SOCIAL AND HEALTH SERVICES
(Economic Services Administration)
Date of Adoption: June 29, 2001.
Purpose: Chapter 388-448 WAC, Incapacity, this revision is being done to clarify treatment and referral requirements for general assistance unemployable recipients and remove ambiguity from the language in related incapacity rules.
Citation of Existing Rules Affected by this Order: Amending WAC 388-448-0020, 388-448-0070, 388-448-0120, 388-448-0130, 388-448-0140, 388-448-0180, and 388-448-0200.
Statutory Authority for Adoption: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, and 74.08.090.
Adopted under notice filed as WSR 01-11-106 on May 21, 2001.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 7, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule: August 1, 2001.
June 29, 2001
Brian Lindgren, Manager
Rules and Policies Assistance Unit2947.4
We accept medical evidence from the sources listed below:
(1) For a physical impairment, we only accept reports from the following licensed medical professionals as primary evidence:
(a) A physician;
(b) An advanced registered nurse practitioner (ARNP) in the ARNP's area of certification;
(c) The chief of medical administration of the Veterans' Administration, or their designee, as authorized in federal law; or
(d) A physician assistant when the report is co-signed by the supervising physician.
(2) For a mental impairment, we only accept reports from one of the following licensed professionals as primary evidence:
(a) A psychiatrist;
(b) A psychologist;
(c) An advanced registered nurse practitioner when certified in psychiatric nursing;
(d) A person who provides mental health services in a
community mental health services ((
setting)) agency and meets the
minimum mental health (( practitioner)) professional
qualifications set by (( the local community mental health
agency)) them, which consist of having a (( Master of Arts (MA)))
Master's degree and two years experience; or
(e) The physician who is currently treating you for a mental disorder.
(3) "Supplemental medical evidence" means a report from a practitioner that can be used to support medical evidence given by any of the practitioners listed in subsections (1) and (2) of this section. We accept as supplemental medical evidence reports from:
(a) A practitioner who is providing on-going treatment to you, such as a chiropractor, nurse, physician assistant; or
DSHS)) State institutions and agencies that are
providing or have provided services to you.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0020, filed 8/2/00, effective 9/1/00.]
(b) Special senses and speech,
(g) Hemic and lymphatic,
(i) Endocrine and obesity,
(k) Mental disorders,
(l) Neoplastic, and
(l))) (m) Immune systems.
(2) We follow these rules when there are multiple impairments:
(a) We group each diagnosis by body system.
(b) When you have two or more diagnosed impairments that limit work activities, we assign an overall severity rating as follows:
|Your Condition||Severity Rating|
|(i) All impairments are in the same body system, are rated two and there is no cumulative effect on basic work activities.||2|
|(ii) All impairments are in the same
body system, are rated two and there
is a cumulative effect on basic work
(iii) All impairments are in different body systems, are rated two and there is a cumulative effect on basic work activities.
|(iv) Two or more impairments are in
different body systems and are rated
(v) Two or more impairments are in different body systems; one is rated three and one is rated four.
|(vi) Two or more impairments in different body systems are rated four.||5|
(d) We approve incapacity when the overall severity rating is five.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0070, filed 8/2/00, effective 9/1/00.]
Thirty-six months when we decide it is evident you
meet federal disability criteria to receive Social Security
Supplemental Security Income (SSI))) If you are eligible for GAU,
a maximum of twelve months; or
Twelve months)) If we decide you are eligible for
general assistance expedited Medicaid (GAX), a maximum of
thirty-six months from the date of the latest incapacity
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0120, filed 8/2/00, effective 9/1/00.]
(1) When you are first approved and at each review
determination, we give you written information regarding your
treatment requirements ((
when you are initially approved, and at
(2) You must accept and follow through on required medical
treatment and referrals to other agencies and services, including
applying for SSI, unless you have ((
a convincing reason)) good
cause for not doing so. Examples of good cause are found in WAC 388-448-0140.
If your basic claim of incapacity is alcoholism or
drug dependency, we refer you for evaluation under the alcoholism
and drug addiction treatment and support act (ADATSA).
(4))) We may require you to undergo alcohol or drug
treatment before ((
re-evaluating)) reviewing your eligibility for
(5))) (4) You may request a fair hearing if you disagree
with the treatment or referral requirements we set for you (see
WAC 388-458-0040). (( If you request a fair hearing we will not
reduce or stop your benefits as a result of your refusal to
follow the requirement until the fair hearing is decided.))
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0130, filed 8/2/00, effective 9/1/00.]
(1) Valid reasons for refusing treatment referrals:
(a) You are so fearful of the treatment that your fear could interfere with the treatment or reduce its benefits;
(b) Treatment could cause further limitations or loss of a function or an organ and you are not willing to take that risk;
(c) You practice an organized religion that prohibits treatment; or
(d) Treatment is not available without cost to you.
(2) Valid reasons for refusing treatment or other agency referrals:
You)) We did not (( have)) give you enough information
(( on)) about the requirement;
(b) You did not receive written notice of the requirement;
(b))) (c) The requirement was made in error;
(c))) (d) You are temporarily unable to participate
because of documented interference, or
(d))) (e) Your medical condition or limitations are
consistent with the definition of necessary supplemental
accommodation (NSA), WAC (( 388-200-1300)), 388-472-0020 and your
condition or limitations contributed to your refusal, per WAC 388-472-0050.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0140, filed 8/2/00, effective 9/1/00.]
(1) If you remain on GAX at the end of the thirty-six-month
period, we determine your eligibility ((
at the end of the
thirty-six-month period,)) using current medical evidence.
(2) If ((
you applied)) your application for SSI(( , were)) is
denied, and the denial (( was)) is upheld by an SSI/SSA
administrative (( appeal)) hearing before the end of the
thirty-six-month incapacity period, we change your program
eligibility from GAX to GAU and adjust the incapacity (( period))
review date to be sixty days after the (( SSI denial))
administrative hearing date.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0180, filed 8/2/00, effective 9/1/00.]
(1) Apply for SSI ((
and)), follow through with your
application, and do not withdraw your application;
(2) Agree to assign the initial or reinstated SSI payment to DSHS as provided under WAC 388-448-0210; and
(3) Are otherwise eligible according to WAC 388-400-0025.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0200, filed 8/2/00, effective 9/1/00.]