WSR 12-17-036

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Division of Developmental Disabilities)

[ Filed August 7, 2012, 2:02 p.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 12-11-123.

     Title of Rule and Other Identifying Information: The department is proposing the amendment of current sections and adoption of new sections in chapter 388-845 WAC.

     The proposed amendments are WAC 388-845-0005 What are home and community based services (HCBS) waivers?, 388-845-0010 What is the purpose of HCBS waivers?, 388-845-0030 Do I meet criteria for HCBS waiver-funded services?, 388-845-0045 When there is capacity to add people to a waiver, how does DDD determine who will be enrolled?, 388-845-0050 How do I request to be enrolled in a waiver?, 388-845-0060 Can my waiver enrollment be terminated?, 388-845-0070 What determines if I need ICF/MR level of care?, 388-845-0105 What criteria determine assignment to the community protection waiver?, 388-845-0110 Are there limitations to the waiver services I can receive?, 388-845-0205 Basic waiver services, 388-845-0210 Basic Plus waiver services, 388-845-0215 CORE waiver services, 388-845-0220 Community protection waiver services, 388-845-0225 Children's intensive in-home behavioral support (CIIBS) waiver services, 388-845-0310 Are there limits to the AFH services I can receive?, 388-845-0400 What are adult residential care (ARC) services?, 388-845-0405 Who is a qualified provider of ARC services?, 388-845-0410 Are there limits to the ARC services I can receive?, 388-845-0500 What is behavior management and consultation?, 388-845-0501 What is included in behavior management and consultation for the children's intensive in-home behavioral support (CIIBS) waiver?, 388-845-0505 Who is a qualified provider of behavior management and consultation?, 388-845-0510 Are there limits to the behavior management and consultation I can receive?, 388-845-0750 What are community transition services?, 388-845-0800 What is emergency assistance?, 388-845-0820 Are there limits to my use of emergency assistance?, 388-845-0900 What are environmental accessibility adaptations?, 388-845-1100 What are mental health crisis diversion bed services?, 388-845-1105 Who is a qualified provider of mental health crisis diversion bed services?, 388-845-1110 What are the limits of mental health crisis diversion bed services?, 388-845-1150 What are mental health stabilization services?, 388-845-1155 Who are qualified providers of mental health stabilization services?, 388-845-1160 Are there limitations to the mental health stabilization services that I can receive?, 388-845-1310 Are there limits to the personal care services I can receive?, 388-845-1600 What is respite care?, 388-845-1605 Who is eligible to receive respite care?, 388-845-1610 Where can respite care be provided?, 388-845-1615 Who are qualified providers of respite care?, 388-845-1620 Are there limits to the respite care I can receive?, 388-845-1710 Are there limitations to the skilled nursing services I can receive?, 388-845-1800 What are specialized medical equipment and supplies?, 388-845-1900 What are specialized psychiatric services?, 388-845-1910 Are there limitations to the specialized psychiatric services I can receive?, 388-845-2000 What is staff/family consultation and training?, 388-845-2200 What are transportation services?, 388-845-3000 What is the process for determining the services I need?, 388-845-3055 What is a waiver individual support plan (ISP)?, 388-845-3056 What if I need assistance to understand my individual support plan?, 388-845-3060 When is my plan of care or individual support plan effective?, 388-845-3061 Can a change in my plan of care or individual support plan be effective before I sign it?, 388-845-3062 Who is required to sign or give verbal consent to the plan of care or individual support plan?, 388-845-3065 How long is my plan effective?, 388-845-3070 What happens if I do not sign or verbally consent to my individual support plan (ISP)?, 388-845-3075 What if my needs change?, 388-845-3080 What if my needs exceed the maximum yearly funding limit or the scope of services under the Basic or Basic Plus waiver?, 388-845-3085 What if my needs exceed what can be provided under the CIIBS, CORE or community protection waiver?, 388-845-4000 What are my appeal rights under the waiver?, and 388-845-4005 Can I appeal a denial of my request to be enrolled in a waiver?

     The proposed new sections are WAC 388-845-1607 Can someone who lives with me be my respite provider? and 388-845-3063 Can my individual support plan be effective before the end of the month?

     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), on October 9, 2012, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than October 9, 2012.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on October 9, 2012.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by September 19, 2012, 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: Chapter 388-845 WAC is being amended to comply with federal and state law. Proposed updates include:

• Rename ICF/MR to ICF/ID;
• Rename behavior management and consultation and mental health stabilization;
• Remove duplication of plan of care language;
• Remove obsolete link and rule citations;
• Eliminate skilled nursing services under mental health stabilization services;
• Clarify residential setting to community transition services;
• Clarify when ISP is effective, and
• Clarify intent of respite services.

     The changes that are reflected above are required to maintain compliance with the HCBS waiver programs for the division of developmental disabilities that was approved by the Centers for Medicare and Medicaid Services. This request for rule modification is to address obsolete language that is in conflict in all of the approved HCBS waivers, clarify language to ensure that services are implemented consistent with services contained in the approved HCBS waiver program, or to update language that is no longer in compliance with federal and state law. These changes ensure the division is in compliance with the HCBS waiver program and to ensure the division can continue to collect federal financial match for the receipt of services.

     Reasons Supporting Proposal: See above.

     Statutory Authority for Adoption: RCW 71A.12.030, 74.08.090.

     Statute Being Implemented: RCW 71A.12.030, 74.08.090.

     Rule is necessary because of federal law, [no further information supplied by agency].

     Name of Proponent: Department of social and health services.

     Name of Agency Personnel Responsible for Drafting and Implementation: Kris Pederson, P.O. Box 45310, Olympia, WA 98504-5310, (360) 725-3445; and Enforcement: Mark Eliason, P.O. Box 45310, Olympia, WA 98504-5310, (360) 725-3452.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The preparation of a small business impact statement is not required as no new costs will be imposed on small businesses or nonprofits as a result of this rule amendment.

     A cost-benefit analysis is not required under RCW 34.05.328. Rules are exempt per RCW 34.05.328 (5)(b)(v), rules the content of which is explicitly and specifically dictated by statute.

July 30, 2012

Katherine J. Vasquez

Rules Coordinator

4371.2
AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0005   What are home and community based services (HCBS) waivers?   (1) Home and community based services (HCBS) waivers are services approved by the Centers For Medicare and Medicaid Services (CMS) under section 1915(c) of the Social Security Act as an alternative to intermediate care facility for the ((mentally retarded (ICF/MR) care)) individuals with intellectual disabilities (ICF/ID).

     (2) Certain federal regulations are "waived" enabling the provision of services in the home and community to individuals who would otherwise require the services provided in an ((ICF/MR)) ICF/ID as defined in chapters 388-835 and 388-837 WAC.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0005, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0010   What is the purpose of HCBS waivers?   The purpose of HCBS waivers is to provide services in the community to individuals with ((ICF/MR)) ICF/ID level of need to prevent their placement in an ((ICF/MR)) ICF/ID.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0010, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-0030   Do I meet criteria for HCBS waiver-funded services?   You meet criteria for DDD HCBS waiver-funded services if you meet all of the following:

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

     (2) You have been determined to meet ((ICF/MR)) ICF/ID 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)) ICF/ID 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)) ICF/ID, 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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-0045   When there is capacity to add people to a waiver, how does DDD determine who will be enrolled?   When there is capacity on a waiver and available funding for new waiver participants, DDD may enroll people from the statewide data base in a waiver based on the following priority considerations:

     (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)) ICF/ID 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 (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, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0045, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-0045, 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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-0050   How do I request to be enrolled in a waiver?   (1) You can contact DDD and request to be enrolled in a waiver or to enroll in a different waiver at any time.

     (2) If you are assessed as meeting ((ICF/MR)) ICF/ID 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)) ICF/ID 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 data base.

[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, § 388-845-0050, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0050, 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.]


AMENDATORY SECTION(Amending WSR 09-10-021, filed 4/28/09, effective 5/29/09)

WAC 388-845-0060   Can my waiver enrollment be terminated?   DDD may terminate your waiver enrollment if DDD determines that:

     (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)) ICF/ID, 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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0070   What determines if I need ((ICF/MR)) ICF/ID level of care?   DDD determines if you need ((ICF/MR)) ICF/ID level of care based on your need for waiver services. To reach this decision, DDD uses the DDD assessment as specified in chapter 388-828 WAC.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0070, 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, § 388-845-0070, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0105   What criteria determine assignment to the community protection waiver?   DDD may assign you to the community protection waiver only if you are at least eighteen years of age, not currently residing in a hospital, jail or other institution, and meet the following criteria:

     (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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0110   Are there limitations to the waiver services I can receive?   There are limitations to waiver services. In addition to the limitations to your access to nonwaiver services cited for specific services in WAC 388-845-0115, the following limitations apply:

     (1) A service must be offered in your waiver and authorized in your ((plan of care or)) individual support plan.

     (2) ((Mental)) Behavioral 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)) ICF/ID placement.

     (4) The cost of your waiver services cannot exceed the average daily cost of care in an ((ICF/MR)) ICF/ID.

     (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.]


AMENDATORY SECTION(Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)

WAC 388-845-0205   Basic waiver services.  


BASIC WAIVER SERVICES YEARLY LIMIT
AGGREGATE SERVICES: May not exceed $1454 per year on any combination of these services
Behavior ((management)) support 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:


Community access

 May not exceed $6804 per year
Person-to-person
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)) BEHAVIORAL HEALTH STABILIZATION SERVICES: Limits are determined by a ((mental)) behavioral health professional or DDD
Behavior ((management)) support and consultation
((Mental)) Behavioral health crisis diversion bed services
Skilled nursing
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.]


AMENDATORY SECTION(Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)

WAC 388-845-0210   Basic Plus waiver services.  


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


Person-to-person


Prevocational services


Supported employment

 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)) assisted living)
((MENTAL)) BEHAVIORAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD
Behavior ((management)) support and consultation
((Mental)) Behavioral health crisis diversion bed services
Skilled nursing
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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0215   CORE waiver services.  


CORE WAIVER SERVICES YEARLY LIMIT
Behavior ((management)) support and consultation Determined by the ((plan of care or )) individual support plan, not to exceed the average cost of an ((ICF/MR)) ICF/ID for any combination of services
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
Prevocational services
Supported employment
((MENTAL)) BEHAVIORAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD
Behavior ((management)) support and consultation
((Mental)) Behavioral health crisis diversion bed services
Skilled nursing
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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0220   Community protection waiver services.  


COMMUNITY PROTECTION WAIVER SERVICES YEARLY LIMIT
Behavior ((management)) support and consultation Determined by the ((plan of care or)) individual support plan, not to exceed the average cost of an ((ICF/MR)) ICF/ID for any combination of services
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
Prevocational services
Supported employment
((MENTAL)) BEHAVIORAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD
Behavioral ((management)) support and consultation
((Mental)) Behavioral health crisis diversion bed services
Skilled nursing
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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-0225   Children's intensive in-home behavioral support (CIIBS) waiver services.       


CIIBS Waiver Services Yearly Limit
• Behavior ((management)) support 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.

[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, § 388-845-0225, filed 11/1/10, effective 12/2/10.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0310   Are there limits to the AFH services I can receive?   Adult family homes services are limited by the following:

     (1) AFH services are defined and limited per chapter 388-106 WAC ((and chapter 388-71 WAC)) governing medicaid personal care and the comprehensive assessment and reporting evaluation (CARE).

     (2) Rates are determined by and limited to department published rates for the level of care generated by CARE.

     (3) AFH reimbursement cannot be supplemented by other department funding.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0310, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0400   What are adult residential care (ARC) services?   Adult residential care (ARC) facilities may provide residential care to adults. This service is available in the Basic Plus waiver.

     (1) An ARC is a licensed ((boarding home)) assisted living facility for seven or more unrelated adults.

     (2) Services include, but are not limited to, individual and group activities; assistance with arranging transportation; assistance with obtaining and maintaining functional aids and equipment; housework; laundry; self-administration of medications and treatments; therapeutic diets; cuing and providing physical assistance with bathing, eating, dressing, locomotion and toileting; stand-by one person assistance for transferring.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0400, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0405   Who is a qualified provider of ARC services?   The provider of ARC services must:

     (1) Be a licensed ((boarding home)) assisted living facility;

     (2) Be contracted with ADSA to provide ARC services; and

     (3) Have completed the required and approved DDD specialty training.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0405, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0410   Are there limits to the ARC services I can receive?   ARC services are limited by the following:

     (1) ARC services are defined and limited by ((boarding home)) assisted living facility licensure and rules in chapter 388-78A WAC, and chapter 388-106 WAC ((and chapter 388-71 WAC)) governing medicaid personal care and the comprehensive assessment and reporting evaluation (CARE).

     (2) Rates are determined and limited to department published rates for the level of care generated by CARE.

     (3) ARC reimbursement cannot be supplemented by other department funding.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0410, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-0500   What is behavior ((management)) support and consultation?   (1) Behavior ((management)) support and consultation may be provided to persons on any of the DDD HCBS waivers and includes the development and implementation of programs designed to support waiver participants using:

     (a) Individualized 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, conducting a functional assessment, development and implementation of a positive behavior support plan).

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

[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, § 388-845-0500, 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, § 388-845-0500, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-0501   What is included in behavior ((management)) support and consultation for the children's intensive in-home behavioral support (CIIBS) waiver?   (1) In addition to the definition in WAC 388-845-0500, behavior ((management)) support and consultation in the CIIBS waiver must include the following characteristics:

     (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)) support 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.

[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, § 388-845-0501, filed 11/1/10, effective 12/2/10.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-0505   Who is a qualified provider of behavior ((management)) support and consultation?   Under the Basic, Basic Plus, Core, and Community Protection waivers, the provider of behavior ((management)) support and consultation must be one of the following professionals contracted with DDD and duly licensed, registered or certified to provide this service:

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

     (11) Polygrapher.

[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0505, 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, § 388-845-0505, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0510   Are there limits to the behavior ((management)) support and consultation I can receive?   The following limits apply to your receipt of behavior ((management)) support and consultation:

     (1) DDD and the treating professional will determine the need and amount of service you will receive, subject to the limitations in subsection (2) below.

     (2) The dollar limitations for aggregate services in your Basic and Basic Plus waiver limit the amount of service unless provided as a ((mental)) behavioral health stabilization service.

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

     (4) Behavior ((management)) support and consultation not provided as a ((mental)) behavioral health stabilization service requires prior approval by the DDD regional administrator or designee.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0510, 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, § 388-845-0510, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)

WAC 388-845-0750   What are community transition services?   (1) Community transition services are reasonable costs (necessary expenses in the judgment of the state for you to establish your basic living arrangement) associated with moving from:

     (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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0800   What is emergency assistance?   Emergency assistance is a temporary increase to the yearly aggregate services and/or employment/day program services dollar limit specified in the Basic and Basic Plus waiver when additional waiver services are required to prevent ((ICF/MR)) ICF/ID placement. These additional services are limited to the services provided in your waiver.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0800, 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, § 388-845-0800, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-0820   Are there limits to my use of emergency assistance?   All of the following limitations apply to your use of emergency assistance:

     (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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-0900   What are environmental accessibility adaptations?   (1) Environmental accessibility adaptations are available in all of the DDD HCBS waivers and provide the physical adaptations to the home required by the individual's ((plan of care or)) individual support plan needed to:

     (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.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1100   What are ((mental)) behavioral health crisis diversion bed services?   ((Mental)) Behavioral health crisis diversion bed services are temporary residential and behavioral services that may be provided in a client's home or licensed or certified setting. These services are available to eligible clients who are at risk of serious decline of mental functioning and who have been determined to be at risk of psychiatric hospitalization. These services are available in all four HCBS waivers administered by DDD as ((mental)) behavioral 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, § 388-845-1100, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1105   Who is a qualified provider of ((mental)) behavioral health crisis diversion bed services?   Providers of ((mental)) behavioral health crisis diversion bed services must be:

     (1) DDD certified residential agencies per chapter 388-101 WAC; or

     (2) Other department licensed or certified agencies.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1105, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-1110   What are the limits of ((mental)) behavioral health crisis diversion bed services?   (1) ((Mental)) Behavioral health crisis diversion bed services are intermittent and temporary. The duration and amount of services you need to stabilize your crisis is determined by a mental health professional and/or DDD.

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

     (3) The costs of ((mental)) behavioral 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.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-1110, 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, § 388-845-1110, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-1150   What are ((mental)) behavioral health stabilization services?   ((Mental)) Behavioral health stabilization services assist persons who are experiencing a mental health crisis. These services are available in the Basic, Basic Plus, Core, and Community Protection waivers to adults determined by mental health professionals or DDD to be at risk of institutionalization in a psychiatric hospital without one of more of the following services:

     (1) Behavior ((management)) support and consultation;

     (2) Specialized psychiatric services; or

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

[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, § 388-845-1150, 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, § 388-845-1150, 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.
AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1155   Who are qualified providers of ((mental)) behavioral health stabilization services?   Providers of these ((mental)) behavioral health stabilization services are listed in the rules in this chapter governing the specific services listed in WAC 388-845-1150.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1155, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1160   Are there limitations to the ((mental)) behavioral health stabilization services that I can receive?   (1) ((Mental)) Behavioral health stabilization services are intermittent and temporary. The duration and amount of services you need to stabilize your crisis is determined by a mental health professional and/or DDD.

     (2) The costs of ((mental)) behavioral health stabilization services do not count toward the dollar limitations for aggregate services in the Basic and Basic Plus waiver.

     (3) ((Mental)) Behavioral health stabilization services require prior approval by DDD or its designee.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1160, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)

WAC 388-845-1310   Are there limits to the personal care services I can receive?   (1) You must meet the programmatic eligibility for medicaid personal care in chapter(([s])) 388-106 (([and 388-71])) WAC governing medicaid personal care (MPC) using the current department approved assessment form: Comprehensive assessment reporting evaluation (CARE).

     (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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-1600   What is respite care?   Respite care is short-term intermittent relief for persons who normally ((providing)) provide care for ((waiver individuals)) and live with you. This service is available in the Basic, Basic Plus, CIIBS, and Core waivers.

[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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-1605   Who is eligible to receive respite care?   You are eligible to receive respite care if you are in the Basic, Basic Plus, CIIBS or Core waiver and:

     (1) You live in a private home and no ((one)) person living with you is ((paid)) contracted by ADSA to provide ((personal care services to you)) you with a service; or

     (2) You are age eighteen or older and:

     (a) You live with ((a paid personal care provider who is)) your natural, step or adoptive parent(s) who is also contracted by ADSA to provide you with a service; ((or)) and

     (b) No one else living with you is contracted by ADSA to provide you with a service; or

     (3) You are under the age of eighteen and:

     (a) You live with your natural, step or adoptive parent(s); and ((your paid personal care provider also lives with you; or))

     (b) There is a person living with you who is contracted by ADSA to provide you with a service; 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.]


NEW SECTION
WAC 388-845-1607   Can someone who lives with me be my respite provider?   Someone who lives with you may be your respite provider as long as they are not the person who normally provides care for you.

[]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-1610   Where can respite care be provided?   (1) Respite care can be provided in the following location(s):

     (a) Individual's home or place of residence;

     (b) Relative's home;

     (c) Licensed children's foster home;

     (d) Licensed, contracted and DDD certified group home;

     (e) Licensed ((boarding home)) assisted living facility contracted as an adult residential center;

     (f) Adult residential rehabilitation center;

     (g) Licensed and contracted adult family home;

     (h) Children's licensed group home, licensed staffed residential home, or licensed childcare center;

     (i) Other community settings such as camp, senior center, or adult day care center.

     (2) Additionally, your respite care provider may take you into the community while providing respite services.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1610, 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, § 388-845-1610, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-1615   Who are qualified providers of respite care?   Providers of respite care can be any of the following individuals or agencies contracted with DDD for respite care:

     (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)) providers 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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-1620   Are there limits to the respite care I can receive?   The following limitations apply to the respite care you can receive:

     (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.

     (6) If your personal care provider is your parent and you live in your parent's adult family home you may not receive respite.

     (7) DDD 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, 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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-1710   Are there limitations to the skilled nursing services I can receive?   The following limitations apply to your receipt of skilled nursing services:

     (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)) behavioral 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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-1800   What are specialized medical equipment and supplies?   (1) Specialized medical equipment and supplies are durable and nondurable medical equipment not available through medicaid or the state plan which enables individuals to:

     (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)) 182-543-1000 and ((388-543-2800)) 182-543-2800 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 DDD HCBS waivers.

[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, § 388-845-1800, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1800, 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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-1900   What are specialized psychiatric services?   (1) Specialized psychiatric services are specific to the individual needs of persons with developmental disabilities who are experiencing mental health symptoms. These services are available in all DDD HCBS waivers.

     (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)) behavioral health stabilization service in accordance with WAC 388-845-1150 through 388-845-1160.

[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, § 388-845-1900, 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, § 388-845-1900, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-1910   Are there limitations to the specialized psychiatric services I can receive?   (1) Specialized psychiatric services are excluded if they are available through other medicaid programs.

     (2) The dollar limitations for aggregate service in your Basic and Basic Plus waiver limit the amount of specialized psychiatric services unless provided as a ((mental)) behavioral health stabilization service.

     (3) Specialized psychiatric services require prior approval by the DDD regional administrator or designee.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-1910, 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, § 388-845-1910, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-2000   What is staff/family consultation and training?   (1) Staff/family consultation and training is professional assistance to families or direct service providers to help them better meet the needs of the waiver person. This service is available in all DDD HCBS waivers.

     (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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-2200   What are transportation services?   Transportation services provide reimbursement to a provider when the transportation is required and specified in the waiver ((plan of care or)) individual support plan. This service is available in all DDD HCBS waivers if the cost and responsibility for transportation is not already included in your provider's contract and payment.

     (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.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-3000   What is the process for determining the services I need?   Your service needs are determined through the DDD assessment and the service planning process as defined in chapter 388-828 WAC. Only identified health and welfare needs will be authorized for payment in the ISP.

     (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)) ICF/ID 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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-3055   What is a waiver individual support plan (ISP)?   (1) The individual support plan (ISP) ((replaces the plan of care and)) is the primary tool DDD uses to determine and document your needs and to identify the services to meet those needs. ((Your plan of care remains in effect until a new ISP is developed.))

     (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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-3056   What if I need assistance to understand my ((plan of care or)) individual support plan?   If you are unable to understand your ((plan of care or)) individual support plan and the individual who has agreed to provide assistance to you as your necessary supplemental accommodation representative is unable to assist you with understanding your individual support plan, DDD will take the following steps:

     (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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-3060   When is my ((plan of care or)) individual support plan effective?   (((1) For an initial 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.

     (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 a signature or consent is obtained.

[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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-3061   Can a change in my ((plan of care or)) individual support plan be effective before I sign it?   If you verbally request a change in service to occur immediately, DDD can sign the ((plan of care or)) individual support plan and approve it prior to receiving your signature.

     (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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-3062   Who is required to sign or give verbal consent to the ((plan of care or)) individual support plan?   (1) If you do not have a legal representative, you must sign or give verbal consent to the ((plan of care or)) individual support plan.

     (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.]


NEW SECTION
WAC 388-845-3063   Can my individual support plan be effective before the end of the month?   You may request to DDD to have your individual support plan effective prior to the end of the month. The effective date will be the date DDD signs it after receiving your signature or verbal consent.

[]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-3065   How long is my plan effective?   (((1) Your plan of care is effective until it is replaced by your individual support plan.

     (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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-3070   What happens if I do not sign or verbally consent to my individual support plan (ISP)?   If DDD is unable to obtain the necessary signature or verbal consent for an initial, reassessment or review of your individual support plan (ISP), DDD will take one or more of the following actions:

     (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.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-3075   What if my needs change?   You may request a review of your ((plan of care or)) individual support plan at any time by calling your case manager. If there is a significant change in your condition or circumstances, DDD must reassess your ((plan of care or)) individual support plan with you and amend the plan to reflect any significant changes. This reassessment does not affect the end date of your annual ((plan of care or)) individual support plan.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-3075, 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.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-3080   What if my needs exceed the maximum yearly funding limit or the scope of services under the Basic or Basic Plus waiver?   (1) If you are on the Basic or Basic Plus waiver and your assessed need for services exceeds the maximum permitted, DDD will make the following efforts to meet your health and welfare needs:

     (a) Identify more available natural supports;

     (b) Initiate an exception to rule to access available nonwaiver services not included in the Basic or Basic Plus waiver other than natural supports;

     (c) Authorize emergency services up to six thousand dollars per year if your needs meet the definition of emergency services in WAC 388-845-0800.

     (2) If emergency services and other efforts are not sufficient to meet your needs, you will be offered:

     (a) An opportunity to apply for an alternate waiver that has the services you need;

     (b) Priority for placement on the alternative waiver when there is capacity to add people to that waiver;

     (c) Placement in an ((ICF/MR)) ICF/ID.

     (3) If none of the options in subsections (1) and (2) above is successful in meeting your health and welfare needs, DDD may terminate your waiver eligibility.

     (4) 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, § 388-845-3080, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-3085   What if my needs exceed what can be provided under the CIIBS, Core or Community Protection waiver?   (1) If you are on the CIIBS, Core or Community Protection waiver and your assessed need for services exceeds the scope of services provided under your waiver, DDD will make the following efforts to meet your health and welfare needs:

     (a) Identify more available natural supports;

     (b) Initiate an exception to rule to access available nonwaiver services not included in the CIIBS, 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)) ICF/ID.

     (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.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-3085, 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, § 388-845-3085, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)

WAC 388-845-4000   What are my appeal rights under the waiver?   In addition to your appeal rights under WAC 388-825-120, you have the right to appeal the following decisions:

     (1) Disenrollment from a waiver under WAC 388-845-0060, including a disenrollment from a waiver and enrollment in a different waiver.

     (2) A denial of your request to receive ((ICF/MR)) ICF/ID services instead of waiver services; or

     (3) A denial of your request to be enrolled in a waiver, subject to the limitations described in WAC 388-845-4005.

[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-4000, 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, § 388-845-4000, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)

WAC 388-845-4005   Can I appeal a denial of my request to be enrolled in a waiver?   (1) If you are not enrolled in a waiver and your request to be enrolled in a waiver is denied, your appeal rights are limited to the decision that you are not eligible to have your request documented in a statewide data base due to the following:

     (a) You do not need ((ICF/MR)) ICF/ID 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, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-4005, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-4005, 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.]