSI.

"State Funded Services" means services that are funded entirely with state dollars.

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NEW SECTION
WAC 388-845-0005   What are home and community based services (HCBS) waivers?   (1) Home and community based services (HCBS) waivers are services approved by the Centers For Medicare and Medicaid Services (CMS) under section 1915 (c) of the Social Security Act as an alternative to intermediate care facility for the mentally retarded (ICF/MR) care.

(2) Certain federal regulations are "waived" enabling the provision of services in the home and community to individuals who would otherwise require the services provided in an ICF/MR as defined in chapters 388-835 and 388-837 WAC.

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NEW SECTION
WAC 388-845-0010   What is the purpose of HCBS waivers?   The purpose of HCBS waivers is to provide services in the community to individuals with ICF/MR level of need to prevent their placement in an ICF/MR.

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NEW SECTION
WAC 388-845-0015   What HCBS waivers are provided by the division of developmental disabilities (DDD)?   DDD has replaced its community alternatives program (CAP) waiver with four HCBS waivers:

(1) Basic waiver;

(2) Basic Plus waiver;

(3) CORE waiver; and

(4) Community Protection waiver.

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NEW SECTION
WAC 388-845-0020   When were these four HCBS waivers effective?   The four DDD HCBS waivers were effective April 1, 2004.

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NEW SECTION
WAC 388-845-0025   Does this change in waivers affect the waiver services I am currently receiving?   Your services will not be disrupted with this transfer to new waivers.

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NEW SECTION
WAC 388-845-0030   Do I meet criteria for HCBS waiver-funded services?   You meet criteria for DDD HCBS waiver-funded services if you meet all of the following:

(1) You have been determined eligible for DDD services per RCW 71A.10.020(3).

(2) You have been determined to meet ICF/MR level of care per WAC 388-845-0070 through 388-845-0090.

(3) You meet disability criteria established in the Social Security Act.

(4) You meet financial eligibility requirements as defined in WAC 388-515-1510.

(5) You choose to receive services in the community rather than in an ICF/MR facility.

(6) You have a need for waiver services as identified in your plan of care.

(7) You are not residing in hospital, jail, prison, nursing facility, ICF/MR, or other institution.

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NEW SECTION
WAC 388-845-0035   Am I guaranteed placement on a waiver if I meet waiver criteria?   If you are not currently enrolled in a waiver, meeting criteria for the waiver does not guarantee access to or receipt of waiver services.

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NEW SECTION
WAC 388-845-0040   Is there a limit to the number of people who can be enrolled in each HCBS waiver?   Each waiver has a limit on the number of people who can be served in a waiver year. In addition, DDD has the authority to limit enrollment into the waivers based on availability of funding for new waiver participants.

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NEW SECTION
WAC 388-845-0041   What is DDD's responsibility to provide my services under the waivers administered by DDD?   If you are enrolled in an HCBS waiver administered by DDD, DDD must meet your assessed needs for health and welfare.

(1) DDD must address your assessed health and welfare needs in your plan of care, as specified in WAC 388-845-3055.

(2) You have access to DDD paid services that are provided within the scope of your waiver, subject to the limitations in WAC 388-845-0110 and WAC 388-845-0115.

(3) DDD will provide waiver services you need and qualify for within your waiver.

(4) DDD will not deny or limit your waiver services based on a lack of funding.

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NEW SECTION
WAC 388-845-0045   When there is capacity to add people to a waiver, how does DDD determine who will be enrolled?   When there is capacity on a waiver and available funding for new waiver participants, DDD may enroll people in a waiver based on the following priority considerations:

(1) First priority will be given to current waiver participants assessed to require a different waiver because their needs have increased and these needs cannot be met within the scope of their current waiver.

(2) DDD may also consider any of the following populations in any order:

(a) Priority populations as identified and funded by the legislature.

(b) Persons DDD has determined to be in immediate risk of ICF/MR admission due to unmet health and safety needs.

(c) Persons identified as a risk to the safety of the community.

(d) Persons currently receiving services through state-only funds.

(e) Persons on an HCBS waiver that provides services in excess of what is needed to meet their identified health and welfare needs.

(f) Persons who were previously on an HCBS waiver since April 2004 and lost waiver eligibility per WAC 388-845-0060(9).

(3) For the Basic waiver only, DDD may consider persons who need the waiver services available in the Basic waiver to maintain them in their family's home.

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NEW SECTION
WAC 388-845-0050   How do I request to be enrolled in a waiver?   You can contact DDD and request to be enrolled in a waiver at any time.

(1) Your request for waiver enrollment will be documented by DDD in a statewide database.

(2) When there is capacity available to enroll additional people in a waiver, WAC 388-845-0045 describes how DDD will determine who will be enrolled.

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NEW SECTION
WAC 388-845-0051   How will I be notified of the decision by DDD to enroll me in a waiver?   DDD will notify you in writing of its decision to enroll you in a waiver or its decision to deny your request to be enrolled in a waiver.

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NEW SECTION
WAC 388-845-0055   How do I remain eligible for the waiver?   If you are already on a HCBS waiver, you must continue to meet eligibility criteria.

(1) DDD completes a reassessment at least every twelve months to determine if you continue to meet all of the eligibility requirements in WAC 388-845-0030.

(2) You must receive a waiver service at least once in every thirty consecutive days, as specified in WAC 388-513-1320 (3)(b).

(3) Your plan of care, CARE assessment/reassessment and respite assessment/reassessment must be done in person.

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NEW SECTION
WAC 388-845-0060   Can my waiver eligibility be terminated?   DDD may terminate your waiver eligibility if DDD determines that your health and safety needs cannot be met in your current waiver or for one of the following reasons:

(1) You no longer meet one of the requirements listed in WAC 388-845-0030;

(2) You no longer need waiver services;

(3) You do not use a waiver service at least once in every thirty consecutive days;

(4) You are on the Community Protection waiver and choose not to be served by a certified residential community protection provider-intensive supported living services (CP-ISLS);

(5) You choose to disenroll from the waiver;

(6) You reside out of state;

(7) You cannot be located or do not make yourself available for the annual waiver reassessment of eligibility;

(8) You refuse to participate with DDD in:

(a) Service planning;

(b) Required quality assurance and program monitoring activities; or

(c) Accepting services agreed to in your plan of care as necessary to meet your health and safety needs.

(9) You are residing in a hospital, jail, prison, nursing facility, ICF/MR, or other institution and remain in residence at least one full calendar month, and are still in residence:

(a) At the end of the twelfth month following the effective date of your current plan of care, as described in WAC 388-845-3060; or

(b) On March 31st, the end of the waiver fiscal year, whichever date occurs first.

(10) Your needs exceed the maximum funding level or scope of services under the Basic or Basic Plus waiver as specified in WAC 388-845-3080; or

(11) Your needs exceed what can be provided under the CORE or Community Protection waiver as specified in WAC 388-845-3085.

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NEW SECTION
WAC 388-845-0065   What happens if I am terminated or choose to disenroll from a waiver?   If you are terminated from a waiver or choose to disenroll from a waiver, DDD will notify you.

(1) DDD cannot guarantee continuation of your current services, including Medicaid eligibility.

(2) Your eligibility for nonwaiver state-only funded DDD services is based upon availability of funding and program eligibility for a particular service.

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NEW SECTION
WAC 388-845-0070   What determines if I need ICF/MR level of care?   DDD determines if you need ICF/MR level of care based on your need for waiver services. To reach this decision, DDD uses its department-approved assessment and/or other information specified in WAC 388-845-0085.

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NEW SECTION
WAC 388-845-0075   How is a child age twelve or younger assessed for ICF/MR level of care?   If you are age twelve or younger, DDD assesses you for ICF/MR level of care using the "child's assessment of ICF/MR level of care--current support needs" form. You must have support needs exceeding what is expected of others of the same age.

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NEW SECTION
WAC 388-845-0080   What score indicates ICF/MR level of care if I am age twelve or younger?   (1) If you are age five or younger you need major or moderate support in five of nine tasks.

(2) If you are age six through twelve, you need major or moderate support in seven of nine of the tasks in (3) below.

(3) The form indicates certain tasks that require major support and which require moderate or major support.

(a) Major support for:

(i) Dressing and grooming self;

(ii) Toileting self.

(b) Major or moderate support for:

(i) Eating;

(ii) Mobility;

(iii) Communication;

(iv) Making choices and taking responsibility;

(v) Exploring one's environment;

(vi) Supports needed to meet therapy and health needs; or

(vii) Family/caregiver support required to maintain the child at home.

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NEW SECTION
WAC 388-845-0085   If I am age twelve or younger, what if my score on the current needs assessment does not indicate ICF/MR level of care?   For children age twelve or younger:

(1) If you do not have a qualifying score for determining ICF/MR level of care using the department approved assessment, you may provide DDD other current information that provides evidence of your need for waiver services.

(2) This additional information may include occupational therapy (OT), physical therapy (PT), psychological, nursing, social work, speech and hearing, or other professional evaluations that reflect current needs.

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NEW SECTION
WAC 388-845-0090   How is a person age thirteen or older assessed for ICF/MR level of care?   If you are age thirteen or older, DDD assesses you for ICF/MR level of care using the "assessment of ICF/MR level of care--current support needs" form.

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NEW SECTION
WAC 388-845-0095   What score indicates ICF/MR level of care if I am age thirteen or older?   If you are age thirteen or older, you must have a qualifying score of at least forty in responses to twenty questions assessing your residential, school or employment, and social support needs.

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NEW SECTION
WAC 388-845-0096   If I am age thirteen or older, what if my score on the current needs assessment does not indicate the need for ICF/MR level of care?   If you are age thirteen or older and your current needs assessment does not indicate the need for ICF/MR level of care, you are not eligible for an HCBS waiver.

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NEW SECTION
WAC 388-845-0100   What determines which waiver I am assigned to?   DDD will assign you to a waiver based on the following criteria:

(1) If you were on the CAP waiver as of March 2004, your initial assignment to the Basic, Basic Plus, CORE, or Community Protection waiver was based on:

(a) Services you received from DDD in October 2002 through September 2003; and

(b) Services you were authorized to receive in October, November and December 2003.

(2) If you are new to a waiver since April 1, 2004, assignment is based on your assessment and service plan.

(3) Additional criteria apply to the assignment to the Community Protection waiver.

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NEW SECTION
WAC 388-845-0105   What criteria determine assignment to the community protection waiver?   DDD may assign you to the Community Protection waiver only if you are at least eighteen years of age, not currently residing in a hospital, jail or other institution, and meet the following criteria:

(1) You have been identified by DDD as a person who meets one or more of the following:

(a) You have been convicted of or charged with a crime of sexual violence as defined in chapter 71.09 RCW;

(b) You have 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, or persons of casual acquaintance with whom no substantial personal relationship exists;

(c) You have been convicted of or charged with a sexually violent offense and/or predatory act, and may constitute a future danger as determined by a qualified professional;

(d) You have not been convicted and/or charged, but you have 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, as determined by a qualified professional; or

(e) You have committed one or more violent crimes.

(2) You receive or agree to receive residential services from certified residential community protection provider-intensive supported living services (CP-ISLS); and

(3) You comply with the specialized supports and restrictions in your:

(a) Plan of care (POC);

(b) Individual instruction and support plan (IISP); and/or

(c) Treatment plan provided by DDD approved certified individuals and agencies.

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NEW SECTION
WAC 388-845-0110   Are there limitations to the waiver services I can receive?   There are limitations to waiver services. In addition to the limitations to your access to nonwaiver services cited for specific services in WAC 388-845-0115, the following limitations apply:

(1) A service must be offered in your waiver and authorized in your plan of care.

(2) Mental health stabilization services may be added to your plan of care after the services are provided.

(3) Waiver services are limited to services required to prevent ICF/MR placement.

(4) The cost of your waiver services cannot exceed the average daily cost of care in an ICF/MR.

(5) Waiver services cannot replace or duplicate other available paid or unpaid supports or services.

(6) Waiver funding cannot be authorized for treatments determined by DSHS to be experimental.

(7) The Basic and Basic Plus waivers have yearly limits on some services and combinations of services. The combination of services is referred to as aggregate services or employment/day program services.

(8) Your choice of qualified providers and services is limited to the most cost effective option that meets your assessed needs.

(9) Services provided out-of-state, other than in recognized bordering cities, are limited to respite care and personal care during vacations.

(a) You may receive services in a recognized out-of-state bordering city on the same basis as in-state services.

(b) The only recognized bordering cities are:

(i) Coeur d'Alene, Moscow, Sandpoint, Priest River and Lewiston, Idaho; and

(ii) Portland, The Dalles, Hermiston, Hood River, Rainier, Milton-Freewater and Astoria, Oregon.

(10) Other out-of-state waiver services require an approved exception to rule before DDD can authorize payment.

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NEW SECTION
WAC 388-845-0115   Does my waiver eligibility limit my access to DDD nonwaiver services?   If you are enrolled in a DDD HCBS waiver:

(1) You are not eligible for state-only funding for DDD services; and

(2) You are not eligible for Medicaid personal care.

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NEW SECTION
WAC 388-845-0120   Will I continue to receive state supplementary payments (SSP) if I am on the waiver?   Your participation in the new waivers does not affect your continued receipt of State Supplemental Payment from DDD.

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NEW SECTION
WAC 388-845-0200   What waiver services are available to me?   Each of the four HCBS waivers has a different scope of service and your service plan defines the waiver services available to you.

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NEW SECTION
WAC 388-845-0205   Basic waiver services.  


BASIC WAIVER SERVICES YEARLY LIMIT
AGGREGATE SERVICES: May not exceed $1425 per year on any combination of these services

Behavior management and consultation
Community guide
Environmental accessibility adaptations
Occupational therapy
Physical therapy
Specialized medical equipment/supplies
Specialized psychiatric services
Speech, hearing and language services
Staff/family consultation and training
Transportation
EMPLOYMENT/DAY PROGRAM SERVICES: May not exceed $6500 per year
Community access
Person-to-person
Prevocational services
Supported employment
Sexual Deviancy Evaluation Limits are determined by DDD
Respite care Limits are determined respite assessment
Personal care Limits are determined by CARE assessment
MENTAL HEALTH STABILIZATION SERVICES: Limits are determined by a mental health professional or DDD

Behavior management and consultation
Mental health crisis diversion bed services
Skilled nursing
Specialized psychiatric services
Emergency assistance is only for services contained in the Basic waiver $6000 per year; Preauthorization required

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NEW SECTION
WAC 388-845-0210   Basic Plus waiver services.  


BASIC PLUS WAIVER SERVICES YEARLY LIMIT
AGGREGATE SERVICES: May not exceed $6070 per year on any combination of these services

Behavior management and consultation
Community guide
Environmental accessibility adaptations
Occupational therapy
Physical therapy
Skilled nursing
Specialized medical equipment/supplies
Specialized psychiatric services
Speech, hearing and language services
Staff/family consultation and training
Transportation
EMPLOYMENT/DAY PROGRAM SERVICES: May not exceed $9500 per year
Community access
Person-to-person
Prevocational services
Supported employment
Adult foster care (adult family home) Determined per department rate structure
Adult residential care (boarding home)
MENTAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD
Behavior management and consultation
Mental health crisis diversion bed services
Skilled nursing
Specialized psychiatric services
Personal care Limits determined by the CARE assessment
Respite care Limits are determined by respite assessment
Sexual Deviancy Evaluation Limits are determined by DDD
Emergency assistance in only for services contained in the Basic Plus waiver $6000 per year; Preauthorization required

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NEW SECTION
WAC 388-845-0215   CORE waiver services.  


CORE WAIVER SERVICES YEARLY LIMIT
Behavior management and consultation Determined by the Plan of Care, not to exceed the average cost of an ICF/MR for any combination of services
Community guide
Community transition
Environmental accessibility adaptations
Occupational therapy
Respite care
Sexual deviancy evaluation
Skilled nursing
Specialized medical equipment/supplies
Specialized psychiatric services
Speech, hearing and language services
Staff/family consultation and training
Transportation
Residential habilitation
Community access
Person-to-person
Prevocational services
Supported employment
MENTAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD

Behavior management and consultation
Mental health crisis diversion bed services
Skilled nursing
Specialized psychiatric services
Personal care Limited by CARE assessment

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NEW SECTION
WAC 388-845-0220   Community Protection waiver services.  


COMMUNITY PROTECTION WAIVER SERVICES YEARLY LIMIT
Behavior management and consultation Determined by the Plan of Care, not to exceed the average cost of an ICF/MR for any combination of services
Community transition
Environmental accessibility adaptations
Occupational therapy
Physical therapy
Sexual deviancy evaluation
Skilled nursing
Specialized medical equipment and supplies
Specialized psychiatric services
Speech, hearing and language services
Staff/family consultation and training
Transportation
Residential habilitation
Person-to-person
Prevocational services
Supported employment
MENTAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD

Behavioral management and consultation
Mental health crisis diversion bed services
Skilled nursing
Specialized psychiatric services

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WAIVER SERVICES DEFINITIONS
NEW SECTION
WAC 388-845-0300   What are adult family home (AFH) services?   Per RCW 70.128.010 an adult family home (AFH) is a regular family abode in which a person or persons provide personal care, special care, room, and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the service. Adult family homes (AFH) may provide residential care to adults in the Basic Plus waiver.

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NEW SECTION
WAC 388-845-0305   Who is a qualified provider of AFH services?   The provider of AFH services must be licensed and contracted with ADSA as an AFH who has successfully completed the DDD specialty training provided by the department.

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NEW SECTION
WAC 388-845-0310   Are there limits to the AFH services I can receive?   Adult family homes services are limited by the following:

(1) AFH services are defined and limited per chapter 388-106 WAC and chapter 388-71 WAC governing Medicaid personal care and the comprehensive assessment and reporting evaluation (CARE).

(2) Rates are determined by and limited to department published rates for the level of care generated by CARE.

(3) AFH reimbursement cannot be supplemented by other department funding.

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NEW SECTION
WAC 388-845-0400   What are adult residential care (ARC) services?   Adult residential care (ARC) facilities may provide residential care to adults. This service is available in the Basic Plus waiver.

(1) An ARC is a licensed boarding home for seven or more unrelated adults.

(2) Services include, but are not limited to, individual and group activities; assistance with arranging transportation; assistance with obtaining and maintaining functional aids and equipment; housework; laundry; self-administration of medications and treatments; therapeutic diets; cuing and providing physical assistance with bathing, eating, dressing, locomotion and toileting; stand-by one person assistance for transferring.

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NEW SECTION
WAC 388-845-0405   Who is a qualified provider of ARC services?   The provider of ARC services must:

(1) Be a licensed boarding home;

(2) Be contracted with ADSA to provide ARC services; and

(3) Have completed the required and approved DDD specialty training.

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NEW SECTION
WAC 388-845-0410   Are there limits to the ARC services I can receive?   ARC services are limited by the following:

(1) ARC services are defined and limited by boarding home licensure and rules in chapter 388-78A WAC, and chapter 388-106 WAC and chapter 388-71 WAC governing Medicaid personal care and the comprehensive assessment and reporting evaluation (CARE).

(2) Rates are determined and limited to department published rates for the level of care generated by CARE.

(3) ARC reimbursement cannot be supplemented by other department funding.

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NEW SECTION
WAC 388-845-0500   What is behavior management and consultation?   (1) Behavior management and consultation may be provided to persons on any of the four HCBS waivers and include the development and implementation of programs designed to support waiver participants using:

(a) Strategies for effectively relating to caregivers and other people in the waiver participant's life; and

(b) Direct interventions with the person to decrease aggressive, destructive, and sexually inappropriate or other behaviors that compromise their ability to remain in the community (i.e., training, specialized cognitive counseling).

(2) Behavior management and consultation may also be provided as a mental health stabilization service in accordance with WAC 388-845-1150 through 388-845-1160.

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NEW SECTION
WAC 388-845-0505   Who is a qualified provider of behavior management and consultation?   The provider of behavior management and consultation must be one of the following professionals contracted with DDD and duly licensed, registered or certified to provide this service:

(1) Marriage and family therapist;

(2) Mental health counselor;

(3) Psychologist;

(4) Sex offender treatment provider;

(5) Social worker;

(6) Registered nurse (RN) or licensed practical nurse (LPN);

(7) Psychiatrist;

(8) Psychiatric advanced registered nurse practitioner (ARNP);

(9) Physician assistant working under the supervision of a psychiatrist;

(10) Registered counselor; or

(11) Polygrapher.

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NEW SECTION
WAC 388-845-0510   Are there limits to the behavior management and consultation I can receive?   The following limits apply to your receipt of behavior management and consultation:

(1) DDD and the treating professional will determine the need and amount of service you will receive, subject to the limitations in subsection (2) below.

(2) The dollar limitations for aggregate services in your Basic and Basic Plus waiver limit the amount of service unless provided as a mental health stabilization service.

(3) DDD reserves the right to require a second opinion from a department-selected provider.

(4) Behavior management and consultation not provided as a mental health stabilization service requires prior approval by DDD.

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NEW SECTION
WAC 388-845-0600   What is community access?   Community access is a service provided in the community to enhance or maintain the person's competence, integration, physical or mental skills.

(1) If you are age sixty-two or older, this service is available to assist you to participate in activities, events and organizations in the community in ways similar to others of retirement age.

(2) This service is available to adults in the Basic, Basic Plus, and CORE waiver.

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NEW SECTION
WAC 388-845-0605   Who is a qualified provider of community access?   The provider of community access must be a county or an individual or agency contracted with a county or DDD.

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NEW SECTION
WAC 388-845-0610   Are there limits to community access I can receive?   The following limits apply to your receipt of community access:

(1) You must be age sixty-two or older.

(2) You cannot be authorized to receive community access services if you receive pre-vocational services or supported employment services.

(3) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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NEW SECTION
WAC 388-845-0700   What is a community guide service?   Community guide service increases access to informal community supports. Services are short-term and designed to develop creative, flexible and supportive community resources for individuals with developmental disabilities. This service is available in Basic, Basic Plus and CORE waivers.

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NEW SECTION
WAC 388-845-0705   Who is a qualified community guide?   Any individual or agency contracted with DDD as a "community guide" is qualified to provide this service.

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NEW SECTION
WAC 388-845-0710   Are there limitations to the community guide services I can receive?   (1) You may not receive community guide services if you are receiving residential habilitation services as defined in WAC 388-845-1500 because your residential provider can meet this need.

(2) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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NEW SECTION
WAC 388-845-0750   What are community transition services?   (1) Community transition services are reasonable costs (necessary expenses in the judgment of the state for an individual to establish his or her basic living arrangement) associated with moving from an institutional setting to a community setting and receiving services from a DDD certified residential habilitation services provider as defined in WAC 388-845-1505 and WAC 388-845-1510.

(2) Community transition services include:

(a) Security deposits (not to exceed the equivalent of two month's rent) that are required to obtain a lease on an apartment or home;

(b) Essential furnishings such as a bed, a table, chairs, window blinds, eating utensils and food preparation items;

(c) Moving expenses required to occupy and use a community domicile;

(d) Set-up fees or deposits for utility or service access (e.g., telephone, electricity, heating); and

(e) Health and safety assurances, such as pest eradication, allergen control or one-time cleaning prior to occupancy.

(3) Community transition services are available in the CORE and Community Protection waivers.

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NEW SECTION
WAC 388-845-0755   Who are qualified providers of community transition services?   (1) Providers of community transition services for individuals in the CORE waiver must meet the requirements as a provider of residential habilitation services contained in WAC 388-845-1505.

(2) Providers of community transition services for individuals in the Community Protection waiver must meet the requirements as a provider of residential habilitation services contained in WAC 388-845-1510.

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NEW SECTION
WAC 388-845-0760   Are there limitations to community transition services I can receive?   (1) Community transition services do not include:

(a) Diversional or recreational items such as televisions, cable TV access, VCRs, MP3, CD or DVD players; and

(b) Computers whose use is primarily diversional or recreational.

(2) Community transition services are available only to individuals that are moving from an institution to a community setting and are enrolled in either the CORE or Community Protection waiver.

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NEW SECTION
WAC 388-845-0800   What is emergency assistance?   Emergency assistance is a temporary increase to the yearly dollar limit specified in the Basic and Basic Plus waiver when additional waiver services are required to prevent ICF/MR placement. These additional services are limited to the services provided in your waiver.

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NEW SECTION
WAC 388-845-0805   Who is a qualified provider of emergency assistance?   The provider of the service you need to meet your emergency must meet the provider qualifications for that service.

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NEW SECTION
WAC 388-845-0810   How do I qualify for emergency assistance?   You qualify for emergency assistance only if you have used all of your waiver funding and your current situation meets one of the following criteria:

(1) You involuntarily lose your present residence for any reason either temporary or permanent;

(2) You lose your present caregiver for any reason, including death;

(3) There are changes in your caregiver's mental or physical status resulting in the caregiver's inability to perform effectively for the individual; or

(4) There are significant changes in your emotional or physical condition that requires a temporary increase in the amount of a waiver service.

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NEW SECTION
WAC 388-845-0820   Are there limits to my use of emergency assistance?   All of the following limitations apply to your use of emergency assistance:

(1) Prior authorization is required based on a reassessment of your plan of care to determine the need for emergency services;

(2) Payment authorizations are reviewed every thirty days and cannot exceed six thousand dollars per twelve months based on the effective date of your current plan of care (POC);

(3) Emergency services are limited to the scope of services in your waiver;

(4) Emergency Assistance may be used for interim services until:

(a) The emergency situation has been resolved; or

(b) You are transferred to alternative supports that meet your assessed needs; or

(c) You are transferred to an alternate waiver that provides the service you need.

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NEW SECTION
WAC 388-845-0900   What are environmental accessibility adaptations?   (1) Environmental accessibility adaptations are available in all of the HCBS waivers and provide the physical adaptations to the home required by the individual's plan of care needed to:

(a) Ensure the health, welfare and safety of the individual; or

(b) Enable the individual who would otherwise require institutionalization to function with greater independence in the home.

(2) Environmental accessibility adaptations may include the installation of ramps and grab bars, widening of doorways, modification of bathroom facilities, or installing specialized electrical and/or plumbing systems necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.

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NEW SECTION
WAC 388-845-0905   Who is a qualified provider for building these environmental accessibility adaptations?   The provider making these environmental accessibility adaptations must be a registered contractor per chapter 18.27 RCW and contracted with DDD.

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NEW SECTION
WAC 388-845-0910   What limitations apply to environmental accessibility adaptations?   The following service limitations apply to environmental accessibility adaptations:

(1) Prior approval by DDD is required.

(2) Environmental accessibility adaptations or improvements to the home are excluded if they are of general utility without direct medical or remedial benefit to the individual, such as carpeting, roof repair, central air conditioning, etc.

(3) Environmental accessibility adaptations cannot add to the total square footage of the home.

(4) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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NEW SECTION
WAC 388-845-1000   What are extended state plan services?   Extended state plan services refer to physical therapy; occupational therapy; and speech, hearing and language services available to you under Medicaid without regard to your waiver status. They are "extended" services when the waiver pays for more services than is provided under the state Medicaid plan. These services are available under all four HCBS waivers.

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NEW SECTION
WAC 388-845-1010   Who is a qualified provider of extended state plan services?   Providers of extended state plan services must be certified, registered or licensed therapists as required by law and contracted with DDD for the therapy they are providing.

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NEW SECTION
WAC 388-845-1015   Are there limits to the extended state plan services I can receive?   (1) Additional therapy may be authorized as a waiver service only after you have accessed what is available to you under Medicaid and any other private health insurance plan;

(2) The department does not pay for treatment determined by DSHS to be experimental;

(3) The department and the treating professional determine the need for and amount of service you can receive:

(a) The department reserves the right to require a second opinion from a department-selected provider.

(b) The department will require evidence that you have accessed your full benefits through Medicaid and private insurance before authorizing this waiver service.

(4) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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NEW SECTION
WAC 388-845-1100   What are mental health crisis diversion bed services?   Mental health crisis diversion bed services are temporary residential and behavioral services that may be provided in a client's home or licensed or certified setting. These services are available to eligible clients who are at risk of serious decline of mental functioning and who have been determined to be at risk of psychiatric hospitalization. These services are available in all four HCBS waivers administered by DDD as mental health stabilization services in accordance with WAC 388-845-1150 through 388-845-1160

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NEW SECTION
WAC 388-845-1105   Who is a qualified provider of mental health crisis diversion bed services?   Providers of mental health crisis diversion bed services must be:

(1) DDD certified residential agencies per Chapter 388-101 WAC; or

(2) Other department licensed or certified agencies.

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NEW SECTION
WAC 388-845-1110   What are the limits of mental health crisis diversion bed services?   (1) Mental health crisis diversion bed services are intermittent and temporary. The duration and amount of services you need to stabilize your crisis is determined by a mental health professional and/or DDD.

(2) These services are available in all four HCBS waivers administered by DDD as mental health stabilization services in accordance with WAC 388-845-1150 through 388-845-1160.

(3) The costs of mental health crisis diversion bed services do not count toward the dollar limits for aggregate services in the Basic and Basic Plus waivers.

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NEW SECTION
WAC 388-845-1150   What are mental health stabilization services?   Mental health stabilization services assist persons who are experiencing a mental health crisis. These services are available in all four waivers to adults determined by mental health professionals or DDD to be at risk of institutionalization in a psychiatric hospital without one of more of the following services:

(1) Behavior management and consultation;

(2) Skilled nursing services;

(3) Specialized psychiatric services; or

(4) Mental health crisis diversion bed services.

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NEW SECTION
WAC 388-845-1155   Who are qualified providers of mental health stabilization services?   Providers of these mental health stabilization services are listed in the rules in this chapter governing the specific services listed in WAC 388-845-1150.

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NEW SECTION
WAC 388-845-1160   Are there limitations to the mental health stabilization services that I can receive?   (1) Mental health stabilization services are intermittent and temporary. The duration and amount of services you need to stabilize your crisis is determined by a mental health professional and/or DDD.

(2) The costs of mental health stabilization services do not count toward the dollar limitations for aggregate services in the Basic and Basic Plus waiver.

(3) Mental health stabilization services require prior approval by DDD or its designee.

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NEW SECTION
WAC 388-845-1200   What is a "person-to-person" service?   "Person-to-person" is a day program service intended to assist participants to progress toward employment goals through individualized planning, skill instruction, information and referral, and one to one relationship building. This service may be provided in addition to community access, prevocational services, or supported employment. This service is available to adults in all four HCBS waivers.

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NEW SECTION
WAC 388-845-1205   Who is a qualified provider of person-to-person services?   The provider of "person-to-person" services must be a county or an individual or agency contracted with a county or DDD.

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NEW SECTION
WAC 388-845-1210   Are there limits to the person-to-person service I can receive?   (1) You must be age twenty-one and graduated from high school or age twenty-two or older to receive person-to-person services.

(2) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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NEW SECTION
WAC 388-845-1300   What are personal care services?   Personal care services are the provision of assistance with personal care tasks as defined in WAC 388-106-0010, personal care services. These services are available in the Basic, Basic Plus, and CORE waivers.

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NEW SECTION
WAC 388-845-1305   Who are the qualified providers of personal care services?   (1) Qualified providers of personal care services may be individuals or licensed homecare agencies contracted with DDD.

(2) All individual providers and homecare agency providers must meet provider qualifications for in-home caregivers in WAC 388-71-0500 through 388-71-0556.

(3) Providers of personal care services for adults must comply with the training requirements in these rules governing Medicaid personal care providers in WAC 388-71-05670 through 388-71-05799.

(4) Natural, step, or adoptive parents can be the personal care provider of their adult child age eighteen or older.

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NEW SECTION
WAC 388-845-1310   Are there limits to the personal care services I can receive?   (1) You must meet the programmatic eligibility for Medicaid personal care in chapter 388-106 WAC and chapter 388-71 WAC governing Medicaid personal care (MPC) using the current department approved assessment form: Comprehensive assessment reporting evaluation (CARE) or children's comprehensive assessment.

(2) The maximum hours of personal care you may receive are determined by the approved department assessment for Medicaid personal care services.

(a) Provider rates are limited to the department established hourly rates for in-home Medicaid personal care.

(b) Homecare agencies must be licensed through the department of health and contracted with DDD.

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NEW SECTION
WAC 388-845-1400   What are prevocational services?   Prevocational services prepare an adult for paid or unpaid employment through the teaching of such concepts as compliance, attendance, task completion, problem solving and safety. These services are available in all four HCBS waivers.

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NEW SECTION
WAC 388-845-1405   Who are the qualified providers of prevocational services?   Providers of prevocational services must be a county or an individual or agency contracted with a county or DDD.

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NEW SECTION
WAC 388-845-1410   Are there limits to the prevocational services I can receive?   The following limitations apply to your receipt of prevocational services:

(1) You must be age twenty-one and graduated from high school or age twenty-two or older.

(2) You are not expected to be competitively employed within one year (excluding supported employment programs).

(3) You cannot be authorized to receive prevocational services if you receive community access services or supported employment services.

(4) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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NEW SECTION
WAC 388-845-1500   What are residential habilitation services?   Residential habilitation services (RHS) are available in the CORE and Community Protection waivers.

(1) Residential habilitation services include assistance:

(a) With personal care and supervision; and

(b) To learn, improve or retain social and adaptive skills necessary for living in the community.

(2) Residential habilitation services may provide instruction and support addressing one or more of the following outcomes:

(a) Health and safety;

(b) Personal power and choice;

(c) Competence and self-reliance;

(d) Positive recognition by self and others;

(e) Positive relationships; and

(f) Integration into the physical and social life of the community.

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NEW SECTION
WAC 388-845-1505   Who are qualified providers of residential habilitation services for the CORE waiver?   Providers of residential habilitation services for participants in the CORE waiver must be one of the following:

(1) Individuals contracted with DDD to provide residential support as a "companion home" provider;

(2) Individuals contracted with DDD to provide training as an "alternative living provider";

(3) Agencies contracted with DDD and certified per chapter 388-101 WAC;

(4) State-operated living alternatives (SOLA);

(5) Licensed and contracted group care homes, group training homes, foster homes, child placing agencies, staffed residential homes or adult residential rehabilitation centers per WAC 246-325-0012.

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NEW SECTION
WAC 388-845-1510   Who are qualified providers of residential habilitation services for the Community Protection waiver?   Providers of residential habilitation services for participants of the Community Protection waiver are limited to state-operated living alternatives (SOLA) and supported living providers who are contracted with DDD and certified under chapter 388-101 WAC as a residential community protection provider-intensive supported living services (CP-ISLS).

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NEW SECTION
WAC 388-845-1515   Are there limits to the residential habilitation services I can receive?   (1) You may only receive one type of residential habilitation service at a time.

(2) None of the following can be paid for under the CORE or Community Protection waiver:

(a) Room and board;

(b) The cost of building maintenance, upkeep, improvement, modifications or adaptations required to assure the health and safety of residents, or to meet the requirements of the applicable life safety code;

(c) Activities or supervision already being paid for by another source;

(d) Services provided in your parent's home unless you are receiving alternative living services for a maximum of six months to transition you from your parent's home into your own home.

(3) The following persons cannot be paid providers for your service:

(a) Your spouse;

(b) Your natural, step, or adoptive parents if you are a child age seventeen or younger;

(c) Your natural, step, or adoptive parent unless your parent is certified as a residential agency per chapter 388-101 WAC or is employed by a certified or licensed agency qualified to provide residential habilitation services.

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NEW SECTION
WAC 388-845-1600   What is respite care?   Respite care is intended to provide short-term intermittent relief for persons normally providing care for waiver individuals. This service is available in the Basic, Basic Plus, and CORE waivers.

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NEW SECTION
WAC 388-845-1605   Who is eligible to receive respite care?   The person providing your care is eligible to receive respite care if you are in the Basic, Basic Plus or CORE waiver and:

(1) You live in a private home with an unpaid caregiver; or

(2) You live with a paid caregiver who is:

(a) A natural, step or adoptive parent;

(b) A contracted companion home provider; or

(c) A licensed children's foster home provider.

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NEW SECTION
WAC 388-845-1606   Can DDD approve an exception to the requirements in WAC 388-845-1605?   DDD may approve an exception to WAC 388-845-1605 above only through June 30, 2006 if all of the following conditions exist:

(1) Your live-in caregiver is a relative as defined in WAC 388-825-345(2);

(2) You were living with this caregiver in January 2005;

(3) Your relative caregiver was receiving payment from the department as your caregiver in January 2005; and

(4) You were enrolled in the Basic, Basic Plus, or CORE Waiver in January 2005.

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NEW SECTION
WAC 388-845-1610   Where can respite care be provided?   Respite care can be provided in the following location(s):

(1) Individual's home or place of residence;

(2) Relative's home;

(3) Licensed children's foster home;

(4) Licensed, contracted and DDD certified group home;

(5) State operated living alternative (SOLA) and other DDD certified supported living settings;

(6) Licensed boarding home contracted as an adult residential center;

(7) Adult residential rehabilitation center;

(8) Licensed and contracted adult family home;

(9) Children's licensed group home, licensed staffed residential home, or licensed childcare center;

(10) Other community settings such as camp, senior center, or adult day care center.

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NEW SECTION
WAC 388-845-1615   Who are qualified providers of respite care?   Providers of respite care can be any of the following individuals or agencies contracted with DDD for respite care:

(1) Individuals meeting the provider qualifications under chapter 388-825 WAC;

(2) Homecare/home health agencies, licensed under chapter 246-335 WAC, Part 1;

(3) Licensed and contracted group homes, foster homes, child placing agencies, staffed residential homes and foster group care homes;

(4) Licensed and contracted adult family home;

(5) Licensed and contracted adult residential care facility;

(6) Licensed and contracted adult residential rehabilitation center under WAC 246-325-012;

(7) Licensed childcare center under chapter 388-295 WAC;

(8) Licensed child daycare center under chapter 388-295 WAC;

(9) Adult daycare centers contracted with DDD;

(10) Certified provider per chapter 388-101 WAC when respite is provided within the DDD contract for certified residential services; or

(11) Other DDD contracted providers such as community center, senior center, parks and recreation, summer programs, adult day care.

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NEW SECTION
WAC 388-845-1620   Are there limits to the respite care I can receive?   The following limitations apply to the respite care you can receive:

(1) If you are in the Basic or Basic Plus waiver, a respite care assessment will determine how much respite you can receive per WAC 388-845-3005 through WAC 388-845-3050.

(2) If you are in the CORE waiver, the plan of care (POC), not the respite assessment, will determine the amount of respite care you can receive.

(3) Prior approval by DDD is required to exceed fourteen days per month.

(4) Respite cannot replace:

(a) Daycare while a parent or guardian is at work; and/or

(b) Personal care hours available to you. When determining your unmet need, DDD will first consider the personal care hours available to you.

(5) Respite providers have the following limitations and requirements:

(a) If respite is provided in a private home, the home must be licensed unless it is the client's home or the home of a relative of specified degree per WAC 388-825-345;

(b) The respite provider cannot be the spouse of the caregiver receiving respite if the spouse and the caregiver reside in the same residence; and

(c) If you receive respite from a provider who requires licensure, the respite services are limited to those age-specific services contained in the provider's license.

(6) Your caregiver cannot provide paid respite services for you or other persons during your respite care hours.

(7) If you require respite from a licensed practical nurse (LPN) or a registered nurse (RN), services may be authorized as skilled nursing services per WAC 388-845-1700 using an LPN or RN. If you are in the Basic Plus waiver, skilled nursing services are limited to the dollar limits of your aggregate services per WAC 388-845-0210. The dollar limit governing aggregate services does not apply to skilled nursing services provided as part of mental health stabilization services per WAC 388-845-1100(2).

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NEW SECTION
WAC 388-845-1650   What are sexual deviation evaluations?   Sexual deviation evaluations are professional evaluations of sexual deviancy to determine the need for psychological, medical or therapeutic services. Sexual deviancy evaluations are available in all four waivers.

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NEW SECTION
WAC 388-845-1655   Who is a qualified provider of sexual deviation evaluations?   The provider of sexual deviancy evaluations must:

(1) Be a certified sexual offender treatment provider (SOTP); and

(2) Meet the standards contained in WAC 246-930-030 (education required prior to examination) and WAC 246-930-040 (professional experience required prior to examination).

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NEW SECTION
WAC 388-845-1660   Are there limitations to the sexual deviation evaluations I can receive?   (1) The evaluations must meet the standards contained in WAC 246-930-320.

(2) The costs of sexual deviation evaluations do not count toward the dollar limits for aggregate services in the Basic or Basic Plus waivers.

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NEW SECTION
WAC 388-845-1700   What is skilled nursing?   (1) Skilled nursing is continuous, intermittent, or part time nursing services. These services are available in the Basic Plus, CORE, and Community Protection waivers.

(2) Services include nurse delegation services provided by a registered nurse, including the initial visit, follow-up instruction, and/or supervisory visits.

(3) These services are available in all four HCBS waivers administered by DDD as mental health stabilization services in accordance with WAC 388-845-1150 through 388-845-1160.

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NEW SECTION
WAC 388-845-1705   Who is a qualified provider of skilled nursing services?   The provider of skilled nursing services must be a licensed practical nurse (LPN) or registered nurse (RN) acting within the scope of the Nurse Practice Act chapter 246-845 WAC and contracted with DDD to provide this service.

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NEW SECTION
WAC 388-845-1710   Are there limitations to the skilled nursing services I can receive?   The following limitations apply to your receipt of skilled nursing services:

(1) Skilled nursing services require prior approval by DDD.

(2) The department and the treating professional determine the need for and amount of service.

(3) The department reserves the right to require a second opinion by a department-selected provider.

(4) Skilled nursing services provided as a mental health stabilization service require prior approval by DDD or its designee.

(5) The dollar limitation for aggregate services in your Basic Plus waiver limit the amount of skilled nursing services unless provided as a mental health stabilization service.

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NEW SECTION
WAC 388-845-1800   What are specialized medical equipment and supplies?   (1) Specialized medical equipment and supplies are services to help individuals with their activities of daily living or to better participate in their environment. These services are available in all four HCBS waivers.

(2) Included are devices, controls, appliances, and items necessary for life support; ancillary supplies and equipment necessary to the proper functioning of such items; and durable and nondurable medical equipment not available through Medicaid under the Medicaid state plan.

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NEW SECTION
WAC 388-845-1805   Who are the qualified providers of specialized medical equipment and supplies?   The provider of specialized medical equipment and supplies must be a medical equipment supplier contracted with DDD.

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NEW SECTION
WAC 388-845-1810   Are there limitations to my receipt of specialized medical equipment and supplies?   The following limitations apply to your receipt of specialized medical equipment and supplies:

(1) Prior approval by the department is required for each authorization.

(2) The department reserves the right to require a second opinion by a department-selected provider.

(3) Items reimbursed with waiver funds shall be in addition to any medical equipment and supplies furnished under the Medicaid state plan.

(4) Items must be of direct medical or remedial benefit to the individual and necessary as a result of the individual's disability.

(5) Medications, prescribed or nonprescribed, and vitamins are excluded.

(6) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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NEW SECTION
WAC 388-845-1900   What are specialized psychiatric services?   (1) Specialized psychiatric services are specific to the individual needs of persons with developmental disabilities who are experiencing mental health symptoms. These services are available in all four HCBS waivers.

(2) Service may be any of the following:

(a) Psychiatric evaluation,

(b) Medication evaluation and monitoring,

(c) Psychiatric consultation.

(3) These services are also available as a mental health stabilization service in accordance with WAC 388-845-1150 through 388-845-1160.

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NEW SECTION
WAC 388-845-1905   Who are qualified providers of specialized psychiatric services?   Providers of specialized psychiatric services must be one of the following licensed or registered, and contracted healthcare professionals:

(1) Psychiatrist;

(2) Psychiatric advanced registered nurse practitioner (ARNP); or

(3) Physician assistant working under the supervision of a psychiatrist.

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NEW SECTION
WAC 388-845-1910   Are there limitations to the specialized psychiatric services I can receive?   (1) Specialized psychiatric services are excluded if they are available through other Medicaid programs.

(2) The dollar limitations for aggregate service in your Basic and Basic Plus waiver limit the amount of specialized psychiatric services unless provided as a mental health stabilization service.

(3) Specialized psychiatric services provided as a mental health stabilization service require prior approval by DDD or its designee.

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NEW SECTION
WAC 388-845-2000   What is staff/family consultation and training?   (1) Staff/family consultation and training is professional assistance to families or direct service providers to help them better meet the needs of the waiver person. This

service is available in all four HCBS waivers.

(2) Consultation and training is provided to families, direct staff, or personal care providers to meet the specific needs of the waiver participant as outlined in the individual's plan of care, including:

(a) Health and medication monitoring;

(b) Positioning and transfer;

(c) Basic and advanced instructional techniques;

(d) Positive behavior support; and

(e) Augmentative communication systems.

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NEW SECTION
WAC 388-845-2005   Who is a qualified provider of staff/family consultation and training?   To provide staff/family consultation and training, a provider must be one of the following licensed, registered or certified professionals and be contracted with DDD:

(1) Audiologist;

(2) Licensed practical nurse;

(3) Marriage and family therapist;

(4) Mental health counselor;

(5) Occupational therapist;

(6) Physical therapist;

(7) Registered nurse;

(8) Sex offender treatment provider;

(9) Speech/language pathologist;

(10) Social worker;

(11) Psychologist;

(12) Certified American Sign Language instructor;

(13) Nutritionist;

(14) Registered counselor; or

(15) Certified dietician.

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NEW SECTION
WAC 388-845-2010   Are there limitations to the staff/family consultation and training I can receive?   (1) Expenses to the family or provider for room and board or attendance, including registration, at conferences are excluded as a service under staff/family consultation and training.

(2) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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NEW SECTION
WAC 388-845-2100   What is supported employment?   Supported employment provides intensive ongoing individual or group support in a work setting to adults with developmental disabilities. This service is available in all four HCBS waivers.

(1) Supported employment includes activities needed to sustain paid work by individuals

receiving waiver services, including supervision and training.

(2) Supported employment is conducted in a variety of settings; particularly work sites in which persons without disabilities are employed.

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NEW SECTION
WAC 388-845-2105   Who is a qualified provider of supported employment?   A supported employment provider must be a county, or agencies or individuals contracted with a county or DDD.

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NEW SECTION
WAC 388-845-2110   Are there limits to the supported employment I can receive?   The following limitations apply to your receipt of supported employment:

(1) You must be age twenty-one and graduated from high school or age twenty-two or older.

(2) Payment will be made only for the adaptations, supervision, training, and support with the activities of daily living you require as a result of your disabilities.

(3) Payment is excluded for the supervisory activities rendered as a normal part of the business setting.

(4) You cannot be authorized to receive supported employment services if you receive community access services or prevocational services.

(5) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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NEW SECTION
WAC 388-845-2200   What are transportation services?   Transportation services provide reimbursement to a provider when the transportation is required and specified in the waiver plan of care. This service is available in all four HCBS waivers.

(1) Transportation provides the person access to waiver services, specified by the plan of care.

(2) Whenever possible, the person must use family, neighbors, friends, or community agencies that can provide this service without charge.

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NEW SECTION
WAC 388-845-2205   Who is qualified to provide transportation services?   The provider of transportation services can be an individual or agency contracted with DDD.

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NEW SECTION
WAC 388-845-2210   Are there limitations to the transportation services I can receive?   The following limitations apply to transportation services:

(1) Transportation to/from medical or medically related appointments is a Medicaid transportation service and is to be considered and used first.

(2) Transportation is offered in addition to medical transportation but cannot replace Medicaid transportation services.

(3) Transportation is limited to travel to and from a waiver service.

(4) Transportation does not include the purchase of a bus pass.

(5) Reimbursement for provider mileage requires prior approval by DDD and is paid according to contract.

(6) This service does not cover the purchase or lease of vehicles.

(7) Reimbursement for provider travel time is not included in this service.

(8) Reimbursement to the provider is limited to transportation that occurs when you are with the provider.

(9) You are not eligible for transportation services if the cost and responsibility for transportation is already included in your waiver provider's contract and payment.

(10) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

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ASSESSMENT AND PLAN OF CARE
NEW SECTION
WAC 388-845-3000   What is the process for determining the services I need?   Your service needs are determined through the ICF-MR level of care assessment and the service planning process.

(1) You receive an initial and annual assessment of your needs using a department-approved form.

(a) The ICF-MR level of care assessment identifies your need for waiver services.

(b) The "comprehensive assessment reporting evaluation (CARE)" will determine your eligibility and amount of personal care services.

(c) If you are in the Basic or Basic Plus waiver, a DDD respite assessment will determine the amount of respite care available to you.

(2) From the assessment, DDD develops your waiver plan of care (POC) with you and/or your legal representative and others who are involved in your life such as your parent or guardian, advocate and service providers.

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NEW SECTION
WAC 388-845-3005   What is the waiver respite assessment?   The waiver respite assessment is a series of questions about you and your primary caregiver that will determine the amount of respite care available to you.

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NEW SECTION
WAC 388-845-3010   Who must have a waiver respite assessment?   (1) If you are in the Basic or Basic Plus waiver and are interested in receiving respite care, and are eligible for respite care per WAC 388-845-1605, your personal care needs must first be assessed by CARE.

(2) A respite assessment will then determine the amount of respite care available to you.

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NEW SECTION
WAC 388-845-3015   How is the waiver respite assessment administered?   The waiver respite assessment is administered by department staff during an in-person interview with you if you choose to be present, and at least one other person with knowledge of you, such as your primary caregiver.

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NEW SECTION
WAC 388-845-3020   Who can be the respondent for the waiver respite assessment?   The respondent for your waiver respite assessment must be an adult who is well acquainted with you and can provide the information needed to complete the assessment, such as your primary caregiver.

(1) You cannot be the respondent for your own respite assessment.

(2) The department may select and interview additional respondents as needed to get complete and accurate information.

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NEW SECTION
WAC 388-845-3025   How often is this waiver respite assessment completed?   Your waiver respite assessment must be completed at the time of your CARE assessment/reassessment.

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NEW SECTION
WAC 388-845-3030   What items are assessed to determine my respite allocation?   The waiver respite assessment documents information about you and your caregiver. Information must reflect what is currently happening, not what may occur in the future or what has occurred more than thirty days ago. The information documented includes:

(1) The level of monitoring you require, above and beyond what is typically required for persons of similar age;

(2) Circumstances in your primary caregiver's life that may impact his/her care giving ability;

(3) The effect of your disability on other household members;

(4) Your primary caregiver's care giving responsibilities for others;

(5) How many parents, legal representatives and/or primary caregivers live in the same household as you;

(6) Availability of others to provide your care; and

(7) Your disability related emotional or behavior issues and how that affects your caregiver; the frequency and severity of these issues; and what a caregiver does to help you manage these behaviors.

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NEW SECTION
WAC 388-845-3035   How is the waiver respite assessment scored?   The responses to the waiver respite assessment are converted to a respite lid.

(1) The respite lid represents the maximum number of respite hours you are authorized to receive in a twelve-month period.

(2) You may use as many respite hours as you need, up to your assessed respite lid.

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NEW SECTION
WAC 388-845-3040   When will the new respite assessment go into effect?   The new respite assessment will be effective at the time of your next CARE assessment/reassessment.

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NEW SECTION
WAC 388-845-3045   How will I know the results of my respite assessment?   Your respite care allocation will be written into your plan of care as a separate, authorized service.

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NEW SECTION
WAC 388-845-3050   What is the effective date of my respite allocation?   Your respite care allocation is effective when your respite assessment is completed and authorized in your annual or amended POC.

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NEW SECTION
WAC 388-845-3055   What is a waiver plan of care (POC)?   (1) The plan of care is the primary tool DDD uses to determine and document your needs and to identify the services to meet those needs.

(2) Your plan must include:

(a) The services that you and DDD have agreed are necessary for you to receive in order to address your health and welfare needs as specified in WAC 388-845-3000;

(b) Both paid and unpaid services you receive or need;

(c) How often you will receive each waiver service; how long you will need it; and who will provide it; and

(d) Your signature on the plan indicating your agreement.

(3) You may choose any qualified provider for the service, who meets all of the following:

(a) Is able to meet your needs within the scope of their contract, licensure and certification;

(b) Is reasonably available;

(c) Meets provider qualifications in chapters 388-845 and 388-825 WAC for contracting; and

(d) Agrees to provide the service at department rates.

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NEW SECTION
WAC 388-845-3060   When is my plan of care effective?   Your plan of care is effective the date DDD signs and approves it.

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NEW SECTION
WAC 388-845-3065   How long is my plan effective?   Your plan of care is effective through the last day of the twelfth month following the effective date.

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NEW SECTION
WAC 388-845-3070   What happens if I do not sign my plan of care?   If DDD is unable to obtain the necessary signature on the plan of care from you or your legal representative, DDD will take one or more of the following actions:

(1) DDD will continue providing services as identified in your most current POC for up to thirty days from the date you were notified of the plan to implement your most current POC.

(2) After thirty days, unless you file an appeal, DDD will assume consent and implement the new POC without your signature or the signature of your legal representative.

(3) You will be provided written notification and appeal rights to this action to implement the new POC.

(4) Your appeal rights are in WAC 388-825-120 through 388-825-165.

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NEW SECTION
WAC 388-845-3075   What if my needs change?   You may request a review of your plan of care at any time by calling your case manager. If there is a significant change in your condition or circumstances, DDD must reassess your plan of care with you and amend the plan to reflect any significant changes. This reassessment does not affect the end date of your annual plan of care.

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NEW SECTION
WAC 388-845-3080   What if my needs exceed the maximum yearly funding limit or the scope of services under the Basic or Basic Plus waiver?   (1) If you are on the Basic or Basic Plus waiver and your assessed need for services exceeds the maximum permitted, DDD will make the following efforts to meet your health and welfare needs:

(a) Identify more available natural supports;

(b) Initiate an exception to rule to access available nonwaiver services not included in the Basic or Basic Plus waiver other than natural supports;

(c) Authorize emergency services up to six thousand dollars per year if your needs meet the definition of emergency services in WAC 388-845-0800.

(2) If emergency services and other efforts are not sufficient to meet your needs, you will be offered:

(a) An opportunity to apply for an alternate waiver that has the services you need;

(b) Priority for placement on the alternative waiver when there is capacity to add people to that waiver;

(c) Placement in an ICF/MR.

(3) If none of the options in subsections (1) and (2) above is successful in meeting your health and welfare needs, DDD may terminate your waiver eligibility.

(4) If you are terminated from a waiver, you will remain eligible for nonwaiver DDD services but access to state-only funded DDD services is limited by availability of funding.

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NEW SECTION
WAC 388-845-3085   What if my needs exceed what can be provided under the CORE or Community Protection waiver?   (1) If you are on the CORE or Community Protection waiver and your assessed need for services exceeds the scope of services provided under your waiver, DDD will make the following efforts to meet your health and welfare needs:

(a) Identify more available natural supports;

(b) Initiate an exception to rule to access available nonwaiver services not included in the CORE or Community Protection waiver other than natural supports;

(c) Offer you the opportunity to apply for an alternate waiver that has the services you need, subject to WAC 388-845-0045;

(d) Offer you placement in an ICF/MR.

(2) If none of the above options is successful in meeting your health and welfare needs, DDD may terminate your waiver eligibility.

(3) If you are terminated from a waiver, you will remain eligible for nonwaiver DDD services but access to state-only funded DDD services is limited by availability of funding.

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NEW SECTION
WAC 388-845-3090   What if my identified health and welfare needs are less than what is provided in my current waiver?   If your identified health and welfare needs are less than what is provided in your current waiver, DDD may terminate you from your current waiver and enroll you in a waiver that meets but does not exceed your assessed need for waiver services.

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NEW SECTION
WAC 388-845-3095   Will I have to pay toward the cost of waiver services?   (1) Depending on your SSI status, Medicaid status, income and resources, you may be required to participate towards the cost of your care. DDD determines what amount, if any, you pay.

(2) If you live in a licensed facility, you participate from your earned and unearned income per rules in WAC 388-515-1510:

(a) If you have nonexempt income that exceeds the cost of your waiver services, you may keep the difference.

(b) If you are eligible for SSI, you pay only for room and board.

(c) If you are not eligible for SSI, you may be required to participate towards the cost of your waiver services in addition to your facility room and board rate.

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NEW SECTION
WAC 388-845-4000   What are my appeal rights under the waiver?   You have appeal rights under WAC 388-825-120 to the following decisions:

(1) Any denial, reductions, or termination of a service.

(2) A denial or termination of your choice of a qualified provider.

(3) Your termination from waiver eligibility.

(4) Denial of your request to receive ICF/MR services instead of waiver services.

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NEW SECTION
WAC 388-845-4005   Can I appeal a denial of my request to be enrolled in a waiver?   You do not have an appeal right to a denial to be enrolled in a waiver.

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NEW SECTION
WAC 388-845-4010   How do I appeal a department action?   (1) Your rights to appeal a department decision are in RCW 71A.10.050 and WAC 388-825-120 and are limited to an applicant, recipient, or former recipient of services from the division of developmental disabilities.

(2) If you want to appeal a department action, you must request an appeal within ninety days from receipt of the department notice of the action you are disputing.

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NEW SECTION
WAC 388-845-4015   Will my services continue during an appeal?   Services may continue according to the provisions contained in WAC 388-825-145.

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Washington State Code Reviser's Office