SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Preproposal statement of inquiry was filed as WSR 02-07-107.
Title of Rule and Other Identifying Information: Adopting new chapter 388-823 WAC, Division of developmental disabilities intake and determination of developmental disabilities; and repealing existing WAC 388-825-030, 388-825-035, and 388-825-040.
Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on April 5, 2005, at 10:00 a.m.
Date of Intended Adoption: Not earlier than April 6, 2005.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail firstname.lastname@example.org, fax (360) 664-6185, by 5 p.m., April 5, 2005.
Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by April 1, 2005, TTY (360) 664-6178 or (360) 664-6097.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of these rules is to clarify the entire application and eligibility determination process used by the Division of Developmental Disabilities (DDD). This new chapter:
• Describes how to apply for a determination of a developmental disability;
• Defines the conditions required to be considered a person with a developmental disability, defines how these conditions may meet substantial limitations to adaptive functioning and defines the evidence required to substantiate adaptive functioning limitations;
• Defines how the age of an individual affects the eligibility determination process;
• Describes the inventory for client and agency planning (ICAP);
• Defines the expiration of eligibility, reviews and reapplication; and
• Describes an individual's rights as a client of DDD.
Reasons Supporting Proposal: DDD determined that adopting new rules on the application and eligibility determination process would be more effective and clearer than amending current rules in chapter 388-825 WAC.
Statutory Authority for Adoption: RCW 71A.10.020, 71A.12.030, 71A.12.050, 71A.12.070, 71A.16.020, 71A.16.030, 71A.16.040, and 71A.16.050.
Statute Being Implemented: Chapters 71A.10, 71A.12 and 71A.16 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, 640 Woodland Square Loop S.E., Lacey, WA 98503-1045, P.O. Box 45310, Olympia, WA 98507-5310, e-mail email@example.com, phone (360) 725-3416, fax (360) 407-0955; Implementation and Enforcement: Sue Poltl, 640 Woodland Square Loop S.E., Lacey, WA 98503-1045, P.O. Box 45310, Olympia, WA 98507-5310, e-mail firstname.lastname@example.org, phone (360) 725-3454, fax (360) 407-0955.
No small business economic impact statement has been prepared under chapter 19.85 RCW. DDD has determined that these rules do not affect small businesses.
A cost-benefit analysis is not required under RCW 34.05.328. These rules are exempt from preparing a cost-benefit analysis pursuant to RCW 34.05.328 (5)(b)(vii). These rules relate only to client medical and financial eligibility.
January 24, 2005
Andy Fernando, Manager
Rules and Policies Assistance Unit3497.3
DIVISION OF DEVELOPMENTAL DISABILITIES INTAKE AND DETERMINATION OF DEVELOPMENTAL DISABILITIES
"Client" means a person with a developmental disability as defined in chapter 388-823 WAC who is currently eligible and active with the division of developmental disabilities.
"DAS" means Differential Ability Scales, which is a cognitive abilities battery for children and adolescents at least age two years, six months but under age eighteen.
"DDD" means the division of developmental disabilities, a division within the aging and disability services administration, department of social and health services.
"Department" means the department of social and health services.
"Division" means the division of developmental disabilities.
"Eligible" means you have a developmental disability that meets all of the requirements in this chapter for a specific condition.
"Expiration date" means a specific date that your eligibility as a client of DDD and all services paid by DDD will stop.
"FSIQ" means the full scale intelligence quotient which is a broad measure of intelligence achieved through one of the standardized intelligence tests included in these rules. Any standard error of measurement value will not be taken into consideration when making a determination for DDD eligibility.
"ICAP" means the inventory for client and agency planning. This is a standardized assessment of functional ability. The adaptive behavior section of the ICAP assesses daily living skills and the applicant awareness of when to perform these skills. The goal is to get a snapshot of his/her ability.
"IMR" means an institution for the mentally retarded, per chapter 388-835 WAC or chapter 388-837 WAC.
"K-ABC" means Kaufman Assessment Battery for Children, which is a clinical instrument for assessing cognitive development. It is an individually administered test of intelligence and achievement for children at least age two years, six months but under age twelve years, six months. The K-ABC comprises four global scales, each yielding standard scores. A special nonverbal scale is provided for children at least age four years but under age twelve years, six months.
"Leiter-R" means Leiter International Performance Scale -Revised, which is an untimed, individually administered test of nonverbal cognitive ability for individuals at least age two years but under age twenty-one years.
"Review" means DDD must redetermine that you still have a developmental disability according to the rules that are in place at the time of the review.
"RHC" means one of five residential habilitation centers operated by the division: Lakeland Village, Yakima Valley School, Fircrest, Rainier School, and Francis Haddon Morgan Center.
"SIB-R" means the scale of independent behavior-revised which is an adaptive behavior assessment derived from quality standardization and norming. It can be administered as a questionnaire or as a carefully structured interview, with special materials to aid the interview process.
"SOLA" means a state operated living alternative residential service for adults operated by the Division.
"Stanford-Binet" is a battery of fifteen subtests measuring intelligence for individuals at least age two years but under age twenty-three years.
"Termination" means an action taken by DDD that stops your DDD eligibility and services paid by DDD.
"VABS" means Vineland Adaptive Behavior Scales, which in an assessment to measure adaptive behavior in children from birth but under age eighteen years, nine months and in adults with low functioning in four separate domains: communication, daily living skills, socialization, and motor skills.
"Wechsler" means the Wechsler Intelligence Scale, which is an individually administered 11-subtest measure of an individual's capacity for intelligent behavior. The Wechsler has both a verbal scale and a performance scale. The Wechsler is used with individuals at least age three years but under age seventy-four years. The verbal scale can be used alone with individuals who have visual or motor impairments, and the performance scale can be used alone with individuals who cannot adequately understand or produce spoken language. There are three Wechsler Intelligence Scales, dependent upon the age of the individual:
• The Wechsler Preschool and Primary Scale of Intelligence - Revised (WPPSI-R), for children at least age three years but under age seven years;
• The Wechsler Intelligence Scale for Children - Third Edition, (WISC-III), for children at least age six years but under age sixteen years; and
• The Wechsler Adult Intelligence Scale - Revised (WAIS-R), for individuals at least age sixteen years but under age seventy-four years.
(1) Your meeting eligibility requirements for the specific service;
(2) An assessed need for the service; and
(3) Available funding for the service.
(a) Be attributable to mental retardation, cerebral palsy, epilepsy, autism, or another neurological or other condition found by DDD to be closely related to mental retardation or requiring treatment similar to that required for individuals with mental retardation;
(b) Originate prior to age eighteen;
(c) Be expected to continue indefinitely; and
(d) Result in substantial limitations to an individual's adaptive functioning.
(2) In addition to the requirements listed in (1) above, you must meet the other conditions contained in this chapter.
(1) The receipt of Medicaid or other benefits from the department of social and health services that require residency as a condition of eligibility; or
(2) Documentation that shows you live in the state of Washington, or, if you are a child under the age of eighteen, documentation that shows your parent or legal guardian lives in the state of Washington.
(a) The parent or legal representative must apply on behalf of a child under the age of eighteen years; or
(b) An adult applicant age eighteen years or older can apply on his/her own behalf or through a legal guardian.
(2) Any person, agency, or advocate may refer an adult for a determination of a developmental disability and assist with the application process. However, since the request for a determination of developmental disability is voluntary, DDD will request the verbal or written consent from the legal guardian of the adult or from the adult applicant if there is no legal guardian.
(2) If DDD has received all requested documentation but it is insufficient to establish eligibility, DDD will make a determination of ineligibility and send you written notice of denial of eligibility.
(3) If DDD has insufficient information to determine you eligible but has not received all of the requested documentation, DDD may deny your eligibility after ninety days from the date of application. Rules governing reapplying for eligibility are in WAC 388-823-1080.
(1) If you are not eligible, the written notice will explain why you are not eligible, explain your appeal rights to this decision, and provide you with a fair hearing request form.
(2) If you are eligible, the written notice will include:
(a) Your eligibility condition(s);
(b) The effective date of your eligibility;
(c) The expiration date or review date of your eligibility, if applicable; and
(d) The name and phone number of your assigned case manager.
(2) Paid DDD services cannot begin before the effective date of your DDD eligibility.
(1) DDD will assist you in obtaining records but the purchase of diagnostic assessments or intelligence quotient (IQ) testing is your responsibility.
(2) If DDD determines that an inventory of client and agency planning (ICAP) is required, DDD will administer the ICAP at no expense to you.
(2) DDD will determine if the reported verbal information is adequate for documenting the existence of your condition prior to age eighteen.
(3) Additional evidence of your eligible condition and the resulting substantial limitations to adaptive functioning is still required.
(1) Developmental delays per WAC 388-823-0800 through WAC 388-823-0850, or
(2) Developmental disabilities per WAC 388-823-0200 through 388-823-0710.
DETERMINATION OF A DEVELOPMENTAL DISABILITY
WAC 388-823-0200 What evidence do I need to substantiate "mental retardation" as an eligible condition? Evidence that you have an eligible condition under "mental retardation" requires a diagnosis of mental retardation by a licensed psychologist, or a finding of mental retardation by a certified school psychologist or a diagnosis of Down syndrome by a licensed physician.
(1) This diagnosis is based on documentation of a lifelong condition originating before age eighteen.
(2) The condition results in significantly below average cognitive and adaptive skills functioning that will not improve with treatment, instruction or skill acquisition.
(3) A diagnosis or finding of mental retardation by the examining psychologist must include an evaluation of adaptive functioning that includes the use of a standardized adaptive behavior scale indicating adaptive functioning that is more than two standard deviations below the mean, in at least two of the following areas: communication, self care, home living, social/interpersonal skills, use of community resources, self direction, functional academic skills, work, leisure, health, and safety.
(1) The test must be administered by a licensed psychologist or certified school psychologist.
(2) The FSIQ cannot be attributable to mental illness or other psychiatric condition, or other illness or injury occurring after age eighteen:
(a) If you are dually diagnosed with mental retardation and mental illness, other psychiatric condition, or other illness or injury, DDD must make its decision based solely on the diagnosis of mental retardation, excluding the effects of the mental illness, other psychiatric condition, illness or injury; or
(b) If DDD is unable to make this decision based solely on the diagnosis of mental retardation due to the existence of mental illness, other psychiatric condition or illness or injury, DDD has the authority to deny eligibility.
(3) If you have a significant hearing impairment, the administering professional may estimate an FSIQ score using only the performance IQ score of the appropriate Wechsler or administer the Leiter-R.
(4) If you have a vision impairment that prevents completion of the performance portion of the IQ test, the administering professional may estimate an FSIQ using only the verbal IQ score of the appropriate Wechsler.
(5) The following table shows the standard deviation for each assessment and the qualifying score of more than two standard deviations below the mean.
|ASSESSMENT||STANDARD DEVIATION||QUALIFYING SCORE|
|Stanford-Binet||16||67 or less|
|Wechsler Intelligence Scales (Wechsler)||15||69 or less|
|Differential Abilities Scale (DAS)||15||69 or less|
|Kaufman Assessment Battery for Children (K-ABC)||15||69 or less|
|Leiter International Performance Scale-Revised (Leiter-R) [for persons with significant hearing impairments or when English is not a primary language]||15||69 or less|
Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.
WAC 388-823-0220 If I am too cognitively impaired to complete a standardized IQ test, how do I meet the criteria under mental retardation? If in the opinion of the examining psychologist, you are too cognitively impaired to complete all of the subtests necessary to achieve an FSIQ score on an approved standardized IQ test, the examining psychologist may estimate an FSIQ from the available information based on a professional judgment about your intellectual functioning.
(a) If there is no significant difference among these, DDD will accept the score the closest to age eighteen.
(b) If there are significant differences among the FSIQ scores, DDD will review the pattern and attempt to determine reasons for the fluctuations to ensure that the FSIQ is resulting from mental retardation and not from mental illness or other psychiatric condition, or illness, or other injury.
(2) If you are age eighteen or older, DDD will use the FSIQ obtained at age thirteen or older.
(3) If you are under age eighteen, DDD will use the most current FSIQ.
(4) DDD will exclude any FSIQ score attributable to a condition or impairment that began after the age of eighteen.
(1) Existed prior to age three; and
(2) Impair control of movement.
(5) Mobility; or
Reviser's note: The above new section was filed by the agency as WAC 388-0823-0310.
This section is placed among sections forming new chapter 388-823 WAC, and therefore should be numbered WAC
388-823-0310. Pursuant to the requirements of RCW 34.08.040, the section is published in the same form as filed by the agency.
WAC 388-823-0320 What evidence do I need of my need for direct physical assistance with activities of daily living? Evidence for direct physical assistance with activities of daily living requires that:
(1) You need the presence and assistance of another person on a daily basis to be able to communicate and be understood by any other person.
(a) If you are able to communicate through a communication device you will be considered independent in communication.
(b) You must require more than "setting up" of the communication device.
(2) You need direct physical assistance from another person on a daily basis with toileting, bathing, eating, dressing, or mobility.
(a) You require more than "setting up" the task to enable you to perform the task independently.
(b) Your ability to be mobile is your ability to move yourself from place to place, not your ability to walk. For instance, if you can transfer in and out of a wheelchair and are independently mobile in a wheelchair, you do not meet the requirement for hands-on assistance with mobility. You must require direct assistance for more than transferring in and out of wheelchair, in and out of the bath or shower, and/or on and off of the toilet.
(1) The comprehensive assessment reporting evaluation (CARE) tool or other department assessments that measures direct assistance needs in the areas specified above;
(2) Assessments and reports from educational or healthcare professionals that are current and consistent with your current functioning;
(3) In the absence of professional reports or assessments, DDD may document its own observation of your direct assistance needs along with reported information by family and others familiar with you.
(1) This condition requires a diagnosis of epilepsy or seizure disorder that originated prior to age eighteen and is expected to continue indefinitely.
(2) The diagnosis must be made by a board certified neurologist and be based on documentation of medical history and neurological testing.
(3) You must provide confirmation from your physician or neurologist that your seizures are currently uncontrolled and ongoing or recurring and cannot be controlled by medication.
(4) DDD will not consider your seizures uncontrolled or ongoing if it is documented or reported that you refuse to take medications.
(5) Your seizures must occur more than once per month and make you physically incapacitated, requiring direct physical assistance for one or more activities as defined in WAC 388-823-0310 and WAC 388-823-0320 during or following seizures.
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.
WAC 388-823-0420 What evidence do I need to substantiate adaptive functioning limitations for the eligible conditions of epilepsy, autism and other conditions similar to mental retardation? (1) Evidence of substantial limitations of adaptive functioning for the conditions of epilepsy, autism, and other conditions similar to mental retardation requires a qualifying score in a VABS, a SIB-R, or an ICAP completed in the past twenty-four months.
(a) Professionals who administer and score the VABS must have a background in individual assessment, human development and behavior, and tests and measurements, as well as an understanding of individuals with disabilities.
(b) Department staff or designee contracted with DDD must administer the ICAP.
(c) DDD will administer or arrange for the administration of the ICAP if VABS or SIB-R results are not submitted.
(d) Qualifying scores for each assessment are as follows:
|ASSESSMENT||STANDARD DEVIATION||QUALIFYING SCORE|
|Vineland Adaptive Behavior Scales (VABS)||15||An adaptive behavior composite score of 69 or less|
|Scales of Independent Behavior-Revised (SIB-R)||15||A broad independence standard score of 69 or less for the adaptive behaviors|
|Inventory for Client and Agency Planning (ICAP)||15||The broad independence domain score based on the applicant's birth date and the date the test is administered.|
(a) DDD will not accept the results of a VABS or SIB-R administered after that event and will not administer the ICAP; and
(b) Your eligibility will have to be determined under a different condition that does not require evidence of adaptive functioning per a VABS, SIB-R or ICAP.
(1) The following professionals are qualified to give this diagnosis:
(a) Board eligible neurologist;
(b) Board eligible psychiatrist;
(c) Licensed psychologist; or
(d) Board certified developmental and behavioral pediatrician.
(2) The evidence provided by a diagnosing professional in (1) above exhibits a total of six or more of the following diagnostic criteria listed in the current DSM IV for Autistic Disorder 299.00:
(a) Two or more qualitative impairments in social interactions;
(b) One or more qualitative impairments in communication; and
(c) One or more impairments in restricted repetitive and stereotypical patterns or behavior, interests, and activities.
(3) A checklist of diagnostic criteria follows:
|DSM-IV Diagnostic Criteria required for Autism||Check if present|
|1. Qualitative impairment in social interaction|
|a. Marked impairment in the use of multiple non-verbal behaviors|
|b. Failure to develop peer relationships appropriate to developmental level|
|c. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people|
|d. Lack of social or emotional reciprocity|
|2. Qualitative impairment in communication|
|a. Delay in the development of spoken language without non-verbal compensation|
|b. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others|
|c. Stereotyped and repetitive use of language or idiosyncratic use of language|
|d. Lack of varied, spontaneous, make-believe play or social imitative play appropriate to developmental level|
|3. Restricted repetitive and stereotyped patterns of behavior, interests, and activities|
|a. Encompassing preoccupation with stereotyped and restricted patterns of interest that is abnormal in either intensity or focus|
|b. Apparently inflexible adherence to specific, nonfunctional routines or rituals|
|c. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)|
|d. Persistent occupation with parts of objects|
(1) Evidence of delay or abnormal functioning prior to age three years in at least one of the following areas:
(a) Social interaction;
(b) Language as used in social interaction;
(c) Communication; or
(d) Symbolic or imaginative play.
(2) Eligible scores in adaptive functioning per WAC 388-823-0420 (1)(d) and subject to all of WAC 388-823-0420.
ANOTHER NEUROLOGICAL CONDITION
(1) Originated before age eighteen;
(2) Results in both physical disability and cognitive impairment;
(3) Is expected to continue indefinitely; and
(4) Is not attributable to a mental illness or psychiatric disorder.
(1) You must have an FSIQ score of 1.5 or more standard deviations below the mean on one of the following acceptable assessments in addition to the other criteria in this section. The acceptable assessments, the standard deviation and the qualifying scores are contained in the following table:
|ASSESSMENT||STANDARD DEVIATION||QUALIFYING SCORE|
|Stanford-Binet||16||76 or less|
|Wechsler||15||78 or less|
|Differential Abilities Scale (DAS)||15||78 or less|
|Kaufman Assessment Battery for Children (K-ABC)||15||78 or less|
|Leiter-R [for persons with significant hearing impairments or when English is not primary language]||15||78 or less|
(3) The cognitive impairment and physical assistance needs must be the result of the central nervous system impairment and not due to another condition or diagnosis.
Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040."OTHER CONDITION" SIMILAR TO MENTAL RETARDATION
WAC 388-823-0700 How do I meet the definition for an "other condition" similar to mental retardation? You will need evidence in (1) or (2) below to substantiate that you have an "other condition" similar to mental retardation.
(1) You have a diagnosis of a condition or disorder that by definition results in both cognitive and adaptive skills deficits; and
(a) The diagnosis must be made by a licensed physician or licensed psychologist;
(b) The diagnosis must be due to a neurological condition, central nervous system disorder involving the brain or spinal column, or chromosomal disorder;
(c) The diagnosis or condition is not attributable to or is itself a mental illness, or emotional, social or behavior disorder;
(d) The condition must have originated before age eighteen; and
(e) The condition must be expected to continue indefinitely.
(2) You are under the age of eighteen and are eligible for DSHS-paid in-home nursing through the medically intensive program, defined in WAC 388-551-3000.
(a) Evidence of cognitive impairment requires documentation of either (i) or (ii) or (iii) below:
(i) An FSIQ of 1.5 or more standard deviations below the mean as described in WAC 388-823-0615(1) for another neurological condition; or
(ii) Significant academic delays resulting in delay of at least twenty-five percent below the chronological age or age equivalent academic functioning in at least two academic areas or grade placement; or
(iii) In the absence of school records to substantiate (ii) above, DDD may review other information about your academic progress sufficient to validate your cognitive deficits.
(b) If there is no evidence of other conditions or impairments unrelated to the eligible condition currently affecting adaptive functioning, the following evidence will determine if the eligible condition or disorder results in a substantial limitation in adaptive functioning:
(i) A score of more than two standard deviations below the mean on a VABS or SIB-R current within the past two years, or in the absence of a VABS or SIB-R, an ICAP administered by DDD.
(ii) The qualifying scores for these tests are listed in WAC 388-823-0420 (1)(d).
(2) You do not need the additional evidence of your substantial limitations to adaptive functioning in (1)(a) and (b) above if your eligible condition is solely due to your eligibility and participation in the medically intensive program offered through DDD, defined in WAC 388-551-3000.
EFFECT OF AGE ON ELIGIBILITY
(2) Children at least age six but under the age of ten can meet the definition of developmental disability by:
(a) Meeting the requirements listed in WAC 388-823-0200 through WAC 388-823-0710; or
(b) Meeting the requirements listed in WAC 388-823-0810 through WAC 388-823-0850.
(3) Children age ten and older must meet the requirements in WAC 388-823-0200 through WAC 388-823-0710.
(4) The following chart summarizes the applicable eligibility conditions by age.
|Eligible Conditions||Age 0-5||Age 6-9||Age 10-17||Age 18 and older|
|Too severe to be assessed||X||X|
|Mental Retardation (MR)||X||X||X|
|Other condition similar to MR||X||X||X|
(1) Developmental delay measured by developmental assessment tools administered by qualified professionals as described in WAC 388-823-0850.
(2) A diagnosis of Down syndrome by a licensed physician;
(3) A determination of eligibility for the DSHS medically intensive program;
(4) A diagnosis by a licensed physician or licensed psychologist of a condition that is so severe the child is unable to demonstrate the minimal skills required to complete a developmental evaluation or assessment.
(a) Physical skills (fine or gross motor);
(b) Self help/adaptive skills;
(c) Expressive or receptive communication, including American Sign Language;
(d) Social/emotional skills; and
(e) Cognitive, academic, or problem solving skills.
(2) The number of areas in which you are required to have delays to meet the evidence is specific to your age.
(1) A child from birth but under age three must have a developmental delay in one or more developmental areas.
(2) A child age three but under age ten must have developmental delays in three or more developmental areas.
|AGE||NUMBER of AREAS of DELAY|
|Birth but under age three||One or more|
|Age three but under age ten||Three or more|
(1) The results of the evaluation/assessment are reasonably reliable and valid by professional standards.
(a) If you are under age three, there is an evaluation of developmental areas that is current within the past twelve months. Evaluations determine eligibility for services and need to address each of the five developmental areas.
(b) If you are age three or older, there is an assessment of developmental areas. Assessments are more detailed than evaluations and are needed for determining types of services, method, intensity, and funding. Assessments are also the way to document the ongoing status of child's development, progress and recommended steps to meet outcomes.
(2) The evaluation/assessment is administered by one of the following professionals qualified to administer the evaluation or assessment of developmental areas:
(a) Licensed physician;
(b) Licensed psychologist or certified school psychologist;
(c) Speech language pathologist;
(e) Registered occupational therapist;
(f) Licensed physical therapist;
(g) Registered nurse;
(h) Certified teacher;
(i) Masters level social worker; or
(j) Orientation and mobility specialist.
INVENTORY FOR CLIENT AND AGENCY PLANNING (ICAP)
|AGE||SCORE (at or below)|
|17 and older||509|
(2) There is a computer generated broad independence score of your motor skills, personal living skills, social and communication skills, and community living skills, based on your age.
(2) DDD will choose the respondent and may interview more than one respondent to ensure that information is complete and accurate.
(3) DDD will ask you to demonstrate some of the skills in order to evaluate what skills you are able to perform. DDD cannot administer the ICAP if no respondent is identified and available.
ELIGIBILITY EXPIRATION, REVIEWS, AND REAPPLICATION
(a) DDD will notify you at least ninety days before your eligibility expiration date.
(b) You must reapply for eligibility with DDD.
(2) If you are determined eligible at age four but under age ten per WAC 388-823-0810 through WAC 388-823-0850, your eligibility expires on your tenth birthday.
(a) DDD will notify you at least ninety days before your eligibility expiration date.
(b) You must reapply for eligibility with DDD.
(3) If your eligibility determination was prior to July 2005 under developmental delays, Down syndrome, or medically intensive program and you are age four or older, your eligibility expires on your tenth birthday.
(a) DDD will notify you at least ninety days before of your eligibility expiration date.
(b) You must reapply for eligibility with DDD.
(4) If your eligibility determination was made after July 2005 and is solely due to your need for continuous nursing through the medically intensive program, your eligibility expires when you are no longer eligible for the program but no later than your eighteenth birthday.
(a) DDD will notify you at least ninety days before your eighteenth birthday.
(b) You must reapply for eligibility with DDD.
(2) Your eligibility will be reviewed at age seventeen with termination occurring no sooner than your eighteenth birthday if your most current eligibility determination was at sixteen or younger under mental retardation, cerebral palsy, epilepsy, autism, another neurological condition, or other condition similar to mental retardation.
(3) DDD will review your eligibility prior to the initial authorization of any paid service from DDD when you are not currently receiving paid services and:
(a) You are age eighteen or older and your most current eligibility determination is more than twenty-four months old; or
(b) You are age four but under age eighteen and your eligibility was established under the eligible conditions of developmental delay or Down syndrome and your eligibility effective date is prior to July 2005.
(4) DDD will review your eligibility if DDD discovers:
(a) The evidence used to make your most recent eligibility determination is insufficient, in error, or fraudulent; or
(b) New information becomes available that does not support your current eligibility.
(1) Authorization of a paid service within the last ninety days as evidenced by a social services payment system (SSPS) authorization, a county authorization for day program services, an A-19 payment, a Waiver Plan of Care approving a DDD paid service, or residence in a SOLA, RHC, or IMR;
(2) Authorization of family support services within the last twelve months.
(3) Documentation of DDD approval of your absence from DDD paid services for more than ninety days with available funding for your planned return to services.
(2) This expiration of eligibility takes effect even if DDD is unable to locate you to provide written notification that eligibility is expiring.
(3) There is no appeal right to an expired eligibility determination.
(4) Your appeal rights to the termination of services resulting from your expired eligibility are in WAC 388-825-120.
(1) Your eligibility was terminated because DDD could not locate you;
(2) Your eligibility was terminated because you lost residency in the state of Washington and you have reestablished residency;
(3) You have additional or new information relevant to the determination that DDD did not review for the previous determination of eligibility; or
(4) DDD denied or terminated your eligibility based solely on your ICAP score and it has been more than twenty-four months since your last ICAP; or
(5) DDD denied or terminated your eligibility based solely on your SIB-R or VABS score and the assessment used to determine your eligibility is more than twenty-four months old and you have a new SIB-R or VABS score.
(1) The right to be free from any kind of abuse or punishment (verbal, mental, physical, and/or sexual); or being sent to a place by yourself, if you do not choose to be alone.
(2) The right to appeal any decision by DDD that denies, reduces, or terminates your eligibility, your services or your choice of provider.
(3) The right to receive only those services you agree to.
(4) The right to meet with and talk privately with your friends and family.
(5) The right to personal privacy and confidentiality of your personal and other records.
(6) The right to choose activities, schedules, and health care that meet your needs.
(7) The right to be free from discrimination because of your race, color, creed, national origin, religion, age, disability, marital status, or sexual orientation.
(8) The right to set your own rules in your home and to know what rules your providers have when you are living in their house or working in their facility.
(9) The right to request information regarding services that may be available from DDD.
(10) The right to know what your doctor wants you to do or take and to help plan how that will happen.
(11) The right to be free from unnecessary medication, restraints and restrictions.
(12) The right to vote and help people get elected to office.
(13) The right to complain and not to have someone "get even".
(14) The right to have your provider listen to your concerns including those about the behavior of other people where you live.
(15) The right to receive help from an advocate.
(16) The right to manage your money or choose other persons to assist you.
(17) The right to be part of the community.
(18) The right to make choices about your life.
(19) The right to wear your clothes and hair the way you want.
(20) The right to work and be paid for the work you do.
(21) The right to decide whether or not to participate in research after the research has been explained to you, and after you or your guardian gives written consent for you to participate in the research.
(1) First, contact your case resource manager or social worker by phone, in writing, email, or in person and explain your problem.
(2) If you are not happy with the results from speaking with your case resource manager or social worker, you may ask to speak with their supervisor.
(3) If steps (1) and (2) do not solve your problem, you submit your complaint in writing to the regional office.
(4) If you do not reach a solution with the regional office, you can request that your complaint be forwarded to the DDD Headquarters in Olympia.
The following sections of the Washington Administrative Code are repealed:
|WAC 388-825-030||Eligibility for services.|
|WAC 388-825-035||Determination of eligibility.|
|WAC 388-825-040||Application for services.|