WSR 16-03-004
(Developmental Disabilities Administration)
[Filed January 6, 2016, 2:00 p.m., effective January 7, 2016]
Effective Date of Rule: January 7, 2016.
Purpose: These rules will support the below Center for Medicare and Medicaid Services (CMS) decision and support the requirement in C.F.R. 441.510(d).
The Basic Plus waiver and Core waiver both provide home and community-based services to individuals as an alternative to placement in an intermediate care facility for individuals with intellectual disabilities. CMS has approved an amendment that removes personal care services from those waivers, as those services are available through the state's 1915(k) Community First Choice (CFC) program in the medicaid state plan. The CMS amendments also added a new service, wellness education, to both the Basic and Core waivers which provides wellness information to participants designed to assist them in achieving goals identified during their person-centered planning process.
Statutory Authority for Adoption: RCW 71A.12.030 General authority of secretaryRule adoption; RCW 34.05.350 (1)(b) Emergency rules and amendments; C.F.R. 441.510(d).
Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: 42 C.F.R. § 431.232(d) requires the state to discontinue medicaid benefits following an initial administrative order that affirms the state's decision to reduce or terminate those benefits. WAC 388-825-0135(2) currently allows continued benefits (including medicaid benefits) past the initial order. This emergency rule is necessary to conform DSHS rules with federal requirements.
Number of Sections Adopted in Order to Comply with Federal Statute: New 4, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 4, Amended 0, Repealed 0.
Date Adopted: December 29, 2015.
Katherine I. Vasquez
Rules Coordinator
Wellness Education
WAC 388-845-2280 What is wellness education?
Wellness education provides you with monthly individualized printed educational materials designed to assist you in managing health related issues and achieving wellness goals identified in your person-centered service plan that address your health and safety issues. Individualized educational materials are developed by the state, other content providers and the contracted wellness education provider. This service is available on the Basic Plus and Core Waivers.
WAC 388-845-2283 How are my wellness educational materials selected?
Individualized educational materials are selected for you by the wellness education provider's algorithm and are based on your DDA assessment. Goals, diagnoses, treatments, conditions and other factors identified in your DDA assessment provide the basis for the algorithm to select educational materials for you. These goals, diagnoses, treatments, conditions and other factors may include, but are not limited to the following:
(1) Diabetes - IDDM;
(2) Diabetes - NIDDM;
(3) COPD;
(4) Cardiovascular disease;
(5) Rheumatoid arthritis;
(6) Traumatic brain injury;
(7) Cerebral palsy;
(8) Alzheimer's disease;
(9) Anxiety disorder;
(10) Asthma;
(11) Autism;
(12) Stroke;
(13) Congestive heart failure;
(14) Decubitus ulcer;
(15) Depression;
(16) Emphysema;
(17) GERD;
(18) Hypertension;
(19) Hypotension;
(20) Down's syndrome;
(21) Fragile X syndrome;
(22) Prader-Willi;
(23) ADD;
(24) ADHD;
(25) Post-traumatic stress disorder;
(26) Asperger's syndrome;
(27) Hepatitis;
(28) Paraplegia;
(29) Quadriplegia;
(30) Fetal alcohol syndrome/fetal alcohol effect;
(31) Epilepsy;
(32) Seizure disorder;
(33) Sleep apnea;
(34) Urinary tract infection;
(35) Multiple sclerosis;
(36) Falls;
(37) Smoking;
(38) Alcohol abuse;
(39) Substance abuse;
(40) Bowel incontinence;
(41) Bladder incontinence;
(42) Diabetic foot care;
(43) Pain daily;
(44) Sleep issues;
(45) BMI = or greater than 25;
(46) BMI less than 18.5;
(47) Skin care (pressure ulcers, abrasions, burns, rashes);
(48) Seasonal allergies;
(49) Edema;
(50) Poor balance;
(51) Recent loss/grieving;
(52) Conflict management;
(53) Importance of regular dental visits;
(54) ADA diet;
(55) Cardiac diet;
(56) Celiac diet;
(57) Low sodium diet;
(58) Goals; and
(59) Parkinson's Disease.
WAC 388-845-2285 Are there limits to wellness education?
Wellness education is a once a month service. In the basic plus waiver, you are limited to the aggregate service expenditure limits defined in WAC 388-845-0210.
WAC 388-845-2290 Who are qualified providers of wellness education?
The wellness education provider must have the ability and resources to:
1) Receive and manage client data in compliance with all applicable federal HIPPA regulations, state law and rules and ensure client confidentiality and privacy;
2) Translate materials into the preferred language of the participant;
3) Ensure that materials are targeted to the participant's assessment and person-centered service plan;
4) Manage content sent to participants to prevent duplication of materials;
5) Deliver newsletters and identify any undeliverable client/representative addresses prior to each monthly mailing and manage any returned mail in a manner that ensures participants receive the monthly information; and
6) Contract with ALTSA or DDA to provide this service.
Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.