Effective Date of Rule: April 21, 2010.

     Purpose: This emergency rule making is necessary to implement chapter 194, Laws of 2009, and the Centers for Medicare and Medicaid Services approval to begin the new HCBS waiver as of May 1, 2009. A CR-101 was filed as WSR 08-19-112 on September 17, 2008. This emergency supersedes the emergency filed as WSR 09-18-059.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-845-0001, 388-845-0015, 388-845-0020, 388-845-0030, 388-845-0041, 388-845-0045, 388-845-0050, 388-845-0055, 388-845-0065, 388-845-0100, 388-845-0111, 388-845-0120, 388-845-0200, 388-845-0500, 388-845-0505, 388-845-0900, 388-845-0910, 388-845-1000, 388-845-1015, 388-845-1110, 388-845-1150, 388-845-1200, 388-845-1300, 388-845-1400, 388-845-1600, 388-845-1605, 388-845-1620, 388-845-1650, 388-845-1700, 388-845-1800, 388-845-1900, 388-845-2000, 388-845-2005, 388-845-2100, 388-845-2200, 388-845-3000, 388-845-3085, and 388-845-4005.

     Statutory Authority for Adoption: RCW 71A.12.030, 71A.12.120, chapter 194, Laws of 2009; and section 205 (1)(i), chapter 329, Laws of 2008.

     Other Authority: Title 71A RCW.

     Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

     Reasons for this Finding: This emergency rule making is necessary to implement chapter 194, Laws of 2009, and the Centers for Medicare and Medicaid Services approval to begin the new HCBS waiver May 1, 2009. A CR-101 was filed as WSR 08-19-112 on September 17, 2008. This emergency filing supersedes the emergency filed as WSR 09-18-059. The department has filed a CR-102 and is waiting for the public hearing to receive any additional comments from stakeholders.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 18, Amended 38, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 18, Amended 38, Repealed 0.

     Date Adopted: April 14, 2010.

Katherine I. Vasquez

Rules Coordinator

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

     "CARE" means the comprehensive assessment and reporting evaluation.

     "Client or person" means a person who has a developmental disability as defined in RCW 71A.10.020(3) and 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 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.

     "EPSDT" means early and periodic screening, diagnosis, and treatment, Medicaid's child health component providing a mandatory and comprehensive set of benefits and services for children up to age twenty one.

     "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.

     "Evidence based treatment" means the use of physical, mental and behavioral health interventions for which systematic, empirical research has provided evidence of statistically significant effectiveness as treatments for specific conditions. Alternate terms with the same meaning are evidence-based practice (EBP) and empirically-supported treatment (EST).

     "Family" means relatives who live in the same home with the eligible client. Relatives include spouse((,)) or registered domestic partner; natural, adoptive or step parent((s)); grandparent((s)); ((brother; sister; stepbrother; stepsister)) child; stepchild; sibling; stepsibling; uncle; aunt; first cousin; niece; or nephew.

     "Family home" means the residence where you and your relatives live.

     "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, Children's Intensive In-Home Behavioral Support, 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)) a state-paid cash assistance program for certain clients of the division of developmental disabilities.

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

     "You/your" means the client.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-0001, filed 9/22/08, effective 10/23/08; 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.]

     (1) Basic waiver;

     (2) Basic Plus waiver;

     (3) ((CORE)) Core waiver; ((and))

     (4) Community Protection waiver; and

     (5) Children's Intensive In-Home Behavioral Support waiver (CIIBS).

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0015, 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, § 388-845-0015, filed 12/13/05, effective 1/13/06.]

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0020, filed 12/13/05, effective 1/13/06.]

     (1) You have been determined eligible for DDD services per RCW 71A.10.020(3).

     (2) You have been determined to meet ICF/MR level of care per WAC 388-845-0070, 388-828-3060 and 388-828-3080.

     (3) You meet disability criteria established in the Social Security Act.

     (4) You meet financial eligibility requirements as defined in WAC 388-515-1510.

     (5) You choose to receive services in the community rather than in an ICF/MR facility.

     (6) You have a need for waiver services as identified in your plan of care or individual support plan.

     (7) You are not residing in hospital, jail, prison, nursing facility, ICF/MR, or other institution.

     (8) Additionally, for the Children's Intensive In-Home Behavioral Support (CIIBS) waiver-funded services:

     (a) You are age eight or older and under the age of eighteen for initial enrollment and under age twenty-one for continued enrollment;

     (b) You have been determined to meet CIIBS program eligibility per chapter 388-828 WAC prior to initial enrollment only;

     (c) You live with your family; and

     (d) Your parent/guardian(s) and primary caregiver(s), if other than parent/guardian(s), have signed the participation agreement.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0030, 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, § 388-845-0030, filed 12/13/05, effective 1/13/06.]

     (1) DDD must address your assessed health and welfare needs in your ((plan of care or the)) individual support plan, as specified in WAC 388-845-3055.

     (2) You have access to DDD paid services that are provided within the scope of your waiver, subject to the limitations in WAC 388-845-0110 and 388-845-0115.

     (3) DDD will provide waiver services you need and qualify for within your waiver.

     (4) DDD will not deny or limit your waiver services based on a lack of funding.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0041, 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, § 388-845-0041, filed 12/13/05, effective 1/13/06.]

     (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.

     (c) Persons identified as a risk to the safety of the community.

     (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))) 388-845-0060 (1)(i).

     (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. 08-20-033, § 388-845-0045, filed 9/22/08, effective 10/23/08; 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.]

     (2) If you are assessed as meeting ICF/MR level of care as defined in WAC 388-845-0070 and chapter 388-828 WAC, your request for waiver enrollment will be documented by DDD in a statewide data base.

     (3) For the Children's Intensive In-Home Behavioral Support (CIIBS) waiver only, if you are assessed as meeting both ICF/MR level of care and CIIBS eligibility as defined in WAC 388-845-0030 and chapter 388-828 WAC, your request for waiver enrollment will be documented by DDD in a statewide database.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0050, 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, § 388-845-0050, filed 12/13/05, effective 1/13/06.]

     (1) ((DDD)) You complete((s)) a reassessment with DDD at least once every twelve months to determine if you continue to meet all of these eligibility requirements; and

     (2) You must either receive a waiver service at least once in every thirty consecutive days, as specified in WAC 388-513-1320 (3)(b), or your health and welfare needs require monthly monitoring, which will be documented in your client record; and

     (3) ((Your)) You complete an in-person DDD assessment/reassessment interview ((must be)) administered ((in person and)) in your home((. See)) per WAC 388-828-1520.

     (4) In addition, for the Children's Intensive In-Home Behavioral Supports waiver, you must:

     (a) Be under age twenty-one;

     (b) Live with your family; and

     (c) Have an annual participation agreement signed by your parent/guardian(s) and primary caregiver(s), if other than parent/guardian(s).

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0055, 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, § 388-845-0055, filed 12/13/05, effective 1/13/06.]

     (1) DDD cannot guarantee continuation of your current services, including medicaid eligibility.

     (2) Your eligibility for nonwaiver state-only funded DDD services is based upon availability of funding and program eligibility for a particular service.

     (3) If you are terminated from the CIIBS waiver due to turning age twenty-one, DDD will assist with transition planning at least twelve months prior to your twenty-first birthday.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0065, filed 12/13/05, effective 1/13/06.]

     (1) For the Basic waiver:

     (a) You must live with your family or in your own home;

     (b) Your family/caregiver's ability to continue caring for you can be maintained with the addition of services provided in the Basic waiver; and

     (c) You do not need out-of-home residential services.

     (2) For the Basic Plus waiver, your health and welfare needs exceed the amount allowed in the Basic waiver or require a service that is not contained in the Basic waiver; and

     (a) You are at high risk of out-of-home placement or loss of your current living situation; or

     (b) You require out-of-home placement and your health and welfare needs can be met in an adult family home or adult residential care facility.

     (3) For the Core waiver:

     (a) You are at immediate risk of out-of-home placement; and/or

     (b) You have an identified health and welfare need for residential services that cannot be met by the Basic Plus waiver.

     (4) For the Community Protection waiver, refer to WAC 388-845-0105 and chapter 388-831 WAC.

     (5) For the Children's Intensive In-Home Behavioral Support waiver, you:

     (a) Are age eight or older and under age eighteen;

     (b) Live with your family;

     (c) Are assessed at high or severe risk of out of home placement due to challenging behavior per chapter 388-828 WAC; and

     (d) You have a signed participation agreement from your parent/guardian(s) and primary caregiver(s), if other than parent/guardian(s).

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0100, 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, § 388-845-0100, filed 12/13/05, effective 1/13/06.]

     (1) Your spouse ((cannot)) must not be your paid provider for any waiver service.

     (2) If you are under age eighteen, your natural, step, or adoptive parent ((cannot)) must not be your paid provider for any waiver service.

     (3) If you are age eighteen or older, your natural, step, or adoptive parent ((cannot)) must not be your paid provider for any waiver service with the exception of:

     (a) Personal care;

     (b) Transportation to and from a waiver service;

     (c) Residential habilitation services per WAC 388-845-1510 if your parent is certified as a residential agency per chapter 388-101 WAC; or

     (d) Respite care if you and the parent who provides the respite care live in separate homes.

     (4) If you receive CIIBS waiver services, your legal representative or family member per WAC 388-845-0001 must not be your paid provider for any waiver service with the exception of:

     (i) Personal care;

     (ii) Transportation to and from a waiver service; and

     (iii) Respite per WAC 388-845-1605 through 388-845-1620.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0111, 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, § 388-845-0120, filed 12/13/05, effective 1/13/06.]

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0200, 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, § 388-845-0200, filed 12/13/05, effective 1/13/06.]

CIIBS Waiver	Services	Yearly Limit
	• Behavior management and consultation • Staff/family consultation and training • Environmental accessibility adaptations • Occupational therapy • Physical therapy • Sexual deviancy evaluation • Nurse delegation • Specialized medical equipment / supplies • Specialized psychiatric services • Speech, hearing and language services • Transportation • Assistive technology • Therapeutic equipment and supplies • Specialized nutrition and clothing • Vehicle modifications	Determined by the individual support plan. Total cost of waiver services cannot exceed the average cost of $4,000 per month per participant.
	Personal care	Limits determined by the DDD assessment. Costs are included in the total average cost of $4000 per month per participant for all waiver services.
	Respite care	Limits determined by the DDD assessment. Costs are included in the total average cost of $4000 per month per participant for all waiver services.

[]

     (1) The evaluation of the needs of the waiver participant, including a functional evaluation of the child in the child's customary environment;

     (2) Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices;

     (3) Selecting, designing, fitting, customizing, adapting, applying, retaining, repairing, or replacing assistive technology devices;

     (4) Coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;

     (5) Training or technical assistance for the participant and/or if appropriate, the child's family; and

     (6) Training or technical assistance for professionals, including individuals providing education and rehabilitation services, employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of children with disabilities.

[]

     (1) Occupational therapist;

     (2) Physical therapist;

     (3) Speech and language pathologist;

     (4) Certified music therapist;

     (5) Certified recreation therapist; or

     (6) Audiologist.

[]

     (2) Vendors of assistive technology must maintain a business license required by law and be contracted with DDD to provide this service.

     (3) Assistive technology may be authorized as a waiver service only after you have accessed what is available to you under medicaid, including EPSDT, and any other private health insurance plan.

     (4) The department does not pay for technology determined by DSHS to be experimental.

     (5) The department and the treating professional determine the need for the technology.

     (6) The department reserves the right to require a second opinion from a department-selected provider.

     (7) The department will require evidence that you have accessed your full benefits through medicaid and private insurance before authorizing this waiver service.

[]

     (a) Strategies for effectively relating to caregivers and other people in the waiver participant's life; and

     (b) Direct interventions with the person to decrease aggressive, destructive, and sexually inappropriate or other behaviors that compromise their ability to remain in the community (i.e., training, specialized cognitive counseling, development and implementation of a positive behavior support plan).

     (2) Behavior management and consultation may also be provided as a mental health stabilization service in accordance with WAC 388-845-1150 through 388-845-1160.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0500, filed 12/13/05, effective 1/13/06.]

     (a) Treatment must be evidence based, driven by individual outcome data, and consistent with DDD's positive behavior support guidelines as outlined in contract;

     (b) The following written components will be developed in partnership with the child and family by a behavior specialist as defined in WAC 388-845-0506:

     (i) Functional behavioral assessment; and

     (ii) Positive behavior support plan based on functional behavioral assessment.

     (c) Treatment goals must be objective and measurable. The goals must relate to an increase in skill development and a resulting decrease in challenging behaviors that impede quality of life for the child and family; and

     (d) Behavioral support strategies will be individualized and coordinated across all environments, such as home, school, and community, in order to promote a consistent approach among all involved persons.

     (2) Behavior management and consultation in the CIIBS waiver may also include the following components:

     (a) Positive behavior support plans may be implemented by a behavioral technician as defined in WAC 388-845-0506 and include 1:1 behavior interventions and skill development activity.

     (b) Positive behavior support plans may include recommendations by a music and/or recreation therapist, as defined in WAC 388-845-0506.

[]

     (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)) Counselors registered or certified in accordance with the requirements of chapter 18.19 RCW; or

     (11) Polygrapher.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0505, filed 12/13/05, effective 1/13/06.]

     (1) Behavior specialist;

     (2) Behavior technician;

     (3) Certified music therapist; and/or

     (4) Certified recreation therapist.

[]

     (a) Ensure the health, welfare and safety of the individual; or

     (b) Enable the individual who would otherwise require institutionalization to function with greater independence in the home.

     (2) Environmental accessibility adaptations may include the installation of ramps and grab bars, widening of doorways, modification of bathroom facilities, or installing specialized electrical and/or plumbing systems necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.

     (3) For the CIIBS waiver only, adaptations include repairs to the home necessary due to property destruction caused by the participant's behavior.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0900, 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, § 388-845-0900, filed 12/13/05, effective 1/13/06.]

     (1) Environmental accessibility adaptations require prior approval by the DDD regional administrator or designee.

     (2) With the exception of damage repairs under the CIIBS waiver, environmental accessibility adaptations or improvements to the home are excluded if they are of general utility without direct medical or remedial benefit to the individual, such as carpeting, roof repair, central air conditioning, etc.

     (3) Environmental accessibility adaptations cannot add to the total square footage of the home.

     (4) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

     (5) Damage repairs under the CIIBS waiver are subject to the following restrictions:

     (a) Limited to the cost of restoration to the original condition.

     (b) Repairs to personal property and normal wear and tear is excluded.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0910, 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, § 388-845-0910, filed 12/13/05, effective 1/13/06.]

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1000, filed 12/13/05, effective 1/13/06.]

     (2) The department does not pay for treatment determined by DSHS to be experimental;

     (3) The department and the treating professional determine the need for and amount of service you can receive:

     (a) The department reserves the right to require a second opinion from a department-selected provider.

     (b) The department will require evidence that you have accessed your full benefits through medicaid, including early and periodic screening, diagnosis, and treatment (EPSDT) for children under the age of twenty-one, and private insurance before authorizing this waiver service.

     (4) The dollar limitations for aggregate 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, § 388-845-1015, filed 12/13/05, effective 1/13/06.]

     (2) These services are available in ((all four HCBS)) the Basic, Basic Plus, Core, and Community Protection waivers administered by DDD as mental health stabilization services in accordance with WAC 388-845-1150 through 388-845-1160.

     (3) The costs of mental health crisis diversion bed services do not count toward the dollar limits for aggregate services in the Basic and Basic Plus waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1110, filed 12/13/05, effective 1/13/06.]

     (1) Behavior management and consultation;

     (2) ((Skilled nursing services;

     (3))) Specialized psychiatric services; or

     (((4))) (3) Mental health crisis diversion bed services.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1150, filed 12/13/05, effective 1/13/06.]

     Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-845-1170   What is nurse delegation:   (1) Nurse delegation services (chapter 388-101 WAC) are services provided by a registered nurse or a nursing agency to provide training and nursing management for providers who perform delegated nursing tasks. Delegated tasks include administration of noninjectable medications, blood glucose testing, and tube feedings.

     (2) Services include the initial visit, additional instruction and supervisory visits.

     (3) Clients who receive nurse delegation services must be considered "stable and predictable" by the delegating nurse.

     (4) Nurse delegation is available in the CIIBS waiver. This service is available through skilled nursing services (WAC 388-845-1700) in the Basic Plus, Core and Community Protection waivers.

[]

     Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-845-1175   Who is a qualified provider of nurse delegation?   Providers of nurse delegation are registered nurses contracted with DDD to provide this service or employed by a nursing agency contracted with DDD to provide this service.

[]

     (1) The department and the treating professional determine the need for and amount of service.

     (2) The department reserves the right to require a second opinion by a department selected provider.

     (3) The following tasks must not be delegated:

     (a) Injections, other than insulin;

     (b) Central lines;

     (c) Sterile procedures; and

     (d) Tasks that require nursing judgment.

[]

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

     (b) Development of a person centered employment plan;

     (c) Preparation of an individualized budget; and

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

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

     (3) These services are available in ((all four HCBS)) the Basic, Basic Plus, Core and Community Protection waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-1200, filed 9/22/08, effective 10/23/08. 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.]

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1300, 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, § 388-845-1300, filed 12/13/05, effective 1/13/06.]

     (2) Prevocational services are available in ((all four HCBS)) the Basic, Basic Plus, Core and Community Protection waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-1400, filed 9/22/08, effective 10/23/08. 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.]

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-1600, filed 9/22/08, effective 10/23/08. 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.]

     (1) You live in a private home and no one living with you is paid to ((be your caregiver)) provide personal care services to you;

     (2) You are age eighteen or older and live with a paid ((caregiver)) personal care provider who is your natural, step or adoptive parent; or

     (3) You are under the age of eighteen and live with your natural, step or adoptive parent and your paid personal care provider also lives with you; or

     (4) You live with a caregiver who is paid by DDD to provide ((care to you and is)) supports as:

     (a) A contracted companion home provider; or

     (b) A licensed children's foster home provider.

[Statutory Authority: RCW 71A.12.30 [71A.12.030], 71A.12.120, and Title 71A RCW. 08-03-109, § 388-845-1605, filed 1/22/08, effective 2/22/08. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1605, filed 12/13/05, effective 1/13/06.]

     (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 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 ((will not be paid to)) may not provide DDD services for you or other persons ((at the same time you receive respite services)) during your respite care hours.

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

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

     (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. 08-20-033, § 388-845-1620, filed 9/22/08, effective 10/23/08; 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.]

     (a) Are professional evaluations 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

     (c) Provide treatment recommendations to mitigate any assessed risk.

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

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-1650, filed 9/22/08, effective 10/23/08. 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.]

     (2) Services include nurse delegation services, per WAC 388-845-1170, provided by a registered nurse, including the initial visit, follow-up instruction, and/or supervisory visits.

     (((3) These services are available in all four HCBS waivers administered by DDD as mental health stabilization services in accordance with WAC 388-845-1150 through 388-845-1160.))

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1700, filed 12/13/05, effective 1/13/06.]

     (a) Increase their abilities to perform their activities of daily living; or

     (b) Perceive, control or communicate with the environment in which they live.

     (2) Durable and nondurable medical equipment are defined in WAC 388-543-1000 and 388-543-2800 respectively.

     (3) Also included are items necessary for life support; and ancillary supplies and equipment necessary to the proper functioning of the equipment and supplies described in subsection (1) above.

     (4) Specialized medical equipment and supplies are available in all ((four)) DDD HCBS waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1800, 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, § 388-845-1800, filed 12/13/05, effective 1/13/06.]

     (a) Assessment, intervention, and monitoring services from a certified dietitian; and/or

     (b) Specially prepared food, or purchase of particular types of food, needed to sustain you in the family home. Specialized nutrition is in addition to meals a parent would provide and specific to your medical condition or diagnosis.

     (2) Specialized clothing is available to you in the CIIBS waiver and defined as nonrestrictive clothing adapted to the participant's individual needs and related to his/her disability. Specialized clothing can include weighted clothing, clothing designed for tactile defensiveness, specialized footwear, or reinforced clothing.

[]

     (a) Certified dietitians contracted with DDD to provide this service or employed by an agency contracted with DDD to provide this service; and

     (b) Specialized nutrition vendors contracted with DDD to provide this service.

     (2) Providers of specialized clothing are specialized clothing vendors contracted with DDD to provide this service.

[]

     (a) Services may be authorized as a waiver service only after you have accessed what is available to you under medicaid, EPSDT, and any private health insurance plan;

     (b) Services must be evidence based;

     (c) Services must be ordered by a physician licensed to practice in the state of Washington;

     (d) Specialized diets must be periodically monitored by a certified dietitian;

     (e) Specialized nutrition products will not constitute a full nutritional regime unless an enteral diet is the primary source of nutrition;

     (f) Department coverage of specialized nutrition products is limited to costs that are over and above inherent family food costs;

     (g) DDD reserves the right to require a second opinion by a department selected provider; and

     (h) Prior approval by regional administrator or designee is required.

     (2) The following limitations apply to your receipt of specialized clothing:

     (a) Services may be authorized as a waiver service only after you have accessed what is available to you under medicaid, EPSDT, and any private health insurance plan;

     (b) Specialized clothing must be recommended by an appropriate health professional, such as an OT, behavior therapist, or podiatrist;

     (c) DDD reserves the right to require a second opinion by a department-selected provider; and

     (d) Prior approval by regional administrator or designee is required.

[]

     (2) Service may be any of the following:

     (a) Psychiatric evaluation,

     (b) Medication evaluation and monitoring,

     (c) Psychiatric consultation.

     (3) These services are also available as a mental health stabilization service in accordance with WAC 388-845-1150 through 388-845-1160.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1900, filed 12/13/05, effective 1/13/06.]

     (2) Consultation and training is provided to families, direct staff, or personal care providers to meet the specific needs of the waiver participant as outlined in the individual's plan of care or individual support plan, including:

     (a) Health and medication monitoring;

     (b) Positioning and transfer;

     (c) Basic and advanced instructional techniques;

     (d) Positive behavior support; ((and))

     (e) Augmentative communication systems;

     (f) Diet and nutritional guidance;

     (g) Disability information and education;

     (h) Strategies for effectively and therapeutically interacting with the participant;

     (i) Environmental consultation; and

     (j) For the CIIBS waiver only, individual and family counseling.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-2000, 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, § 388-845-2000, filed 12/13/05, effective 1/13/06.]

     (1) Audiologist;

     (2) Licensed practical nurse;

     (3) Marriage and family therapist;

     (4) Mental health counselor;

     (5) Occupational therapist;

     (6) Physical therapist;

     (7) Registered nurse;

     (8) Sex offender treatment provider;

     (9) Speech/language pathologist;

     (10) Social worker;

     (11) Psychologist;

     (12) Certified American sign language instructor;

     (13) Nutritionist;

     (14) ((Registered counselor)) Counselors registered or certified in accordance with the requirements of chapter 18.19 RCW;

     (15) Certified dietician; ((or))

     (16) Recreation therapist certified by the National Council for Therapeutic Recreation; or

     (17) Providers listed in WAC 388-845-0506 and contracted with DDD to provide CIIBS intensive services.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-2005, 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, § 388-845-2005, filed 12/13/05, effective 1/13/06.]

     (1) Individual supported employment services include activities needed to sustain 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;

     (c) Training for your supervisor and/or peer workers to enable them to serve as natural supports to you on the job;

     (d) Modification of your work site tasks;

     (e) Employment retention and follow along support; and

     (f) Development of career and promotional opportunities.

     (2) 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

     (c) Groupings of no more than eight workers with disabilities.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-2100, filed 9/22/08, effective 10/23/08. 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.]

     (2) Therapeutic equipment and supplies are equipment and supplies that are incorporated in a behavioral support plan or other therapeutic plan, designed by an appropriate professional, such as a sensory integration or communication therapy plan, and necessary in order to fully implement the therapy or intervention.

     (3) Included are items such as a weighted blanket, supplies that assist to calm or redirect the child to a constructive activity, or a vestibular swing.

[]

[]

     (1) Therapeutic equipment and supplies may be authorized as a waiver service only after you have accessed what is available to you under medicaid, EPSDT, and any private health insurance plan. The department will require evidence that you have accessed your full benefits through medicaid, EPSDT, and private insurance before authorizing this waiver service.

     (2) The department does not pay for equipment and supplies determined by DSHS to be experimental.

     (3) The department and the treating professional determine the need for the equipment and supplies.

     (4) The department reserves the right to require a second opinion from a department selected provider.

[]

     (1) Transportation provides you access to waiver services, specified by your plan of care or individual support plan.

     (2) Whenever possible, you must use family, neighbors, friends, or community agencies that can provide this service without charge.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-2200, 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, § 388-845-2200, filed 12/13/05, effective 1/13/06.]

[]

     (1) Vehicle service providers contracted with DDD to provide this service; or

     (2) Vehicle adaptive equipment vendors contracted with DDD to provide this service.

[]

     (1) Prior approval by the regional administrator or designee is required.

     (2) Vehicle modifications are excluded if they are of general utility without direct medical or remedial benefit to the individual.

     (3) Vehicle modifications must be the most cost effective modification based upon a comparison of contractor bids as determined by DDD.

     (4) Modifications will only be approved for a vehicle that serves as the participant's primary means of transportation and is owned by the family.

     (5) The department reserves the right to require a second opinion from a department selected provider.

[]

     (1) You receive an initial and annual assessment of your needs using a department-approved form.

     (a) You meet the eligibility requirements for ICF/MR level of care.

     (b) The "comprehensive assessment reporting evaluation (CARE)" tool will determine your eligibility and amount of personal care services.

     (c) If you are in the Basic, Basic Plus, CIIBS, or ((CORE)) Core waiver, the DDD assessment will determine the amount of respite care available to you.

     (2) From the assessment, DDD develops your waiver plan of care or individual support plan (ISP) with you and/or your legal representative and others who are involved in your life such as your parent or guardian, advocate and service providers.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3000, 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, § 388-845-3000, filed 12/13/05, effective 1/13/06.]

     (a) Identify more available natural supports;

     (b) Initiate an exception to rule to access available nonwaiver services not included in the CIIBS, ((CORE)) Core or Community Protection waiver other than natural supports;

     (c) Offer you the opportunity to apply for an alternate waiver that has the services you need, subject to WAC 388-845-0045;

     (d) Offer you placement in an ICF/MR.

     (2) If none of the above options is successful in meeting your health and welfare needs, DDD may terminate your waiver eligibility.

     (3) If you are terminated from a waiver, you will remain eligible for nonwaiver DDD services but access to state-only funded DDD services is limited by availability of funding.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-3085, filed 12/13/05, effective 1/13/06.]

     (a) You do not need ICF/MR level of care per WAC 388-845-0070, 388-828-8040 and 388-828-8060; or

     (b) You requested enrollment in the CIIBS waiver and do not meet CIIBS eligibility per WAC 388-828-8500 through 388-828-8520.

     (2) If you are enrolled in a waiver and your request to be enrolled in a different waiver is denied, your appeal rights are limited to the following:

     (a) DDD's decision that the services contained in a different waiver are not necessary to meet your health and welfare needs and that the services available on your current waiver can meet your health and welfare needs; or

     (b) DDD's decision that you are not eligible to have your request documented in a statewide database because you requested enrollment in the CIIBS waiver and do not meet CIIBS eligibility per WAC 388-828-8500 through 388-828-8520.

     (3) If DDD determines that the services offered in a different waiver are necessary to meet your health and welfare needs, but there is not capacity on the different waiver, you do not have the right to appeal any denial of enrollment on a different waiver when DDD determines there is not capacity to enroll you on a different waiver.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-4005, 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, § 388-845-4005, filed 12/13/05, effective 1/13/06.]

© Washington State Code Reviser's Office