Original Notice.

     Preproposal statement of inquiry was filed as WSR 08-15-131.

     Title of Rule and Other Identifying Information: The community services division is proposing to amend WAC 388-448-0050 PEP step II -- How we determine the severity of mental impairments.

     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) 664-6094), on December 9, 2008, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than December 10, 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 December 9, 2008.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by November 25, 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Including Any Changes in Existing Rules: The department is proposing amendments in order to replace obsolete and outdated medical descriptions and references.

     Reasons Supporting Proposal: The proposed changes are necessary to support documents that are more easily understood by mental health professionals and will promote more accurate and consistent medical evidence.

     Statutory Authority for Adoption: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090.

     Statute Being Implemented: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090.

     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, Implementation and Enforcement: Melissa Mathson, 712 Pear Street S.E., Olympia, WA 98503, (360) 725-4563.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. These proposed rules do not have an economic impact on small businesses. The proposed amendments only affect DSHS clients by clarifying the description of medical evidence requirements to determine incapacity.

     A cost-benefit analysis is not required under RCW 34.05.328. These amendments are exempt as allowed under RCW 34.05.328 (5)(b)(vii) which states in-part, "[t]his section does not apply to... rules of the department of social and health services relating only to client medical or financial eligibility and rules concerning liability for care of dependents."

October 31, 2008

Stephanie E. Schiller

Rules Coordinator

     (1) We review the following psychological evidence to determine the severity of your mental impairment ((is based on)):

     (a) Psychosocial and treatment history records;

     (b) Clinical findings of specific abnormalities of behavior, mood, thought, orientation, or perception;

     (c) Results of psychological tests; and

     (d) Symptoms observed by the examining practitioner that show ((impairment of)) how your impairment affects your ability to perform basic work-related activities.

     (2) We exclude diagnosis and related symptoms of alcohol or substance abuse or addiction;

     (3) If you are diagnosed with mental retardation, the diagnosis must be based on the Wechsler Adult Intelligence Scale (WAIS). The following test results determine the severity rating:

Intelligence Quotient (IQ) Score	Severity Rating
85 or above	1
71 to 84	3
70 or lower	5

     (((3))) (4) If you are diagnosed with a mental impairment with physical causes, we assign a severity rating based on the most severe of the following ((three)) four areas of impairment:

     (a) Short term memory ((defect for recent events)) impairment;

     (b) ((Impoverished, slowed, perseverative thinking, with confusion or disorientation)) Perceptual or thinking disturbances; ((or))

     (c) Disorientation to time and place; or

     (d) Labile, shallow, or coarse affect.

     (((4))) (5) We base the severity of ((the)) a functional ((psychotic or nonpsychotic)) disorder((, excluding alcoholism or drug addiction,)) on a clinical assessment of the intensity and frequency of symptoms that:

     (a) ((Clinical assessment of these twelve symptoms: Depressed mood, suicidal trends, verbal expression of anxiety or fear, expression of anger, social withdrawal, motor agitation, motor retardation, paranoid behavior, hallucinations, thought disorder, hyperactivity, preoccupation with physical complaints)) Affect your ability to perform basic work related activities; and

     (b) ((Clinical assessment of the intensity and pervasiveness of your symptoms and their effect on work activities)) Are consistent with a diagnosis of a mental impairment as listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

     (((5))) (6) We base the severity rating for a functional mental impairment on accumulated severity ratings for the ((twelve)) symptoms in subsection (((4)(a))) (5)(a) of this section as follows:

Symptom Ratings or Condition	Severity Rating
(a) The functional mental impairment is diagnosed with psychotic features; (b) You have had two or more hospitalizations for psychiatric reasons in the past two years; (c) You have had more than six months of continuous psychiatric hospital or residential treatment in the past two years; (d) The overall assessment of symptoms is rated three; or (e) At least three symptoms are rated three or higher.	3
(f) The overall assessment of symptoms is rated four; or (g) At least three symptoms are rated four or five.	4
(h) The overall assessment of symptoms is rated five; or (i) At least three symptoms are rated five.	5

     (((6))) (7) If you ((have more than one type of)) are diagnosed with any combination of mental retardation, mental impairment with physical causes, or functional mental impairment, we assign a severity rating as follows:

Condition	Severity Rating
(a) Two or more disorders with ratings of three; or (b) One or more disorders rated three; and one rated four.	4
(c) Two or more disorders rated four.	5

     (((7))) (8) We deny incapacity when you ((do not have)) haven't been diagnosed with a significant physical impairment and your overall mental severity rating is one or two;

     (((8))) (9) We approve incapacity when you have an overall mental severity rating of five((, regardless of whether you have a physical impairment)).

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, § 388-448-0050, filed 8/2/00, effective 9/1/00.]

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