PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 08-23-042.
Title of Rule and Other Identifying Information: The department is amending chapter 388-832 WAC, Individual and family services program.
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://www.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on May 5, 2009, at 10:00 a.m.
Date of Intended Adoption: Not earlier than May 6, 2009.
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 May 5, 2009.
Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by April 21, 2009, 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 proposed rules clarify existing language and remove certain limitations for the receipt of services under the individual and family services program.
| Washington Administrative Code | Effect of Rule |
| 388-832-0001 Definitions (amended) | Adds or amends definitions used in this chapter. |
| 388-832-0005 (amended) | Reformats this section. |
| 388-832-0007 (amended) | Removes unnecessary language. |
| 388-832-0015 (amended) | Clarifies language. |
| 388-832-0020 (amended) | Adds a cross-reference. |
| 388-832-0022 (amended) | Clarifies the name of the assessment. |
| 388-832-0023 (amended) | Adds a cross-reference. |
| 388-832-0024 (amended) | Clarifies language. |
| 388-832-0025 (amended) | Clarifies that a client cannot receive IFS and SSP for the same reason. |
| 388-832-0060 (amended) | Clarifies language. |
| 388-832-0065 (amended) | Removes the twelve-month limitation for out of home placement and clarifies language. |
| 388-832-0067 (amended) | Limits the receipt of IFS program services to children under age eighteen if the parent is also a client of DDD. |
| 388-832-0070 (amended) | Changes "wait" list to "request" list. |
| 388-832-0072 (amended) | Changes "wait" list to "request" list and allows a client to remain on the request list if in a temporary placement with plans top [to] return home. |
| 388-832-0075 (amended) | Changes "wait" list to "request" list. |
| 388-832-0080 (amended) | Changes "wait" list to "request" list and clarifies when a client must respond to a notification to schedule an assessment. |
| 388-832-0082 (amended) | Changes "wait" list to "request" list and clarifies the request date. |
| 388-832-0085 (amended) | Changes "wait" list to "request" list and changes "new" participants to "additional" participants. |
| 388-832-0087 (amended) | Changes "wait" list to "request" list and clarifies language. |
| 388-832-0090 (amended) | Clarifies language. |
| 388-832-0091 (amended) | Clarifies language. |
| 388-832-0113 (amended) | Clarifies language. |
| 388-832-0120 (amended) | Corrects typographical errors. |
| 388-832-0123 (amended) | Corrects the name of the "medically intensive children's program." |
| 388-832-0125 (amended) | Spells out the acronym "COPES." |
| 388-832-0127 (amended) | Removes the requirement to request an ETR and obtain approval from the director of DDD. |
| 388-832-0128 (amended) | Adds "review" as a time when the ISP plan may become effective. |
| 388-832-0135 (amended) | Removes the limitation that the need must "result" from a developmental disability. |
| 388-832-0136 (amended) | Clarifies language. |
| 388-832-0137 (amended) | Clarifies language when the annual allocation may be used. |
| 388-832-0160 (amended) | Removes "guardian" at work as a condition when respite care can be given. |
| 388-832-0165 (amended) | Clarifies language and replaces "related to the person's disability" with "deemed necessary by their health care professional." |
| 388-832-0166 (amended) | Adds that excess medical costs may be paid to a DDD contracted provider, changes "family support contract" to IFS contract and extends the length of time to remit receipts from thirty days to ninety days. |
| 388-832-0168 (amended) | Replaces "related to the person's disability" with "deemed necessary by their health care professional," specifies that therapies included under WAC 388-332-0170 may not be paid as an excess medical cost and adds a cross-reference. |
| 388-832-0170 (amended) | Clarifies language. |
| 388-832-0175 (amended) | Specifies that DDD will pay the contracted therapist directly for therapy services. |
| 388-832-0180 (amended) | Clarifies language, specifies that DDD will determine the need and amount of services based on the information from the treating professional and adds a cross-reference. |
| 388-832-0185 (amended) | Adds repairs for damages to a client's residence resulting from the client's disability to allowable architectural modifications and adds repairs and maintenance to vehicular modifications to allowable vehicular modifications. |
| 388-832-0195 (amended) | Clarifies language. |
| 388-832-0200 (amended) | Removes the limitation that equipment and supplies must be "specialized medical" and clarifies language. |
| 388-832-0205 (amended) | Clarifies who are qualified providers of equipment and supplies. |
| 388-832-0210 (amended) | Removes the limitation that equipment and supplies must be "specialized medical" and excludes supplies for incontinence as requiring prior approval by the DDD regional administrator. |
| 388-832-0215 (amended) | Specifies that specialized clothing must be "nonrestrictive." |
| 388-832-0220 (amended) | Changes "family support" contract to "IFS" contract. |
| 388-832-0225 (amended) | Clarifies language. |
| 388-832-0235 (amended) | Clarifies the definition of copays. |
| 388-832-0240 (amended) | Changes "family support" contract to "IFS" contract. |
| 388-832-0245 (amended) | Clarifies language. |
| 388-832-0255 (amended) | Changes "family support" contract to "IFS" contract. |
| 388-832-0260 (amended) | Clarifies language, removes the prohibition against purchasing bus passes, removes the need for prior approval and clarifies what may be reimbursed as per diem costs. |
| 388-832-0275 (amended) | Clarifies language and removes the need for prior approval. |
| 388-832-0285 (amended) | Adds a cross reference to a DDD policy. |
| 388-832-0290 (amended) | Specifies that DDD will determine the need and amount of behavior management based on the information from the treating professional. |
| 388-832-0308 (amended) | Changes "family support" contract to "IFS" contract and clarifies language. |
| 388-832-0310 (amended) | Removes the need for prior approval. |
| 388-832-0315 (amended) | Clarifies language. |
| 388-832-0320 (amended) | Changes "family support" contract to "IFS" contract and adds the recreational opportunity contract as an additional method for reimbursement. |
| 388-832-0325 (amended) | Clarifies language and removes the requirement of prior approval. |
| 388-832-0330 (amended) | Clarifies language. |
| 388-832-0332 (amended) | Clarifies language. |
| 388-832-0333 (amended) | Adds DVR as a source of funding that must be accessed and clarifies language. |
| 388-832-0335 (amended) | Reformats the section for clarity. |
| 388-832-0340 (amended) | Reformats the section for clarity. |
| 388-832-0345 (amended) | Changes the requirement of prior approval from the DDD director to the DDD regional administrator. |
| 388-832-0350 (amended) | Clarifies language. |
| 388-832-0353 (amended) | Clarifies language. |
| 388-832-0366 (amended) | Lengthens the period of time from sixty to ninety days. |
| 388-832-0367 (amended) | Lengthens the period of time from sixty to ninety days and clarifies language. |
| 388-832-0369 (amended) | Clarifies language. |
| 388-832-0460 (amended) | Clarifies language. |
Reasons Supporting Proposal: See above.
Statutory Authority for Adoption: RCW 71A.12.030, 71A.12.040.
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 98503-1045, P.O. Box 45310, Olympia, WA 98507-5310, e-mail roberdx@dshs.wa.gov, (360) 725-3400, fax (360) 404-0955; Implementation: Debbie Couch, 640 Woodland Square Loop S.E., Lacey, WA 98503-1045, P.O. Box 45310, Olympia, WA 98507-5310, e-mail couchdg@dshs.wa.gov, (360) 725-3515, fax (360) 404-0955; and Enforcement: Doug Washburn, 640 Woodland Square Loop S.E., Lacey, WA 98503-1045, P.O. Box 45310, Olympia, WA 98507-5310, e-mail washbdc@dshs.wa.gov, (360) 725-3452, fax (360) 404-0955.
No small business economic impact statement has been prepared under chapter 19.85 RCW. DDD has analyzed these rules and concluded that they do not impact small businesses or small nonprofits.
A cost-benefit analysis is not required under RCW 34.05.328. These rules are exempt from the preparation of a cost-benefit analysis pursuant to RCW 34.05.328 (5)(b)(ii) and (vii) as they incorporate Washington state legislation, clarify rules without changing their effect and relate only to client medical or financial eligibility.
March 9, 2009
Stephanie E. Schiller
Rules Coordinator
4046.4"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))
relatives who live in the same home with the eligible client.
Relatives include spouse or registered domestic partner;
natural, adoptive or step parent; grandparent; child;
stepchild; sibling; stepsibling; uncle; aunt; first cousin;
niece; or nephew.
"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 and family services contract" means a contract between DDD and the family to reimburse the family for the purchase of goods and services.
"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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0001, filed 8/5/08, effective 9/5/08.]
(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))):
(a) The family support opportunity program (WAC 388-825-200 through 388-825-242);
(b) The traditional family support program (WAC 388-825-252 through 388-825-256);
(c) The family support pilot program (WAC 388-825-500 through 388-825-595); and
(d) Other family support rules (WAC 388-825-244 through 388-825-250).
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0005, filed 8/5/08, effective 9/5/08.]
(1) Form a partnership between the state and families to
help support families who have a ((client of)) DDD eligible
family member 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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0007, filed 8/5/08, effective 9/5/08.]
(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 adult or child residential service or licensed foster care.
(2) If you are a parent who is a client of DDD, 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 minor child who lives in your home is at risk of being placed up for adoption or into foster care.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0015, filed 8/5/08, effective 9/5/08.]
(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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0020, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0022, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0023, filed 8/5/08, effective 9/5/08.]
(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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0024, filed 8/5/08, effective 9/5/08.]
(2) If you receive SSP in lieu of traditional family support or family support opportunity, you are not eligible to receive IFS program funding.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0025, filed 8/5/08, effective 9/5/08.]
(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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0060, filed 8/5/08, effective 9/5/08.]
(2) You may make this request by contacting your DDD case
manager((, if your out of home placement does not exceed
twelve months)).
(3) Your case manager will schedule an assessment with
you and, if you meet all the eligibility criteria described in
WAC 388-832-0015, have an assessed need, and funding is
available, you ((will)) may receive an IFS program allocation.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0065, filed 8/5/08, effective 9/5/08.]
(1) Are ages birth through ((twenty-one)) seventeen years
of age;
(2) Are at risk of out of home placement; and
(3) Live with you.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0067, filed 8/5/08, effective 9/5/08.]
INDIVIDUAL AND FAMILY SERVICES PROGRAM ((
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0070, filed 8/5/08, effective 9/5/08.]
(2) If you are in temporary placement and the plan is to return home you may remain on the IFS request list.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0072, filed 8/5/08, effective 9/5/08.]
(1) Your name and request date will be added to the
((wait)) request list.
(2) A notice will be sent to you to let you know your
name has been added to the IFS ((wait)) request list.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0075, filed 8/5/08, effective 9/5/08.]
(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)) request list;
(4) You do not respond ((to)) by the date outlined on the
IFS notification to schedule the DDD assessment;
(5) You are offered IFS services and ((accept or)) refuse
services; or
(6) You are on the HCBS waiver((; or
(7) Your DDD assessment determines you are not eligible for the IFS program)).
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0080, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0082, filed 8/5/08, effective 9/5/08.]
(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))
request list the longest.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0085, filed 8/5/08, effective 9/5/08.]
(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)) may need to be reviewed per WAC 388-823-1010(3).
(4) Your DDD eligibility review must be ((completed))
finalized prior to ((completing)) the completion of the DDD
assessment for the IFS program.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0087, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0090, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0091, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0113, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0120, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0123, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0125, filed 8/5/08, effective 9/5/08.]
(1) Provide information and referral for non-DDD community-based supports; and
(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)).
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0127, filed 8/5/08, effective 9/5/08.]
(2) For a reassessment, amendment 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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0128, filed 8/5/08, effective 9/5/08.]
(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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0135, filed 8/5/08, effective 9/5/08.]
(2) You ((need to)) must 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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0136, filed 8/5/08, effective 9/5/08.]
(2) Your annual allocation ((must)) can only 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)) year.
(4) ((If at least some)) You must use a portion of your
IFS program ((services are not used in the)) allocation within
your twelve month assessment period((,)) or you ((will)) may
be terminated from the IFS program.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0137, filed 8/5/08, effective 9/5/08.]
(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)) may
not 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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0160, filed 8/5/08, effective 9/5/08.]
(1) Skilled nursing services (e.g., ventilation, catheterization, and insulin shots);
(2) Psychiatric services;
(3) Medical and dental services ((related to the person's
disability)) deemed medically necessary by your health care
professional and an allowable medicaid covered expense;
(4) Prescriptions for medications; and/or
(5) ((Copays)) Medical and ((deductible limited to your
IFS allocation)) dental premiums.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0165, filed 8/5/08, effective 9/5/08.]
(2) Skilled nursing services are paid to the DSHS contracted nurse directly.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0166, filed 8/5/08, effective 9/5/08.]
(1) The ((payment)) service must be of direct medical or
remedial benefit to ((the individual)) you and deemed
medically necessary ((as a result of the individual's
disability;)) by your health care professional.
(2) Therapies included under WAC 388-832-0170 may not be paid under excess medical costs.
(3) Medical and dental premiums are excluded for family
members other than the DDD eligible clients((; and)).
(((3))) (4) The need for excess medical costs must be
identified in your ISP and, in combination with other IFS
services, ((cannot)) may not exceed your IFS allocation.
(((4))) (5) Other restriction per WAC 388-832-0333 also
apply.
(6) Prior approval by regional administrator or designee is required.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0168, filed 8/5/08, effective 9/5/08.]
(1) Physical therapy;
(2) Occupational therapy; and/or
(3) Speech, hearing and language therapy.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0170, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0175, filed 8/5/08, effective 9/5/08.]
(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)) determines the
need ((for)) and amount of services you ((can)) will receive
based upon information received from the therapist;
(a) DDD may require a second opinion from a DDD selected provider.
(b) DDD ((will)) requires you to provide 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)) may
not exceed your IFS allocations.
(5) ((Prior approval by the regional administrator or
designee is required)) Other restrictions per WAC 388-832-0333
also apply.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0180, filed 8/5/08, effective 9/5/08.]
(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;
(e) Repairs for damages to the client's residence as a result of the client's disability up to the balance of the client's allocation; or
(f) Repairs to architectural modifications if necessary for client safety.
(3) Vehicular modifications include the following:
(a) Wheel chair lifts;
(b) Strap downs; ((or))
(c) Other access modifications; or
(d) Repairs and maintenance to vehicular modifications if necessary for client safety.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0185, filed 8/5/08, effective 9/5/08.]
(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)) may not add to
the square footage of the home.
(4) DDD ((will)) requires 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))
are 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)) may not exceed
your ((annual)) IFS allocation.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0195, filed 8/5/08, effective 9/5/08.]
(a) Increase or maintain their abilities to perform their activities of daily living; or
(b) Perceive, control or communicate with the environment in which they live.
(2) Equipment and supplies may include durable and
nondurable ((medical)) equipment that are ((defined in WAC 388-543-1000 and 388-543-2800 respectively)) specialized or
adapted, and generally not useful to a person in the absence
of illness, injury or disability.
(3) Also included are items ((necessary for life support
and ancillary supplies)) and ((equipment)) services necessary
to the proper functioning of the equipment and supplies
((described in subsection (1) above)).
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0200, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0205, filed 8/5/08, effective 9/5/08.]
(1) ((Specialized medical)) Equipment and supplies with
the exception of supplies for incontinence (e.g., diapers,
disposable underpads, and wipes) 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)) must 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)) may not exceed your IFS
allocation.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0210, filed 8/5/08, effective 9/5/08.]
(2) Specialized clothing is nonrestrictive 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).
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0215, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0220, filed 8/5/08, effective 9/5/08.]
(2) Prior approval by regional administrator or designee is required.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0225, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0235, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0240, filed 8/5/08, effective 9/5/08.]
(2) The copays 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.))
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0245, filed 8/5/08, effective 9/5/08.]
(2) Transportation services can be a reimbursable expense
through the ((parent)) individual and family ((support))
services contract.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0255, filed 8/5/08, effective 9/5/08.]
(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))) (5) Reimbursement to the provider is limited to transportation that occurs when you are with the provider.
(((9))) (6) 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))) (7) Per diem costs may be reimbursed ((with prior
approval from DDD regional administrator or designee))
utilizing the state rate to access medical services if the DDD
client and one family member must travel over one hundred
fifty miles one way ((for client receiving medical services
and one family member)).
(((12))) (8) 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))) (9) The need for transportation services must be
identified in your ISP and, in combination with other IFS
services, ((cannot)) may not exceed your IFS allocation.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0260, filed 8/5/08, effective 9/5/08.]
(1) Expenses to the family for room and board or attendance, including registration fees for conferences are excluded as a service under family counseling and training.
(2) The need for training and counseling must be
identified in your ISP and, in combination with other IFS
services, ((cannot)) may not exceed your IFS allocation.
(((3) Prior approval by regional administrator or
designee is required.))
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0275, filed 8/5/08, effective 9/5/08.]
(1) Marriage and family therapist;
(2) Mental health counselor;
(3) Psychologist;
(4) Sex offender treatment provider;
(5) Social worker;
(6) Registered nurse (RN) or licensed practical nurse (LPN);
(7) Psychiatrist;
(8) Psychiatric advanced registered nurse practitioner (ARNP);
(9) Physician assistant working under the supervision of a psychiatrist;
(10) Registered counselor; or
(11) Polygrapher.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0285, filed 8/5/08, effective 9/5/08.]
(1) DDD ((and the treating professional)) will determine
the need and amount of service you ((will)) may receive based
upon information from the treating professional.
(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)) may not exceed your IFS allocation.
(6) Psychological testing is not allowed.
(7) Behavior management services require prior approval by the regional administrator or designee.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0290, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0308, filed 8/5/08, effective 9/5/08.]
(1) Parent/sibling education does not include conference fees or lodging.
(2) Viewing of VHS or DVD at home by ((yourself)) your
parent or sibling 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)) may not exceed your IFS allocation.
(((4) Prior approval by regional administrator or
designee is required.))
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0310, filed 8/5/08, effective 9/5/08.]
(2) Recreational opportunities may include memberships in civic groups, clubs, crafting classes, or classes outside of K-12 school curriculum or sport activities.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0315, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0320, filed 8/5/08, effective 9/5/08.]
(1) ((The)) Recreational opportunities must occur in
your community or the bordering states addressed in WAC 388-832-0331.
(2) The need for recreation opportunities must be
identified in your ISP and, in combination with other IFS
services, ((cannot)) may not 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.))
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0325, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0330, filed 8/5/08, effective 9/5/08.]
(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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0332, filed 8/5/08, effective 9/5/08.]
(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, division of vocational rehabilitation or child development services.
(2) All IFS program service payments must be agreed to by DDD and you in your ISP.
(3) DDD ((will)) may contract directly with a service
provider or parent for the reimbursement of goods or services
purchased by the family member.
(4) DDD ((will)) may 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)) must 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)) begins 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)) must not pay for psychological
evaluations or testing, or DNA testing.
(9) Supplies/materials related to ((community integration
or recreational activities)) recreation opportunities are the
responsibility of the family.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0333, filed 8/5/08, effective 9/5/08.]
(2) One-time awards can only be used for architectural/vehicular modifications, or specialized equipment.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0335, filed 8/5/08, effective 9/5/08.]
(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
(4) You and your family have no other resource to meet the need or your resources do not cover all of the expense.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0340, filed 8/5/08, effective 9/5/08.]
(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 regional administrator 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.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0345, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0350, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0353, filed 8/5/08, effective 9/5/08.]
(2) Funds are provided for a limited period not to exceed
((sixty)) ninety days.
(3) All requests are reviewed and approved or denied by the regional administrator or designee.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0366, filed 8/5/08, effective 9/5/08.]
(2))), DDD will conduct an administrative review of
((other)) DDD services to determine if the need can be met
through other services.
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0367, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0369, filed 8/5/08, effective 9/5/08.]
[Statutory Authority: RCW 71A.12.030, 71A.12.040, and 2007 c 283. 08-16-121, § 388-832-0460, filed 8/5/08, effective 9/5/08.]