SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Effective Date of Rule: June 21, 2008.
Purpose: The department is combining three family support programs into one individual and family services program as directed by the legislature.
Statutory Authority for Adoption: RCW 71A.12.030, 71A.12.040.
Other Authority: 2SSB 5467.
Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: 2SSB 5467, as amended by the house, directs the department to create the individual and family services program for persons with developmental disabilities by July 1, 2007. A preproposal statement of inquiry (CR-101) was filed as WSR 07-10-018 on April 20, 2007. At that time, the department proposed amending chapter 388-825 WAC but has since decided that a new chapter is required, due to the length of the new rules. These emergency rules replace the emergency rules filed as WSR 08-06-019 while the department proceeds with permanent adoption of these rules. The CR-102 has been filed as WSR 08-11-095 and the hearing is scheduled for July 22, 2008.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 100, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 100, Amended 0, Repealed 0.
Date Adopted: June 10, 2008.
Stephanie E. Schiller
INDIVIDUAL AND FAMILY SERVICES PROGRAM
"Agency Provider" means a licensed and/or ADSA certified business that is contracted with ADSA or a county to provide DDD services (e.g., personal care, respite care, residential services, therapy, nursing, employment, etc.).
"Allocation" means an amount of funding available to the client and family for a maximum of twelve months, based upon assessed need.
"Authorization" means DDD approval of funding for a service as identified in the individual support plan or evidence of payment of a service.
"Back-up Caregiver" is a person who has been identified as an informal caregiver and is available to provide assistance as an informal caregiver when other caregivers are unavailable.
"Client" means a person who has a developmental disability as defined in RCW 71A.10.020(3) who also has been determined eligible to receive services by the division under chapter 71A.16 RCW.
"DDD" means the division of developmental disabilities, a division within the aging and disability services administration (ADSA), department of social and health services (DSHS).
"Department" means the department of social and health services (DSHS).
"Emergency" means the client's health or safety is in jeopardy.
"Family" means individuals, of any age, living together in the same household and related by blood, marriage, adoption or as a result of sharing legal custody of a minor child.
"Family Home" means the residence where you and your relatives live.
"Formal Caregiver" is a person/agency who receives payment from DDD to provide a service.
"Individual Provider" means an individual who is contracted with DDD to provide medicaid or waiver personal care, respite care, or attendant care services.
"Individual Support Plan" or "ISP" is a document that authorizes the DDD paid services to meet a client's needs identified in the DDD Assessment.
"Informal Caregiver" is a person who provides supports without payment from DDD for a service.
"Legal Guardian" means a person/agency, appointed by a court, which is authorized to make some or all decisions for a person determined by the court to be incapacitated. In the absence of court intervention, parents remain the legal guardian for their child until the child reaches the age of eighteen.
"Parent family support contract" means a contract between DDD and the parent to reimburse the parent for the purchase of goods and services paid for by the parent.
"Pass through contract" means a contract between DDD and a third party to reimburse the third party for the purchase of goods and services paid for by the third party.
"Primary Caregiver" is the formal or informal caregiver who provides the most support.
"Residential Habilitation Center" or "RHC" is a state operated facility certified to provide ICF/MR and/or nursing facility level of care for persons with developmental disabilities per chapter 71A.20 RCW.
"Significant change" means changes in your medical condition, caregiver status, behavior, living situation or employment status.
"State funded services" means services that are funded entirely with state dollars.
"State supplementary payment" or "SSP" means a state paid cash assistance program for certain DDD clients eligible for supplemental security income per chapter 388-827 WAC.
"You" means the client.
(1) Provides an array of services to families to help maintain and stabilize the family unit; and
(2) Replaces WAC 388-825-200 through 388-825-242 (the family support opportunity program), WAC 388-825-252 through 388-825-256 (the traditional family support program), WAC 388-825-500 through 388-825-595, (the flexible family support pilot program), and WAC 388-825-244 through 388-825-250 (other family support rules).
(1) Form a partnership between the state and families to help support families who have a client of DDD living in the family home; and
(2) Provide families with a choice of services and allow families more control over the resources allocated to them.
(a) You are currently an eligible client of DDD;
(b) You live in your family home;
(c) You are not enrolled in a DDD home and community based services waiver defined in chapter 388-845 WAC;
(d) You are currently enrolled in traditional family support, family support opportunity or the family support pilot or funding has been approved for you to receive IFS program services;
(e) You are age three or older as of July 1, 2007;
(f) You have been assessed as having a need for IFS program services as listed in WAC 388-832-0140; and
(g) You are not receiving a DDD residential service.
(2) If you are a parent, you are eligible to receive IFS program services in order to promote the integrity of the family unit, provided:
(a) You meet the criteria in subsections (1)(a) through (f) above; and
(b) Your child who lives in your home is at risk of being placed up for adoption or into foster care.
(1) Receipt of IFS services is limited by availability of funding and your assessed need.
(2) WAC 388-832-0085 through 388-832-0090 describes how DDD will determine who will be approved to receive funding.
(2) You may request enrollment in a DDD HCBS waiver at any time per WAC 388-845-0050.
(3) Participation in the IFS program will not affect your potential waiver eligibility.
(1) You no longer meet DDD eligibility per WAC 388-823-0010 through 388-823-0170;
(2) You no longer meet the eligibility criteria for the IFS program per WAC 388-832-0015;
(3) You have not used an IFS program service during the last twelve calendar months;
(4) You cannot be located or do not make yourself available for the annual DDD assessment;
(5) You refuse to participate with DDD in service planning; and/or
(6) You begin to receive a DDD residential service.
(1) Are ages birth through twenty-one years of age;
(2) Are at risk of out of home placement; and
(3) Live with you.
INDIVIDUAL AND FAMILY SERVICES PROGRAM WAIT LIST
(1) Your name and request date will be added to the wait list.
(2) A notice will be sent to you to let you know your name has been added to the IFS wait list.
(1) You no longer live in your family home;
(2) You are no longer eligible for DDD services;
(3) You request your name to be removed from the IFS wait list;
(4) You do not respond to IFS notification to schedule the DDD assessment;
(5) You are offered IFS services and accept or refuse services;
(6) You are on the HCBS waiver; or
(7) Your DDD assessment determines you are not eligible for the IFS program.
(1) Clients who have requested residential habilitation center (RHC) respite, emergency services, or residential placement, prior to June 30, 2007.
(2) Clients with the highest scores in caregiver and behavior status on the mini assessment.
(3) Clients who have been on the IFS program wait list the longest.
(1) Your DDD case/resource manager will contact you, and determine if you meet the eligibility criteria for IFS program per WAC 388-832-0015 (1) though (6);
(2) If you meet the criteria per (1) above, your case/resource manager will schedule an appointment to complete your DDD assessment or reassessment.
(3) If you have not been receiving any DDD paid services, your DDD eligibility will need to be reviewed per WAC 388-823-1010(3)
(4) Your DDD eligibility must be completed prior to completing the DDD assessment.
(1) Families of children who are seventeen years of age or younger; and
(2) All individuals who are receiving state-only funded services.
(1) Provide information and referral for nonDDD community-based supports;
(2) Add your name to the waiver data base, if you have requested enrollment in a DDD HCBS waiver per chapter 388-845 WAC; and
(3) Request short term emergency services as an exception to rule (ETR) per WAC 388-440-0001. Approval is required by the director of DDD or designee.
(2) For a reassessment or review of the individual support plan, the plan is effective the date DDD signs and approves it after a signature or verbal consent is obtained.
(1) Level 1 - Up to $2,000;
(2) Level 2 - Up to $3,000;
(3) Level 3 - Up to $4,000; and
(4) Level 4 - Up to $6,000.
(2) If a significant change occurs, you may contact your DDD case manager for a possible reassessment of your support needs.
(1) The service need relates to and results from your developmental disability, and
(2) The need is identified in your DDD assessment and identified on your ISP.
(2) You need to submit receipts to your case manager whenever you are asking for reimbursement.
(3) Your request for reimbursement must be received within ninety days of the date that the service was received and no later than thirty days after the end of your allocation year.
(2) Your annual allocation must be used during the twelve month period your assessed needs were determined.
(3) If you do not use all of your allocation, your remaining dollars do not carry over to next year's allocation.
(4) If at least some of your IFS program services are not used in the twelve month period, you will be terminated from the IFS program.
(1) If the algorithm does not change your IFS program level, your funding will not change.
(2) If the algorithm changes your level to a higher IFS program level, the difference is added to your fiscal years allocation.
(3) If the algorithm changes your level to a lower IFS program level, your allocation will not be changed until your next annual assessment. At that time your allocation will be calculated with your current information.
(1) Respite care (WAC 388-832-0143 through 388-832-0160);
(2) Therapies (WAC 388-832-0170 through 388-832-0180):
(a) Physical therapy (PT);
(b) Occupational therapy (OT); and
(c) Speech, language and communication therapy.
(3) Architectural and vehicular modifications (WAC 388-832-0185 through 388-832-0189);
(4) Specialized medical equipment and supplies (WAC 388-832-0200 through 388-832-0210);
(5) Specialized nutrition and clothing (WAC 388-832-0215 through 388-832-0225);
(6) Excess medical costs not covered by another source (WAC 388-832-0165 through 388-832-0168);
(7) Co-pays for medical and therapeutic services (WAC 388-832-0235 through 388-832-0245);
(8) Transportation (WAC 388-832-0250 through 388-832-0260);
(9) Training and counseling (WAC 388-832-0265 through 388-832-0275);
(10) Behavior management (WAC 388-832-0280 through 388-832-0290);
(11) Parent/sibling education (WAC 388-832-0300 through 388-832-0310);
(12) Recreational opportunities (WAC 388-832-0315 through 388-832-0325); and
(13) Community service grants (WAC 388-832-0370 through 388-832-0375).
(1) You live in your family home and no one living with you is paid to be your caregiver.
(2) You live with a paid caregiver who is your natural, step, or adoptive parent.
(a) Individual's family home; or
(b) Relative's home.
(2) Respite care can be also be provided in the following location(s) but require a DDD agency respite contract:
(a) Licensed children's foster home;
(b) Licensed, contracted and DDD certified group home;
(c) Licensed boarding home contracted as an adult residential center;
(d) Licensed and contracted adult family home;
(e) Children's licensed group home, licensed staffed residential home, or licensed childcare center; or
(f) Adult day health.
(3) Additionally, your respite care provider may take you into the community while providing respite care.
(1) Individuals meeting the provider qualifications under chapter 388-825 WAC;
(2) Homecare/home health agencies, licensed under WAC 246-335-012(1);
(3) Licensed and contracted group homes, foster homes, child placing agencies, staffed residential homes and foster group care homes;
(4) Licensed and contracted adult family home;
(5) Licensed and contracted adult residential care facility;
(6) Licensed and contracted adult residential rehabilitation center under WAC 246-325-012;
(7) Licensed childcare center under chapter 388-295 WAC;
(8) Licensed child daycare center under chapter 388-295 WAC;
(9) Adult day/health care centers contracted with DDD; or
(10) Certified provider per chapter 388-101 WAC when respite is provided within the DDD contract for certified residential services.
(1) Respite cannot replace:
(a) Daycare, childcare or preschool while a parent or guardian is at work; and/or
(b) Personal care hours available to you. When determining your unmet need, DDD will first consider the personal care hours available to you.
(2) Respite providers have the following limitations and requirements:
(a) If respite is provided in a private home, the home must be licensed unless it is the client's home or the home of a relative of specified degree per WAC 388-825-345;
(b) The respite provider cannot be the spouse of the caregiver receiving respite if the spouse and the caregiver reside in the same residence; and
(c) If you receive respite from a provider who requires licensure, the respite services are limited to those age-specific services contained in the provider's license.
(d) The respite care provider cannot be your natural, step or adoptive parent living with you.
(3) Your caregiver will not be paid to provide DDD services for you or other persons at the same time you receive respite services.
(4) The need for respite must be identified in your ISP and, in combination with other IFS services, cannot exceed your IFS allocation.
(5) If your personal care provider is your parent, your parent provider may not be paid to provide respite services to any client in the same month that you receive respite services.
(1) Skilled nursing services (ventilation, catheterization, and insulin shots);
(2) Psychiatric services;
(3) Medical and dental services related to the person's disability and an allowable medicaid covered expense;
(4) Prescriptions for medications; and/or
(5) Co-pays and deductible limited to your IFS allocation.
(2) Skilled nursing services are paid to the DSHS contracted nurse directly.
(1) The payment must be of direct medical or remedial benefit to the individual and necessary as a result of the individual's disability;
(2) Medical and dental premiums are excluded for family members other than the DDD eligible clients; and
(3) The need for excess medical costs must be identified in your ISP and, in combination with other IFS services, cannot exceed your IFS allocation.
(4) Prior approval by regional administrator or designee is required.
(1) Physical therapy;
(2) Occupational therapy; and/or
(3) Speech, hearing and language therapy.
(1) Additional therapy may be authorized as a service only after you have accessed what is available to you under medicaid and any other private health insurance plan or school;
(2) DDD does not pay for treatment determined by DSHS to be experimental;
(3) DDD and the treating professional determine the need for and amount of service you can receive;
(a) DDD may require a second opinion from a DDD selected provider.
(b) DDD will require evidence that you have accessed your full benefits through medicaid, private insurance and the school before authorizing this service.
(4) The need for therapies must be identified in your ISP and, in combination with other IFS services, cannot exceed your IFS allocations.
(5) Prior approval by the regional administrator or designee is required.
(a) Ensure the health, welfare and safety of the client and or caregiver; or
(b) Enable a client who would otherwise require a more restrictive environment to function with greater independence in the home or in the community.
(2) Architectural modifications include the following:
(a) Installation of ramps and grab bars;
(b) Widening of doorways;
(c) Modification of bathroom facilities; or
(d) Installing specialized electrical and/or plumbing systems necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.
(3) Vehicular modifications include the following:
(a) Wheel chair lifts;
(b) Strap downs; or
(c) Other access modifications.
(1) Prior approval by the regional administrator or designee is required.
(2) Architectural and vehicular modifications to the home and vehicle are excluded if they are of general utility without direct medical or remedial benefit to the individual, such as floor covering (e.g., carpeting, linoleum, tile, hard wood flooring, decking), roof repair, central air conditioning, fencing for the yard, etc.
(3) Architectural modifications cannot add to the square footage of the home.
(4) DDD will require evidence that you accessed your full benefits through medicaid, private insurance and the division of vocational rehabilitation (DVR) before authorizing this service.
(5) Architectural and vehicular modifications must be the most cost effective modification based upon a comparison of contractor bids as determined by DDD.
(6) Architectural and vehicular modifications will be prorated by the number of other members in the household who use these modifications.
(7) The need for architectural and vehicular modifications must be identified in your ISP and, in combination with other IFS services, cannot exceed your annual IFS allocation.
(a) Increase their abilities to perform their activities of daily living; or
(b) Perceive, control or communicate with the environment in which they live.
(2) Durable and nondurable medical equipment are defined in WAC 388-543-1000 and 388-543-2800 respectively.
(3) Also included are items necessary for life support and ancillary supplies and equipment necessary to the proper functioning of the equipment and supplies described in subsection (1) above.
(1) Specialized medical equipment and supplies require prior approval by the DDD regional administrator or designee for each authorization.
(2) DDD reserves the right to require a second opinion by a department-selected provider.
(3) Items reimbursed with state funds shall be in addition to any medical equipment and supplies furnished under medicaid or private insurance.
(4) Items must be of direct medical or remedial benefit to the individual and necessary as a result of the individual's disability.
(5) Medications, prescribed or nonprescribed, and vitamins are excluded.
(6) The need for specialized medical equipment and supplies must be identified in your ISP and, in combination with other IFS services, cannot exceed your IFS allocation.
(2) Specialized clothing is clothing adapted for a physical disability, excessive wear clothing, or specialized footwear for which a written recommendation has been provided by a qualified and appropriate professional (e.g., a podiatrist, physical therapist, or behavior specialist).
(2) Prior approval by regional administrator or designee is required.
(2) The co-pays must be for your disability related medical or therapeutic needs.
(3) Prescribed or nonprescribed vitamins and supplements are excluded.
(4) Prior approval by regional administrator or designee is required.
(1) Transportation provides you access to IFS program services specified by your individual support plan.
(2) Whenever possible you must use family, neighbors, friends, or community agencies that can provide this service without charge.
(2) Transportation services can be a reimbursable expense through the parent family support contract.
(1) Transportation to/from medical or medically related appointments is a Medicaid transportation service and is to be considered and used first.
(2) Transportation is offered in addition to medical transportation but cannot replace Medicaid transportation services.
(3) Transportation is limited to travel to and from an IFS program service.
(4) Transportation does not include the purchase of a bus pass.
(5) Reimbursement for provider mileage requires prior approval by DDD and is paid according to contract.
(6) This service does not cover the purchase or lease of vehicles.
(7) Reimbursement for provider travel time is not included in this service.
(8) Reimbursement to the provider is limited to transportation that occurs when you are with the provider.
(9) You are not eligible for transportation services if the cost and responsibility for transportation is already included in your provider's contract and payment.
(10) Transportation services require prior approval by the DDD regional administrator or designee.
(11) Per diem costs may be reimbursed with prior approval from DDD regional administrator or designee to access medical services if over one hundred fifty miles one way for client receiving medical services and one family member.
(12) Air ambulance costs due to an emergency may be reimbursed after insurance, deductibles, Medicaid and other resources have been exhausted not to exceed your annual IFS allocation.
(13) The need for transportation services must be identified in your ISP and, in combination with other IFS services, cannot exceed your IFS allocation.
(1) Health and medication monitoring;
(2) Positioning and transfer;
(3) Augmentative communication systems; and
(4) Family counseling.
(2) Licensed practical nurse;
(3) Marriage and family therapist;
(4) Mental health counselor;
(5) Occupational therapist;
(6) Physical therapist;
(7) Registered nurse;
(8) Sex offender treatment provider;
(9) Speech/language pathologist;
(10) Social worker;
(12) Certified American sign language instructor;
(14) Registered counselor; or
(15) Certified dietician.
(2) The need for training and counseling must be identified in your ISP and, in combination with other IFS services, cannot exceed your IFS allocation.
(3) Prior approval by regional administrator or designee is required.
(1) Marriage and family therapist;
(2) Mental health counselor;
(4) Sex offender treatment provider;
(5) Social worker;
(6) Registered nurse (RN) or licensed practical nurse (LPN);
(8) Psychiatric advanced registered nurse practitioner (ARNP);
(9) Physician assistant working under the supervision of a psychiatrist;
(10) Registered counselor; or
(1) DDD and the treating professional will determine the need and amount of service you will receive.
(2) DDD may require a second opinion from a DDD-selected provider.
(3) Only scientifically proven, nonexperimental methods may be utilized.
(4) Providers may not use methods that cause pain, threats, isolation or locked settings.
(5) The need for behavior management must be identified in your ISP and, in combination with other IFS services, cannot exceed your IFS allocation.
(6) Psychological testing is not allowed.
(7) Behavior management services require prior approval by the regional administrator or designee.
(b) Licensed practical nurse;
(c) Marriage and family therapist;
(d) Mental health counselor;
(e) Occupational therapist;
(f) Physical therapist;
(g) Registered nurse;
(h) Sex offender treatment provider;
(i) Speech/language pathologist;
(j) Social worker;
(l) Certified American sign language instructor;
(n) Registered counselor; or
(o) Certified dietician.
(2) Along with these professional providers, the Arc, Parent to Parent, PAVE and Families Together may be utilized for parent/sibling education.
(2) Viewing of VHS or DVD at home by yourself does not meet the definition of parent or sibling education.
(3) The need for parent/sibling education must be identified in your ISP and, in combination with other IFS services, cannot exceed your IFS allocation.
(4) Prior approval by regional administrator or designee is required.
(2) Recreational opportunities may include memberships in civic groups, clubs, crafting classes, or classes outside of K-12 school curriculum or sport activities.
(2) The need for recreation opportunities must be identified in your ISP and, in combination with other IFS services, cannot exceed your IFS allocation.
(3) DDD does not pay for recreational opportunities that may pose a risk to individuals with disabilities or the community at large.
(4) Prior approval by regional administrator or designee is required.
(1) Qualifications for individuals and agencies providing DDD services in the client's residence or the provider's residence or other settings; and
(2) Conditions under which DDD will pay for the services of an individual provider or a home care agency provider or other provider.
(1) IFS program services are authorized only after you have accessed what is available to you under medicaid, including medicaid personal care, and any other private health insurance plan, school, or child development services.
(2) All IFS program service payments must be agreed to by DDD and you in your ISP.
(3) DDD will contract directly with a service provider or parent for the reimbursement of goods or services purchased by the family member.
(4) DDD will not pay for treatment determined by DSHS/MAA or private insurance to be experimental.
(5) Your choice of qualified providers and services may be limited to the most cost effective option that meets your assessed need.
(6) The IFS program will not pay for services provided after the death of the eligible client. Payment may occur after the date of death, but not the service.
(7) DDD's authorization period will start when you agree to be in the IFS program and have given written or verbal approval for your ISP. The period will last up to one year and may be renewed if you continue to need and utilize services. If you have not utilized the services within one year period you will be terminated from this program.
(8) IFS program will not pay for psychological evaluations or testing, or DNA testing.
(9) Supplies/materials related to community integration or recreational activities are the responsibility of the family.
ONE TIME AWARDS
(1) You are not currently authorized for IFS program services in your ISP.
(2) You meet the eligibility for the IFS program.
(3) The need is critical to the health or safety of you or your caregiver and you and your family have no other resource to meet the need or your resources do not cover all of the expense.
(2) One time awards cannot exceed six thousand dollars in a twenty-four month period.
(3) One time awards must be approved by the director of DDD or designee.
(4) Eligibility for a one-time award does not guarantee approval and authorization of the service by DDD. Services are based on availability of funding.
(5) One time awards will be prorated by the number of other members in the household who use these modifications or specialized equipment.
(1) You lose your family caregiver due to caregiver hospitalization, or death;
(2) There are changes in your caregiver's mental or physical status resulting in your family caregiver's inability to perform effectively for you; or
(3) There are significant changes in your emotional or physical condition that require emergency services.
(1) Respite per WAC 388-832-0155.
(2) Behavior Management per WAC 388-832-0285.
(3) Nursing per WAC 388-845-1705.
(2) Funds are provided for a limited period not to exceed sixty days.
(3) All requests are reviewed and approved or denied by the regional administrator or designee.
(2) DDD will conduct an administrative review of other DDD services to determine if the need can be met through other services.
(1) Address one or more of the following topics:
(a) Provider support and development;
(b) Parent helping parent; or
(c) Community resource development for inclusion of all.
(2) Meet most of the following goals:
(a) Enable families to use generic resources which are integrated activities and/or resources community members typically have access to;
(b) Reflect geographic, cultural and other local differences;
(c) Support families in a variety of non crisis-oriented ways;
(d) Prioritize support for unserved families;
(e) Address the diverse needs of Native Americans, communities of color and limited or non-English speaking groups;
(f) Be family focused;
(g) Increase inclusion of persons with developmental disabilities;
(h) Benefit families who have children or adults eligible for services from DDD and who do not receive other DDD paid services; and
(i) Promote community collaboration, joint funding, planning and decision making.
HEARINGS AND APPEALS