Effective Date of Rule: Immediately.

     Purpose: The terms of the settlement agreement between Washington Autism Alliance and Advocacy, et al. v. Douglas Porter, U.S. District Court, Western District of Washington, Case No. 2:12-cv-00742-RAJ, require the health care authority (HCA) to provide a coverage benefit under medicaid's early periodic screening, diagnosis, and treatment (EPSDT) requirement on January 2, 2013, to assist children with autism spectrum disorders and their families to improve the symptoms associated with autism spectrum disorders. These emergency rules provide minimum standards for agencies to obtain and maintain licensure from the department of social and health services (DSHS) so that licensed agencies may contract with HCA to deliver applied behavioral analysis (ABA) services to eligible individuals.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-865-0400, 388-865-0405, 388-865-0420, 388-865-0425, and 388-865-0460.

     Statutory Authority for Adoption: RCW 34.05.350, 43.20A.550, 71.24.035, 74.04.050.

     Other Authority: Washington Autism Alliance and Advocacy, et al. v. Douglas Porter, U.S. District Court, Western District of Washington, Case No. 2:12-cv-00742-RAJ, settlement agreement.

     Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest; and that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

     Reasons for this Finding: Emergency rule adoption is required in order to timely comply with the settlement agreement between Washington Autism and Advocacy, et al. v. Douglas Porter, which requires HCA to provide a coverage benefit by January 2, 2013, to assist children with autism spectrum disorders. DSHS must establish minimum licensing standards in rule in order for community mental health agencies to deliver ABA services.

     The CR-101 for the permanent rule is being filed to begin the permanent rule process.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

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

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

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

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

     Date Adopted: December 31, 2012.

Katherine I. Vasquez

Rules Coordinator

     (1) Emergency crisis intervention services;

     (2) Case management services;

     (3) Psychiatric treatment, including medication supervision;

     (4) Behavioral, counseling, and psychotherapy services;

     (5) Day treatment services;

     (6) Consumer employment services; ((and/or))

     (7) Peer support services; and/or

     (8) Applied behavioral analysis (ABA) services.

[Statutory Authority: RCW 71.24.035 (5)(c), 71.24.037. 05-17-156, § 388-865-0400, filed 8/22/05, effective 9/22/05. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0400, filed 5/31/01, effective 7/1/01.]

     (1) All staff members, including contracted staff members, have a current Washington state department of health license or certificate or registration as may be required for their position;

     (2) Washington state patrol background checks are conducted for employees in contact with consumers consistent with RCW 43.43.830;

     (3) Employed or contracted professional staff members required to serve children with autism spectrum disorders meet the professional staff requirements in WAC 388-865-0469(5);

     (4) Mental health services are provided by a mental health professional, or under the clinical supervision of a mental health professional;

     (((4))) (5) Staff performing mental health services (not including crisis telephone) must have access to consultation with a psychiatrist or a physician with at least one year's experience in the direct treatment of persons who have a mental or emotional disorder;

     (((5))) (6) Mental health services to children, older adults, ethnic minorities or persons with disabilities must be provided by, under the supervision of, or with consultation from the appropriate mental health specialist(s) when the consumer:

     (a) Is a child as defined in WAC 388-865-0150;

     (b) Is or becomes an older person as defined in WAC 388-865-0150;

     (c) Is a member of a racial/ethnic group as defined in WAC 388-865-0105 and as reported:

     (i) In the consumer's demographic data; or

     (ii) By the consumer or others who provide active support to the consumer; or

     (iii) Through other means.

     (d) Is disabled as defined in WAC 388-865-0150 and as reported:

     (i) In the consumer's demographic data; or

     (ii) By the consumer or others who provide active support to the consumer; or

     (iii) Through other means.

     (((6))) (7) Staff receive regular supervision and an annual performance evaluation; and

     (((7))) (8) An individualized annual training plan must be implemented for each direct service staff person and supervisor, to include at a minimum:

     (a) The skills he or she needs for his/her job description and the population served; and

     (b) The requirements of RCW 71.05.720.

[Statutory Authority: RCW 71.05.560, 71.05.700, 71.05.705, 71.05.710, 71.05.715, 71.05.720, and 71.24.035. 09-19-012, § 388-865-0405, filed 9/3/09, effective 10/4/09. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0405, filed 5/31/01, effective 7/1/01.]

     (2) The intake evaluation must:

     (a) Be provided by a mental health professional.

     (b) Be initiated within ten working days from the date on which the individual or their parent or other legal representative requests services and completed within thirty working days of the initiation of the intake.

     (c) Be culturally and age relevant.

     (d) Document sufficient information to demonstrate ((medical necessity as defined in the state plan, and must)) and/or include:

     (i) Medical necessity, as defined in WAC 388-865-0150;

     (ii) Presenting problem(s) as described by the individual, including a review of any documentation of a mental health condition provided by the individual. It must be inclusive of people who provide active support to the individual, if the individual so requests, or if the individual is under thirteen years of age;

     (((ii))) (iii) Current physical health status, including any medications the individual is taking;

     (((iii))) (iv) Current substance use and abuse and treatment status (GAIN-SS);

     (((iv))) (v) Sufficient clinical information to justify the provisional diagnosis using diagnostic and statistical manual (DSM IV TR) criteria, or its successor;

     (((v))) (vi) An identification of risk of harm to self and others, including suicide/homicide. Note: A referral for provision of emergency/crisis services, consistent with WAC 388-865-0452, must be made if indicated in the risk assessment;

     (((vi))) (vii) Whether they are under the supervision of the department of corrections; and

     (((vii))) (viii) A recommendation of a course of treatment.

[Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), and 71.34.380. 10-09-061, § 388-865-0420, filed 4/19/10, effective 5/20/10. Statutory Authority: RCW 71.24.035. 07-06-050, § 388-865-0420, filed 3/2/07, effective 4/2/07. Statutory Authority: RCW 71.05.445 and 71.05.390 as amended by 2004 c 166. 05-14-082, § 388-865-0420, filed 6/30/05, effective 7/31/05. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0420, filed 5/31/01, effective 7/1/01.]

     (a) Develop a consumer-driven, strength-based individual service plan that meets the individual's unique mental health needs.

     (b) Ensure an individualized applied behavioral analysis (ABA) treatment plan for a child receiving ABA services meets the requirements in subsection (3) of this section and WAC 388-865-0469.

     (2) An ((The)) individual service plan must:

     (a) Be developed in collaboration with the individual, or the individual's parent or other legal representative if applicable. ((The service plan must:

     (1))) (b) Be initiated with at least one goal identified by the individual, or their parent or other legal representative if applicable, at the intake evaluation or the first session following the intake evaluation.

     (((2))) (c) Be developed within thirty days from the first session following the intake evaluation.

     (((3))) (d) Address age, cultural, or disability issues identified by the individual, or their parent or other legal representative if applicable, as relevant to treatment.

     (((4))) (e) Include treatment goals or objectives that are measurable and that allow the provider and individual to evaluate progress toward the individual's identified recovery goals.

     (((5))) (f) Be in language and terminology that is understandable to individuals and their family.

     (((6))) (g) Identify medically necessary service modalities, mutually agreed upon by the individual and provider, for this treatment episode.

     (((7))) (h) Demonstrate the individual's participation in the development of the individual service plan. Participation may be demonstrated by the individual's signature and/or quotes documented in the plan. Participation must include family or significant others as requested by the individual. If the provider developing the plan is not a mental health professional, the plan must also document approval by a mental health professional.

     (((8))) (i) Include documentation that the individual service plan was reviewed at least every one hundred eighty days. It should also be updated to reflect any changes in the individual's treatment needs or as requested by the individual, or their parent or other legal representative if applicable.

     (((9))) (j) With the individual's consent, or their parent or other legal representative if applicable, coordinate with any systems or organizations the individual identifies as being relevant to the individual's treatment. This includes coordination with any individualized family service plan (IFSP) when serving children ((under)) younger than age three ((years of age)).

     (((10))) (3) Beginning January 2, 2013, the health care authority will administer rules in TITLE 182 WAC for ABA services, including specific rules for an individualized ABA treatment plan. The individualized ABA treatment plan must, at a minimum:

     (a) Be developed by a lead behavior analysis therapist (LBAT) who meets the LBAT requirements in WAC 388-865-0469(5);

     (b) Identify the services to be delivered by a therapy assistant who meets the therapy assistant requirements in WAC 388-865-0469(5); and

     (c) Meet the specific requirements of the health care authority in TITLE 182 WAC.

     (4) If an individual disagrees with specific treatment recommendations or is denied a requested treatment service, they may pursue their rights under WAC 388-865-0255.

[Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), and 71.34.380. 10-09-061, § 388-865-0425, filed 4/19/10, effective 5/20/10. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0425, filed 5/31/01, effective 7/1/01.]

[Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0460, filed 5/31/01, effective 7/1/01.]

     (2) Beginning January 2, 2013:

     (a) An agency currently licensed by the department that meets the minimum standards in this section may deliver ABA services to eligible individuals.

     (b) The health care authority will administer rules in TITLE 182 WAC for ABA services requirements, including:

     (i) Program and clinical eligibility requirements;

     (ii) Prior authorization requirements;

     (iii) Specific ABA provider requirements;

     (iv) Coverage requirements;

     (v) Billing requirements; and

     (vi) Requirements for:

     (A) Referrals to Centers of Excellence (COE) for evaluations and orders;

     (B) ABA assessments and ABA treatment plan development; and

     (C) Delivery of ABA services.

     (3) Licensure requirements.

     (a) An agency not licensed by the department under this chapter must seek and obtain licensure from the department in order to provide ABA services. The agency must:

     (i) Submit an application to the department (see WAC 388-865-0470).

     (ii) Pay the licensing application fee (see WAC 388-865-0103).

     (iii) Meet the applicable agency requirements in WAC 388-865-0400.

     (iv) Qualify for a provisional and full license as described in WAC 388-865-0472 (1) and (2).

     (v) Comply with the applicable rules regarding licensure in WAC 388-865-0472 through 388-865-0482.

     (vi) Meet the additional requirements in this section.

     (b) An agency must have written policies and procedures to support and implement the requirements in this section.

     (4) Certification requirements. An agency must be a department-licensed community mental health agency that is certified by the department to provide ABA services.

     (5) Staff requirements. An agency must meet the applicable competency and documentation requirements in WAC 388-865-0405 for ensuring staff members are qualified for the positions they hold. Contracted professional staff must meet the same requirements as the agency's noncontracted professional staff.

     (a) An agency must employ or contract with a lead behavior analysis therapist (LBAT) who meets one of the following professional requirements. The LBAT must:

     (i) Be licensed by department of health under chapter 18.19 RCW as a licensed health care professional or be an agency-affiliated counselor under RCW 18.19.210 who, in addition, meets the requirements of a mental health professional as defined in WAC 388-865-0150;

     (ii) Hold national certification as a board certified behavior analyst (BCBA); or

     (iii) Have two hundred forty hours of coursework related to behavior analysis and seven hundred fifty hours of supervised experience, or two years of practical experience in designing and implementing comprehensive ABA treatment plans.

     (b) In addition to meeting one of the three professional requirements in (a)(i) through (a)(iii) of this subsection, an LBAT must have expertise in ABA principles;

     (c) An LBAT is responsible for supervising therapy assistants in accordance with agency policies and procedures, if the agency employs or contracts with a therapy assistant(s);

     (d) An agency that chooses to employ or contract with a therapy assistant must ensure the therapy assistant:

     (i) Is licensed by the department of health under chapter 18.19 RCW as a licensed health care professional, or credentialed as an agency affiliated counselor under chapter 18.19 RCW;

     (ii) Has sixty hours of training in ABA principles, techniques, and providing services to children with autism spectrum disorders, and has been approved by the supervising LBAT as having demonstrated competency in delivering ABA services before providing services to individuals;

     (iii) Delivers services according to the individual's ABA treatment plan;

     (iv) Obtains bi-monthly approval and completes a review of the ABA treatment plan and review of the individual's progress with the LBAT; and

     (v) Is supervised by an LBAT who meets the requirements in (a) through (c) of this subsection.

     (6) Maintaining licensure. To maintain department licensure to provide ABA services, an agency must:

     (a) Continue to employ or contract with professional staff to meet the requirements in subsection (5) of this section. Contracted professional staff must meet the same requirements as the agency's noncontracted professional staff.

     (b) Meet the following, as applicable to ABA services:

     (i) Competency requirements for staff in WAC 388-865-0405, except that subsections (5) and (6) do not apply to ABA services.

     (ii) Consumer rights requirements in WAC 388-865-0410, except that subsections (3)(m) and (3)(n) do not apply to ABA services.

     (iii) Access to services requirements in WAC 388-865-0415.

     (iv) Intake evaluation requirements in WAC 388-865-0420, except that subsections (1), (2)(d)(i), (2)(d)(iv), (2)(d)(v), and (2)(d)(vii) do not apply to ABA services.

     (v) Individual service plan requirements in WAC 388-865-0425, except that subsections (1)(a), (2)(d), (2)(g), and (4) do not apply to ABA services.

     (vi) Clinical records requirements in WAC 388-865-0430, except that subsections (7), (10), (11) and (12) do not apply to ABA services.

     (vii) Clinical record access procedures and requirements in WAC 388-865-0435 and 388-865-0436.

     (viii) Quality management process requirements in WAC 388-865-0450.

     (ix) Provider requirements in WAC 388-865-0470, 388-865-0472, 388-865-0478, 388-865-0480, and 388-865-0482, if applicable to the ABA services provided.

     (c) Meet one or more of the following:

     (i) Case management services requirements in WAC 388-865-0456, except that:

     (A) Subsection (6) does not apply to ABA services; and

     (B) Subsection (7) does not apply to ABA services, except that the agency must maintain written procedures for home visits to be in compliance with RCW 71.05.710.

     (ii) Psychiatric treatment, including the medication supervision--additional standards requirements in WAC 388-865-0458, if applicable to the ABA services provided.

     (iii) Behavioral, counseling, and psychotherapy services--additional standards requirements in WAC 388-865-0460, if applicable to the ABA services provided.

     (iv) Day treatment services--additional standards requirements in WAC 388-865-0462, if applicable to the ABA services provided.

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