WSR 07-10-029

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed April 23, 2007, 3:21 p.m. , effective June 1, 2007 ]


Effective Date of Rule: June 1, 2007.

Purpose: The purpose of these new rules in chapter 388-828 WAC is to govern and support the administration of the division's newly developed, computer-based assessment tool that is designed to measure the support needs of clients for service determination. The DDD assessment will replace existing paper-based methods resulting in a universal assessment and support planning process. The purpose of the DDD assessment is to provide a comprehensive assessment process that: (1) Collects a common set of assessment information for reporting purposes to the legislature and the department; (2) promotes consistency and accuracy in evaluating client support needs for purposes of planning, budgeting, and resource management; (3) identifies a level of service and/or number of care hours that is used to support the assessed needs of clients who have been authorized to receive Medicaid/waiver personal care, waiver respite care, and/or voluntary placement program services; and (4) records clients' service requests.

Statutory Authority for Adoption: RCW 71A.12.030.

Other Authority: Title 71A RCW.

Adopted under notice filed as WSR 07-03-158 on January 23, 2007.

Changes Other than Editing from Proposed to Adopted Version: There have been no changes other than minor editing to improve clarity in the proposed rule.

(Strikeouts indicate words deleted from proposed rules. Underlines indicate words added to proposed rules.)


WAC 388-828-1120

(1) You have not identified a person willing to receive notice or correspondence on your behalf regarding specific DDD decisions as required per RCW 71A.10.060 and DDD does not believe you are capable of understanding department decisions that may affect your care (see WAC 388-828-1140); or

(2) A respondent cannot be identified to participate in your DDD Assessment (see WAC 388-828-1540(c));


WAC 388-828-1140

If there is no one available to receive notice or correspondence on your behalf regarding specific DDD decisions, DDD will do all of the following:


WAC 388-828-1360

(2) You or your legal guardian has have not identified an ADSA contracted provider.


WAC 388-828-1380

If you are unable to identify an ADSA contracted provider, DDD will provide you or your legal guardian with contact information for ADSA contracted agency providers.


WAC 388-828-1460

DDD intends to assess all clients per WAC 388-828-1100 by June 30, 2008 based on available resources.

(4) You are not receiving a paid service and You are approved for funding of a DDD paid service and an assessment must be performed prior to the authorization of services;


WAC 388-828-1620

(8) Private Duty Nursing services per chapter 388-106551 WAC; or

A final cost-benefit analysis is available by contacting Mark R. Eliason, P.O. Box 45310, Lacey, WA 98504-5310, phone (360) 725-2517, fax (360) 407-0995, e-mail eliasmr@dshs.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, 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 126, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 126, Amended 0, Repealed 0.

Date Adopted: April 23, 2007.

Blake D. Chard

for Robin Arnold-Williams

Secretary

3788.7
Chapter 388-828 WAC

The Division of Developmental Disabilities (DDD) Assessment

Purpose and Scope
NEW SECTION
WAC 388-828-1000   What is the purpose and scope of this chapter?   This chapter establishes rules governing the administration of the division of developmental disabilities (DDD) assessment to persons determined eligible to be clients of the division per chapter 71A.16 RCW.

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Definitions
NEW SECTION
WAC 388-828-1020   What definitions apply to this chapter?   The following definitions apply to this chapter:

"AAIDD" means the American Association on Intellectual and Developmental Disabilities.

"Acuity Scale" refers to an assessment tool that is intended to provide a framework for documenting important assessment elements and for standardizing the key questions that should be asked as part of a professional assessment. The design helps provide consistency from client to client by minimizing subjective bias and assists in promoting objective assessment of a person's support needs.

"ADSA" means the aging and disability services administration (ADSA), an administration within the department of social and health services, which includes the following divisions: home and community services, residential care services, management services and division of developmental disabilities.

"ADSA contracted provider" means an individual or agency who is licensed, certified, and/or contracted by ADSA to provide services to DDD clients.

"Adult Family Home" or "AFH" means a residential home 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 services (see RCW 70.12.010).

"Agency provider" means a licensed and/or ADSA certified business who is contracted with ADSA or a county to provide DDD services (e.g., personal care, respite care, residential services, therapy, nursing, employment, etc.).

"Algorithm" means a numerical formula used by the DDD Assessment for one or more of the following:

(1) Calculation of assessed information to identify a client's relative level of need;

(2) Determination regarding which assessment modules a client receives as part of his/her DDD assessment; and

(3) Assignment of a service level to support a client's assessed need.

"Authorization" means DDD approval of funding for a service as identified in the Individual Support Plan or evidence of payment for a service.

"CARE" refers to the Comprehensive Assessment Reporting Evaluation assessment per chapter 388-106 WAC.

"Client" means a person who has a developmental disability as defined in RCW 71A.10.020(3) who also has been determined eligible to receive services by the division under chapter 71A.16 RCW.

"Collateral contact" means a person or agency that is involved in the client's life (e.g., legal guardian, family member, care provider, friend, etc.).

"Companion home" is a DDD contracted residential service that provides twenty-four hour training, support, and supervision, to one adult living with a paid provider.

"DDD" means the division of developmental disabilities, a division with the aging and disability services administration (ADSA), department of social and health services (DSHS).

"Department" means the department of social and health services (DSHS).

"Group home" or "GH" means a ADSA licensed adult family home or boarding home contracted and certified by ADSA to provide residential services and support to adults with developmental disabilities.

"ICF/MR" means a facility certified as an intermediate care facility for the mentally retarded to provide habilitation services to DDD clients.

"ICF/MR Level of Care" is a standardized assessment of a client's need for ICF/MR Level of Care per 42 CFR 440 and 42 CFR 483. In addition, ICF/MR Level of Care refers to one of the standards used by DDD to determine whether a client meets minimum eligibility criteria for one of the DDD HCBS waivers.

"Individual Support Plan" or "ISP" is a document that authorizes and identifies the DDD paid services to meet a client's assessed needs.

"Legal Guardian" means a person/agency, appointed by a court, who is authorized to make some or all decisions for a person determined by the court to be incapacitated. In the absence of court intervention, parents remain the legal guardians for their child until the child reaches the age of eighteen.

"LOC score" means a score for answers to questions in the Support Needs Assessment for Children that are used in determining if a client meets eligibility requirements for ICF/MR Level of Care.

"Modules" refers to three sections of the DDD Assessment. They are: the Support Assessment, the Service Level Assessment, and the Individual Support Plan (ISP).

"Panel" refers to the visual user-interface in the DDD Assessment computer application where assessment questions are typically organized by topic and you and your respondents' answers are recorded.

"Plan of Care" or "POC" refers to the paper-based assessment and service plan for clients receiving services on one of the DDD HCBS waivers prior to June 1, 2007.

"Raw Score" means the numerical value when adding a person's "Frequency of Support," "Daily Support Time," and "Type of Support" scores for each activity in the support needs and supplemental protection and advocacy scales of the Supports Intensity Scale (SIS) Assessment.

"Residential Habilitation Center" or "RHC" is a state-operated facility certified to provide ICF/MR and/or nursing facility level of care for persons with developmental disabilities per chapter 71A.20 RCW.

"Respondent" means the adult client and/or another person familiar with the client who participates in the client's DDD Assessment by answering questions and providing information. Respondents may include ADSA contracted providers.

"SIS" means the Supports Intensity Scale developed by the American Association of Intellectual and Developmental Disabilities (AAIDD). The SIS is in the Support Assessment module of the DDD Assessment.

"Service Provider" refers to an ADSA contracted agency or person who provides services to DDD clients. Also refers to state operated living alternative programs (SOLA).

"SOLA" means a state operated living alternative program for adults that is operated by DDD.

"State supplementary payment" or "SSP" is the state paid cash assistance program for certain DDD eligible Social Security Income clients per chapter 388-827 WAC.

"Supported living" or "SL" refers to residential services provided by ADSA certified residential agencies to clients living in homes that are owned, rented, or leased by the clients or their legal representatives.

"Waiver personal care" means physical or verbal assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL) due to your functional limitations per chapter 388-106 WAC to individuals who are authorized to receive services available in the Basic, Basic Plus, and Core waivers per chapter 388-845 WAC.

"Waiver respite care" means short-term intermittent relief for persons normally providing care to individuals who are authorized to receive services available in the Basic, Basic Plus, and Core waivers per chapter 388-845 WAC.

"You/Your" means the client.

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Division of Developmental Disabilities Assessment
NEW SECTION
WAC 388-828-1040   What is the DDD assessment?   (1) The DDD Assessment is an assessment tool designed to measure the support needs of persons with developmental disabilities.

(2) The DDD Assessment has three modules:

(a) The Support Assessment (see WAC 388-828-2000 to WAC 388-828-6020);

(b) The Service Level Assessment (see WAC 388-828-7000 to WAC 388-828-7080); and

(c) The Individual Support Plan (ISP) (see WAC 388-828-8000 to 388-828-8060).

(3) The DDD Assessment is part of the Aging and Disability Services Administration's (ADSA) Comprehensive Assessment Reporting Evaluation system (CARE).

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NEW SECTION
WAC 388-828-1060   What is the purpose of the DDD assessment?   The purpose of the DDD Assessment is to provide a comprehensive assessment process that:

(1) Collects a common set of assessment information for reporting purposes to the legislature and the department.

(2) Promotes consistency in evaluating client support needs for purposes of planning, budgeting, and resource management.

(3) Identifies a level of service and/or number of hours that is used to support the assessed needs of clients who have been authorized by DDD to receive:

(a) Medicaid personal care services or DDD HCBS Waiver Personal Care per chapter 388-106 WAC;

(b) Waiver respite care services per chapter 388-845 WAC;

(c) Services in the Voluntary Placement Program (VPP) per chapter 388-826 WAC.

(4) Records your service requests.

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NEW SECTION
WAC 388-828-1080   Who must administer the DDD assessment?   Only DDD employees can administer the DDD Assessment.

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NEW SECTION
WAC 388-828-1100   Who receives the DDD assessment?   DDD must administer a DDD Assessment when you meet any of the following conditions:

(1) You are currently approved by DDD to receive a DDD paid service evidenced by meeting one of the conditions in WAC 388-828-1440;

(2) You request enrollment in one of the DDD HCBS waivers per chapter 388-845 WAC;

(3) You are age three or older and request a DDD Assessment;

(4) You have been determined eligible for categorically needy medical coverage per WAC 388-475-0100 and requested one of the following Medicaid state plan services:

(a) You have requested an assessment for Medicaid personal care services per chapter 388-106 WAC; or

(b) You have been approved to receive Private Duty Nursing services for clients seventeen years of age and younger per WAC 388-551-3000.

(5) You are receiving SSP in lieu of a DDD paid service per chapter 388-827 WAC;

(6) You request admission to a RHC per title 42 CFR 440, title 42 CFR 483, and title 71A RCW;

(7) You reside in a RHC or community ICF/MR and you are involved in discharge planning for community placement;

(8) You do not meet any of the conditions listed in WAC 388-828-1120.

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NEW SECTION
WAC 388-828-1120   Who does not receive the DDD assessment?   DDD will not administer the DDD Assessment when you meet any of the following conditions:

(1) You have not identified a person willing to receive notice or correspondence on your behalf regarding specific DDD decisions as required per RCW 71A.10.060 and DDD does not believe you are capable of understanding department decisions that may affect your care (See WAC 388-828-1140); or

(2) A respondent cannot be identified to participate in your DDD Assessment (See WAC 388-828-1540(c));

(3) You reside in a RHC and are not currently involved in discharge planning for community placement;

(4) You reside in a community ICF/MR and are not authorized by DDD to receive employment/community services paid through the counties; or

(5) You are under the age of three and do not meet any of the conditions in WAC 388-828-1100.

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NEW SECTION
WAC 388-828-1140   What will DDD do if there is no one willing to receive notice on your behalf regarding specific DDD decisions?   If there is no one available to receive notice or correspondence on your behalf regarding specific DDD decisions, DDD will do all of the following:

(1) Consult with the Assistant Attorney General to determine if:

(a) You are able to represent yourself; or

(b) You require a legal representative/guardian.

(2) Continue current services until the issue is resolved per section (1) above.

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NEW SECTION
WAC 388-828-1160   Does everyone receive all three modules of the DDD assessment?   (1) The Support Assessment module is administered to all clients who receive a DDD Assessment.

(2) Only clients receiving a DDD paid service, SSP in lieu of a DDD paid service, or who are approved for a DDD paid service will receive the Service Level Assessment and Individual Support Plan modules since these modules are required:

(a) Prior to the authorization/reauthorization of a DDD paid service or SSP; and

(b) To determine a service level and/or number of hours for a service; and

(c) To authorize the DDD approved paid service(s) per WAC 388-828-8000.

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NEW SECTION
WAC 388-828-1180   How will your assessed unmet need(s) be met if there is no approved funding to provide a DDD paid service?   If you complete the DDD Assessment and are assessed to have an unmet need and there is no approved funding to support that need, DDD will offer you referral information for ICF/MR services per title 71A RCW, chapter 388-825 WAC, and chapter 388-837 WAC. In addition, DDD may:

(1) Provide information and referral for Non-DDD community-based supports; and

(2) Add your name to the waiver data base, if you have requested enrollment in a DDD HCBS waiver per chapter 388-845 WAC; and

(3) Authorize short-term emergency services as an exception-to-rule (ETR) per WAC 388-440-0001.

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NEW SECTION
WAC 388-828-1200   Will DDD ask your family to disclose financial and dependent information?   DDD will only ask for information regarding your family's annual gross income and the number of household dependents when:

(1) You are age seventeen or younger; and

(2) Your family has not made a request for your admission to a Residential Habilitation Center (RHC).

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NEW SECTION
WAC 388-828-1220   Will DDD require your family to provide supporting documentation of their annual gross income and number of household dependents?   DDD accepts your family's verbal report and does not require your family to provide supporting documentation of their annual gross income and number of household dependents.

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NEW SECTION
WAC 388-828-1240   What does DDD do when family income and household dependent information are not provided?   If you meet the criteria in WAC 388-828-1200 and your family does not report family income and dependent information, the only consequence will be a denial for any new state-only DDD paid services.

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NEW SECTION
WAC 388-828-1260   What action will DDD take if your family does not report income and dependent information?   If during your DDD Assessment your family does not report family income and dependent information, DDD will:

(1) Ask if you would like referral information for ICF/MR services; and

(2) Continue to administer your DDD Assessment; and

(3) Continue to authorize the DDD paid services or SSP you are receiving at the time of your DDD Assessment if you continue to meet the eligibility requirements for those services.

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NEW SECTION
WAC 388-828-1280   How will your access to, or receipt of, DDD HCBS waiver services be affected if your family does not report family income and dependent information?   Your waiver eligibility or right to request waiver enrollment is not affected if your family does not report family income and dependent information.

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NEW SECTION
WAC 388-828-1300   How will your access to, or receipt of, Medicaid personal care, private duty nursing services, or SSP be affected if your family does not report family income and dependent information?   Your access to, or receipt of, Medicaid personal care services per chapter 388-106 WAC, Private Duty Nursing services for children seventeen years of age and younger per WAC 388-551-3000, or SSP per chapter 388-827 WAC is not affected if your family does not report income and dependent information.

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NEW SECTION
WAC 388-828-1320   What happens if you are approved to receive a DDD paid service and you refuse to have a DDD assessment administered?   If you are approved to receive a DDD paid service and refuse to have a DDD Assessment administered, DDD is unable to authorize new or current DDD paid services and will do all of the following:

(1) Explain what happens if you refuse to allow DDD to administer the DDD Assessment to you, your respondents, and the person you have identified to receive notice on your behalf per RCW 71A.10.060.

(2) Consult with the Assistant Attorney General when you have not identified a person to receive notice on your behalf per RCW 71A.10.060 to determine if:

(a) You are able to represent yourself; or

(b) You require a legal representative/guardian.

(3) Terminate existing DDD paid services when they reach their authorized end date.

(4) Provide you notice and appeal rights for denied and/or terminated service(s) per WAC 388-825-100 and WAC 388-825-120.

(5) Provide you with information on how to contact DDD in case you later decide you want a DDD Assessment administered.

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NEW SECTION
WAC 388-828-1340   After administering the DDD assessment, how long does DDD have to complete your DDD assessment?   (1) DDD will complete your DDD Assessment as soon as possible after it is administered.

(2) DDD will complete your DDD Assessment no later than thirty days from the date it was created in CARE.

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NEW SECTION
WAC 388-828-1360   Are there any exceptions to completing your DDD assessment within thirty days?   DDD will not complete your DDD assessment when:

(1) You are approved to receive a DDD paid service; and

(2) You or your legal guardian has not identified an ADSA contracted provider.

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NEW SECTION
WAC 388-828-1380   What will DDD do if you are unable to identify an ADSA contracted provider?   If you are unable to identify an ADSA contracted provider, DDD will provide you or your legal guardian with contact information for ADSA contracted agency providers.

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NEW SECTION
WAC 388-828-1400   What is your responsibility when selecting and/or hiring an ADSA contracted individual provider?   You or your legal representative/guardian has the primary responsibility for identifying, hiring, supervising, and/or terminating an ADSA contracted individual provider.

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NEW SECTION
WAC 388-828-1420   What is your responsibility when selecting an ADSA contracted agency provider?   You or your legal representative/guardian has the responsibility of choosing an agency provider. DDD or the county will provide you information on contracted and qualified agency providers.

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NEW SECTION
WAC 388-828-1440   What is the definition of DDD "paid service" in chapter 388-828 WAC?   For the purpose of this chapter, a DDD paid service is defined as an authorization of a program and/or service as evidenced by one or more of the following:

(1) An open social service payment system (SSPS) authorization within the past ninety days used for payment of a service or SSP; or

(2) A current county service authorization for one of the following services:

(a) Person to Person; or

(b) Individual Employment; or

(c) Group Supported Employment; or

(d) Pre-vocational/Specialized Industries; or

(e) Community Access; or

(f) Individual and Family Assistance.

(3) A current waiver POC or waiver ISP; or

(4) Residence in a State Operated Living Alternative (SOLA) program; or

(5) Authorization of Family Support services within the last twelve months per chapter 388-825 WAC; or

(6) Documentation of DDD approval of your absence from DDD paid services for more than ninety days with available funding for your planned return to services; or

(7) Evidence of approval for funding of a DDD service or enrollment in a DDD HCBS waiver; or

(8) Payment of services using Form A-19 State of Washington Invoice Voucher for receipt of:

(a) Dangerous Mentally Ill Offender funds

(b) Crisis stabilization services;

(c) Specialized psychiatric services; or

(d) Diversion bed services.

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NEW SECTION
WAC 388-828-1460   When will you receive an initial DDD assessment?   DDD intends to assess all clients per WAC 388-828-1100 by June 30, 2008. DDD must administer an initial DDD Assessment when:

(1) You are receiving a DDD paid service and your annual reassessment is due for continuation of the DDD paid service; or

(2) You are receiving a DDD paid service and a reassessment is needed due to a significant change that may affect your support needs; or

(3) You are receiving SSP in lieu of a DDD paid service and your eligibility for SSP needs to be re-determined per WAC 388-827-0120;

(4) You are approved for funding of a DDD paid service and an assessment must be performed prior to the authorization of services; or

(5) You make a request to have a DDD Assessment administered and meet the criteria in WAC 388-828-1100; or

(6) You are contacted by DDD and offered an opportunity to have a DDD Assessment.

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NEW SECTION
WAC 388-828-1480   Are there any exceptions allowing authorization of a DDD paid service prior to administering a DDD assessment?   During the year prior to July 2008, due to staff resources, DDD may authorize or reauthorize the following services before a DDD assessment is administered:

(1) Funding from the legislature that provides resources for services to be available by a certain date;

(2) The annual reallocation of dollars for Traditional Family Support in June 2007; or

(3) Emergency services as determined by DDD as critical to the client's health and safety.

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NEW SECTION
WAC 388-828-1500   When does DDD conduct a reassessment?   A reassessment must occur:

(1) On an annual basis if you are receiving a paid service or SSP; or

(2) When a significant change is reported that may affect your need for support. (e.g. changes in your medical condition, caregiver status, behavior, living situation, employment status).

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NEW SECTION
WAC 388-828-1520   Where is the DDD assessment and reassessment administered?   The DDD Assessment and reassessment are administered in your place of residence.

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NEW SECTION
WAC 388-828-1540   Who participates in your DDD assessment?   (1) All relevant persons who are involved in your life may participate in your DDD Assessment, including your parent(s), legal representative/guardian, advocate(s), and service provider(s).

(2) DDD requires that at a minimum: you, one of your respondents, and your DDD case resource manager/social worker participate in your DDD Assessment interview. In addition:

(a) If you are under the age of eighteen, your parent(s) or legal guardian(s) must participate in your DDD Assessment interview.

(b) If you are age eighteen or older, your court appointed legal representative/guardian must be consulted if he/she does not attend your DDD Assessment interview.

(c) If you are age eighteen and older and have no legal representative/guardian, DDD will assist you to identify a respondent.

(d) DDD may require additional respondents to participate in your DDD Assessment interview, if needed, to obtain complete and accurate information.

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NEW SECTION
WAC 388-828-1560   Do all questions in the DDD assessment have to be answered?   All questions in the DDD Assessment that are on a mandatory panel must be answered.

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NEW SECTION
WAC 388-828-1580   Why does DDD require all questions on mandatory panels to be answered in the DDD assessment?   DDD requires that all questions on mandatory panels be answered because:

(1) The legislature has directed DDD to assess all eligible clients with a common, standardized assessment process that measures the support needs of individuals with developmental disabilities.

(2) The DDD Assessment algorithms in the Support Assessment module are designed to:

(a) Determine acuity scores and acuity levels for a variety client needs; and

(b) Provide a valid measure of each client's support needs relative to the support needs of other clients who have received the DDD Assessment.

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NEW SECTION
WAC 388-828-1600   What happens if you refuse to answer a question on a mandatory panel in the DDD assessment?   If you refuse to answer a question on a mandatory panel in the DDD Assessment, DDD is unable to complete your DDD Assessment and will do all of the following:

(1) Explain what happens if you refuse to answer a question on a mandatory panel to you, your respondents, and the person you have identified to receive notice on your behalf per RCW 71A.10.060.

(2) Consult with the Assistant Attorney General when you have not identified a person to receive notice on your behalf per RCW 71A.10.060 to determine if:

(a) You are able to represent yourself; or

(b) You require a legal representative/guardian.

(3) Terminate existing DDD paid services when they reach their authorized end date;

(4) Provide you notice and appeal rights for denied and/or terminated service(s) per WAC 388-825-100 and WAC 388-825-120; and

(5) Provide you with information on how to contact DDD in case you later decide you want a DDD Assessment administered.

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NEW SECTION
WAC 388-828-1620   How does DDD determine which panels are mandatory in your DDD assessment?   DDD determines which panels are mandatory in your DDD Assessment by assigning you to a client group using the following table:


If you are approved by DDD to receive: Your client group is:
(1) DDD DCBS Waiver services per chapter 388-845 WAC; or

(2) State-only residential services per chapter 388-825 WAC; or

(3) ICF/MR services per 42 CFR 440 and 42 CFR 483.

Waiver and State-Only Residential
(4) Medicaid personal care (MPC) per chapter 388-106 WAC; or

(5) DDD HCBS Basic, Basic Plus, or Core Waiver services per chapter 388-845 WAC and Personal Care services per chapter 388-106 WAC; or

(6) Medically Intensive Health Care Program services per chapter 388-551 WAC; or

(7) Adult Day Health services per chapter 388-106 WAC; or

(8) Private Duty Nursing services per chapter 388-106 WAC; or

(9) Community Options Program Entry System (COPES) services per chapter 388-106 WAC; or

(10) Medically Needy Residential waiver services per chapter 388-106 WAC; or

(11) Medicaid Nursing Facility Care services per chapter 388-106 WAC.

Other Medicaid Paid Services
(12) County Employment services per chapter 388-850 WAC.

(13) Other DDD paid services per chapter 388-825 WAC, such as:

(a) Family support services; or

(b) Professional services.

(14) Non-waiver voluntary placement program services per chapter 388-826 WAC;

(15) SSP only per chapter 388-827 WAC;

State-Only Paid Services
(16) You are not approved to receive any DDD paid services. No Paid Services

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NEW SECTION
WAC 388-828-1640   What are the mandatory panels in your DDD assessment?   After DDD has determined your client group, DDD determines the mandatory panels in your DDD Assessment using the following tables. An "X" indicates that the panel is mandatory; an "O" indicates the panel is optional. If it is blank, the panel is not used.

(1) DDD "Assessment Main" and Client Details Information


Client Group
DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State Only Paid Services
Assessment Main X X X X
Demographics X X X X
Overview X X X X
Addresses X X X X
Collateral Contacts X X X X
Financials X X X X

(2) Supports Intensity Scale Assessment


Client Group
DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State-Only Paid Services
Home Living X X X X
Community Living X X X X
Lifelong Learning X X X X
Employment X X X X
Health & Safety X X X X
Social Activities X X X X
Protection & Advocacy X X X X

(3) Support Assessment for Children


Client Group
DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State-Only Paid Services
Activities of Daily Living X X X X
IADLs (Instrumental Activities of Daily Living) X X X X
Family Supports X X X X
Peer Relationships X X X X
Safety & Interactions X X X X

(4) Common Support Assessment Panels


DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State-Only Paid Services
Medical Supports X X X X
Behavioral Supports X X X X
Protective Supervision X X X X
DDD Caregiver Status* X X X X
Programs and Services X X X X
*Information on the DDD Caregiver Status panel is not mandatory for clients receiving paid services in an AFH, SL, GH, SOLA, or RHC.

(5) Service Level Assessment Panels


DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State-Only Paid Services
Environment X X O
Medical Main O X O
Medications X X X
Diagnosis X X X
Seizures X X X
Medication Management X X X
Treatments/programs X X X
ADH (Adult Day Health) O O O
Pain X X X
Indicators-Main O X O
Allergies X X X
Indicators/Hospital X X X
Foot X X O
Skin X X O
Skin Observation O O O
Vitals/Preventative X X O
Comments O O O
Communication-Main O X O
Speech/Hearing O X O
Psych/Social O X O
MMSE (Mini-Mental Status Exam) O X O
Memory O X O
Behavior O X O
Depression O X O
Suicide O O O
Sleep O O O
Relationships & Interests O O O
Decision Making O X O
Goals X O O
Legal Issues O O O
Alcohol O O O
Substance Abuse O O O
Tobacco O X O
Mobility Main O X O
Locomotion In Room O X O
Locomotion Outside Room O X O
Walk in Room O X O
Bed Mobility O X O
Transfers O X O
Falls O O O
Toileting-Main O X O
Bladder/Bowel O X O
Toilet Use O X O
Eating-Main O X O
Nutritional/Oral O X O
Eating O X O
Meal Preparation O X O
Hygiene-Main O X O
Bathing O X O
Dressing O X O
Personal Hygiene O X O
Household Tasks O X O
Transportation O X O
Essential Shopping O X O
Wood Supply O X O
Housework O X O
Finances O O O
Pet Care O O O
Functional Status O O O
Employment Support* X* X* X*
Mental Health X X X
DDD Sleep* X* O O
*Indicates that:

(a) The "Employment Support" panel is mandatory only for clients age twenty-one and older who are on or being considered for one of the county services listed in WAC 388-828-1440(2).

(b) The "DDD Sleep" panel is mandatory only for clients who are age eighteen or older and who are receiving:

(i) DDD HCBS Core or Community Protection waiver services; or

(ii) State-Only residential services.

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Support Assessment Module
NEW SECTION
WAC 388-828-2000   What is the support assessment module?   The Support Assessment module is the first section of the DDD Assessment and is administered to all DDD clients.

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NEW SECTION
WAC 388-828-2020   What is the purpose of the support assessment module?   The purpose of the Support Assessment module is to:

(1) Collect a common set of assessment information that is scored for all persons who are eligible to receive a DDD Assessment per WAC 388-828-1100;

(2) Promote a consistent process to evaluate client support needs;

(3) Determine whether a person meets the ICF/MR level of care standard for potential waiver eligibility; and

(4) Identify the persons receiving, or approved for, DDD paid services or SSP who will need the additional two assessment modules:

(a) The Service Level Assessment module; and

(b) The Individual Support Plan module.

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NEW SECTION
WAC 388-828-2040   What components are contained in the support assessment module?   The Support Assessment module contains the following components:

(1) The Support Assessment for Children;

(2) The Supports Intensity Scale (SIS)Assessment;

(3) DDD Protective Supervision Acuity Scale;

(4) DDD Caregiver Status Acuity Scale;

(5) DDD Activities of Daily Living (ADL) Acuity Scale;

(6) DDD Behavioral Acuity Scale;

(7) DDD Medical Acuity Scale;

(8) DDD Interpersonal Support Acuity Scale;

(9) DDD Mobility Acuity Scale;

(10) DDD Respite Assessment; and

(11) Programs and Services component.

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NEW SECTION
WAC 388-828-2060   How does your assessment age affect the support assessment module?   Age guidelines are incorporated into the support assessment module to exclude age appropriate supports unrelated to a disability. The following table illustrates which components DDD includes in your Support Assessment module based on your assessment age:


Components contained in the Support Assessment module Age

(0-15)

Age

(16+)

The Support Assessment for Children Yes No
SIS Support Needs and Supplemental Protection and Advocacy Scales No Yes
SIS Exceptional Medical and Behavior Support Needs Scales Yes Yes
DDD Protective Supervision Acuity Scale Yes Yes
DDD Caregiver Status Acuity Scale Yes Yes
DDD Activities of Daily Living Acuity Scale Yes Yes
DDD Behavioral Acuity Scale Yes Yes
DDD Medical Acuity Scale Yes Yes
DDD Interpersonal Support Acuity Scale Yes Yes
DDD Mobility Scale Yes Yes
Current Programs and Services component Yes Yes

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NEW SECTION
WAC 388-828-2080   How does DDD determine your assessment age?   If you are within thirty calendar days of your next birthday, DDD determines your assessment age to be that of your next birthday.

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The Support Assessment for Children
NEW SECTION
WAC 388-828-3000   What is the purpose of the support assessment for children?   The Support Assessment for Children measures the support needs of children from birth to age fifteen.

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NEW SECTION
WAC 388-828-3020   What is the purpose of the support assessment for children?   The purpose of the Support Assessment for Children ages fifteen or younger is to determine:

(1) Your ICF/MR Level of Care score for DDD HCBS waiver eligibility;

(2) The health and welfare needs that must be addressed in your individual support plan if you are enrolled in a DDD HCBS waiver; and

(3) Your support need levels for:

(a) The DDD Activities of Daily Living Acuity Scale;

(b) The DDD Interpersonal Support Acuity Scale; and

(c) The DDD Mobility Acuity Scale.

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NEW SECTION
WAC 388-828-3040   What questions are asked in the support assessment for children and how are they scored?   DDD scores the answers to each of the following questions in the Support Assessment for Children based on the respondent information:

(1) Dress and groom self: What support does the child need to dress and groom self as expected of others of same age?


Answers Definitions LOC Score Acuity Score
Physical Assistance Needs major support in the form of total physical assistance, intensive training and/or therapy for dressing and grooming. 1 4
Training Needs moderate support in the form of some physical assistance and/or training and/or therapies to dress and groom self. 0 3
Reminders/Prompts Needs reminders or prompts to dress and groom self appropriately. 0 2
No support needed or at age level At age level (may have physical supports) in dressing and grooming. 0 0

(2) Toilet self: What support does the child need to toilet self as expected of others in his/her age group?


Answers Definitions LOC Score Acuity Score
Total physical support Needs major support in the form of total physical support. Intensive training intervention and/or daily therapy to toilet self. 1 4
Partial physical assistance, training Needs moderate support in the form of some physical assistance, standard training and/or regular therapy. 0 3
Reminders/prompts Needs reminders or prompts. 0 2
No support needed or at age level Toilets self or has physical support in place to toilet self. 0 0

(3) Eat at age level: What support does the child need to eat at age level?


Answers Definitions LOC Score Acuity Score
Total physical support Needs major support in the form of total physical assistance, intensive training and/or daily therapy. 1 4
Partial physical assistance, training Needs moderate support in the form of some physical assistance, standard training, and/or regular therapy. 1 3
Reminders/prompts Needs help with manners and appearance when eating, in the form of reminders and prompts. 0 2
No support needed or at age level At age level (may have physical supports) in eating. 0 0

(4) Move Around: What support does the child need to move around in the same ways as other children of same age?


Answers Definitions LOC Score Acuity Score
Total physical support Needs major intervention in the form of total physical support to move around, intensive training and/or daily therapy. 1 4
Partial physical assistance, training Needs moderate support such as someone's help to move around or may use or learn to use adaptive device or may require standard training. 1 3
Reminders/prompts Needs mild intervention in the form of training and physical prompting for scooting/crawling/walking behaviors. 0 2
No support needed or at age level No supports needed - child is scooting/crawling/walking at age level 0 0

(5) Communicate: What support does the child need to communicate as others of same age?


Answers Definitions LOC Score Acuity Score
Total physical support Currently someone else must always determine and communicate child's needs. 1 4
Training/therapy With intensive training or therapy support, child may learn sufficient verbal and/or signing skills to make self easily understandable to others. May include partial physical support. 1 3
Adaptive device/interpreter With physical support (adaptive device, interpreter), child is always able to communicate. 0 2
No support needed or at age level No supports needed and/or at age level. 0 0

(6) Learn about and use money: What support does the child need to learn about and use money?


Answers Definitions LOC Score Acuity Score
Total physical support Child is not old enough to know about money. 0 4
Partial physical assistance, training Family must devise special opportunities for child to earn/or spend money. 0 3
Create opportunities, reminders/prompts Needs to learn about earning and/or spending money in typical age-level ways. 0 2
No support needed or at age level Needs no support. Independently uses opportunities typical to his/her age group to earn and/or spend money. 0 0

(7) Make choices and take responsibility: What support does the child need to make choices and take responsibility?


Answers Definitions LOC Score Acuity Score
Total physical support Needs major support in the form of special and/or technical help to and from family/teachers to create opportunities for making choices and taking responsibility. 1 4
Partial physical assistance, training Needs moderate support in the form of family/teachers creating and explaining a variety of opportunities for making choices and taking responsibility. 1 3
Create opportunities, reminders/prompts Needs some support in the form of explanation of available options for making choices and taking responsibility. 1 2
No support needed or at age level Needs no support. Readily uses a variety of opportunities to indicate choices (activity, food, etc.) and take responsibility for tasks, self, etc. 0 0

(8) Explore environment: What support does the child need to explore environment?


Answers Definitions LOC Score Acuity Score
Total physical support Needs major support in the form of specialized technical help to and from family/teachers to create ways which support/encourage child to explore and reach out. 1 4
Partial physical assistance, training Needs moderate support in the form of some training/physical help to and from family and teachers to create ways and opportunities for child to explore environment and reach out. 1 3
Reminders/prompts Needs some support in the form of verbal encouragement or presence of someone child trusts to explore environment and reach out. 0 2
No support needed or at age level Needs no support and/or is at age level. Readily explores environment (may have adaptive device) and reaches out in ways typical to child's age group. 0 0

(9) Meet therapy health needs: What supports are necessary to get child's therapy health needs met?

Answers Definitions LOC Score Acuity Score
Daily intervention by professionals Child requires medical/health intervention or monitoring by professionals at least daily. 1 4
Monitoring by health professionals Child needs regular (weekly, monthly) monitoring by health professionals. 1 3
Monitoring by trained others Child needs daily support and/or monitoring by training others. 1 2
Community health system Needs regular on-going therapy and/or monitoring of health needs through typical community health systems. 0 1
No support needed or at age level No specialized supports or ongoing therapies necessary. 0 0

(10) Help family continue to meet child's needs: What support services should the system provide to help family continue to meet child's needs?


Answers Definitions LOC Score Acuity Score
Urgent extensive support Substantial significant supports to child and parents needed. Child in, or at risk of, out-of-home placement at this time. 1 4
Substantial support/referrals needed Substantial support needed/requested; (e.g., requests for more than two days per month respite, referral to homemakers, homebuilders; request for long term behavior management training, need extensive and/or expensive environmental modification or equipment; request frequent contact with case manager.) 1 3
Moderate support Moderate external support needed/requested; (e.g., requests for regular respite, intensive but short-term behavior management, referral for parent training help, referral to day care services; and/or request for regular contact with case manager.) 0 2
Minimal support Minimal external support needed/requested; (e.g., requests for occasional respite, referrals to parent support group, and/or case manager helps obtain adaptive equipment.) 0 1
No support needed or at age level No external supports are necessary. Family has obtained any necessary adaptive equipment. 0 0

(11) Have relationships with family members: What support does the child need to make the kind of relationships with family members expected of non-disabled children of the same age?


Answers Definitions LOC Score Acuity Score
Total physical support Opportunities for contributing to family life totally dependent on others to maintain, interpret child's role to other family members. 0 4
Partial physical assistance, training Requires major support in the form of daily/weekly creation of opportunities to be seen as a contributing member and assume typical family responsibilities. 0 3
Reminders/prompts Requires moderate support in the form of adaptive device, training and/or reminders to be seen as contributing member and assume typical family responsibilities. 0 2
No support needed or at age level Needs no support to form positive family relationship. 0 0

(12) Explore and use typical community resources: What support does the child need to explore and use typical community resources such as stores, parks, and playgrounds?


Answers Definitions LOC Score Acuity Score
Total physical support Family needs major support (perhaps respite) to continue to provide child total physical support to use typical resources. 0 4
Partial physical assistance, training Moderate support is needed - family must create ways for child to use these resources in ways typical to child's age group. 0 3
Reminders/prompts Minimal support needed - family may wish suggestions or some support on ways to enable child's regular use of typical resources. 0 2
No support needed or at age level Needs no support and/or at age level. Uses these resources regularly. 0 0

(13) Play with others: What supports are needed for the child to develop age-level skills in playing with others?


Answers Definitions LOC Score Acuity Score
Total physical support Major support needed by others to help child play. Parents may request special adaptive equipment and training to foster child's playing skills. 0 4
Partial physical assistance training Moderate support needed in the form of a verbal and/or some physical intervention to help child play. Parents may be requesting suggestions instruction in ways to help child develop playing skills. 0 3
Reminders/prompts Minimal support needed. 0 2
No support needed or at age level No supports needed and/or at age level. Child's playing skills developing at age level. 0 0

(14) Have opportunities to play with typically developing children: What supports does the child need to have opportunities to play with typically developing children?


Answers Definitions LOC Score Acuity Score
Total physical support Substantial system support (e.g., system must set up "programs" that allow for interaction with typically developing children and the "programs".) 0 4
Partial physical assistance, training Moderate supports (e.g., parents have to create opportunities for contacts). Parents may ask for instruction in how to facilitate such contacts. System may need to provide structural supports (e.g., transportation, barrier-free public play environments, etc). 0 3
Reminders/prompts Minimal support (e.g., some monitoring). Parents may request help on how to broaden child's range of contacts or to increase the age appropriateness of contacts. 0 2
No support needed or at age level No support needed. 0 0

(15) Identify and respond safely to emergencies: What support does the child need to identify and respond safely to emergencies?


Answers Definitions LOC Score Acuity Score
Total physical support Needs total physical support to respond to emergencies. 1 4
Always needs help to identify and respond Needs help all of the time to identify emergencies and to respond. 1 3
Sometimes needs help to identify and respond Needs help some of the time to identify emergencies and to respond. 1 2
Can identify, needs help to respond Independently identifies emergencies; needs help from others to respond. 1 1
No help needed or at age level Needs no help from others in emergencies. 0 0

(16) Practice age-level safety measures: What support does the child need to practice age-level safety measures?


Answers Definitions LOC Score Acuity Score
Total physical support Needs total physical support for safety measures in daily activities and routines. 1 4
Partial physical assistance, training Does not recognize own safety needs and requires help in most safety areas. 1 3
Reminders/prompts Knows importance of safety measures. Needs training and/or physical support in many areas. 1 2
No support needed or at age level Needs no support in providing for own safety. 0 0

(17) Effectively relate to other students/peers: What support does the child need to most effectively relate to fellow students and/or peers?


Answers Definitions LOC Score Acuity Score
Total physical support Needs physical support by others in the form of interpretation of self to others to interact with peers. 1 4
Partial physical assistance, training Needs physical intervention in the form of modeling to enable child to reach out to peers to give and take support. 1 3
Reminders/prompts Needs much encouragement, supervision and guidance in how to give and ask for support and interact with peers. 0 2
No support needed or at age level Without support, child relates to others as a valued member of work/learning unit. 0 0

(18) Have behaviors which promote being included: What support is needed for this child to have behaviors which promote being included?


Answers Definitions LOC Score Acuity Score
Continuous behavioral interventions Needs major tolerance and control. Could include being dangerous to self and/or others. 1 4
Major behavior modifications Needs major behavior modifications to be perceived as typical. Child's behaviors are extremely disagreeable to others. 1 3
Modeling, reminders, prompts Needs participation in typical settings with typically developing others to model desirable behaviors. Child's behaviors cause him/her to be easily recognized as different from others. 0 2
Minor support Needs interactions with typically developing others. Child's behaviors are different from others in minor ways and the child may not immediately be perceived as different. 0 1
No support needed or at age level Needs no support. Behaviors are similar to others in general community of same age and culture. 0 0

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NEW SECTION
WAC 388-828-3060   How does DDD determine your total LOC score for ICF/MR level of care if you are age birth through fifteen years old?   DDD determines your total LOC score for ICF/MR Level of Care by adding all of your LOC scores on questions one through eighteen in the Support Assessment for Children.

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NEW SECTION
WAC 388-828-3080   How does DDD determine if you meet the eligibility requirements for ICF/MR level of care (LOC) if you are age birth through fifteen years old?   DDD determines you are eligible for ICF/MR Level of Care when:

(1) You are age birth through five years old and the total of your LOC scores is five or more; or

(2) You are age six through fifteen years old and the total of your LOC scores is seven or more.

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The Supports Intensity Scale Assessment
NEW SECTION
WAC 388-828-4000   What is the supports intensity scale (SIS) assessment?   The Supports Intensity Scale assessment is a standardized tool developed by the American Association on Intellectual and Developmental Disabilities (AAIDD), to measure the relative intensity of support needs for persons age sixteen and older.

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NEW SECTION
WAC 388-828-4020   What is the purpose of the supports intensity scale (SIS) assessment?   The purpose of the Supports Intensity Scale assessment in the DDD Assessment is to determine all of the following:

(1) Your ICF/MR Level of Care score for DDD HCBS waiver eligibility;

(2) The health and welfare needs that must be addressed in your individual support plan if you are enrolled in a DDD HCBS waiver;

(3) Your DDD behavioral and medical acuity levels regardless of your age; and

(4) Your support need acuity levels specific to the:

(a) DDD Activities of Daily Living Acuity Scale;

(b) DDD Interpersonal Support Acuity Scale; and

(c) DDD Mobility Acuity Scale.

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NEW SECTION
WAC 388-828-4040   What scales are contained in the supports intensity scale (SIS) assessment?   The Supports Intensity Scale Assessment contains the following:

(1) The Support Needs scale;

(2) The Supplemental Protection and Advocacy scale;

(3) Exceptional Medical Support Needs scale; and

(4) Exceptional Behavioral Support Needs scale.

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NEW SECTION
WAC 388-828-4060   What subscales are contained in the support needs scale?   The Support Needs Scale contains the following subscales:

(1) Home living activities;

(2) Community living activities;

(3) Lifelong learning activities;

(4) Employment activities;

(5) Health and safety activities; and

(6) Social activities.

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NEW SECTION
WAC 388-828-4080   How does the SIS measure your support need(s) in the support needs and supplemental protection and advocacy scales?   The SIS measures your support needs in the Support Needs and Supplemental Protection and Advocacy Scales using the following three dimensions of support intensity:

(1) Type of support;

(2) Frequency of support; and

(3) Daily support time.

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NEW SECTION
WAC 388-828-4100   How is type of support scored in the SIS assessment?   DDD scores the type of support you need to perform the assessed activity using the following rating scale:


Type of Support: What kind of support is needed for the assessed activity?
Answer Score
None 0
Monitoring 1
Verbal/gestural prompting 2
Partial physical assistance 3
Full physical assistance 4

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NEW SECTION
WAC 388-828-4120   How is frequency of support scored in the SIS assessment?   DDD scores how frequently support is needed for you to perform the assessed activity using the following rating scale:

Frequency: How frequently is support needed for the assessed activity?
Answer Score
None or less than monthly 0
At least once a month, but not once a week 1
At least once a week, but not once a day 2
At least once a day, but not once an hour 3
Hourly or more frequently 4

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NEW SECTION
WAC 388-828-4140   How is daily support time scored in the SIS assessment?   DDD scores the amount of daily support time you need to perform the assessed activity using the following rating scale:

Daily Support Time: On a typical day when support in this area is needed, how much time should be devoted?
Answer Score
None 0
Less than 30 minutes 1
30 minutes to less than 2 hours 2
2 hours to less than 4 hours 3
4 hours or more 4

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NEW SECTION
WAC 388-828-4160   How does DDD determine your raw score for each of the activities that are assessed in the support needs and supplemental protection and advocacy scales?   DDD adds the three dimensions of support intensity scores for each activity to determine your raw score for the activity.

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NEW SECTION
WAC 388-828-4180   Are all questions in the support needs and supplemental protection and advocacy scales scored the same way?   Some questions in the Support Needs and Supplemental Protection and Advocacy Scales have scoring limitations and some scores are not available for selection related to the standardization process per AAIDD.

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NEW SECTION
WAC 388-828-4200   What activities are assessed in the home living activities subscale of the support needs scale?   The Home Living Activities subscale measures your personal support needs for the following home living activities:


# Home Living Activities Type of Support Frequency of Support Daily Support Time Raw Score
A1 Using the toilet 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
A2 Taking care of clothes (includes laundering) 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
A3 Preparing food 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
A4 Eating food 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
A5 Housekeeping and cleaning 0 1 2 3 4 0 1 2 3 4 0 1 2 * *
A6 Dressing 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
A7 Bathing and taking care of personal hygiene and grooming needs 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
A8 Operating home appliances 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
A9 Using currently prescribed equipment or treatment 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
Total Raw Score for Home Living Activities:
* = Score is not an option per AAIDD.

Note: Question A9 is a question added by DDD. It is for information purposes only and is not used to calculate scores or levels for service determination.

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NEW SECTION
WAC 388-828-4220   What activities are assessed in the community living activities subscale of the support needs scale?   The Community Living Activities subscale measures your personal support needs for the following community living activities:


# Community Living Activities Type of Support Frequency of Support Daily Support Time Raw Score
B1 Getting from place to place throughout the community (transportation) 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
B2 Participating in recreation/leisure activities in community settings 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
B3 Using public services in the community 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
B4 Going to visit friends and family 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
B5 Participating in preferred community activities (church, volunteer, etc.) 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
B6 Shopping and purchasing goods and services 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
B7 Interacting with community members 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
B8 Accessing public buildings and settings 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
Total Raw Score for Community Living Activities:
* = Score is not an option per AAIDD.

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NEW SECTION
WAC 388-828-4240   What activities are assessed in the lifelong learning activities subscale of the support needs scale?   The Lifelong Learning Activities subscale measures your personal support needs for the following lifelong learning activities:


# Lifelong Learning Activities Type of Support Frequency of Support Daily Support Time Raw Score
C1 Interacting with others in learning activities 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
C2 Participating in training/educational decisions 0 1 2 3 4 0 1 2 3 * 0 1 2 3 *
C3 Learning and using problem-solving strategies 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
C4 Using technology for learning 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
C5 Accessing training/educational settings 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
C6 Learning functional academics (reading signs, counting change, etc.) 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
C7 Learning health and physical education skills 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
C8 Learning self-determination skills 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
C9 Learning self-management strategies 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
Total Raw Score for Lifelong Learning Activities:
*= Score is not an option per AAIDD.

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NEW SECTION
WAC 388-828-4260   What activities are assessed in the employment activities subscale of the support needs scale?   The Employment Activities subscale measures your personal support needs for the following employment activities:


# Employment Activities Type of Support Frequency of Support Daily Support Time Raw Score
D1 Accessing/receiving/job/tasks accommodations 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
D2 Learning and using specific job skills 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
D3 Interacting with co-workers 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
D4 Interacting with supervisors and/or coaches 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
D5 Completing work-related tasks with acceptable speed 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
D6 Completing work-related tasks with acceptable quality 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
D7 Changing job assignments 0 1 2 3 4 0 1 2 * * 0 1 2 3 4
D8 Seeking information and assistance from an employer 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
Total Raw Score for Employment Activities:
* = Score is not an option per AAIDD.

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NEW SECTION
WAC 388-828-4280   What activities are assessed in the health and safety activities subscale of the support needs scale?   The Health and Safety Activities subscale measures your personal support needs for the following health and safety activities:


# Health and Safety Activities Type of Support Frequency of Support Daily Support Time Raw Score
E1 Taking medications 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
E2 Avoiding health and safety hazards 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
E3 Obtaining health care services 0 1 2 3 4 0 1 2 3 4 0 1 2 * *
E4 Ambulating and moving about 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
E5 Learning how to access emergency services 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
E6 Maintaining a nutritious diet 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
E7 Maintaining physical health and fitness 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
E8 Maintaining emotional well-being 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
Total Raw Score for Health and Safety Activities:
* = Score is not an option per AAIDD.

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NEW SECTION
WAC 388-828-4300   What activities are assessed in the social activities subscale of the support needs scale?   The Social Activities subscale measures your personal support needs for the following social activities:


# Social Activities Type of Support Frequency of Support Daily Support Time Raw Score
F1 Socializing within the household 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
F2 Participating in recreation and/or leisure activities with others 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
F3 Socializing outside the household 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
F4 Making and keeping friends 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
F5 Communicating with others about personal needs 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
F6 Using appropriate social skills 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
F7 Engaging in loving and intimate relationships 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
F8 Engaging in volunteer work 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
Total Raw Score for Social Activities:
* = Score is not an option per AAIDD.

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NEW SECTION
WAC 388-828-4320   What activities are assessed in the supplemental protection and advocacy activities subscale?   The Supplemental Protection and Advocacy Activities subscale measures your personal support needs for the following protection and advocacy activities:


# Protection and Advocacy Activities Type of Support Frequency of Support Daily Support Time Raw Score
G1 Advocating for self 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
G2 Managing money and personal finances 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
G3 Protecting self from exploitation 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
G4 Exercising legal responsibilities 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
G5 Belonging to and participating in self-advocacy/support organizations 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
G6 Obtaining legal services 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
G7 Making choices and decisions 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
G8 Advocating for others 0 1 2 3 4 0 1 2 3 * 0 1 2 3 4
Total Raw Score for Protection and Advocacy Activities:
* = Score is not an option for AAIDD.

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NEW SECTION
WAC 388-828-4340   How does DDD determine your support score for each of the items identified in the SIS exceptional medical and behavioral support needs scales?   DDD examines the amount of support you need for medical treatments and behavioral support using the following rating scale:


Answer Score
No support needed 0
Some support needed 1
Extensive support needed 2

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NEW SECTION
WAC 388-828-4360   What exceptional medical support activities are evaluated to assess your medical support needs?   The SIS Exceptional Medical Support Needs Scale measures your personal support needs for the following medical support need(s) activities:


# Medical Supports Needed No Support Needed Some Support Needed Extensive Support Needed
1. Inhalation or oxygen therapy 0 1 2
2. Postural drainage 0 1 2
3. Chest PT 0 1 2
4. Suctioning 0 1 2
5. Oral stimulation or jaw positioning 0 1 2
6. Tube feeding (e.g., nasogastric) 0 1 2
7. Parenteral feeding (e.g., IV) 0 1 2
8. Turning or positioning 0 1 2
9. Dressing of open wound(s) 0 1 2
10. Protection from infectious diseases due to immune system impairment 0 1 2
11. Seizure management 0 1 2
12. Dialysis 0 1 2
13. Ostomy care 0 1 2
14. Lifting and/or transferring 0 1 2
15. Therapy services 0 1 2
16. Diabetes Management* 0 1 2
17. Other(s) - Specify: 0 1 2
Sub-total Scores of 1s and 2s:
Add Sub-totals scores for 1's and 2's for total exceptional Medical Support Needs Score:
* #16 is a question added by DDD. It is used as part of the DDD Medical Acuity Scale and is not used to calculate SIS percentiles.

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NEW SECTION
WAC 388-828-4380   What exceptional behavioral support activities are evaluated to assess your behavioral support needs?   The SIS Exceptional Behavioral Support Needs Scale measures your personal support needs for the following behaviors:


# Behavioral Supports Needed No Support Needed Some Support Needed Extensive Support Needed
1. Prevention of assaults or injuries to others 0 1 2
2. Prevention of property destruction (e.g., fire setting, breaking furniture) 0 1 2
3. Prevention of stealing 0 1 2
4. Prevention of self-injury 0 1 2
5. Prevention of PICA (ingestion of inedible substances) 0 1 2
6. Prevention of suicide attempts 0 1 2
7. Prevention of sexual aggression 0 1 2
8. Prevention of non-aggressive but inappropriate behavior (e.g., exposes self in public, exhibitionism, inappropriate touching or gesturing) 0 1 2
9. Prevention of tantrums or emotional outbursts 0 1 2
10. Prevention of wandering 0 1 2
11. Prevention of substance abuse 0 1 2
12. Maintenance of mental health treatments 0 1 2
13. Managing attention-seeking behavior* 0 1 2
14. Managing uncooperative behavior* 0 1 2
15. Managing agitated/over reactive behavior* 0 1 2
16. Managing obsessive/repetitive behavior* 0 1 2
17. Prevention of other serious behavior problem(s) - Specify: 0 1 2
Sub-total Scores of 1s and 2s:
Add sub-totals scores for 1s and 2s for total exceptional Behavioral Support Needs Scores:
*#13-16 are questions added by DDD. They are used as part of the DDD Behavior Acuity Scale and are not used to calculate SIS percentiles.

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NEW SECTION
WAC 388-828-4400   How does DDD determine if you meet the eligibility requirements for ICF/MR level of care if you are age sixteen or older?   If you are age sixteen or older, DDD determines you to be eligible for ICF/MR Level of Care from your SIS scores. Eligibility for ICF/MR Level of Care requires that your scores meet at least one of the following:

(1) You have a percentile rank that is over nine percent for three or more of the six subscales in the SIS Support Needs Scale;

(2) You have a percentile rank that is over twenty-five percent for two or more of the six subscales in the SIS Support Needs Scale;

(3) You have a percentile rank that is over fifty percent in at least one of the six subscales in the SIS Support Needs Scale;

(4) You have a support score of one or two for any of the questions listed in the SIS Exceptional Medical Support Needs Scale;

(5) You have a support score of one or two for at least one of the following items in the SIS Exceptional Behavior Support Needs Scale:

(a) Prevention of assaults or injuries to others;

(b) Prevention of property destruction (e.g., fire setting, breaking furniture);

(c) Prevention of self-injury;

(d) Prevention of PICA (ingestion of inedible substances);

(e) Prevention of suicide attempts;

(f) Prevention of sexual aggression; or

(g) Prevention of wandering.

(6) You have a support score of two for any of the questions listed in the SIS Exceptional Behavior Support Needs Scale; or

(7) You meet or exceed any of the qualifying scores for one or more of the following SIS questions:


Question # of SIS Support Needs Scale Text of Question Your score for

"Type of Support" is:

And your score for "Frequency of Support" is:
A1 Using the toilet 2 or more 4
3 or more 2
A2 Taking care of clothes

2 or more 2 or more
3 or more 1
A3 Preparing food 2 or more 4
3 or more 2
A4

Eating food 2 or more 4
3 or more 2
A5 Housekeeping and cleaning 2 or more 2 or more
3 or more 1
A6

Dressing 2 or more 4
3 or more 2
A7

Bathing and taking care of personal hygiene and grooming needs 2 or more 4
3 or more 2
C3

Learning and using problem-solving strategies 2 or more 3 or more
3 or more 2
C9

Learning self-management strategies 2 or more 3 or more
3 or more 2
B6 Shopping and purchasing goods and services 2 or more 2 or more
3 or more 1
E1 Taking medication 2 or more 4
3 or more 2
E2 Avoiding health and safety hazards 2 or more 3 or more
3 or more 2
E4

Ambulating and moving about 2 or more 4
3 or more 2
E6

Maintaining a nutritious diet 2 or more 2 or more
3 or more 1
E8

Maintaining emotional well-being 2 or more 3 or more
3 or more 2
F6

Using appropriate social skills 2 or more 3 or more
3 or more 2
G2

Managing money and personal finances 2 or more 2 or more
3 or more 1

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NEW SECTION
WAC 388-828-4420   How does DDD determine your percentile rank for each subscale in the SIS support needs scale?   DDD uses the following table to convert your total raw score for each subscale into a percentile ranking:


If your raw score for the following SIS subscale is:
Home Living Community Living Lifelong Learning Employment Support Health and Safety Social Activities Then your percentile rank for the SIS subscale is:
>99
>88 >94 >99
87-88 93-94 >99
85-86 91-92 >97 99
81-84 88-90 >96 >95 92-97 >97 98
77-80 84-87 92-96 91-95 86-91 91-97 95
73-76 79-83 86-91 85-90 79-85 84-90 91
68-72 74-78 79-85 78-84 72-78 76-83 84
62-67 69-73 72-78 70-77 65-71 68-75 75
55-61 63-68 64-71 61-69 57-64 58-67 63
48-54 56-62 55-63 52-60 49-56 48-57 50
40-47 49-55 46-54 42-51 42-48 38-47 37
32-39 41-48 36-45 32-41 34-41 28-37 25
25-31 33-40 27-35 23-31 27-33 19-27 16
18-24 25-32 18-26 15-22 20-26 10-18 9
11-17 16-24 9-17 7-14 13-19 3-9 5
3-10 6-15 <9 <7 7-12 <3 2
<3 <6 1-6 1
<1 <1
<1

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DDD Protective Supervision Acuity Scale
NEW SECTION
WAC 388-828-5000   What is the DDD protective supervision acuity scale?   The DDD Protective Supervision Acuity Scale is an assessment of your protective supervision support need(s).

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NEW SECTION
WAC 388-828-5020   How is information in the protective supervision acuity scale used by DDD?   (1) Information obtained in the Protective Supervision Acuity Scale is one of the factors used by DDD to determine the amount of waiver respite, if any, that you are authorized to receive.

(2) The Protective Supervision Acuity Scale is not used when determining your Medicaid personal care or waiver personal care; and

(3) The information is used for reporting purposes to the legislature and the department.

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NEW SECTION
WAC 388-828-5040   What questions are asked in the DDD protective supervision acuity scale?   The three questions that are asked for the DDD Protective Supervision Acuity Scale are in WAC 388-828-5060.

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NEW SECTION
WAC 388-828-5060   How does DDD score each question?   DDD selects one answer per each question that best describes your reported need.

(1) What level of monitoring does the client typically require during awake hours?


Answers Definitions Score
Independent Can be left unattended. Might occasionally show poor judgement, but does not require routine access to a support person. 0
Remote (e.g., a week or more) Can be left unattended for extended periods of time, but requires access to a support person either via phone or someone who visits the person weekly or so. 1
Periodic (e.g., every couple of days) Can be left unattended for a couple of days, but requires access to a support person who checks in every few days via telephone or in person. 2
Monitoring (e.g., half day, unstructured) Can be left unattended for several hours at a time (2-4 hours) to engage in independent activities, but needs access to a support person daily for guidance or assistance. 3
Close Proximity (e.g., 1-2 hours, structured) Can be left unattended for short periods of time (1-2 hours), provided that the environment is strictly structured and that a support person can respond quickly in an emergency situation. 4
Onsite (e.g., on property) Cannot be left unattended. Requires a support person on the property at all times, at least during awake hours. 5
Line of Sight/Earshot (e.g., close observation) Cannot be left unattended. Requires a support person within the room or within earshot of the client's location at all times during awake hours. 6

(2) What assistance does the client need to handle unfamiliar or unexpected situations?
Answers Definitions
Can resolve independently The client can generally handle unfamiliar or unexpected situations. The client shows generally good judgment and awareness of personal safety.
Can resolve with remote assistance The client can handle unfamiliar or unexpected situations by calling or contacting someone remotely for assistance (e.g., by telephone or email). The support person does not need to be physically present.
Needs someone physically present to assist When unfamiliar or unexpected situations occur, generally someone must be present or come to the client to help the client resolve the issue.
Needs full physical assistance The client cannot generally participate in resolving such situations; someone else must resolve them.

(3) Is client able to summon help?


Answers Definitions
Can call someone on telephone Client can discern when help is needed and contact someone via telephone or other electronic means. This includes dialing 911, using speed dial to contact someone, email, radio, or dialing a phone number.
Can seek help outside the house, nearby Client can discern when help is needed and can summon a remote caregiver, neighbor, or other person outside the house or nearby to assist when necessary.
Can seek help inside house Client can discern when help is needed and can summon a caregiver or roommate within the house to assist when necessary.
Cannot summon help Client is unable to summon help or discern a dangerous situation that would require help.

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NEW SECTION
WAC 388-828-5080   How does DDD determine your adjusted protective supervision acuity score?   DDD determines your adjusted protective supervision acuity score by applying the following age-based score adjustments to your level of monitoring score for question number one in WAC 388-828-5060:


If you are: Then your age-based score adjustment is:
18 years or older Score is equal to your level of monitoring score
16-17 years of age Subtract 1 from your level of monitoring score
12-15 years of age Subtract 2 from your level of monitoring score
8-11 years of age Subtract 3 from your level of monitoring score
5-7 years of age Subtract 4 from your level of monitoring score
0-4 years of age Subtract 5 from your level of monitoring score
If your adjusted level of monitoring score is a negative number, your adjusted protective supervision acuity score is zero.

Example: If you are fifteen years old and "close proximity, (e.g., 1-2 hours, structured)" is identified as your level of monitoring score, your adjusted protective supervision acuity score is: Your close proximity score of four minus age-based score adjustment of two. For age twelve through fifteen, this equals an adjusted protective supervision score of two.

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NEW SECTION
WAC 388-828-5100   How does DDD determine your protective supervision support level?   DDD uses the following table in determining your protective supervision support level:


If your Adjusted Protective Supervision score is: Then your Protective Supervision Support Level is:
5-6 High
3-4 Medium
1-2 Low
0 None

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DDD Caregiver Status Acuity Scale
NEW SECTION
WAC 388-828-5120   What is the DDD caregiver status acuity scale?   The DDD Caregiver Status Acuity Scale is an assessment of risks associated with your caregiver's ability to provide care.

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NEW SECTION
WAC 388-828-5140   How is information in the DDD caregiver status acuity scale used by DDD?   (1) Information obtained in the DDD Caregiver Status Acuity Scale is one of the factors used by DDD to determine the amount of waiver respite, if any, that you are authorized to receive.

(2) The DDD Caregiver Status Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessment; and

(3) The information is used for reporting purposes to the legislature and the department.

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NEW SECTION
WAC 388-828-5160   When is a collateral contact an informal caregiver?   A collateral contact is an informal caregiver when the person provides you supports without payment from DDD for a service.

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NEW SECTION
WAC 388-828-5180   When is a collateral contact a formal caregiver?   A collateral contact is a formal caregiver when the person receives payment from DDD to provide you a service.

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NEW SECTION
WAC 388-828-5200   When is a collateral contact a backup caregiver?   A collateral contact is only a backup caregiver when:

(1) He or she has been identified as an informal caregiver; and

(2) He or she is available to provide assistance as an informal caregiver when other caregivers are unavailable.

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NEW SECTION
WAC 388-828-5220   Are you allowed to identify more than one person as a backup caregiver?   There are no limitations regarding the number of persons you are allowed to identify as backup caregivers.

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NEW SECTION
WAC 388-828-5240   Who is your primary caregiver?   Your primary caregiver is the formal or informal caregiver who provides you with the most support.

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NEW SECTION
WAC 388-828-5260   What questions are asked in the DDD caregiver status acuity scale and how are your caregiver's answers scored?   The DDD Caregiver Status Acuity Scale consists of six questions that must be answered by your primary caregiver. Scores for each question are determined based on your primary caregiver's response for each question.

(1) Overall, how stressed do you feel in caring for the client?


Answers Score
Not stressed 0
Somewhat stressed 4
Very stressed 9

(2) Other care giving for persons who are disabled, seriously ill, or under age 5?


Answers Score
Client is the only person who requires direct care 0
Part-time responsibility for one or more additional persons 1
Full-time responsibility for one additional person 2
Full-time responsibility for two or more additional persons 4

(3) Factors that make it hard to be a caregiver for client?


Answers Score
Decline in physical health 1
Decline in emotional health 1
Negative impact on employment 1
Getting less than 5 hours of uninterrupted sleep because of care giving 1
Health or safety impact 1
Other issues than impact care giving 1

(4) How much do these things impact your ability to care for the client?


Answers Score
Little or no impact 0
Possible impact, no concrete evidence 1
Concrete evidence of reduced care 4
Unable 9

(5) Is the client creating significant stress on other household members?


Answers Score
Stable and healthy 0
Clearly identifiable signs of stress 4
Serious risk of failure 9

(6) How long do you expect to continue providing care?


Answers Score
2 or more years 0
6 months to 2 years 0
1 to 6 months 4
Less than 1 month 9

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NEW SECTION
WAC 388-828-5280   Which caregiver risk factors determine the caregiver risk level?   The following criteria are used to determine a caregiver's risk level:


If the following criteria are met: Then your caregiver risk factor (s) are:
(1) You have a score of "less than 1 month" for question 6 ("How long do you expect to continue providing care?") in WAC 388-828-5260. Immediate risk of loss of caregiver
(2) You have not identified any collateral contacts in the CARE system as having a contact role of "informal caregiver;" and

(3) You have not identified any collateral contacts in the CARE system as having a contact role of "formal caregiver;" and

(4) You have not identified any collateral contacts in the CARE system as having a contact role of "backup caregiver;" and

(5) You do not have a paid provider, authorized by DDD, to provide supports for a DDD paid service; and

(6) You have an adjusted protective supervision score of 3 or more in WAC 388-828-5080.

No caregiver, and needs one
(7) You have identified one of your collateral contacts in the CARE system as having a contact role of primary caregiver; and

(8) Your primary caregiver is 70 years of age or older; and

(9) Your primary caregiver lives with you in the same residence.

Aging caregiver

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NEW SECTION
WAC 388-828-5300   How does DDD determine a caregiver risk level?   (1) The following table reflects the criteria that are used to calculate the caregiver risk level score:


Your scores for the following questions in

WAC 388-828-5240

Your Caregiver Risk Level
Your score for question 4 Your score for question 5 Your score for question 6
0 0 0 None
0 0 4 Medium
0 0 9 Immediate
0 4 0 Medium
0 4 4 Medium
0 4 9 Immediate
0 9 0 High
0 9 4 High
0 9 9 Immediate
1 0 0 Low
1 0 4 Medium
1 0 9 Immediate
1 4 0 Medium
1 4 4 Medium
1 4 9 Immediate
1 9 0 High
1 9 4 High
1 9 9 Immediate
4 0 0 Medium
4 0 4 Medium
4 0 9 Immediate
4 4 0 Medium
4 4 4 Medium
4 4 9 Immediate
4 9 0 High
4 9 4 High
4 9 9 Immediate
9 0 0 High
9 0 4 High
9 0 9 Immediate
9 4 0 High
9 4 4 High
9 4 9 Immediate
9 9 0 High
9 9 4 High
9 9 9 Immediate

(2) If your maximum scores for questions four, five, and six are four or less and you have an "Aging Caregiver" risk factor in WAC 388-828-5280, your caregiver risk level is medium.

(3) If your caregiver risk factor is "No caregiver, and needs one" in WAC 388-828-5280, your caregiver risk level is immediate regardless of your scores for questions four, five, and six.

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NEW SECTION
WAC 388-828-5320   How does DDD determine the availability of a backup caregiver?   DDD's determination of availability of a back up caregiver is based on the responses of you and your respondent(s) to the following question:

(1) Under what conditions are other caregivers available?


Answers available for selection Score
Routinely provides care 0
Upon request 2
Emergency only 4
No other caregiver available 9

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NEW SECTION
WAC 388-828-5340   How does DDD determine whether a backup caregiver lives with you?   You or your respondent identifies that your backup caregiver(s) lives with you.

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NEW SECTION
WAC 388-828-5360   How does DDD determine the risk level score of your backup caregiver not being able to provide the supports you need when you need them?   The following table identifies the criteria that are used to calculate the risk level score of your backup caregiver not being able to provide the supports you need when you need them:


If the availability of your back caregiver is: Then your risk level score is:
(1) Your backup caregivers are available routinely or upon request as evidenced by a score of 0 to 2 for question 1 of the backup caregiver subscale; and

(2) You have a person identified as a backup caregiver that does not live with you evidenced by the "Lives with client" checkbox not being selected as contact details information for him or her.

1

(Not at risk)

(3) Your backup caregivers are available upon an emergency only basis evidenced by a score of 4 for question 1 of the backup caregiver subscale; and

(4) "Lives with client" has been selected for all of the persons you have identified as your backup caregivers.

2

(Some risk)

(5) You have no other caregiver available evidenced by a score of 9 for question 1 of the backup caregiver subscale. 3

(High risk)

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DDD Activities of Daily Living (ADL) Acuity Scale
NEW SECTION
WAC 388-828-5380   What is the DDD activities of daily living (ADL) acuity scale?   The DDD Activities of Daily Living Acuity Scale is an algorithm that determines your ADL support needs level.

(1) The DDD Activities of Daily Living Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessments; and

(2) The information is used for reporting purposes to the legislature and the department.

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NEW SECTION
WAC 388-828-5400   What does the activities of daily living (ADL) acuity scale measure?   The DDD ADL acuity scale measures:

(1) Your ADL support needs level from the Support Assessment for Children if you are age birth through fifteen years old; or

(2) Your ADL support needs level from the SIS Assessment if you are age sixteen or older.

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NEW SECTION
WAC 388-828-5420   How does DDD determine your ADL support needs score if you are age birth through fifteen?   If you are a child age birth through fifteen, your ADL support needs score is the total of your acuity scores for each of the following ADL questions in the Support Assessment for Children:


ADL questions from the Support Assessment for Children in WAC 388-828-3040
Question # Text of ADL Questions:
1 Dress and Groom self
2 Toilet self
3 Eat at age level
4 Move around

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NEW SECTION
WAC 388-828-5440   How does DDD use your ADL support needs score for the support assessment for children?   (1) DDD uses your ADL support needs score and the following table to determine your ADL support needs level for the Support Assessment for Children:


If your ADL support needs score is: Then your ADL support need level is: Value
11 to 16 High 3
7 to 10 Medium 2
2 to 6 Low 1
0 or 1 None 0

(2) If your acuity score is four for any of the ADL questions in WAC 388-828-3040, your ADL support needs level is determined to be high.

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NEW SECTION
WAC 388-828-5460   How does DDD determine your ADL support needs score if you are age sixteen or older?   (1) If you are age sixteen or older, your ADL support needs score is the total adjusted "Type of Support" scores from the following SIS questions:


ADL questions from the SIS assessment in WAC 388-828-4200 and WAC 388-828-4280
Question # Text of ADL questions:
A1 Using the toilet
A4 Eating food
A6 Dressing
A7 Bathing and taking care of personal hygiene and grooming needs
E1 Taking medications
E4 Ambulating and moving about

(2) If your "Frequency of Support" score for a SIS ADL question is zero or one, adjust your "Type of Support" score for that question to zero.

(3) If your "Frequency of Support" score for a SIS ADL support question is two, three, or four, no adjustment is needed to your "Type of Support" score.

Example:


SIS ADL Questions Text of SIS ADL Questions If your "Frequency of Support" score is: And your

"Type of Support" score is:

Then your adjusted "Type of Support" score is:
A1 Using the toilet 3 3 3
A4 Eating food 1 2 0
A6 Dressing 3 3 3
A7 Bathing and taking care of personal hygiene and grooming needs 1 2 0
E1 Taking medications 3 2 2
E4 Ambulating and moving about 0 0 0
Your SIS ADL support needs score: 8

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NEW SECTION
WAC 388-828-5480   How does DDD determine your ADL support needs level for the SIS assessment?   (1) DDD uses your ADL support needs score and the following table to determine your ADL support needs level for the SIS Assessment if you are age sixteen or older:


If the sum of your adjusted ADL support needs score for the SIS is: Then your ADL support needs level for the SIS is: Value
16 to 24 High 3
10 to 15 Medium 2
2 to 9 Low 1
0 or 1 None 0

(2) If you have a "Type of Support" score of four for any of the questions listed in WAC 388-828-5460, your ADL support needs level for the SIS Assessment is determined to be high.

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DDD Behavioral Acuity Scale
NEW SECTION
WAC 388-828-5500   What is the DDD behavioral acuity scale?   The DDD Behavioral Acuity scale is an assessment of your behavioral support needs based on your scores from the SIS Exceptional Behavior scale.

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NEW SECTION
WAC 388-828-5520   How is information in the DDD behavioral acuity scale used by DDD?   (1) Information obtained in the DDD Behavioral Acuity Scale is one of the factors used by DDD to determine the amount of waiver respite, if any, that you are authorized to receive.

(2) The DDD Behavioral Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessment.

(3) The information is used for reporting purposes to the legislature and the department.

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NEW SECTION
WAC 388-828-5540   How does DDD determine if you have a prominent behavior?   You are determined to have a prominent behavior when a question in WAC 388-828-4380 has a support score of one or two.

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NEW SECTION
WAC 388-828-5560   Do all prominent behaviors get scored?   If you have two or more prominent behaviors, DDD will ask you and your respondent(s) for input and must select only one behavior to be scored as your most prominent behavior.

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NEW SECTION
WAC 388-828-5580   How does DDD determine the frequency of your most prominent behavior?   If you have a prominent behavior, DDD asks you and your respondent(s) to identify the frequency of occurrence of your most prominent behavior using the following table:


If the frequency of occurrence of your most prominent behavior is: Then your score for frequency is:
Less than once per month Rare
1 to 3 times per month Occasional
1 to 4 times per week Occasional
1 to 3 times daily Frequent
4 or more times daily Frequent

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NEW SECTION
WAC 388-828-5600   How does DDD determine the severity of your most prominent behavior?   If you have a prominent behavior, DDD asks you and your respondent(s) to identify the severity of your most prominent behavior using the following table:


If the characteristics of your most prominent behavior are: Then your score for severity is:
Your behavior may be uncooperative, inconvenient, repetitive, and/or require time intensive support. However, your behavior is not considered aggressive or self-injurious. Minor incidents
Your behavior, if allowed to continue over time, may result in life-threatening harm for yourself and/or others. Potentially dangerous
Your behavior without immediate intervention will result in life-threatening harm for yourself and/or others. Life threatening

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NEW SECTION
WAC 388-828-5620   How does DDD determine the type of caregiver assistance you receive to help you keep your most prominent behavior under control?   DDD asks you and your respondent(s) to identify the type of caregiver assistance you receive to help you keep your most prominent behavior under control using the following table:


If the caregiver assistance provided to support your most prominent behavior is: Then your score for caregiver assistance is:
Your respondent reports that you do not require any assistance to keep your most prominent behavior under control. No supervision, Oversight
Your respondent reports that you may at times require supervision and verbal redirection to keep your most prominent behavior under control. Verbal redirection
Your respondent reports that you require occasional physical guidance of limbs and/or caregiver intervention to keep your most prominent behavior under control. Occasional physical guiding or intervention
Your respondent reports that you require in-sight supervision at all times and may require 1 to 2 person physical restraint or removal from the area to keep your most prominent behavior under control. In-Sight Supervision -Physical restraint

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NEW SECTION
WAC 388-828-5640   How does DDD determine your behavioral acuity level?   DDD uses your frequency, severity, and caregiver assistance scores to determine your behavioral acuity level using the following table:


If your score for frequency is: And your score for severity is: And your score for caregiver assistance is: Then your behavioral acuity level is:

Rare

Minor

None Low
Verbal redirection Low
Physical guiding or selection Low
Physical restraint Low

Potentially Dangerous

None Low
Verbal redirection Low
Physical guiding or selection Medium
Physical restraint High

Life-Threatening

None Medium
Verbal redirection Medium
Physical guiding or selection High
Physical restraint High

Occasional

Minor

None Low
Verbal redirection Low
Physical guiding or selection Low
Physical restraint Medium

Potentially Dangerous

None Medium
Verbal redirection Medium
Physical guiding or selection Medium
Physical restraint High

Life Threatening

None Medium
Verbal redirection Medium
Physical guiding or selection High
Physical restraint High

Frequent

Minor

None Low
Verbal redirection Low
Physical guiding or selection Medium
Physical restraint Medium

Potentially Dangerous

None Medium
Verbal redirection Medium
Physical guiding or selection High
Physical restraint High

Life-Threatening

None High
Verbal redirection High
Physical guiding or selection High
Physical restraint High

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DDD Medical Acuity Scale
NEW SECTION
WAC 388-828-5660   What is the DDD medical acuity scale?   The DDD Medical Acuity Scale is an algorithm that determines your medical support needs level.

(1) The DDD Medical Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessments; and

(2) The information is used for reporting purposes to the legislature and the department.

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NEW SECTION
WAC 388-828-5680   What is the purpose of the DDD medical acuity scale?   The purpose of the DDD Medical Acuity scale is to determine your medical acuity level.

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NEW SECTION
WAC 388-828-5700   How does DDD determine your medical acuity level?   DDD uses your SIS support scores to questions in the Exceptional Medical Support Needs Scale per WAC 388-828-4360 and the following table to determine your medical acuity level:


If you meet the following criteria: Then your medical acuity level is: Value
(1) If you have a score of 2 on questions 1, 4, and 7; High 3
(2) If you have a score of 2 on any two of the following questions: 2, 3, 5, 6, 8, 9, 10, 11, 12, 13, 14, 16, or 17; High 3
(3) If your total exceptional medical support needs score is 8 or higher; High 3
(4) If you have a score of 2 on any of the following questions: 2, 3, 5, 6, 8, 9, 10, 11, 12, 13, 14, 16, or 17 and do not meet the criteria for a high medical acuity level; Medium 2
(5) If your total exceptional medical support needs score is 6 or 7 and you do not meet the criteria for a high medical acuity level; Medium 2
(6) If your total exceptional medical support needs score is 5 or less, but greater than zero, and you do not have a score of 2 on any questions excluding number 15; Low 1
(7) If your total exceptional medical support needs score equals zero. None 0

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DDD Interpersonal Support Acuity Scale
NEW SECTION
WAC 388-828-5720   What is the DDD interpersonal support acuity scale?   The DDD Interpersonal Support Acuity Scale is an algorithm that measures your ability to interact with others in a variety of settings and determines your interpersonal support needs level.

(1) The DDD Interpersonal Support Acuity Scale does not affect service determination for the Medicaid personal care or waiver Personal Care assessments; and

(2) The information is used for reporting purposes to the legislature and the department.

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NEW SECTION
WAC 388-828-5740   What does the DDD interpersonal support acuity scale determine?   The DDD Interpersonal Support Acuity Scale determines:

(1) Your interpersonal support acuity level from the Support Assessment for Children if you are age birth through fifteen; or

(2) Your interpersonal support acuity level from the SIS Assessment if you are age sixteen or older.

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NEW SECTION
WAC 388-828-5760   How does DDD determine your interpersonal support needs score if you are age birth through fifteen?   If you are a child age birth through fifteen, your interpersonal support needs score is the total of your acuity scores for each of the following questions in the Support Assessment for Children:


Interpersonal support needs questions from the Support Assessment for Children in WAC 388-828-3040
Question # Text of Questions:
5 Communicate: What support does the child need to communicate with others of same age?
11 Have relationships with family members: What support does the child need to make the kind of relationships with family members expected of non disabled children of the same age?
13 Play with others: What supports are needed for the child to develop age-level skills in playing with others?
17 Effectively relate to other students/peers: What support does the person need to most effectively relate to fellow students and/or peers?
18 Have behaviors which promote being included: What support is needed for this person to have behaviors which promote being included?

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NEW SECTION
WAC 388-828-5780   What does the DDD interpersonal support needs score determine if you are age birth through fifteen?   If you are age birth through fifteen, DDD uses your interpersonal support needs score and the following table to determine your interpersonal support needs level:


If your interpersonal support needs score is: Then your interpersonal support needs level is: Value
(1) Your interpersonal support needs score is 10 or more. High 3
(2) Your interpersonal support needs score is a 4, 5, 6, 7, 8, or 9; or

(3) You have an acuity score of 3 or 4 for one of the interpersonal support needs questions listed in WAC 388-828-3040.

Medium 2
(4) Your interpersonal support needs score is 1, 2, or 3; and

(5) You do not have an acuity score of 3 or 4 for one of the interpersonal support needs questions listed in WAC 388-828-3040.

Low 1
(6) Your interpersonal support needs score is zero. None 0

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NEW SECTION
WAC 388-828-5800   How does DDD determine your interpersonal support needs score if you are age sixteen or older?   If you are age sixteen or older, your interpersonal support needs score is determined by adding your raw scores to the following SIS questions:


Interpersonal support needs questions from the SIS assessment
Question # Text of interpersonal support needs questions:
B7 Interacting with community members
C1 Interacting with others in learning activities
D3 Interacting with co-workers
D4 Interacting with supervisors/coaches
D8 Seeking information and assistance from an employer
F1 Socializing within the household
F3 Socializing outside the household
F5 Communicating with others about personal needs
F6 Using appropriate social skills

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NEW SECTION
WAC 388-828-5820   How does DDD use your interpersonal support needs score if you are age sixteen or older?   If you are age sixteen or older, DDD uses your interpersonal support needs score and the following table to determine your interpersonal support needs level:


If your interpersonal support needs score is: Then your interpersonal support needs level is: Value
(1) 56 or more High 3
(2) At least 20; and

(3) Less than 56

Medium 2
(4) 3 or 4 for both "Type of Support" and "Frequency of Support" for one of the interpersonal support needs questions Medium 2
(5) At least 1; and

(6) Less than 20; and

(7) You do not have a score of 3 or 4 for both "Type of Support" and "Frequency of Support" for one of the interpersonal support needs questions

Low 1
(8) Zero None 0

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DDD Mobility Acuity Scale
NEW SECTION
WAC 388-828-5840   What is the DDD mobility acuity scale?   The DDD Mobility Acuity Scale is an algorithm that measures your ability to ambulate and move around.

(1) The DDD Mobility Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessments; and

(2) The information is used for reporting purposes to the legislature and the department.

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NEW SECTION
WAC 388-828-5860   What does the DDD mobility acuity scale determine?   The DDD Mobility Acuity Scale determines:

(1) Your mobility acuity level from the Support Assessment for Children if you are age birth through fifteen; or

(2) Your mobility acuity level from the SIS Assessment if you are age sixteen or older.

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NEW SECTION
WAC 388-828-5880   How does DDD determine your mobility acuity level if you are age birth through fifteen?   If you are age birth through fifteen, your mobility acuity level is determined by your acuity score to question four of the ICF/MR Level of Care Assessment in WAC 388-828-3040 using the following table:


If your acuity score for question 4 is: Then your mobility acuity level is:
4 High
3 Medium
1 or 2 Low
0 None

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NEW SECTION
WAC 388-828-5900   How does DDD determine your mobility acuity level if you are age sixteen or older?   If you are age sixteen or older, your mobility acuity level is determined by your scores to question E4 "Ambulating and moving about" in WAC 388-828-4280 using the following table:


If you score for "Frequency of Support" is: And your score for "Type of Support" is: Then your Mobility Acuity Level is: Value
3 or 4 4 High 3
3 or 4 3 Medium 2
If your raw score for question E4 or 5 or more and you do not meet the criteria for a high or medium mobility acuity level Low 1
If your raw score for question E4 is 4 or less None 0

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Respite Assessment
NEW SECTION
WAC 388-828-5920   What is the respite assessment?   The respite assessment is an algorithm in the DDD Assessment that determines the number of hours of respite care, if any, that your provider may receive per year if DDD has authorized you to receive Basic, Basic Plus, or Core waiver services per chapter 388-845 WAC.

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NEW SECTION
WAC 388-828-5940   Are there any exceptions when the respite assessment is not used to determine the number of hours for waiver respite services?   The respite assessment is not used to determine waiver respite when you are receiving any of the following:

(1) Voluntary Placement Program services per chapter 388-826 WAC; or

(2) Companion home services per chapter 388-821 WAC.

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NEW SECTION
WAC 388-828-5960   What is the purpose of the respite assessment?   The purpose of the respite assessment is to determine your respite assessment level using your scores from:

(1) The Protective Supervision Acuity Scale;

(2) The DDD Caregiver Status Acuity Scale; and

(3) The DDD Behavioral Acuity Scale.

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NEW SECTION
WAC 388-828-5980   How does DDD determine your respite assessment level?   (1) DDD determines your respite assessment level using the following table:


If your Protective Supervision Support Level is: And your primary caregiver risk level is: And your backup caregiver risk score is: And your behavioral acuity level is: Then your respite assessment level is:
0 None 1 None 1
0 None 1 Low 1
0 None 1 Medium 1
0 None 1 High 2
0 None 2 or 3 None 1
0 None 2 or 3 Low 1
0 None 2 or 3 Medium 2
0 None 2 or 3 High 2
0 Low 1 None 1
0 Low 1 Low 1
0 Low 1 Medium 1
0 Low 1 High 2
0 Low 2 or 3 None 1
0 Low 2 or 3 Low 1
0 Low 2 or 3 Medium 2
0 Low 2 or 3 High 2
0 Medium 1 None 1
0 Medium 1 Low 1
0 Medium 1 Medium 1
0 Medium 1 High 2
0 Medium 2 or 3 None 1
0 Medium 2 or 3 Low 1
0 Medium 2 or 3 Medium 2
0 Medium 2 or 3 High 2
0 High 1 None 1
0 High 1 Low 1
0 High 1 Medium 2
0 High 1 High 2
0 High 2 or 3 None 2
0 High 2 or 3 Low 2
0 High 2 or 3 Medium 2
0 High 2 or 3 High 3
0 Immediate 1 None 1
0 Immediate 1 Low 1
0 Immediate 1 Medium 2
0 Immediate 1 High 2
0 Immediate 2 or 3 None 2
0 Immediate 2 or 3 Low 2
0 Immediate 2 or 3 Medium 2
0 Immediate 2 or 3 High 3
1 None 1 None 1
1 None 1 Low 1
1 None 1 Medium 1
1 None 1 High 2
1 None 2 or 3 None 1
1 None 2 or 3 Low 1
1 None 2 or 3 Medium 2
1 None 2 or 3 High 3
1 Low 1 None 1
1 Low 1 Low 1
1 Low 1 Medium 1
1 Low 1 High 2
1 Low 2 or 3 None 1
1 Low 2 or 3 Low 1
1 Low 2 or 3 Medium 2
1 Low 2 or 3 High 3
1 Medium 1 None 1
1 Medium 1 Low 1
1 Medium 1 Medium 2
1 Medium 1 High 3
1 Medium 2 or 3 None 1
1 Medium 2 or 3 Low 2
1 Medium 2 or 3 Medium 2
1 Medium 2 or 3 High 3
1 High 1 None 2
1 High 1 Low 2
1 High 1 Medium 2
1 High 1 High 3
1 High 2 or 3 None 2
1 High 2 or 3 Low 2
1 High 2 or 3 Medium 3
1 High 2 or 3 High 4
1 Immediate 1 None 2
1 Immediate 1 Low 2
1 Immediate 1 Medium 2
1 Immediate 1 High 3
1 Immediate 2 or 3 None 2
1 Immediate 2 or 3 Low 2
1 Immediate 2 or 3 Medium 3
1 Immediate 2 or 3 High 4
2 or 3 None 1 None 1
2 or 3 None 1 Low 1
2 or 3 None 1 Medium 2
2 or 3 None 1 High 3
2 or 3 None 2 or 3 None 2
2 or 3 None 2 or 3 Low 2
2 or 3 None 2 or 3 Medium 2
2 or 3 None 2 or 3 High 4
2 or 3 Low 1 None 1
2 or 3 Low 1 Low 1
2 or 3 Low 1 Medium 2
2 or 3 Low 1 High 3
2 or 3 Low 2 or 3 None 2
2 or 3 Low 2 or 3 Low 2
2 or 3 Low 2 or 3 Medium 2
2 or 3 Low 2 or 3 High 4
2 or 3 Medium 1 None 2
2 or 3 Medium 1 Low 2
2 or 3 Medium 1 Medium 2
2 or 3 Medium 1 High 3
2 or 3 Medium 2 or 3 None 2
2 or 3 Medium 2 or 3 Low 2
2 or 3 Medium 2 or 3 Medium 3
2 or 3 Medium 2 or 3 High 4
2 or 3 High 1 None 2
2 or 3 High 1 Low 2
2 or 3 High 1 Medium 2
2 or 3 High 1 High 3
2 or 3 High 2 or 3 None 2
2 or 3 High 2 or 3 Low 2
2 or 3 High 2 or 3 Medium 3
2 or 3 High 2 or 3 High 4
2 or 3 Immediate 1 None 2
2 or 3 Immediate 1 Low 2
2 or 3 Immediate 1 Medium 2
2 or 3 Immediate 1 High 3
2 or 3 Immediate 2 or 3 None 2
2 or 3 Immediate 2 or 3 Low 2
2 or 3 Immediate 2 or 3 Medium 3
2 or 3 Immediate 2 or 3 High 4
4 None 1 None 2
4 None 1 Low 2
4 None 1 Medium 2
4 None 1 High 3
4 None 2 or 3 None 2
4 None 2 or 3 Low 2
4 None 2 or 3 Medium 3
4 None 2 or 3 High 4
4 Low 1 None 2
4 Low 1 Low 2
4 Low 1 Medium 2
4 Low 1 High 3
4 Low 2 or 3 None 2
4 Low 2 or 3 Low 2
4 Low 2 or 3 Medium 3
4 Low 2 or 3 High 4
4 Medium 1 None 2
4 Medium 1 Low 2
4 Medium 1 Medium 3
4 Medium 1 High 3
4 Medium 2 or 3 None 2
4 Medium 2 or 3 Low 3
4 Medium 2 or 3 Medium 3
4 Medium 2 or 3 High 4
4 High 1 None 2
4 High 1 Low 2
4 High 1 Medium 3
4 High 1 High 3
4 High 2 or 3 None 2
4 High 2 or 3 Low 3
4 High 2 or 3 Medium 4
4 High 2 or 3 High 4
4 Immediate 1 None 2
4 Immediate 1 Low 2
4 Immediate 1 Medium 3
4 Immediate 1 High 3
4 Immediate 2 or 3 None 2
4 Immediate 2 or 3 Low 3
4 Immediate 2 or 3 Medium 4
4 Immediate 2 or 3 High 4
5 None 1 None 2
5 None 1 Low 2
5 None 1 Medium 3
5 None 1 High 4
5 None 2 or 3 None 3
5 None 2 or 3 Low 3
5 None 2 or 3 Medium 4
5 None 2 or 3 High 5
5 Low 1 None 2
5 Low 1 Low 2
5 Low 1 Medium 3
5 Low 1 High 4
5 Low 2 or 3 None 3
5 Low 2 or 3 Low 3
5 Low 2 or 3 Medium 4
5 Low 2 or 3 High 5
5 Medium 1 None 2
5 Medium 1 Low 2
5 Medium 1 Medium 3
5 Medium 1 High 4
5 Medium 2 or 3 None 3
5 Medium 2 or 3 Low 3
5 Medium 2 or 3 Medium 4
5 Medium 2 or 3 High 5
5 High 1 None 2
5 High 1 Low 2
5 High 1 Medium 3
5 High 1 High 4
5 High 2 or 3 None 3
5 High 2 or 3 Low 3
5 High 2 or 3 Medium 4
5 High 2 or 3 High 5
5 Immediate 1 None 2
5 Immediate 1 Low 2
5 Immediate 1 Medium 3
5 Immediate 1 High 4
5 Immediate 2 or 3 None 3
5 Immediate 2 or 3 Low 3
5 Immediate 2 or 3 Medium 4
5 Immediate 2 or 3 High 5
6 None 1 None 2
6 None 1 Low 3
6 None 1 Medium 3
6 None 1 High 4
6 None 2 or 3 None 3
6 None 2 or 3 Low 3
6 None 2 or 3 Medium 4
6 None 2 or 3 High 5
6 Low 1 None 2
6 Low 1 Low 3
6 Low 1 Medium 3
6 Low 1 High 4
6 Low 2 or 3 None 3
6 Low 2 or 3 Low 3
6 Low 2 or 3 Medium 4
6 Low 2 or 3 High 5
6 Medium 1 None 3
6 Medium 1 Low 3
6 Medium 1 Medium 3
6 Medium 1 High 4
6 Medium 2 or 3 None 3
6 Medium 2 or 3 Low 4
6 Medium 2 or 3 Medium 4
6 Medium 2 or 3 High 5
6 High 1 None 3
6 High 1 Low 3
6 High 1 Medium 4
6 High 1 High 4
6 High 2 or 3 None 4
6 High 2 or 3 Low 4
6 High 2 or 3 Medium 5
6 High 2 or 3 High 5
6 Immediate 1 None 3
6 Immediate 1 Low 3
6 Immediate 1 Medium 4
6 Immediate 1 High 4
6 Immediate 2 or 3 None 4
6 Immediate 2 or 3 Low 4
6 Immediate 2 or 3 Medium 5
6 Immediate 2 or 3 High 5

(2) DDD adds one level to your respite assessment level when your respite assessment level is determined to be a one, two, three, or four and you have a score of four for question two "Other caregiving for persons who are disabled, seriously ill, or under five" in the DDD Caregiver Status Acuity Scale. See WAC 388-828-5260.

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NEW SECTION
WAC 388-828-6000   How does DDD determine the maximum number of hours you may receive for respite care?   The maximum number of hours you may receive per year is determined by using the following table:


If your respite assessment level is: Then the maximum number of hours you may receive for respite care each year is:
1 240
2 240
3 336
4 432
5 528

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Programs and Services Component
NEW SECTION
WAC 388-828-6020   What is the purpose of the programs and services component?   The purpose of the Programs and Services component is to document:

(1) DDD services you are currently receiving;

(2) DDD services you have been approved to receive; and

(3) If you currently meet the ICF/MR Level of Care requirements for continued DDD HCBS waiver eligibility or for potential DDD HCBS waiver services if resources become available.

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Service Level Assessment Module
NEW SECTION
WAC 388-828-7000   What is the purpose of the service level assessment module?   The purpose of the Service Level Assessment module is to determine a service level and the number of hours you are eligible to receive for Medicaid or Waiver Personal Care services per chapter 388-106 WAC.

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NEW SECTION
WAC 388-828-7020   What components contained in the service level assessment module determine a service level and/or number of hours?   The Service Level Assessment module contains two components that are used to determine a service level and/or number of hours for the following:

(1) The CARE Assessment for Medicaid or waiver personal care services, as defined in chapter 388-106 WAC; and

(2) The DDD Seizure Acuity Scale as defined in WAC 388-828-7040 through WAC 388-828-7080.

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DDD Seizure Acuity Scale
NEW SECTION
WAC 388-828-7040   What is the DDD seizure acuity scale?   (1) The DDD Seizure Acuity Scale is an assessment of your seizure support needs.

(2) The DDD Seizure Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessments.

(3) The information is used for reporting purposes to the legislature and the department.

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NEW SECTION
WAC 388-828-7060   What does the DDD seizure acuity scale measure?   The DDD Seizure Acuity Scale is used to measure your seizure acuity level.

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NEW SECTION
WAC 388-828-7080   How does DDD determine your seizure acuity level?   DDD uses criteria in the following table to determine your seizure acuity level:


If you meet the following criteria: Then your seizure acuity level is:
(1) You received medical attention for your seizures, on two or more occasions.

(2) Medical attention includes:

(a) Visits to a primary care physician;

(b) Visits to an emergency room;

(c) Calls to 911 that result in paramedics having to provide care, treatment, or stabilization services.

High
(3) You have convulsive seizures (Tonic-clonic or atonic) and meed the following conditions:

(a) You have a seizure at least once every three months; and

(b) Your seizures last at least five minutes.

High
(4) You have convulsive seizures (Tonic-clonic or atonic) and meet the following conditions:

(a) You have a seizure at least once every three months; and

(b) Your seizures last less than five minutes.

Medium
(5) You report a history of having seizures and you do not meet the requirements for a high or medium seizure acuity level. Low
(6) You report that you do not have a history of seizures. None

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Individual Support Plan Module
NEW SECTION
WAC 388-828-8000   What is the purpose of the individual support plan (ISP) module?   The purpose of the individual support plan module is to create a written plan that includes:

(1) Your acuity scores generated from the Support Assessment;

(2) Referral information;

(3) The SSP, if any, you are approved to receive in lieu of a DDD paid service; and

(4) DDD paid services you are authorized to receive:

(a) If you are enrolled in a DDD waiver, the ISP must address all the health and welfare needs identified in your ICF/MR Level of Care assessment and the supports used to meet your assessed needs; or

(b) If you are not enrolled in a DDD waiver, DDD is only required to address the DDD paid services you are approved to receive.

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NEW SECTION
WAC 388-828-8020   What components contained in the individual support plan module determines a service level and/or number of hours?   The foster care rate assessment, as defined in chapter 388-826 WAC, is the only component in the Individual Support Plan module that determines a service level and/or number of hours.

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NEW SECTION
WAC 388-828-8040   How does DDD determine which health and welfare needs must be addressed in your individual support plan if you are age birth through fifteen?   If you are age birth through fifteen and are receiving DDD HCBS waiver services or reside in a state-only residential setting, DDD uses the following tables to determine the health and welfare needs that must be addressed in your Individual Support Plan:

(1) Activities from the Support Needs Assessment for Children:


# Questions in the Support Needs Assessment for Children: DDD must address in your ISP if you have an acuity score of: Health and Welfare Category
1 Dress and groom self 2 or more Home Living
2 Toilet self 2 or more Home Living
3 Eat at age level 3 or more Home Living
4 Move around 3 or more Home Living
5 Communicate 2 or more Home Living
7 Make choices and take responsibility 2 or more Protection and Advocacy
8 Explore environment 3 or more Community Living
9 Meet therapy health needs 1 or more Medical Supports
10 Help family continue to meet child's needs 1 or more Protection and Advocacy
15 Identify and respond safely to emergencies 1 or more Health and Safety
16 Practice age-level safety measures 2 or more Protection and Advocacy
17 Effectively relate to other students/peers 3 or more Employment
18 Have behaviors which promote being included 3 or more Behavior Supports

(2) Medical Supports from the SIS Exceptional Medical Support Needs Scale


# Questions in the Exceptional Medical Support Needs Scale DDD must address in your ISP if you have an acuity score of: Health and Welfare Category
1 Inhalation or oxygen therapy 1 or more Medical Supports
2 Postural drainage 1 or more Medical Supports
3 Chest PT 1 or more Medical Supports
4 Suctioning 1 or more Medical Supports
5 Oral Stimulation or Jaw Repositioning 1 or more Medical Supports
6 Tube feeding (e.g., nasogastric) 1 or more Medical Supports
7 Parenteral feeding (e.g., IV) 1 or more Medical Supports
8 Turning or positioning 1 or more Medical Supports
9 Dressing of open wound(s) 1 or more Medical Supports
10 Protection from infectious diseases due to immune system impairment 1 or more Medical Supports
11 Seizure management 1 or more Medical Supports
12 Dialysis 1 or more Medical Supports
13 Ostomy care 1 or more Medical Supports
14 Lifting and/or transferring 1 or more Medical Supports
15 Therapy services 1 or more Medical Supports
16 Diabetes management 1 or more Medical Supports
17 Other(s) 1 or more Medical Supports

(3) Behavioral Supports from the SIS Exceptional Behavior Support Needs Scale


# Questions in the Exceptional Behavior Support Needs Scale: DDD must address in your ISP if you have an acuity score of: Health and Welfare Category
1 Prevention of assaults or injuries to others 1 or more Behavioral Supports
2 Prevention of property destruction (e.g., fire setting, breaking furniture) 1 or more Behavioral Supports
3 Prevention of stealing 1 or more Behavioral Supports
4 Prevention of self-injury 1 or more Behavioral Supports
5 Prevention of pica (ingestion of inedible substances) 1 or more Behavioral Supports
6 Prevention of suicide attempts 1 or more Behavioral Supports
7 Prevention of sexual aggression 1 or more Behavioral Supports
8 Prevention of non-aggressive but inappropriate behavior (e.g., exposes self in public, exhibitionism, inappropriate touching or gesturing) 1 or more Behavioral Supports
9 Prevention of tantrums or emotional outbursts 1 or more Behavioral Supports
10 Prevention of wandering 1 or more Behavioral Supports
11 Prevention of substance abuse 1 or more Behavioral Supports
12 Maintenance of mental health treatments 1 or more Behavioral Supports
13 Managing attention-seeking behavior 1 or more Behavioral Supports
14 Managing uncooperative behavior 1 or more Behavioral Supports
15 Managing agitated/over-reactive behavior 1 or more Behavioral Supports
16 Managing obsessive/repetitive behavior 1 or more Behavioral Supports
17 Prevention of other serious behavior problem(s) 1 or more Behavioral Supports

(4) Caregiver from the SIS Exceptional Behavior Support Needs Scale


# Question in the DDD Caregiver Status Acuity Scale: DDD must address in your ISP if you have a score: Health and Welfare Category
6 How long do you think you expect to continue providing care? 1 to 6 months or less than 1 month DDD Caregiver Status

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NEW SECTION
WAC 388-828-8060   How does DDD determine which health and welfare needs must be addressed in your individual support plan if you are age sixteen or older?   (1) If you are age sixteen or older and receiving DDD HCBS waiver services or reside in a state-only residential setting, DDD uses the following table to determine the health and welfare needs that must be addressed in your Individual Support Plan:


# SIS Activity DDD must address in the ISP if your Type of Support score is: Health and Welfare Category
A1 Using the toilet 3 or more
A2 Taking care of clothes (includes laundering) 3 or more
A3 Preparing food 3 or more
A4 Eating food 3 or more
A5 Housekeeping and cleaning 3 or more Home Living
A6 Dressing 3 or more
A7 Bathing and taking care of personal hygiene and grooming needs 3 or more
A8 Operating home appliances 3 or more
A9 Using currently prescribed equipment or treatment 3 or more
B1 Getting from place to place throughout the community (transportation) 2 or more
B2 Participating in recreation/leisure activities in the community settings 2 or more
B3 Using public services in the community 2 or more Community Living
B4 Going to visit friends and family 4
B6 Shopping and purchasing goods and services 2 or more
B7 Interacting with community members 4
B8 Accessing public buildings and settings 2 or more
D3 Interacting with co-workers 3 or more
D4 Interacting with supervisors and or coaches 3 or more Employment
E1 Taking medications 2 or more
E2 Avoiding health and safety hazards 3 or more
E3 Obtaining health care services 3 or more
E4 Ambulating and moving about 3 or more Health and Safety
E6 Maintaining a nutritious diet 3 or more
E7 Maintaining physical health and fitness 3 or more
F2 Participating in recreation/leisure activities with others 2 or more
F4 Making and keeping friends 4 Social Activities
F6 Using appropriate social skills 4
G2 Managing money and personal finances 2 or more
G3 Protecting self from exploitation 2 or more Protection and Advocacy
G7 Making choices and decisions 2 or more

(2) If you have a support score of one or more for any of the questions in the SIS Exceptional Medical Support Needs Scale, DDD must address your support need using the medical supports category.

(3) If you have a support score of one or more for any of the questions in the SIS Exceptional Behavior Support Needs Scale, DDD must address your support need using the behavior supports category.

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Washington State Code Reviser's Office