WSR 24-13-094
PERMANENT RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Economic Services Administration)
[Filed June 18, 2024, 9:34 a.m., effective July 19, 2024]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The department of social and health services is adopting amendments to WAC 388-449-0015 What medical evidence do I need to provide? These amendments streamline medical evidence rules for the aged, blind or disabled cash assistance program to allow functional medical evidence to be obtained within 90 days from the date of disability review.
Citation of Rules Affected by this Order: Amending WAC 388-449-0015.
Statutory Authority for Adoption: RCW 74.04.005, 74.04.0052, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.08.043, 74.08.090, 74.08.335, and 74.08A.100.
Adopted under notice filed as WSR 24-10-071 on April 29, 2024.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: June 18, 2024.
Katherine I. Vasquez
Rules Coordinator
SHS-5029.3
AMENDATORY SECTION(Amending WSR 12-10-042, filed 4/27/12, effective 6/1/12)
WAC 388-449-0015What medical evidence do I need to provide?
You must give us medical evidence of your impairment(s) and how they affect your ability to perform regular and continuous work activity. Medical evidence must be in writing and be clear, objective, and complete.
(1) Objective evidence for physical impairments means:
(a) Laboratory test results;
(b) Pathology reports;
(c) Radiology findings including results of X-rays and computer imaging scans;
(d) Clinical findings, including but not limited to ranges of joint motion, blood pressure, temperature or pulse, and documentation of a physical examination; and
(e) Hospital history and physical reports and admission and discharge summaries; or
(f) Other medical history and physical reports related to your current impairments.
(2) Objective evidence for mental impairments means:
(a) Clinical interview observations, including objective mental status exam results and interpretation((.));
(b) Explanation of how examination findings meet the clinical and diagnostic criteria of the most recent edition of the diagnostic and statistical manual of mental disorders (DSM)((.));
(c) Hospital, outpatient, and other treatment records related to your current impairments((.)); and
(d) Testing results, if any, including:
(i) Description and interpretation of tests of memory, concentration, cognition, or intelligence; or
(ii) Interpretation of medical tests to identify or exclude a connection between the mental impairment and physical illness.
(3) Medical evidence sufficient for a disability determination must be from a medical professional described in WAC 388-449-0010 and must include:
(a) A diagnosis for the impairment, or impairments, based on an examination performed by an acceptable medical source defined in WAC 388-449-0010 within five years of application;
(b) A clear description of how the impairment relates to your ability to perform the work-related activities listed in WAC 388-449-0005;
(c) Documentation of how long a condition has impaired your ability to perform work related activities;
(d) A prognosis, or written statement of how long an impairment will impair your ability to perform work related activities; and
(e) A written statement from a medical professional (defined in WAC 388-449-0010) describing what you are capable of doing despite your impairment (medical source statement) based on an examination performed within ((ninety))90 days of the date of application or ((forty-five days before the month of)) disability review.
(4) We consider documentation in addition to objective evidence to support the acceptable medical source or treating provider's opinion that you are unable to perform substantial gainful employment, such as proof of hospitalization.
(5) When making a disability decision, we don't use your report of symptoms as evidence unless objective evidence shows there is an impairment that could reasonably be expected to produce those symptoms.
(6) We don't use symptoms related to substance ((abuse))use disorder or a diagnosis of ((chemical dependency))substance use disorder when determining disability if we have evidence substance use is material to your impairment(s).
(7) We consider substance use to be material to your impairment(s) if you are disabled primarily because of ((drug or alcohol abuse or addiction))a substance use disorder.
(8) If your impairment will persist at least ((sixty))60 days after you stop using drugs or alcohol, we do not consider substance use to be material to your impairment.
(9) If you can't obtain medical evidence sufficient for us to determine if you are likely to be disabled without cost to you, and you meet the other eligibility conditions in WAC 388-400-0060, we pay the costs to obtain objective evidence based on published payment limits and fee schedules.
(10) We determine the likelihood of disability based solely on the objective information we receive. We are not obligated to accept another agency's or person's decision that you are disabled or unemployable.