WSR 08-05-097

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed February 15, 2008, 2:33 p.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 07-15-081 and 07-14-081.

     Title of Rule and Other Identifying Information: The department is amending chapter 388-828 WAC regarding the DDD assessment.

     Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6097), on April 22, 2008, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than April 23, 2008.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail schilse@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on April 22, 2008.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by April 15, 2008, TTY (360) 664-6178 or (360) 664-6097 or by e-mail at schilse@dshs.wa.gov.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule making adds sections to chapter 388-828 WAC regarding the residential algorithm. The residential algorithm determines the residential service level of support for clients receiving supported living, group home, group training home, and companion home residential services.

     The department is amending the following sections to include references to the residential algorithm and the individual and family services algorithm: WAC 388-828-1060, 388-828-5020, 388-828-5140, 388-828-5520, and 388-828-8020.

     The department is amending the following sections to maintain consistency with the DDD computer based assessment, agency standards, and to correct references to other rule: WAC 388-828-1480, 388-828-1540, 388-828-1640, and 388-828-5940.

     The proposed rules incorporate the following emergency rules:

•     WAC 388-828-5080 filed as WSR 07-21-145 which amends the WAC to accurately reflect the protective supervision age-based score adjustment.

•     WAC 388-828-1200 through 388-828-1300 filed as WSR 07-23-020 which amends and repeals the WAC to remove penalties for clients and their families that decline to provide income information when receiving the DDD assessment.

•     WAC 388-828-5360 filed as WSR 07-24-029 which amends the back-up caregiver availability table. The department will propose the other emergency rules included in WSR 07-24-029 in the proposed rules for the individual and family services program.

     Statutory Authority for Adoption: RCW 71A.12.030.

     Statute Being Implemented: Title 71A 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: Debbie Roberts, 640 Woodland Square Loop S.E., Lacey, WA 98504, (360) 725-3400; Implementation and Enforcement: Don Clintsman, 640 Woodland Square Loop S.E., Lacey, WA 98504, (360) 725-3426.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. DDD has analyzed the proposed rule amendments and has determined that small businesses will not be disproportionately impacted by these changes and any costs will not be considered "more than minor."

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Debbie Roberts, 640 Woodland Square Loop S.E., Lacey, WA 98504, phone (360) 725-3400, fax (360) 404-0955, e-mail roberdx@dshs.wa.gov.

February 11, 2008

Stephanie E. Schiller

Rules Coordinator

3925.1
AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-5080   How does DDD determine your adjusted protective supervision acuity score?   DDD determines your adjusted protective supervision acuity score by applying the following age-based score adjustments to your level of monitoring score for question number one in WAC 388-828-5060:


If you are: Then your age-based score adjustment is:
18 years or older Score is equal to your level of monitoring score
16-17 years of age Subtract ((1)) 2 from your level of monitoring score
12-15 years of age Subtract ((2)) 3 from your level of monitoring score
8-11 years of age Subtract ((3)) 4 from your level of monitoring score
5-7 years of age Subtract ((4)) 5 from your level of monitoring score
0-4 years of age Subtract ((5)) 6 from your level of monitoring score
If your adjusted level of monitoring score is a negative number, your adjusted protective supervision acuity score is zero.

     Example: If you are fifteen years old and "close proximity, (e.g., 1-2 hours, structured)" is identified as your level of monitoring score, your adjusted protective supervision acuity score is: Your close proximity score of four minus age-based score adjustment of ((two)) three. For age twelve through fifteen, this equals an adjusted protective supervision score of ((two)) one.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-5080, filed 4/23/07, effective 6/1/07.]

3899.3
AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-1200   ((Will DDD ask your family to disclose)) Who does DDD ask to disclose financial ((and dependent)) information?   When administering the DDD assessment, DDD ((will only)) is required to ask for ((information regarding your family's)) annual gross income information ((and the number of household dependents when)) from:

     (1) Your family, if:

     (a) You are age seventeen or younger; and

     (((2))) (b) Your family has not made a request for your admission to a residential habilitation center (RHC)((.)); or

     (2) You, if:

     (a) You are age eighteen or older; and

     (b) You are receiving state-only funded services.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-1200, filed 4/23/07, effective 6/1/07.]


AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-1220   Will DDD require ((your family to provide supporting documentation of their annual gross income and number of household dependents)) the reported annual gross income to be verified with supporting documentation?   DDD accepts ((your family's)) a verbal report of annual gross income and does not require ((your family to provide)) supporting documentation ((of their annual gross income and number of household dependents)) to verify the reported information.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-1220, filed 4/23/07, effective 6/1/07.]


REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 388-828-1240 What does DDD do when family income and household dependent information are not provided?
WAC 388-828-1260 What action will DDD take if your family does not report income and dependent information?
WAC 388-828-1280 How will your access to, or receipt of, DDD HCBS waiver services be affected if your family does not report family income and dependent information?

AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-1300   How will your access to, or receipt of, ((Medicaid personal care)) DDD paid services, private duty nursing services, or SSP be affected if ((your family does not report family)) income ((and dependent)) information is not reported?   Your access to, or receipt of, ((Medicaid personal care)) DDD paid services per ((chapter 388-106)) WAC 388-828-1440, Private duty nursing services for children seventeen years of age and younger per WAC 388-551-3000, or SSP per chapter 388-827 WAC is not affected if ((your family does not report)) income ((and dependent)) information is not reported.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-1300, filed 4/23/07, effective 6/1/07.]

3931.1
AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-5360   How does DDD determine the risk level score of your backup caregiver not being able to provide the supports you need when you need them?   The following table identifies the criteria that are used to calculate the risk level score of your backup caregiver not being able to provide the supports you need when you need them:


If the availability of your backup caregiver is: Then your risk level score is:
     (1) Your backup caregivers are available routinely or upon request as evidenced by a score of 0 to 2 for question 1 of the backup caregiver subscale; and

     (2) You have a person identified as a backup caregiver that does not live with you evidenced by the "Lives with client" checkbox not being selected as contact details information for him or her.

 1

(Not at risk)
     (3) Your backup caregivers are available upon an emergency only basis evidenced by a score of 4 for question 1 of the backup caregiver subscale; ((and)) or

     (4) "Lives with client" has been selected for all of the persons you have identified as your backup caregivers.

 2

(Some risk)
     (5) You have no other caregiver available evidenced by a score of 9 for question 1 of the backup caregiver subscale. 3

(High risk)

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-5360, filed 4/23/07, effective 6/1/07.]

3936.4
AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-1060   What is the purpose of the DDD assessment?   The purpose of the DDD assessment is to provide a comprehensive assessment process that:

     (1) Collects a common set of assessment information for reporting purposes to the legislature and the department.

     (2) Promotes consistency in evaluating client support needs for purposes of planning, budgeting, and resource management.

     (3) Identifies a level of service and/or number of hours that is used to support the assessed needs of clients who have been authorized by DDD to receive:

     (a) Medicaid personal care services or DDD HCBS waiver personal care per chapter 388-106 WAC;

     (b) Waiver respite care services per chapter 388-845 WAC;

     (c) Services in the voluntary placement program (VPP) per chapter 388-826 WAC;

     (d) Supported living residential services per chapter 388-101 WAC;

     (e) Group home residential services per chapter 388-101 WAC;

     (f) Group training home residential services per chapter 388-101 WAC;

     (g) Companion home residential services per chapter 388-829C WAC; or

     (h) Individual and family services per chapter 388-832 WAC.

     (4) Records your service requests.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-1060, filed 4/23/07, effective 6/1/07.]


AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-1480   Are there any exceptions allowing authorization of a DDD paid service prior to administering a DDD assessment?   During the year prior to July ((2008)) 2009, due to staff resources, DDD may authorize or reauthorize the following services before a DDD assessment is administered:

     (1) Funding from the legislature that provides resources for services to be available by a certain date; or

     (2) ((The annual reallocation of dollars for traditional family support in June 2007; or

     (3))) Emergency services as determined by DDD as critical to the client's health and safety.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-1480, filed 4/23/07, effective 6/1/07.]


AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-1540   Who participates in your DDD assessment?   (1) All relevant persons who are involved in your life may participate in your DDD assessment, including your parent(s), legal representative/guardian, advocate(s), and service provider(s).

     (2) DDD requires that at a minimum: You, one of your respondents, and ((your)) a DDD ((case resource manager/social worker)) employee participate in your DDD assessment interview. In addition:

     (a) If you are under the age of eighteen, your parent(s) or legal guardian(s) must participate in your DDD assessment interview.

     (b) If you are age eighteen or older, your court appointed legal representative/guardian must be consulted if he/she does not attend your DDD assessment interview.

     (c) If you are age eighteen and older and have no legal representative/guardian, DDD will assist you to identify a respondent.

     (d) DDD may require additional respondents to participate in your DDD assessment interview, if needed, to obtain complete and accurate information.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-1540, filed 4/23/07, effective 6/1/07.]


AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-1640   What are the mandatory panels in your DDD assessment?   After DDD has determined your client group, DDD determines the mandatory panels in your DDD assessment using the following tables. An "X" indicates that the panel is mandatory; an "O" indicates the panel is optional. If it is blank, the panel is not used.

     (1) DDD "Assessment main" and client details information


Client Group
DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State Only Paid Services
Assessment Main X X X X
Demographics X X X X
Overview X X X X
Addresses X X X X
Collateral Contacts X X X X
Financials X X X X

     (2) Supports intensity scale assessment


Client Group
DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State-Only Paid Services
Home Living X X X X
Community Living X X X X
Lifelong Learning X X X X
Employment X X X X
Health & Safety X X X X
Social Activities X X X X
Protection & Advocacy X X X X

     (3) Support assessment for children


Client Group
DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State-Only Paid Services
Activities of Daily Living X X X X
IADLs (Instrumental Activities of Daily Living) X X X X
Family Supports X X X X
Peer Relationships X X X X
Safety & Interactions X X X X

     (4) Common support assessment panels


DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State-Only Paid Services
Medical Supports X X X X
Behavioral Supports X X X X
Protective Supervision X X X X
DDD Caregiver Status* X X X X
Programs and Services X X X X
*Information on the DDD Caregiver Status panel is not mandatory for clients receiving paid services in an AFH, BH, SL, GH, SOLA, or RHC.

     (5) Service level assessment panels


DDD Assessment Panel Name No Paid Services Waiver and State Only Residential Other Medicaid Paid Services State-Only Paid Services
Environment X X O
Medical Main O X O
Medications X X X
Diagnosis X X X
Seizures X X X
Medication Management X X X
Treatments/programs X X X
ADH (Adult Day Health) O O O
Pain X X X
Indicators-Main O X O
Allergies X X X
Indicators/Hospital X X X
Foot X X O
Skin X X O
Skin Observation O O O
Vitals/Preventative X X O
Comments O O O
Communication-Main O X O
Speech/Hearing O X O
Psych/Social O X O
MMSE (Mini-Mental Status Exam) O X O
Memory O X O
Behavior O X O
Depression O X O
Suicide O O O
Sleep O O O
Relationships & Interests O O O
Decision Making O X O
Goals X O O
Legal Issues O O O
Alcohol O O O
Substance Abuse O O O
Tobacco O X O
Mobility Main O X O
Locomotion In Room O X O
Locomotion Outside Room O X O
Walk in Room O X O
Bed Mobility O X O
Transfers O X O
Falls O O O
Toileting-Main O X O
Bladder/Bowel O X O
Toilet Use O X O
Eating-Main O X O
Nutritional/Oral O X O
Eating O X O
Meal Preparation O X O
Hygiene-Main O X O
Bathing O X O
Dressing O X O
Personal Hygiene O X O
Household Tasks O X O
Transportation O X O
Essential Shopping O X O
Wood Supply O X O
Housework O X O
Finances O O O
Pet Care O O O
Functional Status O O O
Employment Support* X* X* X*
Mental Health X X X
DDD Sleep* X* O O
*Indicates that:

     (a) The "Employment Support" panel is mandatory only for clients age twenty-one and older who are on or being considered for one of the county services listed in WAC 388-828-1440(2).

     (b) The "DDD Sleep" panel is mandatory only for clients who are age eighteen or older and who are receiving:

     (i) DDD HCBS Core or Community Protection waiver services; or

     (ii) State-Only residential services.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-1640, filed 4/23/07, effective 6/1/07.]


AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-5020   How is information in the protective supervision acuity scale used by DDD?   (1) Information obtained in the protective supervision acuity scale is one of the factors used by DDD to determine:

     (a) The amount of waiver respite, if any, that you are authorized to receive;

     (b) Your individual and family services level, if you are authorized to receive individual and family services per chapter 388-832 WAC; and

     (c) Your residential service level of support, if you are authorized to receive a residential service listed in WAC 388-828-10020.

     (2) The protective supervision acuity scale is not used when determining your Medicaid personal care or waiver personal care; and

     (3) The information is used for reporting purposes to the legislature and the department.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-5020, filed 4/23/07, effective 6/1/07.]


AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-5140   How is information in the DDD caregiver status acuity scale used by DDD?   (1) Information obtained in the DDD caregiver status acuity scale is one of the factors used by DDD to determine:

     (a) The amount of waiver respite, if any, that you are authorized to receive; and

     (b) Your individual and family services level, if you are authorized to receive individual and family services.

     (2) The DDD caregiver status acuity scale does not affect service determination for the Medicaid personal care or waiver personal care assessment; and

     (3) The information is used for reporting purposes to the legislature and the department.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-5140, filed 4/23/07, effective 6/1/07.]


AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-5520   How is information in the DDD behavioral acuity scale used by DDD?   (1) Information obtained in the DDD behavioral acuity scale is one of the factors used by DDD to determine:

     (a) The amount of waiver respite, if any, that you are authorized to receive;

     (b) Your individual and family services level, if you are authorized to receive individual and family services per chapter 388-832 WAC; and

     (c) Your residential service level of support, if you are authorized to receive a residential service listed in WAC 388-828-10020.

     (2) The DDD behavioral acuity scale does not affect service determination for the Medicaid personal care or waiver personal care assessment.

     (3) The information is used for reporting purposes to the legislature and the department.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-5520, filed 4/23/07, effective 6/1/07.]


AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-5940   Are there any exceptions when the respite assessment is not used to determine the number of hours for waiver respite services?   The respite assessment is not used to determine waiver respite when you are receiving any of the following:

     (1) Voluntary placement program services per chapter 388-826 WAC; or

     (2) Companion home services per chapter ((388-821)) 388-829C WAC.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-5940, filed 4/23/07, effective 6/1/07.]


AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-8020   What components contained in the individual support plan module determine a service level and/or number of hours?   The following components of the individual support plan module determine a service level and/or number of hours:

     (1) The foster care rate assessment, as defined in chapter 388-826 WAC((, is the only component in the individual support plan module that determines a service level and/or number of hours));

     (2) The individual and family services algorithm, as defined in WAC 388-828-9000 through 388-828-9140; and

     (3) The residential algorithm, as defined in WAC 388-828-10000 through 388-828-10380.

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, § 388-828-8020, filed 4/23/07, effective 6/1/07.]

3937.1
NEW SECTION
WAC 388-828-10000   What is the residential algorithm?   The residential algorithm is a formula in the DDD assessment that determines the level of residential services and supports you may expect to receive based on your assessed support needs.

[]


NEW SECTION
WAC 388-828-10020   When is the residential algorithm administered?   The residential algorithm must be administered when you are approved to receive one of the following paid services:

     (1) Supported living residential services per chapter 388-101 WAC;

     (2) Group home residential services per chapter 388-101 WAC;

     (3) Group training home services per chapter 388-101 WAC; or

     (4) Companion home residential services per chapter 388-829C WAC.

[]


NEW SECTION
WAC 388-828-10040   Where does the residential algorithm obtain your support needs information?   The residential algorithm obtains your support needs information from the following components of your current DDD assessment:

     (1) The supports intensity scale assessment (SIS) per WAC 388-828-4000 through 388-828-4320;

     (2) The DDD protective supervision scale per WAC 388-828-5000 through 388-828-5100;

     (3) The DDD behavioral acuity scale per WAC 388-828-5500 through 388-828-5640;

     (4) The DDD medical acuity scale per WAC 388-828-5660 through 388-828-5700;

     (5) The program and services panel per WAC 388-828-6020;

     (6) The DDD seizure acuity scale per WAC 388-828-7040 through 388-828-7080; and

     (7) The DDD sleep panel per WAC 388-828-10260.

[]


NEW SECTION
WAC 388-828-10060   How does the residential algorithm identify your residential support needs score?   The residential algorithm uses the support needs information from your current DDD assessment to identify the following residential support needs scores:

     (1) Community protection program enrollment as defined in WAC 388-828-10100;

     (2) Daily support needs score as defined in WAC 388-828-10120;

     (3) Mid-frequency support needs score as defined in WAC 388-828-10140;

     (4) Behavior support needs score as defined in WAC 388-828-10160;

     (5) Medical support needs score as defined in WAC 388-828-10180;

     (6) Seizure support needs score as defined in WAC 388-828-10200;

     (7) Protective supervision support needs score as defined in WAC 388-828-10220;

     (8) Ability to Seek Help score as defined in WAC 388-828-10240;

     (9) Nighttime support needs score as defined in WAC 388-828-10260;

     (10) Toileting support needs score as defined in WAC 388-828-10280; and

     (11) Total critical support time as defined in WAC 388-828-10300 through 388-828-10360.

[]


NEW SECTION
WAC 388-828-10080   What residential service levels of support does DDD use?   DDD uses the following residential service levels of support which correspond with your assessed support needs (see WAC 388-828-10060):


Support Need Level Typical Support Need Characteristics

from the DDD Assessment

 Expected Level of Support*
Weekly or less

Support Level 1

 Client requires supervision, training, or physical assistance in areas that typically occur weekly or less often, such as shopping, paying bills, or medical appointments. Client is generally independent in support areas that typically occur daily or every couple of days. Clients assessed to need this level receive support on a weekly basis or less frequently.
Multiple times per week

Support Level 2

 Client is able to maintain health and safety for a full day or more at a time AND needs supervision, training, or physical assistance with tasks that typically occur every few days, such as light housekeeping, menu planning, or guidance and support with relationships. Client is generally independent in support areas that must occur daily. Clients assessed to need this level receive support multiple times per week.
Intermittent daily - Low

Support Level 3A

 Client is able to maintain health and safety for short periods of time (i.e., hours, but not days) OR needs supervision, training, or physical assistance with activities that typically occur daily, such as bathing, dressing, or taking medications. Clients assessed to need this level receive daily support.
Intermittent daily -Moderate

Support Level 3B

 Client requires supervision, training, or physical assistance with multiple tasks that typically occur daily OR requires frequent checks for health and safety or due to disruptions in routines. Clients assessed to need this level receive daily support and may receive checks during nighttime hours as needed.
Close proximity

Support Level 4

 Client requires support with a large number of activities that typically occur daily OR is able to maintain health and safety for very short periods of time (i.e., less than 2 hours, if at all) AND requires occasional health and safety checks or support during overnight hours. Clients assessed to need this level receive supports in close proximity 24 hours per day. Support hours may be shared with neighboring households.
Continuous day and continuous night

Support Level 5

 Client is generally unable to maintain health and safety OR requires support with a large number of activities that occur daily or almost every day AND requires nighttime staff typically within the household. Clients assessed to need this level receive support 24 hours per day.
Community Protection

Support Level 6

 Client is enrolled in the community protection program. Clients assessed to need this level of support will receive 24 hour per day supervision per community protection program policy.
*Emergency access to residential staff is available to all clients, 24-hours per day, regardless of the residential service level of support the assessment indicates.

[]


NEW SECTION
WAC 388-828-10100   How does the residential algorithm determine if you are enrolled in the community protection program?   The residential algorithm determines that you are enrolled in the community protection program if your current DDD assessment (see WAC 388-828-6020) shows that you are:

     (1) On the community protection waiver; or

     (2) Considered for the community protection waiver.

[]


NEW SECTION
WAC 388-828-10120   How does the residential algorithm determine your daily support needs score?   The residential algorithm determines that you have daily support needs if you meet or exceed all of the qualifying scores for one or more of the following activities from the SIS:


Qualifying Scores from Supports Intensity Scale

(per WAC 388-828-4200 through 388-828-4320)
SIS Activity If your score for type of support is: And your score for frequency of support is: And your daily support time is:
A1: Using the toilet 2 or more 3 or more 1 or more
A4: Eating food 2 or more 3 or more 1 or more
A6: Dressing 2 or more 3 or more 1 or more
A7: Bathing, personal hygiene, grooming 2 or more 3 or more 1 or more
A9: Using currently prescribed equipment or treatments 2 or more 3 or more 1 or more
E1: Taking medication 2 or more 3 or more 1 or more
E2: Avoiding health and safety hazards 1 or more 3 or more 1 or more
E4: Ambulating and moving about 3 or more 3 or more 1 or more
Or
Any combination of 3 of the SIS activities listed above (A1, A4, A6, A7, A9, E1, E2, E4) 1 or more 3 or more 1 or more

[]


NEW SECTION
WAC 388-828-10130   How does DDD define mid-frequency support?   DDD defines mid-frequency support as support for selected SIS activities that most people perform every two to four days.

[]


NEW SECTION
WAC 388-828-10140   How does the residential algorithm determine your mid-frequency support needs score?   The residential algorithm determines that you have mid-frequency support needs if you meet one of the following three conditions:

     (1) You meet or exceed all of the qualifying scores for one or more of the following activities from the SIS assessment:


Qualifying Scores from Supports Intensity Scale

(per WAC 388-828-4200 through 388-828-4320)
SIS Activity If your type of support score is: And your frequency of support score is: And your daily support time score is:
A3: Preparing food 2 or more 2 or more 2 or more
A5: Housekeeping and cleaning 3 or more 3 or more 2 or more
B2: Participating in recreational/leisure activities in community settings 3 or more 2 or more 2 or more
B7: Interacting with community members 3 or more 2 or more 2 or more
G3: Protecting self from exploitation 2 or more 2 or more 2 or more

     (2) Or you meet or exceed all of the qualifying scores for four or more of the following activities from the SIS assessment:


Qualifying Scores from Supports Intensity Scale

(per WAC 388-828-4200 through 388-828-4320)
SIS Activity If your type of support score is: And your frequency of support score is: And your daily support time score is: Score if you meet or exceed criteria
A1: Using the toilet 1 or more 2 or more 1 or more
A3: Preparing food 1 or more 2 or more 1 or more
A4: Eating food 1 or more 2 or more 1 or more
A5: Housekeeping and cleaning 1 or more 2 or more 1 or more
A6: Dressing 1 or more 2 or more 1 or more
A7: Bathing, personal hygiene and grooming 1 or more 2 or more 1 or more
A9: Using currently prescribed equipment and medications 1 or more 2 or more 1 or more
B2: Participating in recreational/leisure activities in community settings 1 or more 2 or more 1 or more
B7: Interacting with community members 1 or more 2 or more 1 or more
E1: Taking medications 1 or more 2 or more 1 or more
E2: Avoiding health and safety hazards 1 or more 2 or more 1 or more
E4: Ambulating and moving about 1 or more 2 or more 1 or more
G3: Protecting self from exploitation 1 or more 2 or more 1 or more
Total of all questions where criteria is met or exceed = Sum of scores entered

     (3) Or you meet the qualifying scores for the following SIS activities and your total weekly critical support time score exceeds ten hours:


Qualifying Scores from Supports Intensity Scale

(per WAC 388-828-4200 through 388-828-4320)
SIS Activity If your type of support score is: And your frequency of support score is: And your daily support time score is: Your weekly critical support time is: Enter one time for each qualifying SIS activity
A2: Taking care of clothes (includes laundering)

 1 or more

 2 or more

 0 0

1 .25
2 1
3 3
4 5
B3: Using public services in the community

 1 or more

 2 or more

 0 0

1 .25
2 1
3 3
4 5
B6: Shopping and purchasing foods and services

 1 or more

 2 or more

 0 0

1 .25
2 1
3 3
4 5
F2: Participation in recreational / leisure activities with others

 1 or more

 2 or more

 0 0

1 .25
2 1
3 3
4 5
F8: Engaging in volunteer work

 1 or more

 2 or more

 0 0

1 .25
2 1
3 3
4 5
G2: Managing money and personal finances

 1 or more

 2 or more

 0 0

1 .25
2 1
3 3
4 5
Mid-frequency support needs weekly critical support time total = Sum of times entered

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NEW SECTION
WAC 388-828-10160   How does the residential algorithm determine your behavior support needs score?   The residential algorithm uses your behavioral acuity level from the behavioral acuity scale, per WAC 388-828-5500 through 388-828-5640, to determine your behavior support needs score.

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NEW SECTION
WAC 388-828-10180   How does the residential algorithm determine your medical support needs score?   The residential algorithm uses your medical acuity level from the medical acuity scale, per WAC 388-828-5660 through 388-828-5700, to determine your medical support needs score.

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NEW SECTION
WAC 388-828-10200   How does the residential algorithm determine your seizure support needs score?   The residential algorithm uses your seizure acuity level from the seizure acuity scale, per WAC 388-828-7040 through 388-828-7080, to determine your seizure support needs score.

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NEW SECTION
WAC 388-828-10220   How does the residential algorithm determine your protective supervision support needs score?   The residential algorithm uses your adjusted protective supervision score from the protective supervision acuity scale, per WAC 388-828-5000 through 388-828-5100, to determine your protective supervision support needs score.

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NEW SECTION
WAC 388-828-10240   How does the residential algorithm determine your ability to seek help score?   The residential algorithm determines your ability to seek help score by using your answer to the following question found in the protective supervision acuity scale (WAC 388-828-5060(3))


Protective Supervision Acuity Scale Question: If your answer to the following question is: Then your ability to seek help score is:
Is client able to summon help? Can call someone who is remote Yes
Can seek help outside the house, nearby Yes
Can seek help inside house No
Cannot summon help No

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NEW SECTION
WAC 388-828-10260   How does the residential algorithm determine your nighttime support needs score?   The residential algorithm scores the answers to each of the five following questions from the DDD sleep panel in the service level assessment to determine your nighttime support needs:

     (1)


DDD Sleep Panel Question If you answer to the question is: Then your support needs score for this question is:
Nighttime Assistance*needed? Frequency 0 = None or less than monthly Less than daily
1 = At least once a month but not once a week Less than daily
2 = At least once a week but not once a day Less than daily
3 = At least once a day but not once an hour Daily or more frequently
4 = Hourly or more frequently Daily or more frequently
* Nighttime assistance needed means that the person wakes in the night and requires assistance with toileting, mobility, medical issues, behaviors, guidance through sleepwalking, or other support requiring intervention.

     (2)


DDD Sleep Panel Question If your answer to this question is: Then your support needs score for this question is:
Nighttime assistance needed? Daily support time 0 = None Less than (<) 30 minutes
1 = Less than 30 minutes Less than (<) 30 minutes
2 = 30 minutes to less than 2 hours 30 minutes or more
3 = 2 hours to less than 4 hours 30 minutes or more
4 = 4 hours or more 30 minutes or more

     (3)


DDD Sleep Panel Question If your answer to this question is: Then your support needs score for this question is:
Can toilet self at night? Yes Yes
No No

     (4)


DDD Sleep Panel Question If your answer to this question is: Then your support needs score for this question is:
Wakes to toilet most nights? Yes Yes
No No

     (5)


DDD Sleep Panel Question If your answer to this question is: Then your support needs score for this question is:
Nighttime behavioral/anxiety issues? None Defined as: No behavioral or anxiety issues at night. No
Minor Defined as: You experience low to medium behavioral or anxiety issues when left alone at night, but can manage the behaviors/anxiety with minimal or no intervention. No
Moderate Defined as: You experience intense behavioral or anxiety issues when left alone at night, but you are managing to cope, even if only minimally, by yourself or with remote or occasional onsite help as needed. No
Severe Defined as: You experience intense behavioral or anxiety issues on most nights if left alone and require a support person within your home during all overnight hours in order to maintain yours and/or other's health and safety. Yes

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NEW SECTION
WAC 388-828-10280   How does the residential algorithm determine your toileting support needs score?   The residential algorithm adds the three dimensions of the SIS activity "A1: Using the toilet" (see WAC 388-828-4200) to determine your toileting support score. Formula:


Type of support score (0-4)
+
Frequency of support score (0-4)
+
Daily support time score (0-4)
=
Toileting support needs score (0-12)

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NEW SECTION
WAC 388-828-10300   How does the residential algorithm calculate your daily critical support time?   The residential algorithm uses the following chart to calculate your daily critical support time score:


Qualifying Scores from Supports Intensity Scale

(per WAC 388-828-4200 through 388-828-4320)
SIS activity: If your type of support is: And your frequency of support score is: And your daily support time score is: Then your critical task hours= Enter one time for each SIS activity
A1: Using the toilet 1 or more

 0 0 or more 0
1 0 or more 0
2 0 or more 0
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
A4: Eating food 1 or more

 0 0 or more 0
1 0 or more 0
2 0 or more 0
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
A6: Dressing 1 or more

 0 0 or more 0
1 0 or more 0
2 0 or more 0
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
A7: Bathing and taking care of personal hygiene and grooming needs 1 or more

 0 0 or more 0
1 0 or more 0
2 0 or more 0
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
A9: Using currently prescribed equipment or treatment 1 or more

 0 0 or more 0
1 0 or more 0
2 0 or more 0
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
E1: Taking medications 1 or more

 0 0 or more 0
1 0 or more 0
2 0 or more 0
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
E2: Avoiding health and safety hazards 1 or more

 0 0 or more 0
1 0 or more 0
2 0 or more 0
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
E4: Ambulating and moving about 1 or more

 0 0 or more 0
1 0 or more 0
2 0 or more 0
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
Daily critical support time score = Sum of all times entered.

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NEW SECTION
WAC 388-828-10320   How does the residential algorithm calculate your mid-frequency critical support time?   The residential algorithm uses the following chart to calculate your mid-frequency critical support time score:


Qualifying Scores from Supports Intensity Scale

(per WAC 388-828-4200 through 388-828-4320)
SIS Activity If your type of support is: And your frequency of support score is: And your daily support time score is: Then your critical task hours = Enter one time for each SIS activity
A1: Using the toilet 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3 0 or more 0
4 0 or more 0
A3: Preparing food 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
A4: Eating food* 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3 0 or more 0
4 0 or more 0
A5: Housekeeping and cleaning 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
A6: Dressing* 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3 0 or more 0
4 0 or more 0
A7: Bathing and taking care of personal hygiene and grooming needs* 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3 0 or more 0
4 0 or more 0
A9: Using currently prescribed equipment or treatment* 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3 0 or more 0
4 0 or more 0
B2: Participating in recreation/leisure activities in community settings 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
B7: Interacting with community members 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
E1: Taking medications* 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3 0 or more 0
4 0 or more 0
E2: Avoiding health and safety hazards* 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3 0 or more 0
4 0 or more 0
E4: Ambulating and moving about* 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3 0 or more 0
4 0 or more 0
G3: Protecting self from exploitation 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
Mid-frequency critical support time score = Sum of all times entered
*Daily support activities that have less than daily support needs are added into the mid-frequency critical support time score.

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NEW SECTION
WAC 388-828-10340   How does the residential algorithm determine your weekly critical support time?   The residential algorithm uses the following chart to calculate your weekly critical support time score:


Qualifying Scores from Supports Intensity Scale

(per WAC 388-828-4200 through 388-828-4320)
SIS Activity If your type of support is: And your frequency of support score is: And your daily support time score is: Then your critical task hours= Enter one time for each SIS activity
A2: Taking care of clothes (including laundering) 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
B3: Using public services in the community 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
B6: Shopping and purchasing goods and services 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
F2: Participating in recreation and/or leisure activities with others 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
F8: Engaging in volunteer work 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
G2: Managing money and personal finances 1 or more 0 0 or more 0
1 0 or more 0
2

 0 0
1 .25
2 1
3 3
4 5
3

 0 0
1 .25
2 1
3 3
4 5
4

 0 0
1 .25
2 1
3 3
4 5
Weekly critical support time score = Sum of all times entered

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NEW SECTION
WAC 388-828-10360   How does the residential algorithm calculate your total critical support time (CST)?   The residential algorithm uses the following formula to calculate your total critical support time (CST):


DailyCST +

 MidFreqCST +

 WeeklyCST =

 Total CST (hours per day)
1 3 7

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NEW SECTION
WAC 388-828-10380   How does the residential algorithm use your assessed support needs scores to determine your residential service level of support?   (1) The residential algorithm uses your assessed support needs scores (as defined in WAC 388-828-10100 through 388-828-10300) to answer questions in a decision tree.

     (2) The decision tree path determines your residential service level of support (WAC 388-828-10080).

     (3) The decision tree is separated into the following three steps:

     (a) Step 1 determines whether your residential support needs scores meet the criteria for less than daily support or the criteria for community protection.

     (b) Step 2 determines whether your residential support needs scores meet the criteria for continuous day and night support.

     (c) Step 3 determines whether your residential support needs scores meet the criteria for intermittent support.

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