SOCIAL AND HEALTH SERVICES
(Health and Rehabilitative Services)
Date of Adoption: February 1, 1999.
Purpose: Pilot rules have been in existence since 1996. Because the program has been operating successfully as a pilot, rules for the family support opportunity are now being adopted permanently. These rules cover the purpose, eligibility, and basic service elements of the program as well as the formation of regional family support advisory councils and community service grants. The rules state that all family support clients starting June 1996 or later will be covered under these rules.
Citation of Existing Rules Affected by this Order: Amending WAC 275-27-020.
Statutory Authority for Adoption: RCW 71A.12.030.
Adopted under notice filed as WSR 98-23-095 on November 18, 1998.
Changes Other than Editing from Proposed to Adopted Version: Based on comments at the public hearing and other written comments received, the following changes were made: In WAC 275-27-196, the age for approval of diapers was lowered from four to three; goals were enlarged for community service grants in WAC 275-27-192; "long-term funding" was added to the description of serious need; and the families' role in the use of community guides was clarified in WAC 275-27-191 and 275-27-190. Subsection (2)(b) was deleted from WAC 275-27-200.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 18, Amended 1, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 18, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 18, Amended 1, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0. Effective Date of Rule: Thirty-one days after filing.
February 1, 1999
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit2516.4
(1))) "Adolescent" means a
DDD eligible child age thirteen through seventeen years.
(2))) "Best interest" includes, but is not limited to,
client-centered benefits to:
(a))) (1) Prevent regression or loss of skills already
(b))) (2) Achieve or maintain economic self-support;
(c))) (3) Achieve or maintain self-sufficiency;
(d))) (4) Prevent or remedy neglect, abuse, or
exploitation of individuals unable to protect their own interest;
(e))) (5) Preserve or reunite families; and
(f))) (6) Provide the least-restrictive setting that will
meet the person's medical and personal needs.
(3))) "Client or person" means a person the division
determines under RCW 71A.16.040 and WAC 275-27-026 eligible for
(4))) "Community support services" means one or more of
the services listed in RCW 71A.12.040 including, but not limited
to the following services: Architectural, case management, early
childhood intervention, employment, counseling, family support,
respite care, information and referral, health services and
equipment, therapy services, and residential support.
(5))) "Department" means the department of social and
health services of the state of Washington.
(6))) "Director" means the director of the division of
(7))) "Division or DDD" means the division of
developmental disabilities of the department of social and health
(8))) "Emergency" means a sudden, unexpected occurrence
demanding immediate action.
(9))) "Exemption" means the department's approval of a
written request for an exception to a rule in this chapter.
(10))) "Family” means individuals, of any age, living
together in the same household and related by blood, marriage,
adoption or as a result of sharing legal custody of a minor
"Family resources coordinator” means the person who is:
(1) Recognized by the IDEA Part C lead agency; and
(2) Responsible for:
(a) Providing family resources coordination;
(b) Coordinating services across agencies; and
(c) Serving as a single contact to help families receiving assistance and services for their eligible children who are under three years of age.
"ICF/MR" means a facility certified as an intermediate care facility for the mentally retarded by Title XIX to provide services to the mentally retarded or persons with related conditions.
(11))) "ICF/MR Eligible" for admission to an ICF/MR means
a person is determined by DDD as needing active treatment as
defined in CFR 483.440. Active treatment requires:
(a))) (1) Twenty-four hour supervision; and
(b))) (2) Continuous training and physical assistance in
order to function on a daily basis due to deficits in the
following areas: Toilet training, personal hygiene, dental
hygiene, self-feeding, bathing, dressing, grooming, and
(12))) "Individual" means a person applying for services
from the division.
(13))) "Intelligence quotient score" means a full scale
score on the Wechsler, or the intelligence quotient score on the
Stanford-Binet or the Leiter International Performance Scale.
(14))) "Nonresidential programs" means programs including,
but not limited to, county-funded habilitation services.
(15))) "Nursing facility eligible" means a person is
assessed by DDD as meeting the requirements for admission to a
licensed nursing home as defined in WAC 388-97-235. The person
must require twenty-four hour care provided by or under the
supervision of a licensed nurse.
(16))) "Other resources” means resources that may be
available to the client, including but not limited to:
(1) Private insurance;
(3) Indian health care;
(4) Public school services through the office of the superintendent of public instruction; and
(5) Services through the department of health.
"Part C” means early intervention for children from birth through thirty-five months of age as defined in the Individuals with Disabilities Education Act (IDEA), Part C and 34 CFR, Part 303 and Washington’s federally approved grant.
"Residential habilitation center" or "RHC" means a state-operated facility certified to provide ICF/MR and/or nursing facility level of care for persons with developmental disabilities.
(17))) "RHC capacity" means the maximum number of eligible
persons that can reside in a residential habilitation center
without exceeding its 1997 legislated budgeted capacity.
(18))) "Residential programs" means programs providing
domiciliary care or other residential services, including, but
not limited to, state residential facilities, group homes,
nursing facilities, ICF/MRs, tenant support services, congregate
care facilities, boarding homes, children's foster homes, adult
family homes, and group training homes.
(19))) "Respite care" means temporary residential services
provided to a person and/or the person's family on an emergency
or planned basis.
(20))) "Secretary" means the secretary of the department
of social and health services or the secretary's designee.
(21))) "Vacancy" means an opening at a RHC, which when
filled, would not require the RHC to exceed its 1997 biannually
budgeted capacity, minus:
(a))) (1) Twenty-six beds designated for respite care use;
(b))) (2) Any downsizing related to negotiations with the
Department of Justice regarding community placements.
[Statutory Authority: RCW 74.12A.030 and 71A.16.030. 98-20-044, § 275-27-020, filed 9/30/98, effective 10/7/98. Statutory Authority: RCW 71A.14.030 and 71A.16.020. 92-09-115 (Order 3373), § 275-27-020, filed 4/21/92, effective 5/22/92. Statutory Authority: RCW 71A.16.020. 91-17-005 (Order 3230), § 275-27-020, filed 8/9/91, effective 9/9/91. Statutory Authority: RCW 71.20.070. 89-06-049 (Order 2767), § 275-27-020, filed 2/28/89; 84-15-058 (Order 2124), § 275-27-020, filed 7/18/84. Statutory Authority: RCW 72.01.090, 72.33.040, 72.33.125 and 72.33.165. 78-04-033 (Order 1280), § 275-27-020, filed 3/16/78; Order 1143, § 275-27-020, filed 8/11/76.]
The purpose of the family support opportunity program is to:
(1) Strengthen family functioning through use of the program elements;
(2) Provide a wide range of supports that will assist and stabilize families;
(3) Encourage individuals and local communities to provide support for the persons with developmental disabilities that live with families;
(4) Complement other public and private resources in providing supports;
(5) Recognize the ability of communities to participate in a variety of ways;
(6) Allow families to make use of all program elements according to the individual and family needs; and
(7) Provide assistance to as many families as possible.
(1) All individuals living with their families determined to be developmentally disabled according to WAC 275-27-026 are eligible to participate in the program if their family requires assistance in meeting their needs. However, the program will fund or provide support services only as funding is available.
(2) Persons currently receiving services under WAC 275-27-220 and 275-27-223, Family support services, may volunteer to participate in the program.
(3) Families will receive program services based on the date of application.
A number of basic services are available. Some services have their own eligibility requirements. Specific services are:
(1) Case management services: Your family will benefit from case management services. The family and the case manager will develop a family support plan which includes needs assessment, referral, service coordination, service authorization, case monitoring and coordination for community guide services.
(2) Community guide services: Once your case manager assesses your family situation, you will be offered access to the services of a community guide. The community guide will assist your family in using the natural and informal community supports relevant to the age of your family member with developmental disabilities and the specific needs of your family. Community guide services will support your family and help develop connections to your community.
(3) Short-term intervention services: Your family may be eligible for up to eleven hundred dollars in short-term intervention funding if necessary services are not otherwise available. This funding is not intended to cover basic subsistence such as food or shelter costs. Short-term intervention funding is available only for those specialized costs directly related to and resulting from your child's disability.
(4) Personal care services: Medicaid personal care can provide your family with long-term in-home personal assistance. (See WAC 388-15-880 and 388-15-890.) In home personal assistance may be available through Medicaid personal care or through a state-funded alternative.
(5) Community alternatives program (CAP) waiver: If eligible, your family may participate in the CAP waiver program. The CAP waiver gives eligible clients the opportunity to participate in the federal Medicaid program and DDD the opportunity to obtain federal funds for community based services. (See WAC 275-27-800, 275-27-810 and 275-27-820.)
(6) Early intervention services: These services are for your children (from birth through thirty-five months old) and include early childhood programs, birth through two public school programs, children with special health care needs programs, and Part C services (IDEA).
(7) Emergency services: Your family can request emergency funds to be used to respond to a single incident, situation or short term crisis such as care giver hospitalization, absence, or incapacity. Your request must be made through your case manager and include an explanation of how you plan to resolve the emergency situation. Your request will be reviewed by the regional administrator or designee. If approved, you will receive emergency services for a limited time period, not to exceed two months.
(8) Serious need services: Your family may request serious need funds to take care of needs not met by other basic services, including short-term intervention services, personal care services or use of a community guide. Serious need funds are short or long-term funds used to provide additional support to allow the individual with disabilities to continue living at home.
(1) Community guide services are available to support your family and help you become well connected to resources or supports in your community. After an assessment, your case manager will give you information about a community guide, whose services can be used, if desired by the family.
(2) This guide will assist your family in using the natural and informal community supports relevant to the age of your child with developmental disabilities and your family's specific needs.
To be a guide, a person must demonstrate his/her connections to the informal structures of their community. The department may contract with an individual, agency or organization. Guides must be knowledgeable about resources in their community and comfortable assisting families and persons with developmental disabilities. DDD will provide appropriate training for community guides within available resources.
Your family will be offered a choice of community guides that best meets the needs of your family. At your family's discretion, your family resources coordinator may serve as your community guide if your developmentally disabled child is thirty-five months of age or younger.
The program will authorize up to two hundred dollars per year for community guide services for your family.
If your family is eligible, you may receive up to eleven hundred dollars per year in short-term intervention funds to pay for necessary services not otherwise available. Short-term intervention funding cannot be used for basic subsistence such as food or shelter but is available for those specialized costs directly related to and resulting from your child's disability. Short-term intervention funds can be authorized for a one-time only need or for an episodic service need that occurs over a one-year period.
Short-term intervention funds can be used to purchase a wide range of services and supports, such as:
(1) Respite care, including community activities providing respite, attendant care or nursing care;
(2) Training such as parenting classes and supports such as disability related support groups;
(3) The purchase, rental, loan or refurbishment of specialized equipment, adaptive equipment or supplies not covered by other resources, including Medicaid. Specific examples are mobility devices such as walkers and wheelchairs, communication devices and medical supplies. Diapers may be approved only for those three years of age and older.
(4) Environmental modifications including home damage repairs caused by the client and home modifications made necessary because of a family member's disability;
(5) Occupational therapy, physical therapy, communication therapy, behavior management, visual and auditory services, or counseling needed by developmentally disabled individuals but not covered by another resource such as public schools and child development services funding;
(6) Medical/dental services not covered by any other resource. These services may include the payment of insurance premiums and deductibles but are limited to the portion of the premium or deduction that applies to the client.
(7) Nursing services, not covered by another resource, that cannot be provided by an unlicensed care giver but can only be rendered by a registered or licensed practical nurse. Examples of such services are ventilation, catheterization, and insulin shots;
(8) Special formulas or specially prepared foods necessary because of the client's disability;
(9) Parent/family counseling for grief and loss issues, genetic counseling or behavior management;
(10) Specialized clothing adapted for a physical disability, excessive wear clothing, or specialized footwear;
(11) Specialized utility costs including extraordinary utility costs resulting from the client's disability or medical condition;
(12) If another resource is not available, transportation costs, including gas, ferry or transit cost, so a client can receive essential services and maintain appointments; per diem costs may be reimbursed for medical appointments; and
(13) Other services approved by a DDD regional administrator or designee, according to established department guidelines.
Your family may need extraordinary support for children or adults with developmental disabilities living in your home in addition to the basic family support services. The purpose of serious need funds is to help you get that support when you need it. If funding is available, it may be short or long-term in nature and can be used for services such as additional personal care, respite care, behavior management and licensed nursing care.
Your family may qualify for serious need funds if the following conditions are met:
(1) The basic program services outlined in WAC 275-27-190 (community guide, personal care services, short-term intervention services, etc.) are currently being used by your family or they have been exhausted;
(2) You and your case manager have examined other resources like the medically intensive home care program; private insurance, local mental health programs and programs available through the public schools and have found them either unavailable, inappropriate or insufficient for your needs; and
(3) The support is crucial for the child or adult with developmental disabilities to continue living in your home.
You must contact your case manager who will submit a written request to the appropriate DDD regional administrator. The request must:
(1) Indicate the type of services your family needs;
(2) Explain why those services can only be obtained through the use of serious need funds;
(3) Outline the changes you anticipate in your family situation if the requested services are not received;
(4) Estimate the length of time your family will need the requested services; and
(5) Propose funding review dates.
(1) The maximum amount of funding available is four hundred dollars per month or two thousand four hundred dollars in a six-month period, unless the department determines your family member requires licensed nursing care and the funding is used to pay for nursing care. If licensed care is required, the maximum funding level is two thousand four hundred dollars per month.
(a) Funding must be available in order to receive serious need services.
(b) Services paid for by serious needs funds will be reviewed by DDD every six months.
Your family and your case manager determine what services your family needs. The department has final approval over service authorization.
(1) All family support service payments must be authorized by the department.
(2) The department may contract directly with:
(a) A service provider, or
(b) A parent for the reimbursement of goods or services purchased by the parent, or
(c) An agency to purchase goods and services on behalf of a client.
(3) The department's authorization period will start when you agree to be in this program. The period will last one year and may be renewed if you continue to need services.
(1) Each division of developmental disabilities regional administrator must appoint a family support advisory council which may serve as a subcommittee of the regional advisory council. The membership of the family support advisory council must include at least one parent representative and at least one case manager.
(2) The purpose of these family support advisory councils is to advise the regional administrator regarding:
(a) Family support issues;
(b) Guidelines for approving or denying short term intervention requests;
(c) Community needs; and
(d) Recommendations for community service grants.
(3) Family support advisory councils must meet at least twice a year.
(1) Community service grants are funded by the division of developmental disabilities family support program to promote community oriented projects that benefit families. Community service grants may fund long-term or short-term projects that benefit children and/or adults.
Agencies or individuals may apply for funding. The department will announce the availability of funding.
(2) To qualify for funding, a proposed project must address one or more of the following topics:
(a) Provider support and development;
(b) Parent helping parent; or
(c) Community resource development for inclusion of all.
(3) Goals for community service projects are as follows:
(a) Enable families to use generic resources;
(b) Reflect geographic, cultural and other local differences;
(c) Support families in a variety of noncrisis-oriented ways;
(d) Prioritize support for unserved families;
(e) Address the diverse needs of Native Americans, communities of color and limited or non-English speaking groups;
(f) Be family focused;
(g) Increase inclusion of persons with developmental disabilities;
(h) Benefit families who have children or adults eligible for services from DDD; and
(i) Promote community collaboration, joint funding, planning and decision making.
(4) Decisions to approve or reject community service grant requests are made by DDD regional administrators considering the recommendations of their regional family support advisory councils. The DDD director has the discretion to award community service grants that have statewide significance.
(5) DDD may sponsor two family support conferences in different areas of the state each year. The purpose of these conferences is to discuss areas addressed by community service grants and other issues of importance to families.
These sections (WAC 275-27-180 through 275-27-212) apply to persons enrolled in family support after June 1996. Those enrolled before June 1996 are covered under WAC 275-27-220 through 275-27-223.