WSR 04-20-018

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed September 27, 2004, 8:25 a.m. , effective September 27, 2004 ]


     

     Purpose: The Division of Developmental Disabilities has received approval from the federal Centers for Medicare and Medicaid Services (CMS) to implement four home and community based service (HCBS) waivers, which replace the current community alternatives program (CAP) waiver, and as a result is adopting new chapter 388-845 WAC, DDD home and community based services waivers.

     These rules only replace the emergency rules in chapter 388-845 WAC filed as WSR 04-16-019, removing respite care from the aggregate package of services in the Basic and Basic Plus waivers, and implementing a new respite assessment for individuals in the Basic and Basic Plus waivers. Emergency rules in chapter 388-825 WAC as filed in WSR 04-16-019 remain in effect.

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

     Other Authority: Chapter 71A.12 RCW.

     Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest; and that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

     Reasons for this Finding: These rules were originally filed on an emergency basis as WSR 04-08-020. The approval of the HCBS waivers by CMS required the department to implement new rules on April 1, 2004, to protect the health and welfare of eligible clients by ensuring no interruption in services to current participants in the CAP waiver occurs, and to ensure a continuation of federal matching funds under 42 C.F.R. 441, Subpart G - Home and Community Based Services -- Waiver Requirements.

     The department has filed a notice of intent to adopt permanent rules as WSR 03-20-103. Ongoing negotiations with CMS and the need to obtain extensive feedback from stakeholders have delayed the filing of proposed rules for adoption on a permanent basis until the negotiations are completed and the feedback is obtained.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 116, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

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

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

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

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 116, Amended 0, Repealed 0.

     Date Adopted: September 21, 2004.

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3373.9
Chapter 388-845 WAC

DDD HOME AND COMMUNITY BASED SERVICES WAIVERS


NEW SECTION
WAC 388-845-0010   What are home and community based services (HCBS) waivers?   (1) Home and community based services (HCBS) waivers are approved by the Centers For Medicare and Medicaid Services (CMS) under section 1915(c) of the Social Security Act as an alternative to intermediate care facility for the mentally retarded (ICF/MR) care.

     (2) Certain federal regulations are "waived" enabling the provision of services in the home and community to individuals who would otherwise require the services provided in an ICF/MR.

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

     (1) Basic waiver;

     (2) Basic Plus waiver;

     (3) CORE waiver; and

     (4) Community Protection waiver.

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NEW SECTION
WAC 388-845-0020   When are these four HCBS waivers effective?   These four DDD HCBS waivers are effective April 1, 2004 for all persons enrolled on the CAP waiver March 31, 2004.

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

     (1) Your current services will continue as authorized in your current CAP waiver plan.

     (2) At the time of your next waiver plan of care after March 31, 2004, the rules and limits of your new waiver will apply.

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NEW SECTION
WAC 388-845-0030   Do I meet criteria for HCBS waiver-funded services?   If you are on the CAP waiver as of March 31, 2004, your waiver eligibility continues until your plan of care review. You meet criteria for DDD HCBS waiver funded services if you meet all of the following:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

     (1) Your request for waiver enrollment will be documented by DDD in a statewide database if DDD determines that you:

     (a) Meet the criteria for a priority populations in WAC 388-845-0045, and

     (b) Have ICF/MR level of care needs per WAC 388-845-0070 through 388-845-0090.

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

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

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

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

     (3) Your reassessments must be done in-person and may be completed more often if your functional, financial, or other significant circumstances change.

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

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

     (2) You no longer need or use waiver services;

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

     (4) You choose to disenroll from the waiver;

     (5) You reside out of state;

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

     (7) You refuse to participate with DDD in:

     (a) Service planning,

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

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

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

     (a) At the time your annual waiver reassessment is due; or

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

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

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

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

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

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

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

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

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

     (a) Major support for:

     (i) Dressing and grooming self,

     (ii) Toileting self.

     (b) Major or moderate support for:

     (i) Eating,

     (ii) Mobility,

     (iii) Communication,

     (iv) Making choices and taking responsibility,

     (v) Exploring one's environment,

     (vi) Supports needed to meet therapy and health needs

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

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NEW SECTION
WAC 388-845-0085   How is a person age thirteen or older assessed for ICF/MR level of care?   If you are age thirteen and older, DDD assesses you for ICF/MR level of care using the "assessment of ICF/MR level of care--current support needs" form.

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NEW SECTION
WAC 388-845-0090   What score indicates ICF/MR level of care if I am age thirteen or older?   If you are age thirteen or older, you must have a qualifying score of at least forty in response to twenty questions assessing your residential, school or employment, and social support needs.

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NEW SECTION
WAC 388-845-0095   What if my score on the current needs assessment does not indicate ICF/MR level of care?   (1) If you do not have a qualifying score for determining ICF/MR level of care using the department approved assessment, you may provide DDD other current information that provides evidence of your need for waiver services.

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

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

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

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

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

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

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

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

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

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

     (b) You have been convicted of or charged with acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization, or persons of casual acquaintance with whom no substantial personal relationship exists;

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

     (d) You have not been convicted and/or charged, but you have a history of stalking, sexually violent, predatory and/or opportunistic behavior which demonstrates a likelihood to commit a sexually violent and/or predatory act based on current behaviors that may escalate to violence, as determined by a qualified professional;

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

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

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

     (a) Plan of care (POC);

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

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

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

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

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

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

     (4) Waiver services cannot replace or duplicate other available paid and unpaid supports and services, including payments authorized to you by DDD to purchase a service

directly.

     (5) Waiver funding cannot be authorized for treatments determined by DSHS/medical assistance to be experimental.

     (6) The Basic and Basic Plus waivers have yearly limits on some services and combinations of services.

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

     (8) Services out-of-state are limited to respite care and personal care during vacations.

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

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

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

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

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

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

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NEW SECTION
WAC 388-845-0205   Basic waiver services.  
SERVICES YEARLY LIMIT
BASIC WAIVER Behavior management and consultation

Community guide

Environmental accessibility adaptations

Specialized medical equipment/supplies

Occupational therapy

Specialized psychiatric services

Physical therapy

Speech, hearing and language services

Staff/family consultation and training

Transportation

May not exceed $1425 per year on any combination of these services
Person-to-person

Supported employment

Community access

Prevocational services

May not exceed $6500 per year
Respite care Limits are determined by respite assessment
Personal care Limits are determined by CARE assessment
Mental health diversion services:

Behavior management and consultation

Crisis respite care

Specialized psychiatric services

Limits determined by mental health or DDD
Emergency assistance is only for services contained in the Basic waiver $6000 per year; Preauthorization required

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NEW SECTION
WAC 388-845-0210   Basic Plus waiver services.  
SERVICES YEARLY LIMIT
BASIC PLUS WAIVER Behavior management and consultation

Community guide

Environmental accessibility adaptations

Specialized medical equipment/supplies

Occupational therapy

Specialized psychiatric services

Physical therapy

Skilled nursing

Speech, hearing and language services

Staff/family consultation and training

Transportation

May not exceed $6070 per year on any combination of these services
Person-to-person

Supported employment

Community access

Prevocational services

May not exceed $9500 per year
Adult foster care (adult family home)

Adult residential care (boarding home)

Determined per department rate structure
Mental health diversion services:

Behavior management and consultation

Crisis respite care

Specialized psychiatric services

Skilled nursing

Limits determined by mental health or DDD
Personal care Limits determined by the CARE assessment
Respite care Limits are determined by respite assessment
Emergency assistance is only for services contained in the Basic Plus waiver $6000 per year; Preauthorization required

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

SERVICES YEARLY LIMIT
CORE WAIVER Behavior management and consultation

Community guide

Environmental accessibility adaptations

Specialized medical equipment/supplies

Occupational therapy

Specialized psychiatric services

Physical therapy

Respite care

Skilled nursing

Speech, hearing and language services

Staff/family consultation and training

Transportation

Limited to the average cost of an ICF/MR for any combination of services
Residential habilitation
Person-to-person

Supported employment

Community access

Prevocational services

Personal care Limited by CARE assessment

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

SERVICES YEARLY LIMIT
COMMUNITY PROTECTION WAIVER Behavior management and consultation

Environmental accessibility adaptations

Specialized medical equipment/supplies

Occupational therapy

Specialized psychiatric services

Physical therapy

Skilled nursing

Speech, hearing and language services

Staff/family consultation and training

Transportation

Limited to the average cost of an ICF/MR for any combination of services
Residential habilitation
Person-to-person

Supported employment

Prevocational services

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

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

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

     (1) AFH services are defined and limited per chapter 388-72A and 388-71 WAC governing Medicaid personal care and the comprehensive assessment and reporting evaluation (CARE) or the legacy comprehensive assessment.

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

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

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

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

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

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

     (1) Be a licensed boarding home;

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

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

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

     (1) ARC services are defined and limited by boarding home licensure and rules and chapter 388-72A and 388-71 WAC governing Medicaid personal care and the comprehensive assessment and reporting evaluation (CARE) or the legacy comprehensive assessment.

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

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

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NEW SECTION
WAC 388-845-0500   What is behavior management and consultation?   Behavior management interventions and consultation may be provided to persons on any of the HCBS waivers and include:

     (1) The development and implementation of programs designed to support waiver participants to behave in ways that enhance their inclusion in the community.

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

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

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

     (1) Marriage and family therapist (chapter 246-809 WAC);

     (2) Mental health counselor (chapter 246-809; 246-810 WAC);

     (3) Psychologist (chapter 246-924 WAC);

     (4) Registered counselor (chapter 246-810 WAC);

     (5) Sex offender treatment provider (chapter 246-930 WAC);

     (6) Social worker (chapter 246-809 WAC).

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

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

     (2) The dollar limitations in your Basic and Basic Plus waiver limit the amount of service.

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

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

     (1) If you are age sixty-one or younger, the goal of community access is to help you progress towards employment.

     (2) If you are age sixty-two or older, this service is available to meet your retirement needs.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

     (a) The emergency situation has been resolved; or

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

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

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

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

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

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

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

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

     (1) Prior approval by DDD is required.

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

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

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

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

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     Reviser's note: The spelling error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-845-1015   Are there limits to the extended state plan services I can receive?   (1) Additional therapy may be authorized as a waiver service only after you have accessed what is available to you under Medicaid and any other private health insurance plan;

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

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

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

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

     (4) The Basic and Basic Plus waivers limit the amount of service you can receive.

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NEW SECTION
WAC 388-845-1100   What are mental health diversion services?   Mental health diversion services stabilize persons in crisis due to a mental health disorder. These services are available in all four waivers to adults determined by mental health professionals or DDD to be at risk of institutionalization in a psychiatric hospital without one of more of the following services.

     (1) Behavior management and consultation,

     (2) Skilled nursing services,

     (3) Specialized psychiatric services,

     (4) Mental health crisis respite for the purpose of crisis stabilization.

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NEW SECTION
WAC 388-845-1105   Who are qualified providers of mental health diversion services?   Providers of these mental health diversion services are listed in the rules in this chapter governing the specific services listed in WAC 388-845-1100.

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NEW SECTION
WAC 388-845-1110   Are there limitations to the mental health diversion services that I can receive?   Mental health diversion services are intermittent and temporary. The duration and amount of services you need to stabilize your crisis is determined by a mental health professional and/or DDD.

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

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

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

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NEW SECTION
WAC 388-845-1300   What are personal care services?   Personal care services are the provision of assistance with personal care tasks as defined in WAC 388-71-0202, Personal care services. These services are available in the Basic, Basic Plus, and CORE waivers.

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

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

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

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

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NEW SECTION
WAC 388-845-1310   Are there limits to the personal care services I can receive?   (1) You must meet the programmatic eligibility for Medicaid personal care in chapter 388-72A and 388-71 WAC governing Medicaid personal care (MPC) using the current department approved assessment form: Comprehensive assessment reporting evaluation (CARE), legacy comprehensive assessment, or children's comprehensive assessment.

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

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

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

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

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

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

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

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

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

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NEW SECTION
WAC 388-845-1500   What are residential habilitation services?   (1) Residential habilitation services (RHS) services include assistance to learn or improve or retain the social and adaptive skills necessary for living in the community. These services are available in the CORE and Community Protection waivers.

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

     (a) Health and safety;

     (b) Personal power and choice;

     (c) Competence and self-reliance;

     (d) Positive recognition by self and others;

     (e) Positive relationships; and

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

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

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

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

     (3) Agencies contracted with DDD and certified per chapter 388-820 WAC; State-operated living alternatives (SOLA);

     (4) Licensed and contracted group care homes, foster homes, child placing agencies, staffed residential homes (licensed and contracted adult residential rehabilitation center per WAC 246-325-0012.

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NEW SECTION
WAC 388-845-1510   Who are qualified providers of residential habilitation services for the Community Protection waiver?   Providers of residential habilitation services for participants of the Community Protection waiver are limited to state-operated living alternatives (SOLA) and supported living providers who:

     (1) Are contracted with DDD and certified under chapter 388-820 WAC as a residential community protection provider-intensive supported living services (CP-ISLS); and

     (2) Meet the additional standards in DDD Policy 15.04 (Standards for community protection intensive supported living services).

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

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

     (a) Room and board;

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

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

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

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

     (a) Your spouse;

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

     (c) Your natural, step, or adoptive parent unless your parent is certified as a residential agency per chapter 388-820 WAC or is employed by a certified or licensed agency qualified to provide residential habilitation services.

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

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

     (1) You are a child under age eighteen living in a private home;

     (2) You live in a licensed children's foster home;

     (3) You are age eighteen or older and live with a contracted companion home provider;

     (4) You are age eighteen or older and live in a private home with your full-time caregiver:

     (a) This includes paid and unpaid caregivers;

     (b) Paid caregivers are defined as parent providers, companion home providers, and foster homes, and are only able to receive respite care for the hours they are not being paid to provide care to you or other individuals;

     (c) The home cannot be a licensed adult family home or an adult residential care facility or a certified DDD residential program.

     (5) You are age eighteen or older and are authorized respite through mental health crisis diversion.

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

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

     (2) Relative's home;

     (3) Licensed children's foster home;

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

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

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

     (7) Adult residential rehabilitation center;

     (8) Licensed and contracted adult family home;

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

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

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

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

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

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

     (4) Licensed and contracted AFH;

     (5) Licensed and contracted ARC;

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

     (7) Licensed childcare center chapter 388-151 WAC;

     (8) Licensed child daycare center chapter 388-151 WAC;

     (9) Adult day care centers contracted with DDD;

     (10) Certified provider per chapter 388-820 WAC when respite is provided within the DDD contract for certified residential services;

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

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

     (1) A respite care assessment will determine how much respite you can receive if you are in the Basic or Basic Plus waiver.

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

     (3) Respite cannot be a replacement for daycare while a parent or guardian is at work.

     (4) Respite is in addition to any personal care hours available to you.

     (5) Respite care cannot be authorized in an unlicensed private home unless it is the client's home or the home of a relative.

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

     (7) If you require respite from a licensed healthcare professional, your needs will be authorized under skilled nursing per WAC 388-845-1700.

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

     (9) If your caregiver is providing paid care to you or other individuals, they cannot receive respite care during those hours in which they are providing paid care.

     (10) If you are in the CORE waiver, the POC, not the respite assessment, will determine the amount of respite care available to you.

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

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

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NEW SECTION
WAC 388-845-1705   Who is a qualified provider of skilled nursing services?   The provider of skilled nursing services must be a healthcare professional acting within the scope of the Nurse Practice Act chapter 246-845 WAC and contracted with DDD to provide this service.

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

     (1) Prior department approval is required.

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

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

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

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

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

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

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

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

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

     (4) Items are excluded if they are not of direct medical and remedial benefit to the individual.

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

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

     (2) Service may be any of the following:

     (a) Psychiatric evaluation,

     (b) Medication evaluation and monitoring,

     (c) Psychiatric consultation.

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

     (1) Advanced registered nurse practitioner (ARNP),

     (2) Physician assistant,

     (3) Psychiatrist.

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

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

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

     (3) Special needs include:

     (a) Health and medication monitoring,

     (b) Positioning and transfer,

     (c) Basic and advanced instructional techniques,

     (d) Positive behavior support,

     (e) Augmentative communication systems.

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

     (1) Audiologist,

     (2) Licensed practical nurse,

     (3) Marriage and family therapist,

     (4) Mental health counselor,

     (5) Occupational therapist,

     (6) Physical therapist,

     (7) Counselor,

     (8) Registered nurse,

     (9) Sex offender treatment provider,

     (10) Speech/language pathologist,

     (11) Social worker,

     (12) Psychologist.

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

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

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

receiving waiver services, including supervision and training.

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

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

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

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

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

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

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

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

     (1) Transportation provides the person access to waiver and other community services,

activities and resources, specified by the plan of care.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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NEW SECTION
WAC 388-845-3010   Who must have a waiver respite assessment?   If you are in the Basic or Basic Plus waiver and are interested in receiving respite care, and are eligible for respite care per WAC 388-845-1605, a respite assessment will determine the amount of respite care available to you.

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

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

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

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

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NEW SECTION
WAC 388-845-3025   How often is this waiver respite assessment completed?   Your respite assessment must be completed at least every twelve months at the time of your annual CARE assessment/reassessment and plan of care.

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

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

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

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

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

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

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

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

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

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

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

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NEW SECTION
WAC 388-845-3040   When will the new respite assessment go into effect?   The new respite assessment will be effective at your next plan of care after September 1, 2004, and when department staff have completed training in the use of both the CARE and the Waiver Respite Assessment.

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

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NEW SECTION
WAC 388-845-3050   What is the effective date of my respite allocation?   Your respite care allocation is effective when your POC is effective per WAC 388-845-3065.

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NEW SECTION
WAC 388-845-3055   What is a waiver plan of care (POC)?   (1) A waiver plan of care (POC) is a document that is based on an assessment of your needs and the limitations in WAC 388-845-0110.

     (2) Your plan must include:

     (a) The services that you and DDD have agreed are necessary for you to receive in order to address your health and welfare needs;

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

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

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

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

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

     (b) Is reasonably available;

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

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

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

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NEW SECTION
WAC 388-845-3065   How long is my plan effective?   Your plan of care is effective for three hundred sixty-five days.

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

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

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

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

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

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

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

     (a) Add more available natural supports;

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

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

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

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

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

     (c) Placement in an ICF/MR.

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

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

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

     (a) Add more available natural supports;

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

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

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

     (2) If non of the above options is successful in meeting your health and welfare needs, DDD may terminate your waiver eligibility.

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

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     Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-845-3090   What if my identified health and welfare needs are less than what is provided in my current waiver?   If your identified health and welfare needs are less than what is provided in your current waiver, DDD may require you to apply for an alternative waiver whose services meet but do not exceed what is necessary to meet your identified health and welfare needs.

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

     (2) Currently clients are only required to participate towards the cost of residential services provided in a licensed facility.

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

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

     (b) If you are an SSI beneficiary who receives only SSI income, you pay only for board and room and you keep a personal allowance of thirty-eight dollars and eighty-four cents.

     (c) If you are an SSI beneficiary who receives SSI and SSA benefits, you only pay for board and room and you are allowed to keep an additional twenty dollars for a total personal allowance of fifty-eight dollars and eighty-four cents.

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

     (e) If you earn wages and are not an SSI beneficiary, the department exempts the first sixty-five dollars and one-half of the remaining earned gross wages from the amount of income used to calculate participation.

     (f) Guardianship fees, payee fees and medical expenses not covered by Medicaid are deducted from your available income when calculating the amount of your participation.

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

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

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

     (3) Your termination from waiver eligibility.

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

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NEW SECTION
WAC 388-845-4005   Can I appeal a denial of my request to be enrolled in a waiver?   If you are not on an HCBS waiver, your appeal rights are limited to WAC 388-825-120. You have an appeal right to a denial of services or provider but you do not have an appeal right to a denial to be enrolled in a waiver.

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

     (2) If you want to appeal a department action, you must file a written appeal with the office of administrative hearings in Olympia within twenty-eight days from receipt of the department notice of the action you are disputing.

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NEW SECTION
WAC 388-845-4015   Will my services continue during an appeal?   Services may continue during the appeal process except as specified in WAC 388-825-150.

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