Original Notice.

     Preproposal statement of inquiry was filed as WSR 04-23-103.

     Title of Rule and Other Identifying Information: Adopting new chapter 388-824 WAC, Division of Developmental Disabilities (DDD) assessment process.

     Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on June 7, 2005, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than June 8, 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 fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., June 7, 2005.

     Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by June 3, 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 govern and support the implementation of DDD's new mini-assessment and information and referral requirements. DDD plans to implement these rules effective September 15, 2005. Adoption of these rules will help promote consistent application and understanding of the division's client assessment processes. This new chapter:

•	Describes the purpose of the mini-assessment and who receives a mini-assessment;
•	Defines "level of need" groups and how the mini-assessment assigns clients to a level of need group; and
•	Identifies how clients are referred to receive a full assessment.

     Reasons Supporting Proposal: In June 2003, the Joint Legislative Audit and Review Committee (JLARC) recommended that DSHS develop an assessment process for developmentally disabled clients designed to be consistently applied, to all clients, in all parts of the state.

     Statutory Authority for Adoption: RCW 71A.12.030.

     Statute Being Implemented: Chapters 71A.12, 71A.10 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: John Gaskell, 640 Woodland Square Loop S.E., Lacey, WA 98504-5600, P.O. Box 45600, Olympia, WA 98504-5600, e-mail gaskejw@dshs.wa.gov, (360) 725-2517, fax (360) 407-0955; Implementation and Enforcement: Don Clintsman, 640 Woodland Square Loop S.E., Lacey, WA 98504-5600, P.O. Box 45600, Olympia, WA 98504-5600, e-mail ClintDL@dshs.wa.gov, (360) 725-3421, 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 required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Bob Beckman, 640 Woodland Square Loop S.E., Lacey, WA 98504-5600, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2490, fax (360) 407-0955, e-mail beckmrc@dshs.wa.gov.

April 13, 2005

Andy Fernando, Manager

Rules and Policies Assistance Unit

     "Algorithm" means a numerical formula used by the mini-assessment software application to assign a client to a level of need group.

     "CARE" means the Comprehensive Assessment Reporting Evaluation as defined in Chapter 388-106 WAC.

     "Client" means a person with a developmental disability as defined in Chapter 388-823 WAC. For purposes of this chapter, the term "client" may include the client's representative.

     "Crisis" means a serious and imminent threat exists or will exist without immediate intervention and the client lacks the resources to address the situation. The threat may be:

     (1) To the life, health and/or safety of the client; or

     (2) To the safety of the client's family; or

     (3) To the safety of the community.

     "Department" means the Washington State department of social and health services.

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

     "Domain" means a specific area of the client's life. For mini-assessment purposes only, domains are identified in WAC 388-824-0010.

     "Full assessment" means an inventory and evaluation of client needs using a department approved tool to determine service eligibility and amount of services that may be authorized.

     "Full assessment referral database" means a database that contains client identification information and mini-assessment results.

     "Mini-assessment" means a brief computerized assessment tool using a set of questions and responses scored by an algorithm. A mini-assessment identifies the general level of unmet need that exists in specific domains of the client's life.

     "Paid services" means services as defined in WAC 388-823-1015 and include one or more of the following:

     (1) Authorization of a paid service within the last ninety days of the date on the department notice of eligibility review as evidenced by a social services payment system (SSPS), 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 State Operated Living Arrangement or Residential Habilitation Center.

     (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.

     (4) In addition, any child under age three is considered to be receiving paid services because the child may be eligible for services through the federally funded Infant Toddler Early Intervention Program and may also be referred for county funded child development services.

     "Reassessment" means any additional mini-assessment that the client receives after the initial mini-assessment.

     "Respondent" means a client or another person who participates in the mini-assessment interview by answering questions and providing information.

     "Significant change" means any change for better or worse in the client's medical condition, caregiver status, or need for support.

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     (2) DDD staff conducts a mini-assessment as a structured interview with you and/or a respondent to identify the general level of unmet need that exists in specific domains of your life.

     (3) The mini-assessment identifies your general level of unmet need in the following specific domains:

     (a) Housing;

     (b) Caregiver/support system;

     (c) Safety;

     (d) Community protection;

     (e) Behavior;

     (f) Financial/subsistence;

     (g) Physical health;

     (h) Mental health;

     (i) Personal care assistance;

     (j) Education;

     (k) Employment;

     (l) Social/community participation;

     (m) Legal;

     (n) Communication;

     (o) Adaptive equipment; and

     (p) Transportation.

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     (1) Identify the general level of unmet need of clients who do not receive paid services;

     (2) Identify clients who may be in crisis;

     (3) Assign clients to one of the following three level of need groups:

     (a) High level of need;

     (b) Moderate level of need; or

     (c) Low level of need; and

     (4) Determine which clients to refer for a full assessment.

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     (1) You are three years of age or older and do not receive paid services; or

     (2) You are eligible for the Medicaid Categorically Needy Program (CNP) but you have been determined ineligible for Medicaid Personal Care by a CARE assessment.

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     (1) Currently authorized to receive paid services;

     (2) Living in or being discharged from a state paid residential program or facility;

     (3) Receiving services through the Medically Intensive Program; or

     (4) In crisis and referred directly for a full assessment.

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     (2) The interview may occur at any site agreed to by you or your legal representative and DDD.

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     (1) Assigns you to the "low level of need" group; and

     (2) Offers you the opportunity to complete:

     (a) An Assessment of Intermediate Care Facility for the Mentally Retarded Level of Current Support Needs; or

     (b) The Residential Habilitation Center Intermediate Care Facility for the Mentally Retarded Admissions Protocol described in DDD Policy 3.04.

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     (1) When the question has age guidelines, the question is asked only of certain ages.

     (2) When a question has no age guidelines, DDD always asks the question of all clients during the mini-assessment interview.

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     (1) Raw score which is the numerical value assigned to the respondent's answer to a mini-assessment question;

     (2) Maximum raw score which is the highest possible numerical value assigned to a mini-assessment question;

     (3) Domain raw score which is the sum of raw scores for all questions in the domain. Domains are identified in WAC 388-824-0010;

     (4) Domain maximum raw score which is the sum of the maximum raw scores for all questions in the domain;

     (5) Normalized domain score which is the sum of the raw scores for all questions in the domain divided by the sum of the maximum raw scores for all questions in the domain;

     (6) Weighted domain score which is the normalized domain score multiplied by the domain weight;

     (7) Domain weight which is the numerical value assigned to a mini-assessment domain; and

     (8) Aggregate weighted score which is the sum of all the weighted domain scores.

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     (1) The raw score for a mini-assessment question;

     (2) The maximum raw score for a mini-assessment question; and

     (3) The domain weight.

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     (1) Your aggregate weighted score is 11.004 or higher;

     (2) Your mini-assessment indicates that you may be in crisis;

     (3) You are eligible for Medicaid under the categorically needy program (CNP) and request personal care assistance; or

     (4) You have a high level of need score in one or more of the following domains:

     (a) Community protection;

     (b) Financial subsistence;

     (c) Transportation;

     (d) Housing;

     (e) Safety;

     (f) Physical health;

     (g) Mental health;

     (h) Personal care assistance; or

     (i) Caregiver support system.

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     (1) Refer you to receive a full assessment.

     (2) Assist you to resolve a crisis situation before initiating a full assessment.

     (3) Offer necessary information and referral services.

     (4) Refer you for further case management review if the mini-assessment:

     (a) Identifies you to be a high public safety risk;

     (b) Identifies you to be at high risk for placement in a more restrictive residential setting; or

     (c) Indicates you may be functionally eligible for Medicaid Personal Care.

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     (1) Your mini-assessment weighted aggregate score is higher than 1.456 but less than 11.004; and

     (2) You don't meet the criteria for the "low level of need" group.

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     (1) Assigns you to a case resource manager;

     (2) Places your name in the full assessment referral database;

     (3) Offers necessary information and referral services; and

     (4) Refers you for further case management review if the mini-assessment identifies you to be at risk for placement in a more restrictive residential setting.

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     (1) Your mini-assessment:

     (a) Weighted aggregate score is equal to or less than 1.456; and

     (b) Does not exceed the low level of need score for any domain.

     (2) You and the respondent do not request DDD paid services; or

     (3) The respondent does not provide annual gross family income information.

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     (1) Provides needed information and referral services to you but does not place your name in the full assessment referral database;

     (2) Assigns you to a case resource manager; and

     (3) Does not refer you for a full assessment.

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     (a) Mini-assessment score; and

     (b) Assigned level of need group.

     (2) DDD also provides this information to you in writing.

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     (1) Have a significant change in functioning, condition, or situation; and

     (2) Meet the criteria defined in WAC 388-824-0040 and WAC 388-824-0050.

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     (2) The database contains:

     (a) The client's name, date of birth, and phone number;

     (b) The date of the mini-assessment;

     (c) The mini-assessment score; and

     (d) Confirmation of whether or not the mini-assessment indicates the client may be in crisis.

     (3) The full assessment referral database is not a hierarchy of client names or a numerically ordered listing of clients.

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     (1) Your mini-assessment score;

     (2) Your identified unmet needs;

     (3) DDD's capacity for completing full assessments; and

     (4) Capacity and/or funding for needed services.

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     (1) You have received a full assessment;

     (2) Your reassessment assigns you to the "low level of need" group; or

     (3) DDD discharges or terminates your eligibility.

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     (a) Information that is entered into the mini-assessment resulting in the mini-assessment score and level of need group assignment; and

     (b) DDD's denial of a reassessment request.

     (2) You do not have the right to appeal the mini-assessment algorithm.

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