WASHINGTON STATE REGISTER

WSR 08-15-008

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed July 3, 2008, 3:25 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 08-05-004.

Title of Rule and Other Identifying Information: Chapter 388-845 WAC, Division of developmental disabilities home and community based services waivers.

The department of social and health services, aging and disability services administration, division of developmental disabilities (DDD), is amending rules governing chapter 388-845 WAC, DDD home and community based services waivers.

These rules are necessary to amend the procedures for administering the home and community based services waivers. They incorporate changes reflected in the waivers approved by the federal Centers for Medicare and Medicaid Services under Section 1915(c) of the Social Security Act. They also clarify the existing rules.

The major components of the chapter are:

• Adding definitions regarding employment services;

• Clarifying definitions of services provided;

• Revising grammar for clarity;

• Increasing the maximum dollar amounts for employment/day program services;

• Expanding and clarifying the limitations on services; and

• Specifically, limiting a personal care provider to sixty miles per month in mileage reimbursement.



Washington Administrative Code Effect of Rule Change Impact Small Business?

388-845-0001 Definitions -amended
     "CAP Waiver" - removed
     "Gainful employment" - added
     "Integrated settings" - added
     "Living wage" - added

This definition is obsolete.
Adds the definition of "gainful employment."
Adds the definition of "integrated settings."
Adds the definition of "living wage."

No
No
No
No

388-845-0045 - amended Clarifies that needs refer to the identified health and welfare needs. No

388-845-0205 - amended Increases the maximum allowable amount for employment/day program services. No

3388-845-0210 - amended Increases the maximum allowable amount for employment/day program services and that this amount may be exceeded by exception to rule. No

388-845-0600 - amended Rewords the definition of community access services for clarity. No

388-845-0605 - amended Rewords who can be providers of community access services for clarity. No

388-845-0610 - amended Clarifies that community access is a service. No

388-845-0750 - amended Clarifies that community transition services may be available when moving from an institutional setting or from a provider operated setting to a community setting in which you live in your own home or apartment and are responsible for your living expenses. No

388-845-0760 - amended Clarifies that community transitional services may not be used for rent. No

388-845-1200 - amended Clarifies the definition of person-to-person services. No

388-845-1205 - amended Grammatical change only. No

388-845-1210 - amended Clarifies the limitations of person-to-person services. No

388-845-1305 - amended Clarifies that providers of personal care services must be contracted with ADSA rather than DDD. No

388-845-1310 - amended Clarifies that homecare agencies must be contracted with ADSA rather than DDD. No

388-845-1400 - amended Expands the definition of prevocational services. No

388-845-1410 - amended Expands the limitations of prevocational services to require prior approval, that these services are time-limited and when a review of these services may be required. No

388-845-1600 - amended Clarifies the definition of respite care. No

388-845-1620 - amended Expands the limitations on respite care regarding parent providers. No

388-845-1650 - amended Changes the term deviation to deviancy and expands the definition for clarity. No

388-845-1655 - amended Changes the term deviation to deviancy. No

388-845-1660 - amended Changes the term deviation to deviancy. No

388-845-2100 - amended Revises and expands the definition of supported employment services. No

388-845-2105 - amended Rewords the grammar for clarity. No

388-845-2110 - amended Clarifies the limitations on supported employment services. No

388-845-2210 - amended Adds a limitation of sixty miles per month for transportation services provided by a personal care provider. Yes

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, behind Goodyear Courtesy Tire. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on August 26, 2008, at 10:00 a.m.

Date of Intended Adoption: Not earlier than August 27, 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 DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on August 26, 2008.

Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by August 19, 2008, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: These rules are necessary to amend the procedures for administering the home and community based services waivers. They incorporate changes reflected in the waivers approved by the federal Centers for Medicare and Medicaid Services under Section 1915(c) of the Social Security Act. They also clarify the existing rules.

Reasons Supporting Proposal: By amending these rules, the department is able to claim additional federal Title XIX funding.

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

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: Steve Brink, 640 Woodland Square Loop S.E., Lacey, WA 98503-1045, P.O. Box 45310, Olympia, WA 98504-5310, e-mail brinksc@dshs.wa.gov, (360) 725-3416, fax (360) 404-0955; Implementation: Christie Seligman, 640 Woodland Square Loop S.E., Lacey, WA 98503-1045, P.O. Box 45310, Olympia, WA 98504-5310, e-mail seligcl@dshs.wa.gov, (360) 725-3445, fax (360) 404-0955; and Enforcement: Don Clintsman, 640 Woodland Square Loop S.E., Lacey, WA 98503-1045, P.O. Box 45310, Olympia, WA 98504-5310, e-mail clintdl@dshs.wa.gov, (360) 725-3421, fax (360) 404-0955.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement
Chapter 19.85 RCW, the Regulatory Fairness Act, requires that the economic impact of proposed regulations be analyzed in relation to small businesses. The statute defines small businesses as those business entities that employ fifty or fewer people and are independently owned and operated.

The division of developmental disabilities has analyzed the rule amendments and has determined that some personal care providers may be impacted by these changes. Specifically, reimbursement for transportation services is limited to sixty miles per month when provided by personal care providers.

This limitation is part of the letter of agreement with the Service Employees International Union (SEIU) and, as such, cannot be mitigated without a revision of the agreement.

DDD has concluded that no jobs will be created or lost due to the implementation of these rules.

INVOLVEMENT OF INDUSTRY AND OTHER STAKEHOLDERS: DDD filed a preproposal statement of inquiry (WSR 08-05-004) on February 6, 2008, and notified interested persons that it intended to develop and adopt rules regarding the division of developmental disabilities home and community based services waivers.

Additionally, DDD has received input from the SEIU and the counties responsible for providing employment services.

EVALUATION OF PROBABLE COSTS AND PROBABLE BENEFITS: Since the amendments "make significant amendments to a policy or regulatory program" (see RCW 34.05.328 (5)(c)(iii)), DDD has determined the rules to be "significant" as defined by the legislature.

As required by RCW 34.05.328 (1)(c), DDD has analyzed the probable costs and probable benefits of the amendments, taking into account both the qualitative and quantitative benefits and costs. Providers of personal care services and individuals eligible for personal care services from DDD may be impacted by these amended rules. DDD's analysis concludes that no other agencies or individuals are negatively impacted by these rules.

COST OF COMPLIANCE: To fairly consider the costs of compliance, DDD has comprehensively identified those changes to its rules, examining their impact on clients and agencies, weighing perceived costs against potential benefits.

As stated above, some personal care service providers may receive lower reimbursement for transportation services. Without amendments to the letter of agreement with SEIU, this potential lower reimbursement is unavoidable. DDD's analysis revealed that there are no other additional costs imposed by the rules.

BENEFITS:

• These rules do not impose additional costs for services.

• These rules do not impose additional costs to clients.

• Services to clients will improve as these rules establish clear definitions of services that are available. Clients will receive services for which they qualify.

• The department will be able to claim Title XIX match under Section 1915 (c) of the Social Security Act.

CONCLUSION: DDD has given careful consideration to the possible impact of the rules in chapter 388-845 WAC on those impacted by the rules.

DDD has concluded that no jobs will be created or lost due to the implementation of these rules.

DDD has concluded that these rules may impact some personal care providers by limiting the maximum number of miles that these providers may [be] reimbursed for. These limitations cannot be mitigated unless the letter of agreement between the department and SEIU is amended.

Even with the possible lower mileage reimbursement to personal care providers, DDD concludes that the benefits outweigh these costs.

Please contact Steve Brink at (360) 725-3416 or by e-mail at brinksc@dshs.wa.gov if you have any questions.

A copy of the statement may be obtained by contacting Steve Brink, 640 Woodland Square Loop S.E., Lacey, WA 98503-1045, P.O. Box 45310, Olympia, WA 98504-5310, phone (360) 725-3416, fax (360) 404-0955, e-mail brinksc@dshs.wa.gov.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Steve Brink, 640 Woodland Square Loop S.E., Lacey, WA 98503-1045, P.O. Box 45310, Olympia, WA 98504-5310, phone (360) 725-3416, fax (360) 404-0955, e-mail brinksc@dshs.wa.gov.

June 24, 2008

Stephanie E. Schiller

Rules Coordinator

3946.3
AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0001 Definitions. "ADSA" means the aging and disability services administration, an administration within the department of social and health services.

"Aggregate services" means a combination of services subject to the dollar limitations in the Basic and Basic Plus waivers.

((~~"CAP waiver" means the community alternatives program waiver.~~))

"CARE" means the comprehensive assessment and reporting evaluation.

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

"DDD assessment" refers to the standardized assessment tool as defined in chapter 388-828 WAC, used by DDD to measure the support needs of persons with developmental disabilities.

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

"Employment/day program services" means community access, person-to-person, prevocational services or supported employment services subject to the dollar limitations in the Basic and Basic Plus waivers.

"Family" means relatives who live in the same home with the eligible client. Relatives include spouse, natural, adoptive or step parents; grandparents; brother; sister; stepbrother; stepsister; uncle; aunt; first cousin; niece; or nephew.

"Gainful employment" means employment that reflects achievement of or progress towards a living wage.

"HCBS waivers" means home and community based services waivers.

"Home" means your present or intended place of residence.

"ICF/MR" means an intermediate care facility for the mentally retarded.

"Individual support plan (ISP)" is a document that authorizes and identifies the DDD paid services to meet a client's assessed needs.

"Integrated settings" mean typical community settings not designed specifically for individuals with disabilities in which the majority of persons employed and participating are individuals without disabilities.

"Legal representative" means a parent of a person who is under eighteen years of age, a person's legal guardian, a person's limited guardian when the subject matter is within the scope of limited guardianship, a person's attorney at law, a person's attorney in fact, or any other person who is authorized by law to act for another person.

"Living wage" means the amount of earned wages needed to enable an individual to meet or exceed his/her living expenses.

"Necessary supplemental accommodation representative" means an individual who receives copies of DDD planned action notices (PANs) and other department correspondence in order to help a client understand the documents and exercise the client's rights. A necessary supplemental accommodation representative is identified by a client of DDD when the client does not have a legal guardian and the client is requesting or receiving DDD services.

"Plan of care (POC)" means the primary tool DDD uses to determine and document your needs and to identify services to meet those needs until the DDD assessment is administered and the individual support plan is developed.

"Providers" means an individual or agency who meets the provider qualifications and is contracted with ADSA to provide services to you.

"Respite assessment" means an algorithm within the DDD assessment that determines the number of hours of respite care you may receive per year if you are enrolled in the Basic, Basic Plus, or Core waiver.

"SSI" means Supplemental Security Income, an assistance program administered by the federal Social Security Administration for blind, disabled and aged individuals.

"SSP" means state supplementary payment, a benefit administered by the department intended to augment an individual's SSI.

"State funded services" means services that are funded entirely with state dollars.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0001, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0001, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0045 When there is capacity to add people to a waiver, how does DDD determine who will be enrolled? When there is capacity on a waiver and available funding for new waiver participants, DDD may enroll people from the statewide data base in a waiver based on the following priority considerations:

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

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

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

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

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

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

(f) Persons who were previously on an HCBS waiver since April 2004 and lost waiver eligibility per WAC 388-845-0060(9).

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

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0045, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0045, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0205 Basic waiver services.

BASIC WAIVER SERVICES YEARLY LIMIT

AGGREGATE SERVICES: May not exceed $1454 per year on any combination of these services

Behavior management and consultation

Community guide

Environmental accessibility adaptations

Occupational therapy

Physical therapy

Specialized medical equipment/supplies

Specialized psychiatric services

Speech, hearing and language services

Staff/family consultation and training

Transportation

EMPLOYMENT/DAY PROGRAM SERVICES:
Community access
May not exceed $((~~6631~~)) 6804 per year

Person-to-person

Prevocational services

Supported employment

Sexual deviancy evaluation Limits are determined by DDD

Respite care Limits are determined by the DDD assessment

Personal care Limits are determined by the CARE tool used as part of the DDD assessment

MENTAL HEALTH STABILIZATION SERVICES: Limits are determined by a mental health professional or DDD

Behavior management and consultation

Mental health crisis diversion bed services

Skilled nursing

Specialized psychiatric services

Emergency assistance is only for aggregate services and/or employment/day program services contained in the Basic waiver $6000 per year; Preauthorization required

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0205, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.120. 07-05-014, § 388-845-0205, filed 2/9/07, effective 3/12/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0205, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0210 Basic Plus waiver services.

BASIC PLUS WAIVER SERVICES YEARLY LIMIT

AGGREGATE SERVICES:
Behavior management and consultation
May not exceed $6192 per year on any combination of these services

Community guide

Environmental accessibility adaptations

Occupational therapy

Physical therapy

Skilled nursing

Specialized medical equipment/supplies

Specialized psychiatric services

Speech, hearing and language services

Staff/family consultation and training

Transportation

EMPLOYMENT/DAY PROGRAM SERVICES:

Community access

Person-to-person

Prevocational services
Supported employment

Adult foster care (adult family home)

Adult residential care (boarding home)
May not exceed $((~~9691~~)) 9944 per year
This amount may be increased to a maximum of $19,888 per year by exception to rule based on client need

Determined per department rate structure

MENTAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD

Behavior management and consultation

Mental health crisis diversion bed services

Skilled nursing

Specialized psychiatric services

Personal care Limits determined by the CARE tool used as part of the DDD assessment

Respite care Limits are determined by the DDD assessment

Sexual deviancy evaluation Limits are determined by DDD

Emergency assistance is only for aggregate services and/or employment/day program services contained in the Basic Plus waiver $6000 per year; Preauthorization required

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0210, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.120. 07-05-014, § 388-845-0210, filed 2/9/07, effective 3/12/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0210, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0600 What ((is)) are community access services? Community access ((~~is a~~)) services are provided in the community to enhance or maintain ((~~the person's competence,~~)) your community integration, physical or mental skills.

(1) If you are age sixty-two or older, ((~~this service is~~)) these services are available to assist you to participate in activities, events and organizations in the community in ways similar to others of retirement age.

(2) ((~~This service is~~)) These services are available ((~~to adults~~)) in the Basic, Basic Plus, and CORE waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0600, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0605 Who ((~~is a~~)) are qualified providers of community access services? ((~~The~~)) Providers of community access services must be a county or an individual or agency contracted with a county or DDD.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0605, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

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

(1) You must be age sixty-two or older.

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

(3) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0610, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0750 What are community transition services? (1) Community transition services are reasonable costs (necessary expenses in the judgment of the state for ((~~an individual~~)) you to establish ((~~his or her~~)) your basic living arrangement) associated with moving from:

(a) An institutional setting to a community setting in which you are living in your own home or apartment, responsible for your own living expenses and receiving services from a DDD certified residential habilitation services provider as defined in WAC 388-845-1505 and 388-845-1510; or

(b) A provider operated setting, such as a group home, staffed residential, or companion home in the community to a community setting in which you are living in your own home or apartment, responsible for your own living expenses, and receiving services from a DDD certified residential habilitation services provider as defined in WAC 388-845-1505 and 388-845-1510.

(2) Community transition services include:

(a) Security deposits (not to exceed the equivalent of two month's rent) that are required to obtain a lease on an apartment or home;

(b) Essential furnishings such as a bed, a table, chairs, window blinds, eating utensils and food preparation items;

(d) Set-up fees or deposits for utility or service access (e.g., telephone, electricity, heating); and

(e) Health and safety assurances, such as pest eradication, allergen control or one-time cleaning prior to occupancy.

(3) Community transition services are available in the CORE and community protection waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0750, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0760 Are there limitations to community transition services I can receive? (1) Community transition services do not include:

(a) Diversional or recreational items such as televisions, cable TV access, VCRs, MP3, CD or DVD players; and

(b) Computers ((~~whose use is~~)) if primarily ((~~diversional or recreational~~)) used as a diversional or for recreation.

(2) ((~~Community transition services are available only to individuals that are moving from an institution to a community setting and are enrolled in either the CORE or community protection waiver~~)) Rent assistance is not available as a community transition service.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0760, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1200 What ((~~is a~~)) are "person-to-person" services? (1) "Person-to-person" ((~~is a day program~~)) services are intended to assist ((~~participants~~)) you to ((~~progress toward~~)) achieve the outcome of gainful employment ((~~goals~~)) in an integrated setting through ((~~individualized planning, skill instruction, information and referral, and one to one relationship building~~)) a combination of services, which may include:

(a) Development and implementation of self-directed employment services;

(b) Development of a person centered employment plan;

(d) Support to work and volunteer in the community, and/or access the generic community resources needed to achieve integration and employment.

(2) These ((~~This~~)) services may be provided in addition to community access, prevocational services, or supported employment.

(3) These ((~~This~~)) services ((is)) are available ((~~to adults~~)) in all four HCBS waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1200, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1205 Who ((~~is a~~)) are qualified providers of person-to-person services? ((~~The~~)) Providers of "person-to-person" services must be a county or an individual or agency contracted with a county or DDD.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1205, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1210 Are there limits to the person-to-person service I can receive? (1) You must be age twenty and graduating from high school prior to your July or August twenty-first birthday, age twenty-one and graduated from high school or age twenty-two or older to receive person-to-person services.

(2) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive.

(3) These services will be provided in an integrated environment.

(4) Your service hours are determined by the level of assistance you need to reach your employment outcomes and might not equal the number of hours you spend on the job or in job related activities.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1210, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

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

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

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

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

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1305, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-1310 Are there limits to the personal care services I can receive? (1) You must meet the programmatic eligibility for Medicaid personal care in chapters 388-106 and 388-71 WAC governing Medicaid personal care (MPC) using the current department approved assessment form: Comprehensive assessment reporting evaluation (CARE).

(2) The maximum hours of personal care you may receive are determined by the CARE tool used as part of the DDD assessment.

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

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

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1310, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1310, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1400 What are prevocational services? (1) Prevocational services occur in a segregated setting and are designed to prepare ((~~an adult~~)) you for ((~~paid or unpaid~~)) gainful employment in an integrated setting through ((~~the teaching of such concepts as compliance, attendance, task completion, problem solving and safety~~)) training and skill development.

(2) Prevocational ((~~These~~)) services are available in all four HCBS waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1400, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

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

(1) You must be age twenty and graduating from high school prior to your July or August twenty-first birthday, age twenty-one and graduated from high school, or age twenty-two or older to receive prevocational services.

(2) ((~~You are not expected to be competitively employed within one year (excluding supported employment programs)~~)) New referrals for prevocational services require prior approval by the DDD regional administrator and county coordinator or their designees.

(3) Prevocational services are a time limited step on the pathway toward individual employment and are dependent on your demonstrating steady progress toward gainful employment over time. Your annual vocational assessment will include exploration of integrated settings within your next service year. Criteria that would trigger a review of your need for these services include, but are not limited to:

(a) Compensation at more than fifty percent of the prevailing wage;

(b) Significant progress made toward your defined goals;

(d) Recommendation by your individual support plan team.

((~~(3)~~)) (4) You ((~~cannot~~)) will not be authorized to receive prevocational services ((~~if you receive~~)) in addition to community access services or supported employment services.

((~~(4)~~)) (5) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive.

(6) Your service hours are determined by the assistance you need to reach your employment outcomes.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1410, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

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

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1600, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

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

(1) The DDD assessment will determine how much respite you can receive per chapter 388-828 WAC.

(2) Prior approval by the DDD regional administrator or designee is required:

(a) To exceed fourteen days of respite care per month; or

(b) To pay for more than eight hours in a twenty-four hour period of time for respite care in any setting other than your home or place of residence. This limitation does not prohibit your respite care provider from taking you into the community, per WAC 388-845-1610(2).

(3) Respite cannot replace:

(a) Daycare while ((~~a parent or guardian~~)) your 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.

(4) 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.

(5) ((~~Your caregiver cannot provide~~)) Your caregiver will not be paid to provide DDD services for you or other persons at the same time you receive respite services.

(6) If your personal care provider is your parent, your parent provider will not be paid to provide respite services ((~~for you or other persons during your respite care hours~~)) to any client in the same month that you receive respite services.

((~~(6)~~)) (7) DDD cannot pay for any fees associated with the respite care; for example, membership fees at a recreational facility, or insurance fees.

((~~(7)~~)) (8) If you require respite from a licensed practical nurse (LPN) or a registered nurse (RN), services may be authorized as skilled nursing services per WAC 388-845-1700 using an LPN or RN. If you are in the Basic Plus waiver, skilled nursing services are limited to the dollar limits of your aggregate services per WAC 388-845-0210.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1620, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1620, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1650 What are sexual ((~~deviation~~)) deviancy evaluations? (1) Sexual ((~~deviation~~)) deviancy evaluations:

(a) Are professional evaluations ((~~of sexual deviancy to determine the need for psychological, medical or therapeutic services~~)) that assess the person's needs and the person's level of risk of sexual offending or sexual recidivism;

(b) Determine the need for psychological, medical or therapeutic services; and

(2) Sexual deviancy evaluations are available in all four waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1650, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1655 Who is a qualified provider of sexual ((~~deviation~~)) deviancy evaluations? The provider of sexual deviancy evaluations must:

(1) Be a certified sexual offender treatment provider (SOTP); and

(2) Meet the standards contained in WAC 246-930-030 (education required prior to examination) and WAC 246-930-040 (professional experience required prior to examination).

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1655, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-1660 Are there limitations to the sexual ((~~deviation~~)) deviancy evaluations I can receive? (1) ((~~The~~)) Sexual deviancy evaluations must meet the standards contained in WAC 246-930-320.

(2) Sexual ((~~deviation~~)) deviancy evaluations require prior approval by the DDD regional administrator or designee.

(3) The costs of sexual ((~~deviation~~)) deviancy evaluations do not count toward the dollar limits for aggregate services in the Basic or Basic Plus waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1660, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1660, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-2100 What ((is)) are supported employment services? Supported employment services provide((s)) you with intensive ongoing ((~~individual or group~~)) support ((~~in a work setting to adults with developmental disabilities~~)) if you need individualized assistance to gain and/or maintain employment. ((~~This service is~~)) These services are tailored to your individual needs, interests, abilities, and promote your career development. These services are provided in individual or group settings and are available in all four HCBS waivers.

(1) Individual supported employment services include((s)) activities needed to sustain ((~~paid work by individuals receiving waiver services, including supervision and training~~)) minimum wage pay or higher. These services are conducted in integrated business environments and include the following:

(a) Creation of work opportunities through job development;

(b) On-the-job training;

(d) Modification of your work site tasks;

(e) Employment retention and follow along support; and

(f) Development of career and promotional opportunities.

(2) ((~~Supported employment is conducted in a variety of settings; particularly work sites in which persons without disabilities are employed~~)) Group supported employment services are a step on your pathway toward gainful employment in an integrated setting and include:

(a) The activities outlined in individual supported employment services;

(b) Daily supervision by a qualified employment provider; and

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-2100, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-2105 Who ((~~is a~~)) are qualified providers of supported employment services? ((A)) Supported employment services providers must be a county, or agencies or individuals contracted with a county or DDD.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-2105, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

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

(2) Payment will be made only for the ((~~adaptations, supervision, training, and~~)) employment support ((~~with the activities of daily living~~)) you require as a result of your disabilities.

(3) Payment ((~~is excluded for~~)) for individual supported employment excludes the supervisory activities rendered as a normal part of the business setting.

(4) You ((~~cannot~~)) will not be authorized to receive supported employment services ((~~if you receive~~)) in addition to community access ((~~services~~)) or prevocational services.

(5) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of supported employment service you may receive.

(6) Your service hours are determined by the assistance you need to reach your employment outcomes and might not equal the number of hours you spend on the job or in job related activities.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-2110, filed 12/13/05, effective 1/13/06.]

AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

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

(1) Transportation to/from medical or medically related appointments 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 a waiver 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) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

(11) Transportation services require prior approval by the DDD regional administrator or designee.

(12) If your individual personal care provider uses his/her own vehicle to provide transportation to you for essential shopping and medical appointments as a part of your personal care service, your provider may receive up to sixty miles per month in mileage reimbursement. If you work with more than one individual personal care provider, your limit is still a total of sixty miles per month. This cost is not counted toward the dollar limitation for aggregate services in the Basic or Basic Plus waiver.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-2210, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-2210, filed 12/13/05, effective 1/13/06.]

•	Adding definitions regarding employment services;
•	Clarifying definitions of services provided;
•	Revising grammar for clarity;
•	Increasing the maximum dollar amounts for employment/day program services;
•	Expanding and clarifying the limitations on services; and
•	Specifically, limiting a personal care provider to sixty miles per month in mileage reimbursement.

Washington Administrative Code	Effect of Rule Change	Impact Small Business?
388-845-0001 Definitions -amended "CAP Waiver" - removed "Gainful employment" - added "Integrated settings" - added "Living wage" - added	This definition is obsolete. Adds the definition of "gainful employment." Adds the definition of "integrated settings." Adds the definition of "living wage."	No No No No
388-845-0045 - amended	Clarifies that needs refer to the identified health and welfare needs.	No
388-845-0205 - amended	Increases the maximum allowable amount for employment/day program services.	No
3388-845-0210 - amended	Increases the maximum allowable amount for employment/day program services and that this amount may be exceeded by exception to rule.	No
388-845-0600 - amended	Rewords the definition of community access services for clarity.	No
388-845-0605 - amended	Rewords who can be providers of community access services for clarity.	No
388-845-0610 - amended	Clarifies that community access is a service.	No
388-845-0750 - amended	Clarifies that community transition services may be available when moving from an institutional setting or from a provider operated setting to a community setting in which you live in your own home or apartment and are responsible for your living expenses.	No
388-845-0760 - amended	Clarifies that community transitional services may not be used for rent.	No
388-845-1200 - amended	Clarifies the definition of person-to-person services.	No
388-845-1205 - amended	Grammatical change only.	No
388-845-1210 - amended	Clarifies the limitations of person-to-person services.	No
388-845-1305 - amended	Clarifies that providers of personal care services must be contracted with ADSA rather than DDD.	No
388-845-1310 - amended	Clarifies that homecare agencies must be contracted with ADSA rather than DDD.	No
388-845-1400 - amended	Expands the definition of prevocational services.	No
388-845-1410 - amended	Expands the limitations of prevocational services to require prior approval, that these services are time-limited and when a review of these services may be required.	No
388-845-1600 - amended	Clarifies the definition of respite care.	No
388-845-1620 - amended	Expands the limitations on respite care regarding parent providers.	No
388-845-1650 - amended	Changes the term deviation to deviancy and expands the definition for clarity.	No
388-845-1655 - amended	Changes the term deviation to deviancy.	No
388-845-1660 - amended	Changes the term deviation to deviancy.	No
388-845-2100 - amended	Revises and expands the definition of supported employment services.	No
388-845-2105 - amended	Rewords the grammar for clarity.	No
388-845-2110 - amended	Clarifies the limitations on supported employment services.	No
388-845-2210 - amended	Adds a limitation of sixty miles per month for transportation services provided by a personal care provider.	Yes

•	These rules do not impose additional costs for services.
•	These rules do not impose additional costs to clients.
•	Services to clients will improve as these rules establish clear definitions of services that are available. Clients will receive services for which they qualify.
•	The department will be able to claim Title XIX match under Section 1915 (c) of the Social Security Act.

BASIC WAIVER	SERVICES	YEARLY LIMIT
	AGGREGATE SERVICES:	May not exceed $1454 per year on any combination of these services
	Behavior management and consultation
	Community guide
	Environmental accessibility adaptations
	Occupational therapy
	Physical therapy
	Specialized medical equipment/supplies
	Specialized psychiatric services
	Speech, hearing and language services
	Staff/family consultation and training
	Transportation
	EMPLOYMENT/DAY PROGRAM SERVICES: Community access	May not exceed $((~~6631~~)) 6804 per year
	Person-to-person
	Prevocational services
	Supported employment
	Sexual deviancy evaluation	Limits are determined by DDD
	Respite care	Limits are determined by the DDD assessment
	Personal care	Limits are determined by the CARE tool used as part of the DDD assessment
	MENTAL HEALTH STABILIZATION SERVICES:	Limits are determined by a mental health professional or DDD
	Behavior management and consultation
	Mental health crisis diversion bed services
	Skilled nursing
	Specialized psychiatric services
	Emergency assistance is only for aggregate services and/or employment/day program services contained in the Basic waiver	$6000 per year; Preauthorization required

BASIC PLUS WAIVER	SERVICES	YEARLY LIMIT
	AGGREGATE SERVICES: Behavior management and consultation	May not exceed $6192 per year on any combination of these services
	Community guide Environmental accessibility adaptations
	Community guide Environmental accessibility adaptations
	Occupational therapy
	Physical therapy
	Skilled nursing
	Specialized medical equipment/supplies
	Specialized psychiatric services
	Speech, hearing and language services
	Staff/family consultation and training
	Transportation
	EMPLOYMENT/DAY PROGRAM SERVICES: Community access Person-to-person Prevocational services Supported employment Adult foster care (adult family home) Adult residential care (boarding home)	May not exceed $((~~9691~~)) 9944 per year This amount may be increased to a maximum of $19,888 per year by exception to rule based on client need Determined per department rate structure
	MENTAL HEALTH STABILIZATION SERVICES:	Limits determined by a mental health professional or DDD
	Behavior management and consultation	Limits determined by a mental health professional or DDD
	Mental health crisis diversion bed services
	Skilled nursing
	Specialized psychiatric services
	Personal care	Limits determined by the CARE tool used as part of the DDD assessment
	Respite care	Limits are determined by the DDD assessment
	Sexual deviancy evaluation	Limits are determined by DDD
	Emergency assistance is only for aggregate services and/or employment/day program services contained in the Basic Plus waiver	$6000 per year; Preauthorization required

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