Original Notice.

     Preproposal statement of inquiry was filed as WSR 04-12-091.

     Title of Rule and Other Identifying Information: Division of developmental disabilities services rules: WAC 388-825-210, 388-825-228, 388-825-230, 388-825-232, 388-825-234, 388-825-236, 388-825-238, 388-825-242, 388-825-248, 388-825-252, 388-825-253 (new), and 388-825-254.

     Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on September 7, 2004, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than September 8, 2004.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., September 7, 2004.

     Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by September 3, 2004, TTY (360) 664-6178 or (360) 664-6097.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: These revisions are necessary for the implementation date of comprehensive assessment reporting evaluation (CARE) governing children to prevent duplication of services between Medicaid personal care (MPC) and family support, and ensure compliance with the first use of Medicaid and misuse of respite care and MPC for childcare.

     Reasons Supporting Proposal: Many children receiving personal care services through MPC also receive services through the family support program. Revised rules governing MPC and CARE will clearly differentiate personal care from respite care and child care. It is necessary that the department clarify the family support program rules to: Differentiate between personal care and respite care; delete Medicaid personal care and CAP waiver as family support services; clarify the purpose of family support, definitions of services, and limitations of services consistent with rules governing personal care.

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

     Statute Being Implemented: Chapter 71A.12 RCW.

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

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

     Name of Agency Personnel Responsible for Drafting: Steve Brink, Division of Developmental Disabilities, P.O. Box 45310, Olympia, WA 98504-5310, (360) 702-7716; Implementation and Enforcement: Linda Gil, Shirley Everard, Division of Developmental Disabilities, P.O. Box 45310, Olympia, WA 98504-5310, (360) 902-8440, (360) 902-8448.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. These rules have no impact on small businesses.

     A cost-benefit analysis is not required under RCW 34.05.328. These rules relate only to client medical or financial eligibility, and are exempt from the requirements of RCW 34.05.328.

July 30, 2004

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     (1) ((Case management services)) Family support plan: ((Your family will benefit from case management services.)) The family and the case manager will develop a family support plan which includes needs assessment, referral, service coordination, service authorization, case monitoring and coordination for community guide services.

     (2) ((Community guide services: Once your case manager assesses your family situation, you will be offered access to the services of a community guide. The community guide will assist your family in using the natural and informal community supports relevant to the age of your family member with developmental disabilities and the specific needs of your family. Community guide services will support your family and help develop connections to your community)) Community guide services per WAC 388-825-220 through 388-825-226.

     (3) ((Short-term intervention services: Your family may be eligible for up to eleven hundred dollars in short-term intervention funding if necessary services are not otherwise available. This funding is not intended to cover basic subsistence such as food or shelter costs. Short-term intervention funding is available only for those specialized costs directly related to and resulting from your child's disability.

     (4) Personal care services: Medicaid personal care can provide your family with long-term in-home personal assistance. (See WAC 388-15-202 and 388-15-203.) In home personal assistance may be available through Medicaid personal care or through a state-funded alternative.

     (5) Community alternatives program (CAP) waiver: If eligible, your family may participate in the CAP waiver program. The CAP waiver gives eligible clients the opportunity to participate in the federal Medicaid program and DDD the opportunity to obtain federal funds for community based services. (See WAC 388-825-170, 388-825-180 and 388-825-190.)

     (6) Early intervention services: These services are for your children (from birth through thirty-five months old) and include early childhood programs, birth through two public school programs, children with special health care needs programs, and Part C services (IDEA).

     (7))) Short-term intervention services per WAC 388-825-228 and 388-825-230.

     (4) Emergency services: Your family can request emergency funds to be used to respond to a single incident, situation or short term crisis such as care giver hospitalization, absence, or incapacity. Your request must be made through your case manager and include an explanation of how you plan to resolve the emergency situation. Your request will be reviewed by ((the regional administrator or designee. If approved, you will receive emergency services for a limited time period, not to exceed two months)) DDD.

     (a) If approved, you will receive emergency services for a limited time period, not to exceed two months.

     (b) If denied, you have no appeal rights.

     (((8) Serious need services: Your family may request serious need funds to take care of needs not met by other basic services, including short-term intervention services, personal care services or use of a community guide. Serious need funds are short or long-term funds used to provide additional support to allow the individual with disabilities to continue living at home))

     (5) Serious need services per WAC 388-825-232 through 388-825-238.

[Statutory Authority: RCW 71A.16.010, 71A.16.030, 71A.12.030, chapter 71A.20 RCW, RCW 72.01.090, and 72.33.125. 02-16-014, § 388-825-210, filed 7/25/02, effective 8/25/02; 99-19-104, recodified as § 388-825-210, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.030. 99-04-071, § 275-27-190, filed 2/1/99, effective 3/4/99.]

     (1) Short-term intervention funds can be authorized for a one-time only need or for an episodic service need that occurs over a one-year period.

     (2) Short-term intervention funding cannot be used for basic subsistence such as food or shelter but is available for those specialized costs directly related to and resulting from your child's disability. ((Short-term intervention funds can be authorized for a one-time only need or for an episodic service need that occurs over a one-year period.))

[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2001 2nd sp.s. c 7. 02-01-074, § 388-825-228, filed 12/14/01, effective 1/14/02. Statutory Authority: RCW 71A.12.030 and 71A.12.040. 00-23-106, § 388-825-228, filed 11/21/00, effective 12/22/00; 00-08-090, § 388-825-228, filed 4/5/00, effective 5/6/00; 99-19-104, recodified as § 388-825-228, filed 9/20/99, effective 10/21/99. Statutory Authority: RCW 71A.12.030. 99-04-071, § 275-27-195, filed 2/1/99, effective 3/4/99.]

     (1) Respite care((, including)) for intermittent relief to the family caregiver and may include community activities providing respite((, attendant care or nursing care));

     (2) Training ((such as parenting classes)) and supports such as disability related support groups or parenting classes. This does not include registration or costs related to conferences;

     (3) The purchase, rental, loan or refurbishment of specialized equipment, adaptive equipment or supplies not covered by other resources, including Medicaid. Specific examples are mobility devices such as walkers and wheelchairs, communication devices and medical supplies. Diapers may be approved only for those three years of age and older.

     (4) Environmental modifications including home damage repairs caused by the client and home modifications ((made necessary because of a family member's)) specific to the client's disability;

     (5) Occupational therapy, physical therapy, communication therapy, behavior management, visual and auditory services, or counseling needed by developmentally disabled individuals ((but)) and not covered by another resource such as Medicaid, public schools ((and)) or child development services funding;

     (6) Medical/dental services not covered by any other resource. These services may include the payment of insurance premiums and deductibles but are limited to the portion of the premium or deduction that applies to the client.

     (7) Nursing services, not covered by another resource, that ((cannot be provided by an unlicenced care giver but)) can only be rendered by a registered or licensed practical nurse. Examples of such services are ventilation, catheterization, and insulin shots. Parents can provide this service without licensure and will not be paid providers of this service for their natural, step or adopted child;

     (8) Special formulas or specially prepared foods necessary because of the client's disability and prescribed by a licensed physician;

     (9) Parent/family counseling for grief and loss issues, genetic counseling or behavior management. Payments cannot be approved for services occurring after the death of the DDD client;

     (10) Specialized clothing adapted for a physical disability, excessive wear clothing, or specialized footwear;

     (11) Specialized utility costs including extraordinary utility costs resulting from the client's disability or medical condition;

     (12) If another resource is not available, transportation costs, including gas, ferry or transit cost, so a client can receive essential services and ((maintain)) appointments; per diem costs may be reimbursed for medical appointments((; and

     (13) Other services approved by a DDD regional administrator or designee, according to established department guidelines)).

     Funds cannot be used for the purchase or rental of a car or for airfare.

[99-19-104, recodified as § 388-825-230, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.030. 99-04-071, § 275-27-196, filed 2/1/99, effective 3/4/99.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 99-04-071 [99-19-104], filed 9/20/99, effective 9/20/99)

WAC 388-825-232   How can serious need funds help my family?   Your family may need extraordinary support ((for children or adults )) that exceeds your annual family support opportunity allotment for the child or adult with developmental disabilities living in your home ((in addition to the basic family support services)). The purpose of serious need funds is to help you get that support when you need it.

     (1) If funding is available and your request is approved, it may be short or long-term in nature and can be used for services such as ((additional personal care,)) respite care, behavior management and licensed nursing care.

     (2) If your request is denied, there is no right to appeal since this request exceeds your annual family support opportunity allotment.

[99-19-104, recodified as § 388-825-232, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.030. 99-04-071, § 275-27-197, filed 2/1/99, effective 3/4/99.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 02-16-014, filed 7/25/02, effective 8/25/02)

WAC 388-825-234   How can my family qualify for serious need funds?   Your family may qualify for serious need funds if all of the following conditions are met:

     (1) The basic program services outlined in WAC 388-825-210 (community guide, ((personal care services, )) short-term intervention services, etc.) are currently being used by your family or they have been exhausted;

     (2) You and your case manager have examined other resources ((like the)) such as Medicaid personal care, medically intensive ((home care program)) services; private insurance, local mental health programs and programs available through the public schools ((and have found them either unavailable, inappropriate or insufficient for your needs)) and the department determines that your need exceeds these services; and

     (3) The support is crucial for the child or adult with developmental disabilities to continue living in your home.

[Statutory Authority: RCW 71A.16.010, 71A.16.030, 71A.12.030, chapter 71A.20 RCW, RCW 72.01.090, and 72.33.125. 02-16-014, § 388-825-234, filed 7/25/02, effective 8/25/02; 99-19-104, recodified as § 388-825-234, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.030. 99-04-071, § 275-27-198, filed 2/1/99, effective 3/4/99.]

     (1) Indicate the type of services your family needs;

     (2) Explain why those services can only be obtained through the use of serious need funds;

     (3) Outline the changes you anticipate in your family situation if the requested services are not received; and

     (4) Estimate the length of time your family will need the requested services((; and

     (5) Propose funding review dates)).

[99-19-104, recodified as § 388-825-236, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.030. 99-04-071, § 275-27-199, filed 2/1/99, effective 3/4/99.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 02-01-074, filed 12/14/01, effective 1/14/02)

WAC 388-825-238   What amount of serious need funding is available to my family?   (1) The maximum amount of funding available is four hundred fifty-two dollars per month or two thousand seven hundred twelve dollars in a six-month period, unless the department determines your family member requires licensed nursing care and the funding is used to pay for nursing care. If licensed care is required, the maximum funding level is two thousand four hundred fifty dollars per month.

     (2) ((REMEMBER:

     (a))) Funding must be available in order to receive serious need services.

     (((b))) (3) Services paid for by serious needs funds will be reviewed by DDD every six months.

[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2001 2nd sp.s. c 7. 02-01-074, § 388-825-238, filed 12/14/01, effective 1/14/02. Statutory Authority: RCW 71A.12.030 and 71A.12.040. 00-23-106, § 388-825-238, filed 11/21/00, effective 12/22/00; 99-19-104, recodified as § 388-825-238, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.030. 99-04-071, § 275-27-200, filed 2/1/99, effective 3/4/99.]

     (2) All family support service payments must be authorized by the department.

     (((2))) (3) The department may contract directly with:

     (a) A service provider, or

     (b) A parent for the reimbursement of goods or services purchased by the parent, or

     (c) An agency to purchase goods and services on behalf of a client.

     (((3))) (4) The department's authorization period will start when you agree to be in this program. The period will last one year and may be renewed if you continue to need services.

     (5) The department does not pay for treatment determined by DSHS/medical assistance administration (MAA) or private insurance to be experimental.

     (6) Respite care cannot be a replacement for child care while the parent or guardian is at work regardless of the age of the client.

     (7) The department shall not authorize a birth parent, adoptive parent, step-parent or any other primary caregiver (or their spouse) living in the same household with the client for respite, nursing, therapy, or counseling services.

[99-19-104, recodified as § 388-825-242, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.030. 99-04-071, § 275-27-204, filed 2/1/99, effective 3/4/99.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 02-16-014, filed 7/25/02, effective 8/25/02)

WAC 388-825-248   Who is covered under these rules?   These sections (WAC 388-825-200 through 388-825-242) apply to persons enrolled in family support after June 1996. Those enrolled before June 1996 are covered under WAC 388-825-252 through ((288-825-256 [388-825-256])) 388-825-256.

[Statutory Authority: RCW 71A.16.010, 71A.16.030, 71A.12.030, chapter 71A.20 RCW, RCW 72.01.090, and 72.33.125. 02-16-014, § 388-825-248, filed 7/25/02, effective 8/25/02; 99-19-104, recodified as § 388-825-248, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.030. 99-04-071, § 275-27-213, filed 2/1/99, effective 3/4/99.]

     (a))) reduce or eliminate the need for out-of-home residential placement of ((a client where the in-home placement is in the client's best interest;

     (b) Allow a client to live in the most independent setting possible; and

     (c) Have access to services best suited to a client's needs)) an individual with developmental disabilities where it is in the best interest of the person to continue living with their family.

     (2) The department's family support services ((shall)) include((,)) the following and become available only after you have used your full benefits through Medicaid, private insurance, school and child developmentservices:

     (a) Respite care((, including the use of)) is intermittent relief to the family caregiver and may include community activities which provide respite;

     (b) ((Attendant care;

     (c))) Nursing services provided by a registered nurse or licensed practical nurse, that cannot be provided by an unlicenced caregiver, including but not limited to, ventilation, catheterization, insulin injections, etc.((, when not covered by another resource;

     (d)));

     (c) Therapeutic services((, provided these therapeutic services are not covered by another resource such as medicaid, private insurance, public schools, or child development services funding,)) including((:

     (i) Physical therapy;

     (ii) Occupational therapy;

     (iii) Behavior management therapy; and

     (iv) Communication therapy; or

     (v) Counseling for the client relating to a disability)) occupational therapy, physical therapy, communication therapy, behavior management, or counseling needed by individuals with developmental disabilities.

     (3) Receiving family support services is based on:

     (a) Funding for state paid services available in the state operating budget;

     (b) SSP funding available to the ((client)) individual/family((; or

     (c) HCBS waiver status)).

     (4) The following rules, subsections (5) through (9), apply only to family support services authorized by the department and do not govern services purchased by the family with SSP (state supplementary payment) funding (see WAC 388-827-0145 and 388-827-0170).

     (5) Up to nine hundred dollars of the service need level amount in WAC 388-825-254 may be used during a one year period for ((flexible)) use as follows. The requested service must be necessary as a result of the disability of the ((client.)) individual and after you have used your full benefits through Medicaid, private insurance, school and child development services:

     (a) Training and supports including parenting classes and disability related support groups. This does not include registration or costs related to conferences;

     (b) Specialized equipment and supplies including the purchase, rental, loan or refurbishment of specialized equipment or adaptive equipment not covered by another resource including Medicaid. Mobility devices such as walkers and wheelchairs are included, as well as communication devices and medical supplies such as diapers for ((those more than)) children three years of age and older;

     (c) Environmental modification including home repairs for damages((, and)) or modifications to the home needed because of the disability of the ((client)) individual;

     (d) Medical/dental services not covered by any other resource. This may include the payment of insurance premiums and deductibles and is limited to the premiums and deductibles of the ((client)) individual;

     (e) Special formulas or specially prepared foods as prescribed by a licensed physician and needed because of the disability of the ((client)) individual;

     (f) Parent/family counseling related to the individual's disability, dealing with a diagnosis, grief and loss issues, genetic counseling and behavior management. Payments cannot be approved for services occurring after the death of the eligible individual;

     (g) Specialized clothing adapted for a physical disability, excessive wear clothing, or specialized footwear;

     (h) Specialized utility costs including extraordinary supplemental utility costs related to the ((client's)) individual's disability or medical condition;

     (i) ((Transportation costs for gas or tickets (ferry fare, transit cost) for a client to get to essential services and appointments, if another resource is not available;

     (j) Other services approved by the DDD regional administrator or designee that will replace or reduce ongoing departmental expenditures and will reduce the risk of out-of-home placement. Exemption requests under this section are not subject to appeal)) If another resource is not available, transportation costs, including gas, ferry or transit cost, so an individual can receive essential services and appointments; per diem costs may be reimbursed for medical appointments. Funds cannot be used for the purchase or rental of a car or for airfare.

     (6) Recommendations will be made to the regional administrator by a review committee. The regional administrator will approve or disapprove the request and will communicate reasons for denial to the committee.

     (7) Payment for services specified in subsection (5)((, except (5)(a) and (h),)) shall cover only the portion of cost attributable to the ((client)) individual.

     (8) Requests must be received by DDD no later than midway through the service authorization period unless circumstances exist justifying an emergency.

     (9) A plan shall be developed jointly by the family and the department for each service authorization period. The department may choose whether to contract directly with the vendor, to authorize purchase by another agency, or may reimburse the parent of the ((client)) individual.

     (10) Emergency services. Emergency funds may be requested for use in response to a single incident or situation or short term crisis such as care giver hospitalization, absence, or incapacity. The request shall include anticipated resolution of the situation. Funds shall be provided for a limited period not to exceed two months. All requests are to be reviewed and approved or denied by ((the regional administrator or designee.

     (11) A departmental service authorization shall state the type, amount, and period (duration) of service. Each department authorization shall constitute a new service for a new period.

     (12) If the client)) DDD.

     (a) If approved, you will receive emergency services for a limited time period, not to exceed two months.

     (b) If denied, you have no appeal rights.

     (11) If the individual becomes eligible and begins to receive Medicaid Personal Care services as defined in ((WAC 388-71-0202 and 388-71-0203)) chapter 388-71 and 388-72A WAC or other DSHS in-home residential support service, the family support funding will be reduced at the beginning of the next month of service. The family will receive notice of the reconfiguration of services at least five working days before the beginning of the month.

     (((13) If requested family support services are not authorized, such actions shall be deemed a denial of services.

     (14))) (12) Family support services may be authorized below the amount requested by the family for the period. When, during the authorized service period, family support services are reduced or terminated below the amount specified in service authorizations, the department shall deem such actions as a reduction or termination of services.

[Statutory Authority: RCW 71A.12.030, 71A.10.020 and 2002 c 371. 04-02-014, § 388-825-252, filed 12/29/03, effective 1/29/04. Statutory Authority: RCW 71A.16.010, 71A.16.030, 71A.12.030, chapter 71A.20 RCW, RCW 72.01.090, and 72.33.125. 02-16-014, § 388-825-252, filed 7/25/02, effective 8/25/02; 99-19-104, recodified as § 388-825-252, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.030, 71A.12.040 and Title 71A RCW. 97-13-051, § 275-27-220, filed 6/13/97, effective 7/14/97. Statutory Authority: RCW 71A.12.040 and 43.43.745. 94-04-092 (Order 3702), § 275-27-220, filed 2/1/94, effective 3/4/94. Statutory Authority: RCW 71A.12.040. 92-09-114 (Order 3372), § 275-27-220, filed 4/21/92, effective 5/22/92. Statutory Authority: RCW 71.20.070. 88-05-004 (Order 2596), § 275-27-220, filed 2/5/88; 86-18-049 (Order 2418), § 275-27-220, filed 8/29/86.]

     (2) All family support service payments must be authorized by the department.

     (3) The department may contract directly with:

     (a) A service provider; or

     (b) A parent for the reimbursement of goods purchased by the parent; or

     (c) An agency to purchase goods and services on behalf of an individual.

     (4) The department's authorization period will start when you agree to be in this program. The period will last one year and may be renewed if you continue to need services.

     (5) The department does not pay for treatment determined by DSHS/MAA or private insurance to be experimental.

     (6) Respite cannot be a replacement for child care while the parent or guardian is at work regardless of the age of the individual.

     (7) The department shall not authorize a birth parent, adoptive parent, stepparent or any other primary caregiver (or their spouse) living in the same household with the individual to provide respite, nursing, therapy, or counseling services.    

[]

     (a) Requests for family support services described in WAC 388-825-252 (2) and (5);

     (b) Service need levels. The amount of SSP (state supplementary payment) available to ((a client)) an individual will be included when calculating the monthly allocation of state family support dollars.

     (c) Availability of family support funding;

     (d) Authorization by a review committee, in each regional office, which reviews each request for service;

     (e) The amounts designated in subsection (2)(a) through (d) of this section are subject to periodic increase if vendor rate increases are mandated by the legislature.

     (2) Service need level lid amounts as follows:

     (((i))) (a) Clients designated for service need level one (WAC 388-825-256) may receive up to one thousand one hundred fifty-six dollars per month or two thousand four hundred sixty-two dollars per month if the ((client)) individual requires licensed nursing care in the home:

     (((A) If a client))

     (i) If an individual is receiving funding through Medicaid Personal Care or other DSHS in-home residential support, the maximum payable through family support shall be five hundred twelve dollars per month;

     (((B))) (ii) If the combined total of family support services at this maximum plus in-home support is less than one thousand one hundred fifty-six dollars additional family support can be authorized to bring the total to one thousand one hundred fifty-six dollars.

     (((ii))) (b) Clients designated for service need level two (WAC 388-825-256) may receive up to four hundred fifty-six dollars per month if not receiving funding through Medicaid personal care:

     (((A) If a client))

     (i) If an individual is receiving funds through Medicaid personal care or other DSHS in-home residential support service, the maximum receivable through family support shall be two hundred fifty-six dollars per month;

     (((B))) (ii) If the combined total of family support services at this maximum plus in-home support is less than four hundred fifty-six ((hundred four)) dollars, additional family support can be authorized to bring the total to four hundred fifty-six dollars.

     (((iii))) (c) Clients designated for service need level three (WAC 388-825-256) may receive up to two hundred fifty-six dollars per month provided the ((client)) individual is not receiving Medicaid personal care. If the ((client)) individual is receiving Medicaid personal care or other DSHS in-home residential support service, the maximum receivable through family support shall be one hundred twenty-eight dollars per month; and

     (((iv))) (d) Clients designated for service level four (WAC 388-825-256) may receive up to one hundred twenty-eight dollars per month family support services.

     (((d) Availability of family support funding;

     (e) Authorization by a review committee, in each regional office, which reviews each request for service;

     (f) The amounts designated in subsection (1)(b)(i) through (iv) of this section are subject to periodic increase if vendor rate increases are mandated by the legislature.

     (2))) (3) The department shall authorize family support services contingent upon the applicant providing accurate and complete information on disability-related requests.

     (((3))) (4) The department shall ensure service authorizations do not exceed maximum amounts for each service need level based on the availability of funds.

     (((4) The department shall not authorize a birth parent, adoptive parent, or stepparent living in the same household as the client as the direct care provider for respite, attendant, nursing, therapy, or counseling services for a child seventeen years of age or younger.))

[Statutory Authority: RCW 71A.12.030, 71A.10.020 and 2002 c 371. 04-02-014, § 388-825-254, filed 12/29/03, effective 1/29/04. Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2001 2nd sp.s. c 7. 02-01-074, § 388-825-254, filed 12/14/01, effective 1/14/02. Statutory Authority: RCW 71A.12.030 and 71A.12.040. 00-23-106, § 388-825-254, filed 11/21/00, effective 12/22/00; 00-08-090, § 388-825-254, filed 4/5/00, effective 5/6/00; 99-19-104, recodified as § 388-825-254, filed 9/20/99, effective 10/21/99. Statutory Authority: RCW 71A.12.030, 71A.12.040 and Title 71A RCW. 97-13-051, § 275-27-222, filed 6/13/97, effective 7/14/97.]

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