SOCIAL AND HEALTH SERVICES
(Economic Services Administration)
Preproposal statement of inquiry was filed as WSR 08-13-048.
Title of Rule and Other Identifying Information: The community services division is proposing to amend WAC 388-448-0030 What medical evidence do I need to provide? and 388-448-0040 Progressive evaluation process (PEP) step I -- Review of medical evidence required for eligibility determination.
Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on October 21, 2008, at 10:00 a.m.
Date of Intended Adoption: Not earlier than October 22, 2008.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail firstname.lastname@example.org, fax (360) 664-6185, by 5 p.m. on October 21, 2008.
Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by October 14, 2008,
TTY (360) 664-6178 or (360) 664-6094 or by e-mail at email@example.com.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is proposing amendments to the description of medical evidence requirements needed to determine incapacity.
Reasons Supporting Proposal: These changes are needed to clarify and align the medical evidence rules with the intent of RCW 74.04.005.
Statutory Authority for Adoption: RCW 74.08.090, 74.04.005, 74.04.050, 74.04.055, 74.04.057.
Statute Being Implemented: RCW 74.08.090, 74.04.005, 74.04.050, 74.04.055, 74.04.057.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of social and health services, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Melissa Mathson, 712 Pear Street S.E., Olympia, WA 98503, (360) 725-4563.
No small business economic impact statement has been prepared under chapter 19.85 RCW. These proposed rules do not have an economic impact on small businesses. The proposed amendments only affect DSHS clients by clarifying the description of medical evidence requirements to determine incapacity.
A cost-benefit analysis is not required under RCW 34.05.328. These amendments are exempt as allowed under RCW 34.05.328 (5)(b)(vii) which states in-part, "[t]his section does not apply to...rules of the department of social and health services relating only to client medical or financial eligibility and rules concerning liability for care of dependents."
September 11, 2008
Stephanie E. Schiller
(1) Objective evidence for physical impairments means:
For physical impairment:
(i))) Laboratory test results;
(ii))) (b) Pathology reports;
(iii))) (c) Radiology findings including results of X
rays and computer imaging scans;
(iv))) (d) Clinical finding, including but not limited
to ranges of joint motion, blood pressure, temperature or
pulse(( ;)), and (( observations from)) documentation of a
physical examination; (( or))
(v))) (e) Hospital history and physical reports and
admission and discharge summaries; or
(vi))) (f) Other medical history and physical reports
related to your current impairments.
(b) For mental impairment:
(i) Examination results including:
(A))) (2) Objective evidence for mental impairments means:
(a) Clinical interview observations, including objective mental status exam results and interpretation; and
(B))) (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
(ii))) (c) Hospital, outpatient and other treatment
records related to your current impairments.
(d) Testing results, if any, including:
(A))) (i) Description and interpretation of tests of
memory, concentration, cognition or intelligence; or
(B))) (ii) Interpretation of medical tests to identify
or exclude a connection between the mental impairment and
(2) To be complete, medical evidence)) (3) Medical
records sufficient for an incapacity determination must
(a) A diagnosis for the impairment, or impairments, based on an examination performed by a medical professional described in WAC 388-448-0020 within twelve months of application;
(b) Documentation of how the impairment, or impairments, is currently limiting your ability to work based on an examination:
(i) By a medical professional described in WAC 388-448-0020; and
(ii) Performed within the ninety days of the date of application or the forty-five days before the month of incapacity review.
(c) A clear description of how ((
the)) each impairment
relates to your ability to perform the work-related activities
listed in WAC 388-448-0010(5) (( including signs and
observations of drug or alcohol abuse and whether any
limitations on ability to perform work-related activities
would continue after sixty days of abstinence from use of
drugs or alcohol));
(c))) (d) Facts in addition to objective evidence to
support the medical provider's opinion that you are unable to
be gainfully employed, such as proof of hospitalization(( ; and
(d) Based on an examination done within the ninety days of the date of application or the forty-five days prior to the month of incapacity review)).
(3))) (4) When making an incapacity decision, we do not
use your report of symptoms as evidence unless objective
evidence shows there is an impairment that could reasonably be
expected to produce those symptoms.
(4))) (5) We don't use diagnosis or symptoms of
substance abuse or addiction when determining incapacity.
(6) We may use a diagnosis of a permanent impairment that is the result of substance abuse or addiction.
(7) If you ((
cannot get)) can't obtain medical evidence
of an impairment that prevents you from working without cost
to you, and you meet the eligibility conditions other than
incapacity in WAC 388-400-0025, we pay the costs to obtain
objective evidence based on our published payment limits and
(( designated)) fee schedules.
(5))) (8) We decide incapacity based solely on the
objective information we receive. We are not obligated to
accept a decision that you are incapacitated or unemployable
made by another agency or person.
(9) We can't accept a statement that you are incapacitated from a medical professional unless the statement is supported by objective medical evidence.
[Statutory Authority: RCW 74.08.090, 74.04.005, and 2003 1st sp.s. c 10. 04-07-140, § 388-448-0030, filed 3/22/04, effective 5/1/04. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, § 388-448-0030, filed 8/2/00, effective 9/1/00.]
(1) We require a written medical report to determine incapacity. The report must:
(a) Contain sufficient information as described under WAC 388-448-0030;
(b) Be written by an authorized medical professional described in WAC 388-448-0020;
(c) Document the existence of a potentially incapacitating condition; and
(d) Indicate an impairment is expected to last ninety days or more from the application date.
(2) If the information received ((
is not)) isn't clear,
we may require more information before we decide your ability
to be gainfully employed. As examples, we may require you to
get more medical tests or be examined by a medical specialist.
(3) We deny incapacity ((
(a) There is only one impairment ((
with a)) and the
severity rating is less than three;
(b) A reported impairment ((
is not)) isn't expected to
last ninety days (twelve weeks) or more from the date of
The practitioner is not able to determine that the
physical or mental impairment would remain incapacitating
after at least sixty days of abstinence from alcohol and
drugs)) The only impairment supported by objective medical
evidence is drug or alcohol addiction; or
(d) We ((
do not)) don't have clear and objective medical
evidence to approve incapacity.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, § 388-448-0040, filed 8/2/00, effective 9/1/00.]