WSR 13-24-045 PERMANENT RULES DEPARTMENT OF SOCIAL AND HEALTH SERVICES (Developmental Disabilities Administration) [Filed November 26, 2013, 9:05 a.m., effective January 1, 2014] Effective Date of Rule: January 1, 2014.
Purpose: To permanently adopt amendments to sections of chapter 388-845 WAC, DDD home and community based services waivers, to remain in compliance with the requirements of chapter 49, Laws of 2012 (related to community access services). In addition these amendments remove basic waiver, add dental services as a waiver service option until January 1, 2014; align this chapter with amendments to chapter 388-828 WAC for community access services; and provides updates to WAC and RCW references, titles and links, names of state agencies and updates to language structure so that readers will have an easier and better overall understanding of the rules.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-845-0205; and amending WAC 388-845-0001 Definitions, 388-845-0015 What HCBS waivers are provided by the developmental disabilities administration (DDA)?, 388-845-0020 When were the HCBS waivers effective?, 388-845-0030 Do I meet criteria for HCBS waiver-funded services?, 388-845-0035 Am I guaranteed placement on a waiver if I meet waiver criteria?, 388-845-0040 Is there a limit to the number of people who can be enrolled in each HCBS waiver?, 388-845-0041 What is DDD responsibility to provide my services under the DDD HCBS waivers administered by DDD?, 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?, 388-845-0051 How will I be notified of the decision by DDD to enroll me in a waiver?, 388-845-0052 What is the process if I am already on a DDD HCBS waiver and request enrollment onto a different waiver DDD HCBS?, 388-845-0055 How do I remain eligible for the waiver?, 388-845-0060 Can my waiver enrollment be terminated?, 388-845-0065 What happens if I am terminated or choose to disenroll from a waiver?, 388-845-0070 What determines if I need ICF/ID level of care?, 388-845-0100 What determines which waiver I am assigned to?, 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?, 388-845-0115 Does my waiver eligibility limit my access to DDD nonwaiver services?, 388-845-0120 Will I continue to receive state supplementary payments (SSP) if I am on the waiver?, 388-845-0200 What waiver services are available to me?, 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, 388-845-0305 Who is a qualified provider of AFH services?, 388-845-0405 Who is a qualified provider of ARC services?, 388-845-0420 Who is a qualified provider of assistive technology?, 388-845-0425 Are there limits to the assistive technology I can receive?, 388-845-0500 What is behavior support and consultation?, 388-845-0501 What is included in behavior support 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?, 388-845-0506 Who is a qualified provider of behavior ((management)) support and consultation for the children's intensive in-home behavioral supports (CIIBS) waiver?, 388-845-0510 Are there limits to the behavior support and consultation I can receive?, 388-845-0603 Who is eligible to receive community access services?, 388-845-0605 Who are qualified providers of community access services?, 388-845-0610 Are there limits to community access services I can receive?, 388-845-0700 What is a community guide service?, 388-845-0705 Who is a qualified community guide?, 388-845-0710 Are there limitations to the community guide services I can receive?, 388-845-0750 What are community transition services?, 388-845-0800 What is emergency assistance?, 388-845-0810 How do I qualify for emergency assistance?, 388-845-0820 Are there limits to my use of emergency assistance?, 388-845-0900 What are environmental accessibility adaptations?, 388-845-0905 Who is a qualified provider for building these environmental accessibility adaptations?, 388-845-0910 What limitations apply to environmental accessibility adaptations?, 388-845-1000 What are extended state plan services?, 388-845-1010 Who is a qualified provider of extended state plan services?, 388-845-1015 Are there limits to the extended state plan services I can receive?, 388-845-1030 What are individual technical assistance services?, 388-845-1035 Who are qualified providers of individualized technical assistance services?, 388-845-1040 Are there limits to the individualized technical assistance services I can receive?, 388-845-1100 What are behavioral 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?, 388-845-1160 Are there limitations to the behavioral health stabilization services that I can receive?, 388-845-1175 Who is a qualified provider of nurse delegation?, 388-845-1300 What are personal care services?, 388-845-1305 Who are the qualified providers of personal care services?, 388-845-1310 Are there limits to the personal care services I can receive?, 388-845-1400 What are prevocational services?, 388-845-1405 Who are the qualified providers of prevocational services?, 388-845-1410 Are there limits to the prevocational services I can receive?, 388-845-1505 Who are qualified providers of residential habilitation services for the Core waiver?, 388-845-1510 Who are qualified providers of residential habilitation services for the community protection waiver?, 388-845-1515 Are there limits to the residential habilitation services I can receive?, 388-845-1600 What is respite care?, 388-845-1605 Who is eligible to receive respite care?, 388-845-1607 Can someone who lives with me be my respite provider?, 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?, 388-845-1650 What are sexual deviancy evaluations?, 388-845-1655 Who is a qualified provider of sexual deviancy evaluations?, 388-845-1660 Are there limitations to the sexual deviancy evaluations I can receive?, 388-845-1705 Who is a qualified provider of skilled nursing services?, 388-845-1710 Are there limitations to the skilled nursing services I can receive?, 388-845-1800 What are specialized medical equipment and supplies?, 388-845-1805 Who are the qualified providers of specialized medical equipment and supplies?, 388-845-1810 Are there limitations to my receipt of specialized medical equipment and supplies?, 388-845-1845 Who are qualified providers of specialized nutrition and specialized clothing?, 388-845-1850 Are there limitations to my receipt of specialized nutrition and specialized clothing?, 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?, 388-845-2005 Who is a qualified provider of staff/family consultation and training?, 388-845-2010 Are there limitations to the staff/family consultation and training I can receive?, 388-845-2100 What are supported employment services?, 388-845-2105 Who are qualified providers of supported employment services?, 388-845-2110 Are there limits to the supported employment services I can receive?, 388-845-2160 What is therapeutic equipment and supplies?, 388-845-2165 Who are qualified providers of therapeutic equipment and supplies?, 388-845-2200 What are transportation services?, 388-845-2205 Who is qualified to provide transportation services?, 388-845-2210 Are there limitations to the transportation services I can receive?, 388-845-2265 Who are providers of vehicle modifications?, 388-845-2270 Are there limitations to my receipt of vehicle modification 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 individual support plan effective?, 388-845-3061 Can a change in my individual support plan be effective before I sign it?, 388-845-3062 Who is required to sign or give verbal consent to the individual support plan?, 388-845-3063 Can my individual support plan be effective before the end of the month?, 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?, 388-845-3090 What if my identified health and welfare needs are less than what is provided in my current waiver?, 388-845-3095 Will I have to pay toward the cost of waiver services?, 388-845-4005 Can I appeal a denial of my request to be enrolled in a waiver?, 388-845-4010 How do I appeal a department action?, and 388-845-4015 Will my services continue during an appeal?
Statutory Authority for Adoption: RCW 71A.12.030.
Other Authority: Chapter 49, Laws of 2012.
Adopted under notice filed as WSR 13-17-112 on August 21, 2013.
Changes Other than Editing from Proposed to Adopted Version: The definition "ADS" was removed and all references to ADS in the rule was changed to either DSHS or developmental disabilities administration (DDA).
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 17, Repealed 1; 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 0, Amended 98, 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 0, Amended 115, Repealed 1.
Date Adopted: November 19, 2013.
Katherine I. Vasquez
Rules Coordinator
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-0001 Definitions.
"((ADSA))" ((means the aging and disability services administration, an administration within the department of social and health services.)) "Aggregate services" means a combination of services subject to the dollar limitations in the ((Basic and)) Basic Plus waivers. "CARE" means ((the)) comprehensive assessment and reporting evaluation. "Client or person" means a person who has a developmental disability as defined in RCW 71A.10.020(3) and has been determined eligible to receive services by the ((division)) administration under chapter 71A.16 RCW. "Community crisis stabilization services" or "CCSS" means a state operated program that provides short term supports to participants who meet specific criteria and who are in crisis and/or who are at risk of hospitalization or institutional placement. "((DDD)) DDA" means the ((division of)) developmental disabilities administration, ((a division within the aging and disability services administration)) of the department of social and health services. "((DDD)) DDA assessment" refers to the standardized assessment tool as defined in chapter 388-828 WAC, used by ((DDD)) DDA to measure the support needs of persons with developmental disabilities. "Department" means the department of social and health services. "EPSDT" means early and periodic screening, diagnosis, and treatment, medicaid's child health component providing a mandatory and comprehensive set of benefits and services for children up to age twenty one as defined in WAC ((388-534-0100)) 182-534-0100. (("Employment/day program services" means community access, person-to-person, individualized technical assistance, prevocational services or supported employment services subject to the dollar limitations in the Basic and Basic Plus waivers.)) "Enhanced respite services" means respite care for DDA enrolled children and youth, who meet specific criteria, in a DDA contracted and licensed staffed residential setting. "Evidence based treatment" means the use of physical, mental and behavioral health interventions for which systematic, empirical research has provided evidence of statistically significant effectiveness as treatments for specific conditions. Alternate terms with the same meaning are evidence-based practice (EBP) and empirically supported treatment (EST). "Family" means relatives who live in the same home with the eligible client. Relatives include spouse or registered domestic partner; natural, adoptive or step parent; grandparent; child; stepchild; sibling; stepsibling; uncle; aunt; first cousin; niece; or nephew. "Family home" means the residence where you and your relatives live. "Gainful employment" means employment that reflects achievement of or progress towards a living wage. "HCBS waivers" means home and community based services waivers. "Home" means present or intended place of residence. "((ICF/MR)) ICF/ID" means an intermediate care facility for ((the mentally retarded)) individuals with intellectual disabilities. "Individual support plan (ISP)" is a document that authorizes and identifies the ((DDD)) DDA paid services and unpaid supports to meet a client's assessed needs. "Integrated settings" mean typical community settings not designed specifically for individuals with disabilities in which the majority of persons employed and participating are individuals without disabilities. "Legal representative" means a parent of a person who is under eighteen years of age, a person's legal guardian, a person's limited guardian when the subject matter is within the scope of limited guardianship, a person's attorney at law, a person's attorney in fact, or any other person who is authorized by law to act for another person. "Living wage" means the amount of earned wages needed to enable an individual to meet or exceed his/her living expenses. "Necessary supplemental accommodation representative" means an individual who receives copies of ((DDD)) DDA planned action notices (PANs) and other department correspondence in order to help a client understand the documents and exercise the client's rights. A necessary supplemental accommodation representative is identified by a client of ((DDD)) DDA when the client does not have a legal guardian and the client is requesting or receiving ((DDD)) DDA services. "((Providers)) Provider" means an individual or agency who meets the provider qualifications and is contracted with ((ADSA)) DSHS to provide services to you. "Respite assessment" means an algorithm within the ((DDD)) DDA assessment that determines the number of hours of respite care you may receive per year if you are enrolled in the ((Basic,)) Basic Plus, Children's Intensive In-Home Behavioral Support, or Core waiver. "SSI" means Supplemental Security Income, an assistance program administered by the federal Social Security Administration for blind, disabled and aged individuals. "SSP" means a state-paid cash assistance program for certain clients of the ((division of)) developmental disabilities administration. "State funded services" means services that are funded entirely with state dollars. "You/your" means the client.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0015 What HCBS waivers are provided by the ((division of)) developmental disabilities administration (((DDD)) DDA)?
((DDD)) DDA provides services through ((five)) four HCBS waivers: (1) ((Basic waiver; (2))) Basic Plus waiver; (((3))) (2) Core waiver; (((4))) (3) Community Protection waiver; and (((5))) (4) Children's Intensive In-Home Behavioral Support waiver (CIIBS).
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0020 When were the HCBS waivers effective?
((Basic,)) Basic Plus, Children's Intensive In-Home Behavioral Support, Core and Community Protection waivers were effective ((April 1, 2004)) September 1, 2012. ((Children's Intensive In-Home Behavioral Support waiver was effective May 1, 2009.))
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0030 Do I meet criteria for HCBS waiver-funded services?
You meet criteria for ((DDD)) DDA HCBS waiver-funded services if you meet all of the following: (2) You have been determined to meet 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/ID facility. (6) You have a need for monthly waiver services or monthly monitoring as identified in your individual support plan. (7) You are not residing in hospital, jail, prison, nursing facility, 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.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0035 Am I guaranteed placement on a waiver if I meet waiver criteria?
(1) If you are not currently enrolled in a waiver, meeting criteria for the waiver does not guarantee access to or receipt of waiver services. (2) If you are currently on a waiver and you have been determined to have health and welfare needs that can be met only by services available on a different waiver, you are not guaranteed enrollment in that different waiver. (3) WAC 388-845-0041, 388-845-3080 and 388-845-3085 describe ((DDD's)) DDA's responsibilities to provide services.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0040 Is there a limit to the number of people who can be enrolled in each HCBS waiver?
Each waiver has a capacity limit on the number of people who can be served in a waiver year. In addition, ((DDD)) DDA has the authority to limit capacity based on availability of funding for new waiver participants.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-0041 What is ((DDD's)) DDA's responsibility to provide my services under the ((DDD)) DDA HCBS waivers administered by ((DDD)) DDA?
If you are enrolled in an HCBS waiver administered by DDD. (1) ((DDD)) DDA will provide an annual comprehensive assessment to evaluate your health and welfare need. Your individual support plan, as specified in WAC 388-845-3055, will document: (a) Your identified health and welfare needs; and (b) Your HCBS waiver services and nonwaiver services authorized to meet your assessed need. (2) You have access to ((DDD)) DDA paid services that are provided within the scope of your waiver, subject to the limitations in WAC 388-845-0110 and 388-845-0115. (3) ((DDD)) DDA will provide waiver services you need and qualify for within your waiver. (4) ((DDD)) DDA will not deny or limit, based on lack of funding, the number of waiver services for which you are eligible.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0045 When there is capacity to add people to a waiver, how does ((DDD)) DDA determine who will be enrolled?
When there is capacity on a waiver and available funding for new waiver participants, ((DDD)) DDA 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)) DDA may also consider any of the following populations in any order: (a) Priority populations as identified and funded by the legislature. (b) Persons ((DDD)) DDA has determined to be in immediate risk of 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 Plus waiver only, ((DDD)) DDA may consider persons who need the waiver services available in the Basic Plus waiver to maintain them in their family's home or in their own home.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0050 How do I request to be enrolled in a waiver?
(1) You can contact ((DDD)) DDA 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/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)) DDA 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/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)) DDA in a statewide data base.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-0051 How will I be notified of the decision by ((DDD)) DDA to enroll me in a waiver?
((DDD)) DDA will notify you in writing of its decision to enroll you in a waiver or its decision to deny your request to be enrolled in a waiver.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0052 What is the process if I am already on a DDA HCBS waiver and request enrollment onto a different waiver DDA HCBS?
(1) If you are already enrolled in a ((DDD)) DDA HCBS waiver and you request to be enrolled in a different waiver ((DDD)) DDA will do the following: (a) Assess your needs to determine whether your health and welfare needs can be met with services available on your current waiver or whether those needs can only be met through services offered on a different waiver. (b) If ((DDD)) DDA determines your health and welfare needs can be met by services available on your current waiver your enrollment request will be denied. (c) If ((DDD)) DDA determines your health and welfare needs can only be met by services available on a different waiver your service need will be reflected in your ISP. (d) If ((DDD)) DDA determines there is capacity on the waiver that is determined to meet your needs, ((DDD)) DDA will place you on that waiver. (2) You will be notified in writing of ((DDD's)) DDA's decision under subsection (1)(a) of this section and if your health and welfare needs cannot be met on your current waiver, ((DDD)) DDA will notify you in writing whether there is capacity on the waiver that will meet your health and welfare needs and whether you will be enrolled on that waiver. If current capacity on that waiver does not exist, your eligibility for enrollment onto that different waiver will be tracked on a statewide data base.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0055 How do I remain eligible for the waiver?
Once you are enrolled in a ((DDD)) DDA HCBS waiver, you can remain eligible if you continue to meet eligibility criteria in WAC 388-845-0030, and: (1) You complete a reassessment with ((DDD)) DDA at least once every twelve months to determine if you continue to meet all of these eligibility requirements; and (2) You must either receive a waiver service at least once in every thirty consecutive days, as specified in WAC ((388-513-1320)) 182-513-1320 (3)(b), or your health and welfare needs require monthly monitoring, which will be documented in your client record; and (3) You complete an in-person ((DDD)) DDA assessment/reassessment interview administered in your home per WAC 388-828-1520. (4) In addition, for the Children's Intensive In-Home Behavioral Supports waiver, you must: (a) Be under age twenty-one; (b) Live with your family; and (c) Have an annual participation agreement signed by your parent/guardian(s) and primary caregiver(s), if other than parent/guardian(s).
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0060 Can my waiver enrollment be terminated?
((DDD)) DDA may terminate your waiver enrollment if ((DDD)) DDA 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 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)) DDA 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)) DDA in: (i) Service planning; (ii) Required quality assurance and program monitoring activities; or (iii) Accepting services agreed to in your individual support plan as necessary to meet your health and welfare needs. (i) You are residing in a hospital, jail, prison, nursing facility, 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 that full calendar month, there is no immediate plan for you to return to the community; or (ii) At the end of the twelfth month following the effective date of your current individual support plan, as described in WAC 388-845-3060; or (((ii))) (iii) 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)) DDA enrolls you on a different waiver.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0065 What happens if I am terminated or choose to disenroll from a waiver?
If you are terminated from a waiver or choose to disenroll from a waiver, ((DDD)) DDA will notify you. (1) ((DDD)) DDA cannot guarantee continuation of your current services, including medicaid eligibility. (2) Your eligibility for nonwaiver state-only funded ((DDD)) DDA services is based upon availability of funding and program eligibility for a particular service. (3) If you are terminated from the CIIBS waiver due to turning age twenty-one, ((DDD)) DDA will assist with transition planning at least twelve months prior to your twenty-first birthday.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0070 What determines if I need ICF/ID level of care?
((DDD)) DDA determines if you need ICF/ID level of care based on your need for waiver services. To reach this decision, ((DDD)) DDA uses the ((DDD)) DDA assessment as specified in chapter 388-828 WAC.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0100 What determines which waiver I am assigned to?
((If there is capacity, DDD)) DDA will assign you to the waiver with the minimum service package necessary to meet your health and welfare needs, based on its evaluation of your ((DDD)) DDA assessment as described in chapter 388-828 WAC and the following criteria: (1) ((For the Basic waiver: (a) You must live with your family or in your own home; (b) Your family/caregiver's ability to continue caring for you can be maintained with the addition of services provided in the Basic waiver; and (c) You do not need out-of-home residential services. (2))) For the Basic Plus waiver((,)) your health and welfare needs ((exceed the amount allowed in the Basic waiver or)) require a waiver service ((that is not contained in the Basic waiver; and (a) You are at high risk of out-of-home placement or loss of your current living situation; or (b) You require out-of-home placement and your health and welfare needs can be met in an adult family home or adult residential care facility)) to remain in the community. (((3))) (2) For the Core waiver: (a) You are at immediate risk of out-of-home placement; and/or (b) You have an identified health and welfare need for residential services that cannot be met by the Basic Plus waiver. (((4))) (3) For the Community Protection waiver, refer to WAC 388-845-0105 and chapter 388-831 WAC. (((5))) (4) For the Children's Intensive In-Home Behavioral Support waiver, you: (a) Are age eight or older and under age eighteen; (b) Live with your family; (c) Are assessed at high or severe risk of out of home placement due to challenging behavior per chapter 388-828 WAC; and (d) You have a signed participation agreement from your parent/guardian(s) and primary caregiver(s), if other than parent/guardian(s).
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0105 What criteria determine assignment to the community protection waiver?
((DDD)) DDA 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)) DDA 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) Individual support plan; (b) Individual instruction and support plan (IISP); and/or (c) Treatment plan provided by ((DDD)) DDA approved certified individuals and agencies.
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)) waiver has 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 per WAC 182-501-0175 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)) DDA can authorize payment. (11) Waiver services do not cover co-pays, deductibles, dues, membership fees or subscriptions.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-0115 Does my waiver eligibility limit my access to ((DDD)) DDA nonwaiver services?
If you are enrolled in a ((DDD)) DDA HCBS waiver: (1) You are not eligible for state-only funding for ((DDD)) DDA services; and (2) You are not eligible for medicaid personal care.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-0120 Will I continue to receive state supplementary payments (SSP) if I am on the waiver?
Your participation in one of the ((DDD)) DDA HCBS waivers may affect your continued receipt of state supplemental payment from ((DDD)) DDA. To continue to receive SSP, you must meet ((DDD/SSP)) DDA/SSP programmatic eligibility requirements as identified in WAC 388-827-0115.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0200 What waiver services are available to me?
Each of the ((DDD)) DDA HCBS waivers has a different scope of service and your individual support plan defines the waiver services available to you.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-0210 Basic Plus waiver services.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0215 CORE waiver services.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0220 Community protection waiver services.
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.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-0305 Who is a qualified provider of AFH services?
The provider of AFH services must be licensed and contracted with ((ADSA)) DSHS as an AFH who has successfully completed the ((DDD)) DDA specialty training provided by the department.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0405 Who is a qualified provider of ARC services?
The provider of ARC services must: (1) Be a licensed assisted living facility; (2) Be contracted with ((ADSA)) DSHS to provide ARC services; and (3) Have completed the required and approved ((DDD)) DDA specialty training.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0420 Who is a qualified provider of assistive technology?
The provider of assistive technology must be an assistive technology vendor contracted with ((DDD)) DDA or one of the following professionals contracted with ((DDD)) DDA and duly licensed, registered or certified to provide this service: (1) Occupational therapist; (2) Physical therapist; (3) Speech and language pathologist; (4) Certified music therapist; (5) Certified recreation therapist; ((or)) (6) Audiologist; or (7) Behavior specialist.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0425 Are there limits to the assistive technology I can receive?
(1) Providers of assistive technology services must be certified, registered or licensed therapists as required by law and contracted with ((DDD)) DDA for the therapy they are providing. (2) Vendors of assistive technology must maintain a business license required by law and be contracted with ((DDD)) DDA to provide this service. (3) Assistive technology may be authorized as a waiver service by obtaining an initial denial of funding or information showing that the technology is not covered by medicaid or private insurance. (4) The department does not pay for experimental technology. (5) The department requires your treating professional's written recommendation regarding your need for the technology. This recommendation must take into account that: (a) The treating professional has personal knowledge of and experience with the requested and alternative technology; and (b) The treating professional has recently examined you, reviewed your medical records, and conducted a functional evaluation. (6) The department may require a written second opinion from a department selected professional that meets the same criteria in subsection (5) above.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0500 What is behavior support and consultation?
(1) Behavior support and consultation may be provided to persons on any of the ((DDD)) DDA 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 support and consultation may also be provided as a behavioral health stabilization service in accordance with WAC 388-845-1150 through 388-845-1160.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0501 What is included in behavior 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 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)) DDA'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 support and consultation in the CIIBS waiver may also include the following components: (a) Behavioral technicians (as defined in WAC 388-845-0506) may implement positive behavior support plans ((may be implemented by a behavioral technician as defined in WAC 388-845-0506 and)) which may 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)) 388-845-2005.
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)) DDA 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; or (12) State operated behavior support agency limited to behavioral health stabilization services.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-0506 Who is a qualified provider of behavior ((management)) support and consultation for the children's intensive in-home behavioral supports (CIIBS) waiver?
(1) Under the CIIBS waiver, providers of behavior ((management)) support and consultation must be contracted with ((DDD)) DDA to provide CIIBS intensive services as one of the following two provider types: (a) Master's or PhD level behavior specialist, licensed or certified/registered to provide behavioral assessment, intervention, and training; (b) Behavior technician, licensed or certified/registered to provide behavioral intervention and training, following the lead of the behavior specialist. (2) Providers of behavior ((management)) support and consultation per WAC 388-845-0505 may be utilized to provide counseling and/or therapy services to augment the work of the CIIBS intensive service provider types.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0510 Are there limits to the behavior support and consultation I can receive?
The following limits apply to your receipt of behavior support and consultation: (1) ((DDD)) DDA 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 behavioral health stabilization service. (3) ((DDD)) DDA reserves the right to require a second opinion from a department-selected provider. (4) Behavior support and consultation not provided as a behavioral health stabilization service requires prior approval by the ((DDD)) DDA regional administrator or designee.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-0603 Who is eligible to receive community access services?
You are eligible to receive community access services when you are enrolled in the ((Basic,)) Basic Plus or Core waivers and you meet one of the following conditions below: (1) You are age sixty-two or older; or (2) You are twenty-one or older and you have participated in a ((DDD)) DDA employment program for nine months; or (3) You and/or your legal representative request that ((DDD)) DDA grant an exception, per chapter 71A.12 RCW, to the requirement that you participate in an employment program for nine months prior to transitioning to a community access service because: (a) You have a medical condition that requires hospitalization or ongoing care by a medical professional and that affects your ability to participate in daily activities to the degree that employment would: (i) Result in a significant decline in your ability to function; or (ii) Seriously endanger your health. (b) You have been available for employment planning activities and an employment provider has not provided services within ninety days of your request for employment services.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-0605 Who are qualified providers of community access services?
Providers of community access services must be a county or an individual or agency contracted with a county or ((DDD)) DDA to provide community access services.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-0610 Are there limits to community access services I can receive?
The following limits apply to your receipt of community access services: (1) You cannot receive community access services if you are receiving prevocational or supported employment services. (((3))) (2) The ((amount of community access services you may receive cannot exceed the employment/day program yearly limit that is established in your HCBS waiver)) maximum hours of community access services you may receive are determined by the DDA assessment per WAC 388-828-9310.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-0700 What is a community guide service?
Community guide service increases access to informal community supports. Services are short-term and designed to develop creative, flexible and supportive community resources for individuals with developmental disabilities. This service is available in ((Basic,)) Basic Plus and CORE waivers.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-0705 Who is a qualified community guide?
Any individual or agency contracted with ((DDD)) DDA as a "community guide" is qualified to provide this service.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-0710 Are there limitations to the community guide services I can receive?
(1) You may not receive community guide services if you are receiving residential habilitation services as defined in WAC 388-845-1500 because your residential provider can meet this need. (2) The dollar limitations for aggregate services in your ((Basic or)) Basic Plus waiver limit the amount of service you may receive.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) DDA 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)) DDA 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.
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 Basic Plus waiver aggregate ((services and/or employment/day program services)) dollar limit ((specified in the Basic and Basic Plus waiver)) when additional waiver aggregate services are required to prevent ((ICF/MR)) ICF/ID placement. ((These additional services are limited to the services provided in your waiver.))
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-0810 How do I qualify for emergency assistance?
You qualify for emergency assistance only if you have used all of your waiver aggregate funding and your current situation meets one of the following criteria: (1) You involuntarily lose your present residence for any reason either temporary or permanent; (2) You lose your present caregiver for any reason, including death; (3) There are changes in your caregiver's mental or physical status resulting in the caregiver's inability to perform effectively for the individual; or (4) There are significant changes in your emotional or physical condition that requires a temporary increase in the amount of a waiver service.
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)) DDA 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 Basic Plus waiver 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.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-0900 What are environmental accessibility adaptations?
(1) Environmental accessibility adaptations are available in all of the ((DDD)) DDA HCBS waivers and provide the physical adaptations to the home required by the individual's 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.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-0905 Who is a qualified provider for building these environmental accessibility adaptations?
The provider making these environmental accessibility adaptations must be a registered contractor per chapter 18.27 RCW and contracted with ((DDD)) DDA.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0910 What limitations apply to environmental accessibility adaptations?
The following service limitations apply to environmental accessibility adaptations: (1) Environmental accessibility adaptations require prior approval by the ((DDD)) DDA regional administrator or designee. (2) With the exception of damage repairs under the CIIBS waiver, environmental accessibility adaptations or improvements to the home are excluded if they are of general utility without direct medical or remedial benefit to the individual, such as carpeting, roof repair, central air conditioning, etc. (3) Environmental accessibility adaptations cannot add to the total square footage of the home. (4) The dollar limitations for aggregate services in your ((Basic or)) Basic Plus waiver limit the amount of service you may receive. (5) Damage repairs under the CIIBS waiver are subject to the following restrictions: (a) Limited to the cost of restoration to the original condition. (b) Repairs to personal property and normal wear and tear are excluded.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1000 What are extended state plan services?
Extended state plan services refer to physical therapy; occupational therapy; and speech, hearing and language services available to you under medicaid without regard to your waiver status. They are "extended" services when the waiver pays for more services than is provided under the state medicaid plan. These services are available under all ((DDD)) DDA HCBS waivers.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-1010 Who is a qualified provider of extended state plan services?
Providers of extended state plan services must be certified, registered or licensed therapists as required by law and contracted with ((DDD)) DDA for the therapy they are providing.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1015 Are there limits to the extended state plan services I can receive?
(1) Additional therapy may be authorized as a waiver service only after you have accessed what is available to you under medicaid and any other private health insurance plan; (2) The department does not pay for treatment determined by DSHS to be experimental; (3) The department and the treating professional determine the need for and amount of service you can receive: (a) The department may require a second opinion from a department selected provider. (b) The department will require evidence that you have accessed your full benefits through medicaid before authorizing this waiver service. (4) The dollar limitations for Basic Plus waiver aggregate services ((in your Basic or Basic Plus waiver)) limit the amount of service you may receive.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-1030 What are individual technical assistance services?
Individualized technical assistance service is assessment and consultation ((to)) with the employment provider and/or client to identify and address existing barriers to employment. This is in addition to supports received through supported employment services or pre-vocational services for individuals who have not yet achieved their employment goal.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-1035 Who are qualified providers of individualized technical assistance services?
Providers of individualized technical assistance service must be a county or an individual or agency contracted with a county or ((DDD)) DDA.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-1040 Are there limits to the individualized technical assistance services I can receive?
(1) Individualized technical assistance service cannot exceed ((six)) three months in an individual's plan year. (2) These services are available on the ((Basic,)) Basic Plus, Core and Community Protection Waivers. (3) Individual must be receiving supported employment or pre-vocational services. (4) ((The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of supported employment service you may receive)) Services are limited to additional hours per WACs 388-828-9355 and 388-828-9360.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-1100 What are behavioral health crisis diversion bed services?
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 or state operated 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)) DDA as behavioral health stabilization services in accordance with WAC 388-845-1150 through 388-845-1160.
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)) DDA certified residential agencies per chapter 388-101 WAC; ((or)) (2) Other department licensed or certified agencies; or (3) State operated agency.
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)) behavioral health professional and/or ((DDD)) DDA. (2) These services are available in the ((Basic,)) CIIBS, Basic Plus, Core, and Community Protection waivers administered by ((DDD)) DDA 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 waiver((s)).
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)) behavioral health crisis or meet criteria for enhanced respite or community crisis stabilization services. These services are available in the ((Basic,)) Basic Plus, Core, CIIBS and Community Protection waivers to ((adults)) individuals determined by ((mental)) behavioral health professionals or ((DDD)) DDA to be at risk of institutionalization ((in a psychiatric hospital without)) or hospitalization who need one ((of)) or more of the following services: (1) Behavior ((management)) support and consultation; (2) Specialized psychiatric services; or (3) ((Mental)) Behavioral health crisis diversion bed services.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-1160 Are there limitations to the behavioral health stabilization services that I can receive?
(1) 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)) behavioral health professional and/or ((DDD)) DDA. (2) The costs of behavioral health stabilization services do not count toward the dollar limitations for aggregate services in the ((Basic and)) Basic Plus waiver. (3) Behavioral health stabilization services require prior approval by ((DDD)) DDA or its designee.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1175 Who is a qualified provider of nurse delegation?
Providers of nurse delegation are registered nurses contracted with ((DDD)) DDA to provide this service or employed by a nursing agency contracted with ((DDD)) DDA to provide this service.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1300 What are personal care services?
Personal care services as defined in WAC 388-106-0010 are the provision of assistance with personal care tasks. These services are available in the ((Basic,)) Basic Plus, CIIBS and Core waivers.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-1305 Who are the qualified providers of personal care services?
(1) Qualified providers of personal care services may be individuals or licensed homecare agencies contracted with ((ADSA)) DSHS. (2) All individual providers and homecare agency providers must meet provider qualifications for in-home caregivers in WAC 388-71-0500 through 388-71-0556. (3) Providers of personal care services for adults must comply with the training requirements in these rules governing medicaid personal care providers in WAC ((388-71-05670 through 388-71-05799)) 388-71-0841 through 388-71-1006. Additionally, providers must meet the certification requirements in WAC 388-71-0975 through 388-71-0980 and WAC 246-980-010 through 246-980-990. (4) Natural, step, or adoptive parents can be the personal care provider of their adult child age eighteen or older.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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 388-106 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)) DDA 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)) DSHS.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1400 What are prevocational services?
(1) Prevocational services typically occur in a specialized or segregated setting and include individualized monthly employment related activities in the community. Prevocational services are designed to prepare ((you for)) those interested in gainful employment in an integrated setting through training and skill development. (2) Prevocational services are available in the ((Basic,)) Basic Plus, Core and Community Protection waivers.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-1405 Who are the qualified providers of prevocational services?
Providers of prevocational services must be a county or an individual or agency contracted with a county or ((DDD)) DDA to provide prevocational services.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-1410 Are there limits to the prevocational services I can receive?
The following limitations apply to your receipt of prevocational services: (1) You must be age twenty and graduating from high school prior to your July or August twenty-first birthday, age twenty-one and graduated from high school, or age twenty-two or older to receive prevocational services. (2) New referrals for prevocational services require prior approval by the ((DDD)) DDA regional administrator and county coordinator or their designees. (3) Prevocational services are a time limited step on the pathway toward individual employment and are dependent on your demonstrating steady progress toward gainful employment over time. Your annual ((vocational assessment)) employment plan will include exploration of integrated settings within your next service year. Criteria that would trigger a review of your need for these services include, but are not limited to: (a) Compensation at more than fifty percent of the prevailing wage; (b) Significant progress made toward your defined goals; (c) ((Your expressed interest in competitive employment; and/or (d))) Recommendation by your individual support plan team. (4) You will not be authorized to receive prevocational services in addition to community access services or supported employment services. (5) ((The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of service you may receive. (6))) Your service hours are determined by the assistance you need to reach your employment outcomes as described in WAC 388-828-9325.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-1505 Who are qualified providers of residential habilitation services for the Core waiver?
Providers of residential habilitation services for participants in the Core waiver must be one of the following: (1) Individuals contracted with ((DDD)) DDA to provide residential support as a "companion home" provider; (2) Individuals contracted with ((DDD)) DDA to provide training as an "alternative living provider"; (3) Agencies contracted with ((DDD)) DDA and certified per chapter 388-101 WAC; (4) State-operated living alternatives (SOLA); (5) Licensed and contracted group care homes, foster homes, child placing agencies or staffed residential homes per chapter 388-148 WAC.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-1510 Who are qualified providers of residential habilitation services for the community protection waiver?
Providers of residential habilitation services for participants of the community protection waiver are limited to state operated living alternatives (SOLA) and supported living providers who are contracted with ((DDD)) DDA and certified under chapter 388-101 WAC as a residential community protection provider intensive supported living services (CP-ISLS).
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-1515 Are there limits to the residential habilitation services I can receive?
(1) You may only receive one type of residential habilitation service at a time. (2) None of the following can be paid for under the CORE or community protection waiver: (a) Room and board; (b) The cost of building maintenance, upkeep, improvement, modifications or adaptations required to assure the health and safety of residents, or to meet the requirements of the applicable life safety code; (c) Activities or supervision already being paid for by another source; (d) Services provided in your parent's home unless you are receiving alternative living services for a maximum of six months to transition you from your parent's home into your own home. (3) Alternative living services in the CORE waiver cannot: (a) Exceed forty hours per month; (b) Provide personal care or protective supervision. (4) The following persons cannot be paid providers for your service: (a) Your spouse; (b) Your natural, step, or adoptive parents if you are a child age seventeen or younger; (c) Your natural, step, or adoptive parent unless your parent is certified as a residential agency per chapter 388-101 WAC or is employed by a certified or licensed agency qualified to provide residential habilitation services. (5) The initial authorization of residential habilitation services requires prior approval by the ((DDD)) DDA regional administrator or designee.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-1600 What is respite care?
Respite care is short-term intermittent relief for persons who normally provide care for and live with you. This service is available in the ((Basic,)) Basic Plus, CIIBS, and Core waivers.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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 person living with you is contracted by ((ADSA)) DSHS to provide you with a service; or (2) You are age eighteen or older and: (a) You live with your natural, step or adoptive parent(s) who is also contracted by ((ADSA)) DSHS to provide you with a service; and (b) No one else living with you is contracted by ((ADSA)) DSHS 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 (b) There is a person living with you who is contracted by ((ADSA)) DSHS to provide you with a service; or (4) You live with a caregiver who is paid by ((DDD)) DDA to provide supports as: (a) A contracted companion home provider; or (b) A licensed children's foster home provider.
Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings. AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) he or she is not the person who normally provides care for you and is not contracted to provide any other DSHS paid service to you.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) DDA certified group home; (e) Licensed 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.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) DDA 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 homes; (5) Licensed and contracted adult residential care ((facility)) facilities; (6) Licensed and contracted adult residential treatment ((facility)) facilities under chapter 246-337 WAC; (7) Licensed child care centers under chapter 170-295 WAC; (8) Licensed child day care centers under chapter 170-295 WAC; (9) Adult day care providers under chapter 388-71 WAC contracted with ((DDD)) DDA; (10) Certified provider under chapter 388-101 WAC when respite is provided within the ((DDD)) DDA contract for certified residential services; or (11) Other ((DDD)) DDA contracted providers such as community center, senior center, parks and recreation, summer programs((, adult day care)).
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) DDA assessment will determine how much respite you can receive per chapter 388-828 WAC. (2) Respite cannot replace: (a) Day care while your parent or guardian is at work; and/or (b) Personal care hours available to you. When determining your unmet need, ((DDD)) DDA will first consider the personal care hours available to you. (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. (4) Your caregiver may not provide ((DDD)) DDA services for you or other persons during your respite care hours. (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)) DDA 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.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1650 What are sexual deviancy evaluations?
(1) Sexual deviancy evaluations: (a) Are professional evaluations that assess the person's needs and the person's level of risk of sexual offending or sexual recidivism; (b) Determine the need for psychological, medical or therapeutic services; and (c) Provide treatment recommendations to mitigate any assessed risk. (2) Sexual deviancy evaluations are available in all ((DDD)) DDA HCBS waivers.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-1655 Who is a qualified provider of sexual deviancy evaluations?
The provider of sexual deviancy evaluations must: (1) Be a certified sexual offender treatment provider (SOTP); and (2) Meet the standards contained in WAC 246-930-030 (education required prior to ((examination)) certification) and WAC 246-930-040 (professional experience required prior to examination).
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-1660 Are there limitations to the sexual deviancy evaluations I can receive?
(1) Sexual deviancy evaluations must meet the standards contained in WAC 246-930-320. (2) Sexual deviancy evaluations require prior approval by the ((DDD)) DDA regional administrator or designee. (3) The costs of sexual deviancy evaluations do not count toward the dollar limits for aggregate services in the ((Basic or)) Basic Plus waivers.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-1705 Who is a qualified provider of skilled nursing services?
The provider of skilled nursing services must be a licensed practical nurse (LPN) or registered nurse (RN) acting within the scope of the ((Nurse Practice Act)) Standards of Nursing Conduct or Practice chapter ((246-845)) 246-700 WAC and contracted with ((DDD)) DDA to provide this service.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) DDA regional administrator or designee. (2) ((DDD)) DDA and the treating professional determine the need for and amount of service. (3) ((DDD)) DDA 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 limits the amount of skilled nursing services ((unless provided as a behavioral health stabilization service)) you may receive.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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 and medical supplies are defined in WAC 182-543-1000 and ((182-543-2800)) 182-543-5500 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)) DDA HCBS waivers.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-1805 Who are the qualified providers of specialized medical equipment and supplies?
The provider of specialized medical equipment and supplies must be a medical equipment supplier contracted with ((DDD)) DDA or have a state contract as a Title XIX vendor.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-1810 Are there limitations to my receipt of specialized medical equipment and supplies?
The following limitations apply to your receipt of specialized medical equipment and supplies: (1) Specialized medical equipment and supplies require prior approval by the ((DDD)) DDA regional administrator or designee for each authorization. (2) ((DDD)) DDA reserves the right to require a second opinion by a department-selected provider. (3) Items reimbursed with waiver funds shall be in addition to any medical equipment and supplies furnished under the medicaid state plan. (4) Items must be of direct medical or remedial benefit to the individual and necessary as a result of the individual's disability. (5) Medications, prescribed or nonprescribed, and vitamins are excluded. (6) The dollar limitations for aggregate services in your ((Basic or)) Basic Plus waiver limit the amount of service you may receive.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1845 Who are qualified providers of specialized nutrition and specialized clothing?
(1) Providers of specialized nutrition are: (a) Certified dietitians contracted with ((DDD)) DDA to provide this service or employed by an agency contracted with ((DDD)) DDA to provide this service; and (b) Specialized nutrition vendors contracted with ((DDD)) DDA to provide this service. (2) Providers of specialized clothing are specialized clothing vendors contracted with ((DDD)) DDA to provide this service.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-1850 Are there limitations to my receipt of specialized nutrition and specialized clothing?
(1) The following limitations apply to your receipt of specialized nutrition services: (a) Specialized nutrition may be authorized as a waiver service if the service is not covered by medicaid or private insurance. You must assist the department in determining whether third party payments are available; (b) Services must be safe, effective, and individualized; (c) Services must be ordered by a physician licensed to practice in the state of Washington; (d) Specialized diets must be periodically monitored by a certified dietitian; (e) Specialized nutrition products will not constitute a full nutritional regime unless an enteral diet is the primary source of nutrition; (f) Department coverage of specialized nutrition products is limited to costs that are over and above inherent family food costs; (g) ((DDD)) DDA reserves the right to require a second opinion by a department selected provider; and (h) Prior approval by regional administrator or designee is required. (2) The following limitations apply to your receipt of specialized clothing: (a) Specialized clothing may be authorized as a waiver service if the service is not covered by medicaid or private insurance. You must assist the department in determining whether third party payments are available. (b) The department requires written documentation from an appropriate health professional regarding your need for the service. This recommendation must take into account that the health professional has recently examined you, reviewed your medical records, and conducted an assessment. (c) The department may require a second opinion from a department selected provider that meets the same criteria as subsection (b) of this section. (d) Prior approval by regional administrator or designee is required.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) behavioral health symptoms. These services are available in all ((DDD)) DDA 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 behavioral health stabilization service in accordance with WAC 388-845-1150 through 388-845-1160.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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 behavioral health stabilization service. (3) Specialized psychiatric services require prior approval by the ((DDD)) DDA regional administrator or designee.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) DDA 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 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.
AMENDATORY SECTION (Amending WSR 12-16-095, filed 8/1/12, effective 9/1/12)
WAC 388-845-2005 Who is a qualified provider of staff/family consultation and training?
To provide staff/family consultation and training, a provider must be one of the following licensed, registered or certified professionals and be contracted with ((DDD)) DDA: (1) Audiologist; (2) Licensed practical nurse; (3) Marriage and family therapist; (4) Mental health counselor; (5) Occupational therapist; (6) Physical therapist; (7) Registered nurse; (8) Sex offender treatment provider; (9) Speech/language pathologist; (10) Social worker; (11) Psychologist; (12) Certified American sign language instructor; (13) Nutritionist; (14) Counselors registered or certified in accordance with the requirements of chapter 18.19 RCW; (15) Certified dietician; (16) Recreation therapist registered in Washington and certified by the National Council for Therapeutic Recreation; (17) Providers listed in WAC 388-845-0506 and contracted with ((DDD)) DDA to provide CIIBS intensive services; (18) Certified music therapist (for CIIBS only); or (19) Psychiatrist.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-2010 Are there limitations to the staff/family consultation and training I can receive?
(1) Expenses to the family or provider for room and board or attendance, including registration, at conferences are excluded as a service under staff/family consultation and training. (2) Staff/family consultation and training require prior approval by the ((DDD)) DDA regional administrator or designee. (3) The dollar limitations for aggregate services in your ((Basic or)) Basic Plus waiver limit the amount of service you may receive.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-2100 What are supported employment services?
Supported employment services are for those interested in integrated gainful employment. These services provide you with intensive ongoing support if you need individualized assistance to gain and/or maintain employment. These services are tailored to your individual needs, interests, abilities, and promote your career development. These services are provided in individual or group settings and are available in the ((Basic,)) Basic Plus, Core and Community Protection waivers. (1) Individual supported employment services include activities needed to sustain minimum wage pay or higher. These services are conducted in integrated business environments and include the following: (a) ((Creation of work opportunities through job development)) Intake: an initial meeting to gather and share basic information and a general overview of employment supports, resources in the community and the type of available supports that the individual may receive; (b) ((On-the-job training)) Discovery: a person-centered approach to learn the individual's likes and dislikes, job preferences, employment goals and skills; (c) ((Training for your supervisor and/or peer workers to enable them to serve as natural supports to you on the job)) Job preparation: includes activities of work readiness resume development, work experience, volunteer support transportation training; (d) ((Modification of your work site tasks)) Marketing: a method to identify and negotiate jobs, building relationships with employers and customize employment development; (e) ((Employment retention and follow along support)) Job coaching: the supports needed to keep the job; ((and)) (f) ((Development of career and promotional opportunities)) Job retention: the supports needed to keep the job, maintain relationship with employer, identify opportunities, negotiate a raise in pay, promotion and/or increased benefits. (2) Group supported employment services are a step on your pathway toward gainful employment in an integrated setting and include: (a) ((The activities outlined in individual supported employment services)) Supports and paid training in an integrated business setting; (b) ((Daily)) Supervision by a qualified employment provider during working hours; ((and)) (c) Groupings of no more than eight workers with disabilities; and (d) Individualized supports to obtain gainful employment.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-2105 Who are qualified providers of supported employment services?
Providers of supported employment services ((providers)) must be a county, or ((agencies)) agency or ((individuals)) an individual contracted with a county or ((DDD)) DDA.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-2110 Are there limits to the supported employment services I can receive?
The following limitations apply to your receipt of supported employment services: (1) You must be age twenty and graduating from high school prior to your July or August twenty-first birthday, age twenty-one and graduated from high school, or age twenty-two or older to receive supported employment services. (2) Payment will be made only for the employment support you require as a result of your disabilities. (3) Payment for individual supported employment excludes the supervisory activities rendered as a normal part of the business setting. (4) You will not be authorized to receive supported employment services in addition to community access or prevocational services. (5) ((The dollar limitations for employment/day program services in your Basic or Basic Plus waiver limit the amount of supported employment service you may receive. (6))) Your service hours are determined by the assistance you need to reach your employment outcomes as described in WAC 388-828-9325 and might not equal the number of hours you spend on the job or in job related activities.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-2160 What is therapeutic equipment and supplies?
(1) Therapeutic equipment and supplies are only available in the CIIBS waiver. (2) Therapeutic equipment and supplies are equipment and supplies that are ((incorporated in)) necessary to implement a behavioral support plan or other therapeutic plan, designed by an appropriate professional, such as a sensory integration or communication therapy plan, and necessary in order to fully implement the therapy or intervention. (3) Included are items such as a weighted blanket, supplies that assist to calm or redirect the child to a constructive activity, or a vestibular swing.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-2165 Who are qualified providers of therapeutic equipment and supplies?
Providers of therapeutic equipment and supplies are therapeutic equipment and supply vendors contracted with ((DDD)) DDA to provide this service.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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 individual support plan. This service is available in all ((DDD)) DDA 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 individual support plan. (2) Whenever possible, you must use family, neighbors, friends, or community agencies that can provide this service without charge.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-2205 Who is qualified to provide transportation services?
(1) The provider of transportation services can be an individual or agency contracted with ((DDD)) DDA whose contract includes transportation in the statement of work.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-2210 Are there limitations to the transportation services I can receive?
The following limitations apply to transportation services: (1) Transportation to/from medical or medically related appointments is a medicaid transportation service and is to be considered and used first. (2) Transportation is offered in addition to medical transportation but cannot replace medicaid transportation services. (3) Transportation is limited to travel to and from a waiver service. (4) Transportation does not include the purchase of a bus pass. (5) Reimbursement for provider mileage requires prior approval by ((DDD)) DDA and is paid according to contract. (6) This service does not cover the purchase or lease of vehicles. (7) Reimbursement for provider travel time is not included in this service. (8) Reimbursement to the provider is limited to transportation that occurs when you are with the provider. (9) You are not eligible for transportation services if the cost and responsibility for transportation is already included in your provider's contract and payment. (10) The dollar limitations for aggregate services in your ((Basic or)) Basic Plus waiver limit the amount of service you may receive. (11) Transportation services require prior approval by the ((DDD)) DDA regional administrator or designee. (12) If your individual personal care provider uses his/her own vehicle to provide transportation to you for essential shopping and medical appointments as a part of your personal care service, your provider may receive up to sixty miles per month in mileage reimbursement. If you work with more than one individual personal care provider, your limit is still a total of sixty miles per month. This cost is not counted toward the dollar limitation for aggregate services in the ((Basic or)) Basic Plus waiver.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-2265 Who are providers of vehicle modifications?
Providers of vehicle modifications are: (1) Vehicle service providers contracted with ((DDD)) DDA to provide this service; or (2) Vehicle adaptive equipment vendors contracted with ((DDD)) DDA to provide this service.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-2270 Are there limitations to my receipt of vehicle modification services?
The following limitations apply to your receipt of vehicle modifications under the CIIBS waiver: (1) Prior approval by the regional administrator or designee is required. (2) Vehicle modifications are excluded if they are of general utility without direct medical or remedial benefit to the individual. (3) Vehicle modifications must be the most cost effective modification based upon a comparison of contractor bids as determined by ((DDD)) DDA. (4) Modifications will only be approved for a vehicle that serves as the participant's primary means of transportation and is owned by the family. (5) The department requires your treating professional's written recommendation regarding your need for the service. This recommendation must take into account that the treating professional has recently examined you, reviewed your medical records, and conducted a functional evaluation. (6) The department may require a second opinion from a department selected provider that meets the same criteria as subsection (5) of this section.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-3000 What is the process for determining the services I need?
Your service needs are determined through the ((DDD)) DDA 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/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)) DDA assessment will determine the amount of respite care available to you. (2) From the assessment, ((DDD)) DDA develops your waiver 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.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-3055 What is a waiver individual support plan (ISP)?
(1) The individual support plan (ISP) is the primary tool ((DDD)) DDA uses to determine and document your needs and to identify the services to meet those needs. (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.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-3056 What if I need assistance to understand my individual support plan?
If you are unable to understand your 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)) DDA 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 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)) DDA will continue to try to provide necessary supplemental accommodations in order to help you understand your individual support plan.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-3060 When is my individual support plan effective?
Your individual support plan is effective the last day of the month in which ((DDD)) DDA signs it after a signature or consent is obtained.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-3061 Can a change in my individual support plan be effective before I sign it?
If you verbally request a change in service to occur immediately, ((DDD)) DDA can sign the individual support plan and approve it prior to receiving your signature. (1) Your individual support plan will be mailed to you for signature. (2) You retain the same appeal rights as if you had signed the individual support plan.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-3062 Who is required to sign or give verbal consent to the individual support plan?
(1) If you do not have a legal representative, you must sign or give verbal consent to the individual support plan. (2) If you have a legal representative, your legal representative must sign or give verbal consent to the individual support plan. (3) If you need assistance to understand your individual support plan, ((DDD)) DDA will follow the steps outlined in WAC 388-845-3056 (1) and (3).
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-3063 Can my individual support plan be effective before the end of the month?
You may request to ((DDD)) DDA to have your individual support plan effective prior to the end of the month. The effective date will be the date ((DDD)) DDA signs it after receiving your signature or verbal consent.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-3070 What happens if I do not sign or verbally consent to my individual support plan (ISP)?
If ((DDD)) DDA is unable to obtain the necessary signature or verbal consent for an initial, reassessment or review of your individual support plan (ISP), ((DDD)) DDA will take one or more of the following actions: (1) If this individual support plan is an initial plan, ((DDD)) DDA will be unable to provide waiver services. ((DDD)) DDA 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)) DDA will continue providing services as identified in your most current 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)) DDA 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)) DDA 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.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-3075 What if my needs change?
You may request a review of your individual support plan at any time by calling your case manager. If there is a significant change in your condition or circumstances, ((DDD)) DDA must reassess your 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 individual support plan.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) DDA 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)) assistance up to six thousand dollars per year if your needs meet the definition of emergency ((services)) assistance in WAC 388-845-0800. (2) If emergency ((services)) assistance 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/ID. (3) If none of the options in subsections (1) and (2) above is successful in meeting your health and welfare needs, ((DDD)) DDA may terminate your waiver eligibility. (4) If you are terminated from a waiver, you will remain eligible for nonwaiver ((DDD)) DDA services but access to state-only funded ((DDD)) DDA services is limited by availability of funding.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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)) DDA 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/ID. (2) If none of the above options is successful in meeting your health and welfare needs, ((DDD)) DDA may terminate your waiver eligibility. (3) If you are terminated from a waiver, you will remain eligible for nonwaiver ((DDD)) DDA services but access to state-only funded ((DDD)) DDA services is limited by availability of funding.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-3090 What if my identified health and welfare needs are less than what is provided in my current waiver?
If your identified health and welfare needs are less than what is provided in your current waiver, ((DDD)) DDA may terminate you from your current waiver and enroll you in a waiver that meets but does not exceed your assessed need for waiver services.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-3095 Will I have to pay toward the cost of waiver services?
(1) You are required to pay toward board and room costs if you live in a licensed facility or in a companion home as room and board is not considered to be a waiver service. (2) You will not be required to pay towards the cost of your waiver services if you receive SSI. (3) You may be required to pay towards the cost of your waiver services if you do not receive SSI. ((DDD)) DDA determines what amount, if any, you pay in accordance with WAC ((388-515-1510)) 182-515-1510.
AMENDATORY SECTION (Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
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/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)) DDA'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)) DDA'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)) DDA 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)) DDA determines there is not capacity to enroll you on a different waiver.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-4010 How do I appeal a department action?
(1) Your rights to appeal a department decision are in RCW 71A.10.050 and WAC 388-825-120 and are limited to an applicant, recipient, or former recipient of services from the ((division of developmental disabilities)) DDA. (2) If you want to appeal a department action, you must request an appeal within ninety days from receipt of the department notice of the action you are disputing.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-4015 Will my services continue during an appeal?
Services may continue according to the provisions contained in WAC 388-825-145.
REPEALER
The following section of the Washington Administrative Code is repealed:
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