PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services)
Original Notice.
Preproposal statement of inquiry was filed as WSR 11-07-085.
Title of Rule and Other Identifying Information: These amendments to chapter 388-845 WAC, Home and community based waivers, will clarify current definitions in rule to promote consistent expectations for reporting and tracking of employment and day services. The program "person to person" will no longer exist as it currently resides in WAC. Clients that previously received "person to person" services may now qualify for "individual technical assistance" services which are not currently defined in our WAC. These changes were effective July 1, 2011.
Hearing Location(s): Office Building 2, Lookout Room, DSHS Headquarters, 1115 Washington, Olympia, WA 98504 (public parking at 11th and Jefferson. A map is available at http://www1.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html
or by calling (360) 664-6094), on January 10, 2012, at 10:00 a.m.
Date of Intended Adoption: Not earlier than January 11, 2012.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 1115 Washington Street S.E., Olympia, WA 98504, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on January 10, 2012.
Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by December 27, 2011, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at jennisha.johnson@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed amendments are in response to Budget Bill Section 103(7) which mandated that the joint legislative audit and review committee (JLARC) examine the operations of employment and day services as provided by DSHS, DDD, and administered by the counties. JLARC provided to the legislature a description of how funds are used and the rates paid to vendors, and best practices the agency should use for the development of a consistent outcome-based contract for services provided under contracts with the counties. These amendments are proposed to implement the recommendations by JLARC which were provided to the legislature on or before September 1, 2010.
By not making these changes, there is a risk that the department can no longer collect federal funds on individual technical assistance services as the WAC will not specify that these services are covered under the home and community based waiver services and therefore not a federally reimbursable expense.
Statutory Authority for Adoption: RCW 71A.12.030.
Statute Being Implemented: RCW 71A.12.030.
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: Meredith Kelly, 4450 10th Avenue S.E., Olympia, WA 98504, (360) 725-3524; Implementation: Kris Pederson, 4450 10th Avenue S.E., Olympia, WA 98504, (360) 725-3445; and Enforcement: Don Clintsman, 4450 10th Avenue S.E., Olympia, WA 98504, (360) 725-3421.
No small business economic impact statement has been prepared under chapter 19.85 RCW. No small business impact was prepared as the amended rules proposed clarify language in the WAC and generally make the rules easier to understand by the consumer. Furthermore, there are no costs imposed on small businesses by these proposed rules. Based on RCW 19.85.025, the proposed rule making is exempt from preparing a small business economic impact statement.
A cost-benefit analysis is not required under RCW 34.05.328. Rules adopting or incorporating by reference without material change federal statutes or regulations, Washington state statutes, rules of other Washington state agencies, shoreline master programs other than those programs governing shorelines of statewide significance, or, as referenced by Washington state law, national consensus codes that generally establish industry standards, if the material adopted or incorporated regulates the same subject matter and conduct as the adopting or incorporating rule;
(d) Rules that only correct typographical errors, make address or name changes, or clarify language of a rule without changing its effect;
(e) Rules the content of which is explicitly and specifically dictated by statute;
(f) Rules that set or adjust fees or rates pursuant to legislative standards; or
(g) Rules that adopt, amend, or repeal:
(i) A procedure, practice, or requirement relating to agency hearings; or
(ii) A filing or related process requirement for applying to an agency for a license or permit.
November 9, 2011
Katherine I. Vasquez
Rules Coordinator
4327.3"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 as defined in WAC 388-534-0100.
"Employment/day program services" means community access, person-to-person, individualized technical assistance, 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; grandparent; 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 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.
"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 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, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0001, filed 11/1/10, effective 12/2/10. 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) 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, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0030, filed 11/1/10, effective 12/2/10. 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)) identify your assessed health
and welfare needs in your 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)), based on a lack
of funding, the number of waiver services ((based on a lack of
funding)) for which you are eligible.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0041, filed 11/1/10, effective 12/2/10. 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) Your health and welfare needs cannot be met in your current waiver or for one of the following reasons:
(a) You no longer meet one or more of the requirements listed in WAC 388-845-0030;
(b) You do not have an identified need for a waiver
service at the time of your annual ((plan of care or))
individual support plan;
(c) You do not use a waiver service at least once in every thirty consecutive days and your health and welfare do not require monthly monitoring;
(d) You are on the community protection waiver and:
(i) You choose not to be served by a certified residential community protection provider-intensive supported living services (CP-ISLS);
(ii) You engage in any behaviors identified in WAC 388-831-0240 (1) through (4); and
(iii) DDD determines that your health and safety needs or the health and safety needs of the community cannot be met in the community protection program.
(e) You choose to disenroll from the waiver;
(f) You reside out-of-state;
(g) You cannot be located or do not make yourself available for the annual waiver reassessment of eligibility;
(h) You refuse to participate with DDD in:
(i) Service planning;
(ii) Required quality assurance and program monitoring activities; or
(iii) Accepting services agreed to in your ((plan of care
or)) individual support plan as necessary to meet your health
and welfare needs.
(i) You are residing in a hospital, jail, prison, nursing facility, ICF/MR, or other institution and remain in residence at least one full calendar month, and are still in residence:
(i) At the end of the twelfth month following the
effective date of your current ((plan of care or)) individual
support plan, as described in WAC 388-845-3060; or
(ii) The end of the waiver fiscal year, whichever date occurs first.
(j) Your needs exceed the maximum funding level or scope of services under the Basic or Basic Plus waiver as specified in WAC 388-845-3080; or
(k) Your needs exceed what can be provided under WAC 388-845-3085; or
(2) Services offered on a different waiver can meet your health and welfare needs and DDD enrolls you on a different waiver.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, and Title 71A RCW. 09-10-021, § 388-845-0060, filed 4/28/09, effective 5/29/09; 07-20-050, § 388-845-0060, 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, § 388-845-0060, filed 12/13/05, effective 1/13/06.]
(1) You have been identified by DDD as a person who meets one or more of the following:
(a) You have been convicted of or charged with a crime of sexual violence as defined in chapter 71.09 RCW;
(b) You have been convicted of or charged with acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization, or persons of casual acquaintance with whom no substantial personal relationship exists;
(c) You have been convicted of or charged with a sexually violent offense and/or predatory act, and may constitute a future danger as determined by a qualified professional;
(d) You have not been convicted and/or charged, but you have a history of stalking, sexually violent, predatory and/or opportunistic behavior which demonstrates a likelihood to commit a sexually violent and/or predatory act based on current behaviors that may escalate to violence, as determined by a qualified professional; or
(e) You have committed one or more violent offense, as defined in RCW 9.94A.030.
(2) You receive or agree to receive residential services from certified residential community protection provider-intensive supported living services (CP-ISLS); and
(3) You comply with the specialized supports and restrictions in your:
(a) ((Plan of care or)) Individual support plan;
(b) Individual instruction and support plan (IISP); and/or
(c) Treatment plan provided by DDD approved certified individuals and agencies.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0105, 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, § 388-845-0105, filed 12/13/05, effective 1/13/06.]
(1) A service must be offered in your waiver and
authorized in your ((plan of care or)) individual support
plan.
(2) Mental health stabilization services may be added to
your ((plan of care or)) individual support plan after the
services are provided.
(3) Waiver services are limited to services required to prevent ICF/MR placement.
(4) The cost of your waiver services cannot exceed the average daily cost of care in an ICF/MR.
(5) Waiver services cannot replace or duplicate other available paid or unpaid supports or services.
(6) Waiver funding cannot be authorized for treatments determined by DSHS to be experimental.
(7) The Basic and Basic Plus waivers have yearly limits on some services and combinations of services. The combination of services is referred to as aggregate services or employment/day program services.
(8) Your choice of qualified providers and services is limited to the most cost effective option that meets your health and welfare needs.
(9) Services provided out-of-state, other than in recognized bordering cities, are limited to respite care and personal care during vacations.
(a) You may receive services in a recognized out-of-state bordering city on the same basis as in-state services.
(b) The only recognized bordering cities are:
(i) Coeur d'Alene, Moscow, Sandpoint, Priest River and Lewiston, Idaho; and
(ii) Portland, The Dalles, Hermiston, Hood River, Rainier, Milton-Freewater and Astoria, Oregon.
(10) Other out-of-state waiver services require an approved exception to rule before DDD can authorize payment.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0110, 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, § 388-845-0110, filed 12/13/05, effective 1/13/06.]
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0120, filed 11/1/10, effective 12/2/10. 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.]
| BASIC WAIVER | SERVICES | YEARLY LIMIT |
| AGGREGATE SERVICES: | May not exceed $1454 per year on any combination of these services | |
| Behavior management and consultation | ||
| Community guide | ||
| Environmental accessibility adaptations | ||
| Occupational therapy | ||
| Physical therapy | ||
| Specialized medical equipment/supplies | ||
| Specialized psychiatric services | ||
| Speech, hearing and language services | ||
| Staff/family consultation and training | ||
| Transportation | ||
| EMPLOYMENT/DAY
PROGRAM SERVICES:
|
May not exceed $6804 per year | |
| Person-to-person | ||
| Individualized technical assistance | ||
| Prevocational services | ||
| Supported employment | ||
| Sexual deviancy evaluation | Limits are determined by DDD | |
| Respite care | Limits are determined by the DDD assessment | |
| Personal care | Limits are determined by the CARE tool used as part of the DDD assessment | |
| MENTAL HEALTH STABILIZATION SERVICES: | Limits are determined by a mental health professional or DDD | |
| Behavior management and consultation | ||
| Mental health crisis diversion bed services | ||
| (( |
||
| Specialized psychiatric services | ||
| Emergency assistance is only for aggregate services and/or employment/day program services contained in the Basic waiver | $6000 per year; Preauthorization required |
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-0205, filed 9/22/08, effective 10/23/08; 07-20-050, § 388-845-0205, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.120. 07-05-014, § 388-845-0205, filed 2/9/07, effective 3/12/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0205, filed 12/13/05, effective 1/13/06.]
| BASIC PLUS WAIVER | SERVICES | YEARLY LIMIT |
| AGGREGATE SERVICES: | May not exceed $6192 per year on any combination of these services | |
| Behavior management and consultation | ||
| Community guide | ||
| Environmental accessibility adaptations | ||
| Occupational therapy | ||
| Physical therapy | ||
| Skilled nursing | ||
| Specialized medical equipment/supplies | ||
| Specialized psychiatric services | ||
| Speech, hearing and language services | ||
| Staff/family consultation and training | ||
| Transportation | ||
| EMPLOYMENT/DAY PROGRAM SERVICES: | May not exceed $9944 per year | |
| Community access
Individualized technical assistance
|
This amount may be increased to a maximum of $19,888 per year by exception to rule based on client need | |
| Adult foster care (adult family home) | Determined per department rate structure | |
| Adult residential care (boarding home) | ||
| MENTAL HEALTH STABILIZATION SERVICES: | Limits determined by a mental health professional or DDD | |
| Behavior management and consultation | ||
| Mental health crisis diversion bed services | ||
| (( |
||
| Specialized psychiatric services | ||
| Personal care | Limits determined by the CARE tool used as part of the DDD assessment | |
| Respite care | Limits are determined by the DDD assessment | |
| Sexual deviancy evaluation | Limits are determined by DDD | |
| Emergency assistance is only for aggregate services and/or employment/day program services contained in the Basic Plus waiver | $6000 per year; Preauthorization required |
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-0210, filed 9/22/08, effective 10/23/08; 07-20-050, § 388-845-0210, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.120. 07-05-014, § 388-845-0210, filed 2/9/07, effective 3/12/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0210, filed 12/13/05, effective 1/13/06.]
| CORE WAIVER | SERVICES | YEARLY LIMIT |
| Behavior management and consultation | Determined by
the (( |
|
| Community guide | ||
| Community transition | ||
| Environmental accessibility adaptations | ||
| Occupational therapy | ||
| Sexual deviancy evaluation | ||
| Skilled nursing | ||
| Specialized medical equipment/supplies | ||
| Specialized psychiatric services | ||
| Speech, hearing and language services | ||
| Staff/family consultation and training | ||
| Transportation | ||
| Residential habilitation | ||
| Community access | ||
| Person-to-person | ||
| Individualized technical assistance | ||
| Prevocational services | ||
| Supported employment | ||
| MENTAL HEALTH STABILIZATION SERVICES: | Limits determined by a mental health professional or DDD | |
| Behavior management and consultation | ||
| Mental health crisis diversion bed services | ||
| (( |
||
| Specialized psychiatric services | ||
| Personal care | Limits determined by the CARE tool used as part of the DDD assessment | |
| Respite care | Limits are determined by the DDD assessment |
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0215, 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, § 388-845-0215, filed 12/13/05, effective 1/13/06.]
| COMMUNITY PROTECTION WAIVER | SERVICES | YEARLY LIMIT |
| Behavior management and consultation | Determined
by the (( |
|
| Community transition | ||
| Environmental accessibility adaptations | ||
| Occupational therapy | ||
| Physical therapy | ||
| Sexual deviancy evaluation | ||
| Skilled nursing | ||
| Specialized medical equipment and supplies | ||
| Specialized psychiatric services | ||
| Speech, hearing and language services | ||
| Staff/family consultation and training | ||
| Transportation | ||
| Residential habilitation | ||
| Person-to-person | ||
| Individualized technical assistance | ||
| Prevocational services | ||
| Supported employment | ||
| MENTAL HEALTH STABILIZATION SERVICES: | Limits determined by a mental health professional or DDD | |
| Behavioral management and consultation | ||
| Mental health crisis diversion bed services | ||
| (( |
||
| Specialized psychiatric services |
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0220, 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, § 388-845-0220, filed 12/13/05, effective 1/13/06.]
(a) Master's or PhD level behavior specialist, licensed or certified/registered to provide behavioral assessment, intervention, and training;
(b) Behavior technician, licensed or certified/registered
to provide behavioral intervention and training, following the
lead of the behavior specialist((;
(c) Certified music therapist; and/or
(d) Certified recreation therapist)).
(2) Providers of behavior management and consultation per WAC 388-845-0505 may be utilized to provide counseling and/or therapy services to augment the work of the CIIBS intensive service provider types.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0506, filed 11/1/10, effective 12/2/10.]
(1) ((If you are age sixty-two or older, these)) Services
((are available to)) assist you to participate in activities,
events and organizations in the community in ways similar to
others of ((retirement)) similar age.
(2) These services are available in the Basic, Basic Plus, and CORE waivers.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-0600, 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, § 388-845-0600, filed 12/13/05, effective 1/13/06.]
(1) You must be age sixty-two or older or you have accessed nine consecutive months of employment services.
(2) You cannot be authorized to receive community access services if you receive prevocational services or supported employment services.
(3) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-0610, 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, § 388-845-0610, filed 12/13/05, effective 1/13/06.]
(a) An institutional setting to a community setting in which you are living in your own home or apartment, responsible for your own living expenses and receiving services from a DDD certified residential habilitation services provider as defined in WAC 388-845-1505 and 388-845-1510; or
(b) A provider operated setting, such as a group home, staffed residential, adult family home or companion home in the community to a community setting in which you are living in your own home or apartment, responsible for your own living expenses, and receiving services from a DDD certified residential habilitation services provider as defined in WAC 388-845-1505 and 388-845-1510.
(2) Community transition services include:
(a) Security deposits (not to exceed the equivalent of two month's rent) that are required to obtain a lease on an apartment or home;
(b) Essential furnishings such as a bed, a table, chairs, window blinds, eating utensils and food preparation items;
(c) Moving expenses required to occupy your own home or apartment;
(d) Set-up fees or deposits for utility or service access (e.g., telephone, electricity, heating); and
(e) Health and safety assurances, such as pest eradication, allergen control or one-time cleaning prior to occupancy.
(3) Community transition services are available in the CORE and community protection waivers.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-0750, 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, § 388-845-0750, filed 12/13/05, effective 1/13/06.]
(1) Prior approval by the DDD regional administrator or
designee is required based on a reassessment of your ((plan of
care or)) individual support plan to determine the need for
emergency services;
(2) Payment authorizations are reviewed every thirty days
and cannot exceed six thousand dollars per twelve months based
on the effective date of your current ((plan of care or))
individual support plan;
(3) Emergency assistance services are limited to the aggregate services and employment/day program services in the Basic and Basic Plus waivers;
(4) Emergency assistance may be used for interim services until:
(a) The emergency situation has been resolved; or
(b) You are transferred to alternative supports that meet your assessed needs; or
(c) You are transferred to an alternate waiver that provides the service you need.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0820, 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, § 388-845-0820, filed 12/13/05, effective 1/13/06.]
(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, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0900, filed 11/1/10, effective 12/2/10. 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.]
[]
[]
(2) These services are available on the Basic, Basic Plus, Core and Community Protection Waives.
(3) Individual must be receiving supported employment or pre-vocational services.
(4) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of supported employment service you may receive.
[]
(2) The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive.
(3) These services will be provided in an integrated environment.
(4) Your service hours are determined by the level of assistance you need to reach your employment outcomes and might not equal the number of hours you spend on the job or in job related activities.
(5) Person to person services will only be available through June 30, 2012.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-1210, 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, § 388-845-1210, filed 12/13/05, effective 1/13/06.]
(2) The maximum hours of personal care you may receive are determined by the CARE tool used as part of the DDD assessment.
(a) Provider rates are limited to the department established hourly rates for in-home medicaid personal care.
(b) Homecare agencies must be licensed through the department of health and contracted with ADSA.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-1310, filed 9/22/08, effective 10/23/08; 07-20-050, § 388-845-1310, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1310, filed 12/13/05, effective 1/13/06.]
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-1600, filed 11/1/10, effective 12/2/10. 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 provide ((personal care services to you)) ADSA
services; or
(2) You are age eighteen or older and ((live with a paid
personal care provider who)) the only paid provider living
with you 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)) ADSA provider also lives with you; or
(4) You live with a caregiver who is paid by DDD to provide supports as:
(a) A contracted companion home provider; or
(b) A licensed children's foster home provider.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-1605, filed 11/1/10, effective 12/2/10. 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) Individuals meeting the provider qualifications under chapter 388-825 WAC;
(2) Homecare/home health agencies, licensed under chapter 246-335 WAC, Part 1;
(3) Licensed and contracted group homes, foster homes, child placing agencies, staffed residential homes and foster group care homes;
(4) Licensed and contracted adult family home;
(5) Licensed and contracted adult residential care facility;
(6) Licensed and contracted adult residential treatment facility under chapter 246-337 WAC;
(7) Licensed childcare center under chapter 170-295 WAC;
(8) Licensed child daycare center under chapter 170-295 WAC;
(9) Adult daycare ((centers)) services provider under
chapter 388-71 WAC contracted with DDD;
(10) Certified provider under chapter 388-101 WAC when respite is provided within the DDD contract for certified residential services; or
(11) Other DDD contracted providers such as community
center, senior center, parks and recreation, summer
programs((, adult day care)).
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1615, 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, § 388-845-1615, 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))) (3) 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))) (4) Your caregiver may not provide DDD services
for you or other persons during your respite care hours.
(((6))) (5) 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))) (6) DDD may not pay for any fees associated with
the respite care; for example, membership fees at a
recreational facility, or insurance fees.
(((8))) (7) 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, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-1620, filed 11/1/10, effective 12/2/10. 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.]
(1) Skilled nursing services with the exception of nurse delegation and nursing evaluations require prior approval by the DDD regional administrator or designee.
(2) DDD and the treating professional determine the need for and amount of service.
(3) DDD reserves the right to require a second opinion by a department-selected provider.
(4) The dollar limitation for aggregate services in your Basic Plus waiver limit the amount of skilled nursing services unless provided as a mental health stabilization service.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1710, 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, § 388-845-1710, filed 12/13/05, effective 1/13/06.]
(a) ((Services may be authorized as a waiver service only
after you have accessed what is available to you under
medicaid including EPSDT per WAC 388-534-0100, and any private
health insurance plan;
(b) Services must be evidence based)) Specialized nutrition may be authorized as a waiver service by obtaining an initial denial of funding or information showing that the service is not covered by medicaid or private insurance;
(b) Services must be safe, effective, and individualized;
(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 per WAC 388-534-0100, and any private health
insurance plan;)) Specialized clothing may be authorized as a
waiver service by obtaining an initial denial of funding or
information showing that the service is not covered by
medicaid or private insurance.
(b) ((Specialized clothing must be recommended by an
appropriate health professional, such as an OT, behavior
therapist, or podiatrist;)) The department requires your
treating professional's written recommendation regarding your
need for the service. This recommendation must take into
account that the treating professional has recently examined
you, reviewed your medical records, and conducted a functional
evaluation.
(c) ((DDD reserves the right to require a second opinion
by a department-selected provider; and)) The department may
require a second opinion from a department selected provider
that meets the same criteria as subsection (b) of this
section.
(d) Prior approval by regional administrator or designee is required.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-1850, filed 11/1/10, effective 12/2/10.]
(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;
(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, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-2000, filed 11/1/10, effective 12/2/10. 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) Counselors registered or certified in accordance with the requirements of chapter 18.19 RCW;
(15) Certified dietician;
(16) Recreation therapist registered in Washington and
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;
(18) Certified music therapist (for CIIBS only); or
(19) Psychiatrist.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-2005, filed 11/1/10, effective 12/2/10. 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) Therapeutic equipment and supplies may be authorized
as a waiver service ((only after you have accessed what is
available to you under medicaid including EPSDT per WAC 388-534-0100, 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)) by obtaining an
initial denial of funding or information showing that the
service is not covered by medicaid or private insurance.
(2) The department does not pay for experimental equipment and supplies.
(3) The department requires your treating professional's written recommendation regarding your need for the service. This recommendation must take into account that the treating professional has recently examined you, reviewed your medical records, and conducted a functional evaluation.
(4) The department may require a written second opinion from a department selected professional that meets the same criteria in subsection (3) of this section.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-2170, filed 11/1/10, effective 12/2/10.]
(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, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-2200, filed 11/1/10, effective 12/2/10. 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) 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 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, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-3000, filed 11/1/10, effective 12/2/10. 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.]
(2) Your ISP must include:
(a) Your identified health and welfare needs;
(b) Both paid and unpaid services and supports approved to meet your identified health and welfare needs as identified in WAC 388-828-8040 and 388-828-8060; and
(c) How often you will receive each waiver service; how long you will need it; and who will provide it.
(3) For an initial ISP, you or your legal representative must sign or give verbal consent to the plan indicating your agreement to the receipt of services.
(4) For a reassessment or review of your ISP, you or your legal representative must sign or give verbal consent to the plan indicating your agreement to the receipt of services.
(5) You may choose any qualified provider for the service, who meets all of the following:
(a) Is able to meet your needs within the scope of their contract, licensure and certification;
(b) Is reasonably available;
(c) Meets provider qualifications in chapters 388-845 and 388-825 WAC for contracting; and
(d) Agrees to provide the service at department rates.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3055, 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, § 388-845-3055, filed 12/13/05, effective 1/13/06.]
(1) Consult with the office of the attorney general to
determine if you require a legal representative or guardian to
assist you with your ((plan of care or)) individual support
plan.
(2) Continue your current waiver services.
(3) If the office of the attorney general or a court
determines that you do not need a legal representative, DDD
will continue to try to provide necessary supplemental
accommodations in order to help you understand your ((plan of
care or)) individual support plan.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3056, filed 9/26/07, effective 10/27/07.]
(2) For a reassessment or review of a plan of care or individual support plan, the plan is effective the date DDD signs and approves it after a signature or verbal consent is obtained)) Your individual support plan is effective the last day of the month in which DDD signs it after receiving your signature or verbal consent.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3060, 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, § 388-845-3060, filed 12/13/05, effective 1/13/06.]
(1) Your ((plan of care or)) individual support plan will
be mailed to you for signature.
(2) You retain the same appeal rights as if you had
signed the ((plan of care or)) individual support plan.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3061, filed 9/26/07, effective 10/27/07.]
(2) If you have a legal representative, your legal
representative must sign or give verbal consent to the ((plan
of care or)) individual support plan.
(3) If you need assistance to understand your ((plan of
care or)) individual support plan, DDD will follow the steps
outlined in WAC 388-845-3056 (1) and (3).
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3062, filed 9/26/07, effective 10/27/07.]
[]
(2))) Your individual support plan is effective through the last day of the twelfth month following the effective date or until another ISP is completed, whichever occurs sooner.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3065, 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, § 388-845-3065, filed 12/13/05, effective 1/13/06.]
(1) If this individual support plan is an initial plan, DDD will be unable to provide waiver services. DDD will not assume consent for an initial plan and will follow the steps described in WAC 388-845-3056 (1) and (3).
(2) If this individual support plan is a reassessment or review and you are able to understand your ISP:
(a) DDD will continue providing services as identified in
your most current ((plan of care or)) ISP until the end of the
ten-day advance notice period as stated in WAC 388-825-105.
(b) At the end of the ten-day advance notice period, unless you file an appeal, DDD will assume consent and implement the new ISP without the required signature or verbal consent as defined in WAC 388-845-3062 above.
(3) If this individual support plan is a reassessment or review and you are not able to understand your ISP, DDD will continue your existing services and take the steps described in WAC 388-845-3056.
(4) You will be provided written notification and appeal rights to this action to implement the new ISP.
(5) Your appeal rights are in WAC 388-845-4000 and 388-825-120 through 388-825-165.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3070, 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, § 388-845-3070, filed 12/13/05, effective 1/13/06.]
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3075, 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, § 388-845-3075, filed 12/13/05, effective 1/13/06.]