EMERGENCY RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Effective Date of Rule: December 28, 2012.
Purpose: To amend and add new sections to chapter 388-845 WAC, DDD home and community based services waivers, to be in compliance with the requirements of SSB 6384 and related federal waivers recently renewed through Centers for Medicare and Medicaid Services (CMS). These changes add dental services as a waiver service and align this chapter with the changes being made to those in chapter 388-828 WAC for community services. This emergency filing supersedes and replaces the previous emergency filed as WSR 12-18-055.
Citation of Existing Rules Affected by this Order: Amending WAC 388-845-0110, 388-845-0205, 388-845-0210, 388-845-0215, 388-845-0220, 388-845-0225, 388-845-0505, 388-845-0800, 388-845-0820, 388-845-1110, 388-845-1105, 388-845-1150, 388-845-1400, 388-845-1410, 388-845-2110, 388-845-2205, and 388-845-2210.
Statutory Authority for Adoption: RCW 71A.12.030 General authority of secretary--Rule adoption and 34.05.350 (1)(c) Emergency rules and amendments.
Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest; that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule; and that in order to implement the requirements or reductions in appropriations enacted in any budget for fiscal year 2009, 2010, 2011, 2012 or 2013, which necessitates the need for the immediate adoption, amendment, or repeal of a rule, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the fiscal needs or requirements of the agency.
Reasons for this Finding: The passing of SSB 6384 required coordination with CMS to agree on waiver language before we could develop new WAC language. This emergency filing adds dental as a waiver service, keeping in effect language adopted under emergency filed as WSR 12-18-055. The division of developmental disabilities is required to develop and implement the use of a consistent, statewide outcome-based vendor contract for employment and day services as recommended by the joint legislative audit and review committee to include activity listings and dollars appropriated for: Employment services, day services, child development services and county administration of services to the developmentally disabled.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 2, Amended 17, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, 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 2, Amended 17, Repealed 0.
Date Adopted: December 19, 2012.
Katherine I. Vasquez
Rules Coordinator
4384.2(1) A service must be offered in your waiver and authorized in your plan of care or individual support plan.
(2) Mental 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 placement.
(4) The cost of your waiver services cannot exceed the average daily cost of care in an ICF/MR.
(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 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 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 can authorize payment.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0110, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0110, filed 12/13/05, effective 1/13/06.]
| BASIC WAIVER | SERVICES | YEARLY LIMIT |
| AGGREGATE SERVICES: | May not exceed $1454 per year on any combination of these services | |
| Behavior management and consultation | ||
| Community guide | ||
| Environmental accessibility adaptations | ||
| Occupational therapy | ||
| Physical therapy | ||
| Specialized medical equipment/supplies | ||
| Specialized psychiatric services | ||
| Speech, hearing and language services | ||
| Staff/family consultation and training | ||
| Transportation | ||
| EMPLOYMENT((
|
(( |
|
| Person-to-person | ||
| Prevocational services | ||
| Supported employment | ||
| DAY PROGRAM SERVICES: Community access |
Limits are determined by DDD assessment | |
| Sexual deviancy evaluation | Limits are determined by DDD | |
| Respite care | Limits are determined by the DDD assessment | |
| Personal care | Limits are determined by the CARE tool used as part of the DDD assessment | |
| MENTAL HEALTH STABILIZATION SERVICES: | Limits are determined by a mental health professional or DDD | |
| Behavior management and consultation | ||
| Mental health crisis diversion bed services | ||
| Skilled nursing | ||
| Specialized psychiatric services | ||
| Emergency assistance is only for aggregate services and/or employment/day program services contained in the Basic waiver | $6000 per year; Preauthorization required |
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-0205, filed 9/22/08, effective 10/23/08; 07-20-050, § 388-845-0205, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.120. 07-05-014, § 388-845-0205, filed 2/9/07, effective 3/12/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0205, filed 12/13/05, effective 1/13/06.]
| BASIC PLUS WAIVER | SERVICES | YEARLY LIMIT |
| AGGREGATE SERVICES: | May not exceed $6192 per year on any combination of these services | |
| Behavior management and consultation | ||
| Community guide | ||
| Environmental accessibility adaptations | ||
| Occupational therapy | ||
| Physical therapy | ||
| Skilled nursing | ||
| Specialized medical equipment/supplies | ||
| Specialized psychiatric services | ||
| Speech, hearing and language services | ||
| Staff/family consultation and training | ||
| Transportation | ||
| EMPLOYMENT(( |
(( |
|
| ((
Individual technical assistance |
(( |
|
| DAY PROGRAM
SERVICES: Community Access |
Limits are determined by DDD assessment | |
| Adult foster care (adult family home) | Determined per department rate structure | |
| Adult residential care (boarding home) | ||
| MENTAL HEALTH STABILIZATION SERVICES: | Limits determined by a mental health professional or DDD | |
| Behavior management and consultation | ||
| Mental health crisis diversion bed services | ||
| Skilled nursing | ||
| Specialized psychiatric services | ||
| Personal care | Limits determined by the CARE tool used as part of the DDD assessment | |
| Respite care | Limits are determined by the DDD assessment | |
| Sexual deviancy evaluation | Limits are determined by DDD | |
| Emergency assistance
is only for aggregate
services(( |
$6000 per year; Preauthorization required | |
| Adult dental services | Limits are determined by Chapter 182-535 WAC |
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-0210, filed 9/22/08, effective 10/23/08; 07-20-050, § 388-845-0210, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.120. 07-05-014, § 388-845-0210, filed 2/9/07, effective 3/12/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0210, filed 12/13/05, effective 1/13/06.]
| CORE WAIVER | SERVICES | YEARLY LIMIT |
| Behavior management and consultation | Determined by the plan of care or individual support plan, not to exceed the average cost of an ICF/MR for any combination of services | |
| Community guide | ||
| Community transition | ||
| Environmental accessibility adaptations | ||
| Occupational therapy | ||
| Sexual deviancy evaluation | ||
| Skilled nursing | ||
| Specialized medical equipment/supplies | ||
| Specialized psychiatric services | ||
| Speech, hearing and language services | ||
| Staff/family consultation and training | ||
| Transportation | ||
| Residential habilitation | ||
| Day program services Community access |
Limits are determined by assessment | |
| (( |
Limits are determined by DDD assessment and employment status | |
| Prevocational services | ||
| Supported employment Individualized technical assistance |
||
| MENTAL HEALTH STABILIZATION SERVICES: | Limits determined by a mental health professional or DDD | |
| Behavior management and consultation | ||
| Mental health crisis diversion bed services | ||
| Skilled nursing | ||
| Specialized psychiatric services | ||
| Personal care | Limits determined by the CARE tool used as part of the DDD assessment | |
| Respite care | Limits are determined by the DDD assessment | |
| Adult dental services | Limits are determined by chapter 182-535 WAC |
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0215, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0215, filed 12/13/05, effective 1/13/06.]
| COMMUNITY PROTECTION WAIVER | SERVICES | YEARLY LIMIT |
| Behavior management and consultation | Determined by the plan of care or individual support plan, not to exceed the average cost of an ICF/MR for any combination of services | |
| Community transition | ||
| Environmental accessibility adaptations | ||
| Occupational therapy | ||
| Physical therapy | ||
| Sexual deviancy evaluation | ||
| Skilled nursing | ||
| Specialized medical equipment and supplies | ||
| Specialized psychiatric services | ||
| Speech, hearing and language services | ||
| Staff/family consultation and training | ||
| Transportation | ||
| Residential habilitation | ||
| (( |
Limits determined by DDD assessment and employment status | |
| Prevocational services | ||
| Supported
employment Individual technical assistance |
||
| Adult dental services | Limits are determined by chapter 182-535 WAC | |
| MENTAL HEALTH STABILIZATION SERVICES: | Limits determined by a mental health professional or DDD | |
| Behavioral management and consultation | ||
| Mental health crisis diversion bed services | ||
| Skilled nursing | ||
| Specialized psychiatric services |
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0220, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0220, filed 12/13/05, effective 1/13/06.]
| CIIBS Waiver | Services | Yearly Limit |
| • Behavior
management and
consultation • Staff/family consultation and training • Environmental accessibility adaptations • Occupational therapy • Physical therapy • Sexual deviancy evaluation • Nurse delegation • Specialized medical equipment/supplies • Specialized psychiatric services • Speech, hearing and language services • Transportation • Assistive technology • Therapeutic equipment and supplies • Specialized nutrition and clothing • Vehicle modifications |
Determined by the individual support plan. Total cost of waiver services cannot exceed the average cost of $4,000 per month per participant. | |
| Personal care | Limits determined by the DDD assessment. Costs are included in the total average cost of $4000 per month per participant for all waiver services. | |
| Respite care | Limits determined by the DDD assessment. Costs are included in the total average cost of $4000 per month per participant for all waiver services. | |
| Behavioral health Stabilization services: Behavioral support and consultation Crisis diversion bed services Specialized psychiatric services |
Limits determined by mental health specialist |
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0225, filed 11/1/10, effective 12/2/10.]
(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.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-0505, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0505, filed 12/13/05, effective 1/13/06.]
[]
[]
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0800, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0800, filed 12/13/05, effective 1/13/06.]
(1) Prior approval by the DDD 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
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.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 07-20-050, § 388-845-0820, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-0820, filed 12/13/05, effective 1/13/06.]
(1) DDD certified residential agencies per chapter 388-101 WAC; ((or))
(2) Other department licensed or certified agencies; or
(3) State operated agency.
[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1105, filed 12/13/05, effective 1/13/06.]
(2) These services are available in the Basic, CIIBS, Basic Plus, Core, and Community Protection waivers administered by DDD as mental health stabilization services in accordance with WAC 388-845-1150 through 388-845-1160.
(3) The costs of mental health crisis diversion bed services do not count toward the dollar limits for aggregate services in the Basic and Basic Plus waivers.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-1110, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1110, filed 12/13/05, effective 1/13/06.]
(1) Behavior management and consultation;
(2) Specialized psychiatric services; or
(3) Mental health crisis diversion bed services.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-1150, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1150, filed 12/13/05, effective 1/13/06.]
(2) Prevocational services are available in the Basic, Basic Plus, Core and Community Protection waivers.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. 10-22-088, § 388-845-1400, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-1400, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1400, filed 12/13/05, effective 1/13/06.]
(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 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 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 388-828-9235.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-1410, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-1410, filed 12/13/05, effective 1/13/06.]
(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 388-828-9235 and might not equal the number of hours you spend on the job or in job related activities.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-2110, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-2110, filed 12/13/05, effective 1/13/06.]
(2) For adult dental services only, provider can be contracted as a transportation broker through medicaid.
[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-2205, filed 12/13/05, effective 1/13/06.]
(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 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 unless provided by a contracted transportation broker to access adult dental services.
(11) Transportation services require prior approval by the DDD regional administrator or designee, unless provided by transportation broker for adult dental services.
(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.
[Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. 08-20-033, § 388-845-2210, filed 9/22/08, effective 10/23/08; 07-20-050, § 388-845-2210, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, § 388-845-2210, filed 12/13/05, effective 1/13/06.]