WSR 10-07-019

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

[ Filed March 8, 2010, 8:43 a.m. , effective April 8, 2010 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: The purpose of these rules is to amend chapter 388-828 WAC, The DDD assessment, to include information governing the algorithm DDD uses to determine if a person meets the eligibility requirements for the CIIBS waiver program. Once adopted, these rules will replace emergency rules filed as WSR 10-05-084 on February 15, 2010.

Citation of Existing Rules Affected by this Order: Amending WAC 388-828-1620.

Statutory Authority for Adoption: RCW 71A.12.010 and 71A.12.030.

Other Authority: Title 71A RCW.

Adopted under notice filed as WSR 10-03-108 on January 20, 2010.

A final cost-benefit analysis is available by contacting Mark Eliason, 640 Woodland Square Loop S.E., Lacey, WA 98504, phone (360) 725-2517, fax (360) 407-0955, e-mail eliasmr@dshs.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 5, Amended 1, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 5, Amended 1, Repealed 0.

Date Adopted: March 8, 2010.

Susan N. Dreyfus

Secretary

4033.3
AMENDATORY SECTION(Amending WSR 07-10-029, filed 4/23/07, effective 6/1/07)

WAC 388-828-1620   How does DDD determine which panels are mandatory in your DDD assessment?   DDD determines which panels are mandatory in your DDD assessment by assigning you to a client group using the following table:


If you are approved by DDD to receive: Your client group is:
(1) DDD ((DCBS)) HCBS waiver services per chapter 388-845 WAC; or

(2) State-only residential services per chapter 388-825 WAC; or

(3) ICF/MR services per 42 CFR 440 and 42 CFR 483.

Waiver and State-Only Residential
(4) Medicaid personal care (MPC) per chapter 388-106 WAC; or

(5) DDD HCBS Basic, Basic Plus, CIIBS or Core waiver services per chapter 388-845 WAC and personal care services per chapter 388-106 WAC; or

(6) Medically intensive health care program services per chapter 388-551 WAC; or

(7) Adult day health services per chapter 388-106 WAC; or

(8) Private duty nursing services per chapter 388-106 WAC; or

(9) Community options program entry system (COPES) services per chapter 388-106 WAC; or

(10) Medically needy residential waiver services per chapter 388-106 WAC; or

(11) Medicaid nursing facility care services per chapter 388-106 WAC.

Other Medicaid Paid Services
(12) County employment services per chapter 388-850 WAC.

(13) Other DDD paid services per chapter 388-825 WAC, such as:

(a) Family support services; or

(b) Professional services.

(14) Nonwaiver voluntary placement program services per chapter 388-826 WAC;

(15) SSP only per chapter 388-827 WAC;

State-Only Paid Services
(16) You are not approved to receive any DDD paid services. No Paid Services

[Statutory Authority: RCW 71A.12.030 and Title 71A RCW. 07-10-029, 388-828-1620, filed 4/23/07, effective 6/1/07.]


NEW SECTION
WAC 388-828-8500   What is the children's intensive in-home behavioral support (CIIBS) program algorithm?   The children's intensive in-home behavioral support (CIIBS) program algorithm is a formula in the DDD assessment that calculates your out-of-home placement risk score to determine your eligibility for the CIIBS waiver per chapter 388-845 WAC.

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NEW SECTION
WAC 388-828-8505   When does the DDD assessment run the CIIBS algorithm to determine your eligibility for the CIIBS waiver?   The DDD assessment runs the CIIBS algorithm to determine your eligibility for the CIIBS waiver when your support assessment is moved to current and:

(1) You are the assessed age of eight or older and under age eighteen;

(2) Your behavior acuity level is high per WAC 388-828-5640;

(3) Your caregiver's risk score is medium, high or immediate per WAC 388-828-5300;

(4) Your ICF/MR score is eligible per WAC 388-828-4400; and

(5) You are not enrolled in the CIIBS waiver.

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NEW SECTION
WAC 388-828-8510   What elements does the CIIBS algorithm use to calculate your out-of-home placement risk score?   The CIIBS algorithm uses the following elements to determine your out-of-home placement risk score:

(1) The DDD protective supervision acuity scale (WAC 388-828-5000 to 388-828-5100);

(2) The DDD caregiver status acuity scale (WAC 388-828-5120 to 388-828-5360);

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

(4) The DDD activities of daily living (ADL) acuity scale (WAC 388-828-5380 to 388-828-5480);

(5) The DDD mobility acuity scale (WAC 388-828-5380 to 388-828-5480); and

(6) Eligible condition of "autism" as indicated in the DDD determination (WAC 388-823-0500).

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NEW SECTION
WAC 388-828-8515   How does DDD determine your CIIBS out-of-home placement risk score?   Your CIIBS out-of-home placement risk score is calculated using the following table:


Section and WAC reference If you meet the following criteria: Then adjust your score by: Score if you meet criteria
Clients meeting eligibility criteria in WAC 388-828-8505 Beginning Score = 0
DDD Determination

WAC 388-823-0500

Eligible condition of autism in the DDD determination. Adding 40 points =
ADL Acuity Level

WAC 388-828-5480

Your ADL support needs level

= high, medium or low

Subtracting 54 points =
Behavior Acuity Scale

WAC 388-828-5500 through 388-828-5640

Your most prominent behavior

= assault/injury

and

Severity of your most prominent behavior

= "potentially dangerous" or "life threatening"

Adding 14 points =
Protective Supervision Acuity Scale

WAC 388-828-5060

Your answer to the following question: "What level of monitoring does the client typically require during awake hours?"

= "Line of sight/earshot"

Adding 13 points =
DDD Caregiver Status Acuity

WAC 388-828-5300

Your caregiver risk level

= high or immediate

Adding 136 points =
Backup Caregiver Status

WAC 388-828-5320

Your answer to the following question: "Under what conditions are other caregiver(s) available?"

= "No other caregiver available"

Adding 33 points =
Mobility Acuity Scale

WAC 388-828-5900

Your mobility acuity level

= high, medium or low

Subtracting 15 points =
Sum of all of scores above is your CIIBS out-of-home placement risk score =

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NEW SECTION
WAC 388-828-8520   How does DDD determine if I am eligible for the CIIBS waiver?   DDD uses the following table to determine if you are eligible for the CIIBS waiver based on your CIIBS out-of-home placement risk score per WAC 388-828-8510:


If your CIIBS out-of-home placement risk score is: Then your CIIBS eligibility is:
96 or greater Yes - Severe
17 through 95 Yes - High
Less than 17 No - (not eligible)

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Washington State Code Reviser's Office