Brief Description: Concerning services for persons with developmental disabilities.

Brief Summary of Substitute Bill

• Clarifies the role and responsibilities of the state in serving people with developmental disabilities.

Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 16 members: Representatives Sommers, Chair; Fromhold, Vice Chair; Cody, Conway, Dunshee, Grant, Hunter, Kagi, Kenney, Kessler, Linville, McDonald, McIntire, Miloscia, Ruderman and Schual-Berke.

Minority Report: Do not pass. Signed by 11 members: Representatives Sehlin, Ranking Minority Member; Pearson, Assistant Ranking Minority Member; Alexander, Boldt, Buck, Clements, Cox, DeBolt, Pflug, Sump and Talcott.

During the past 18 months, the Division of Developmental Disabilites (DDD) has undergone several major reviews. These reviews include a federal review of the Community Alternatives Program waiver by the Centers for Medicare and Medicaid Services, a legislatively mandated review by the Joint Legislative Audit and Review Committee (JLARC) on caseload and staffing, and a review mandated by the Governor and conducted by Sterling Associates, LLP on internal business practices. A legislatively mandated performance audit of the DDD by the JLARC is ongoing.

• poorly defined and followed procedures for the use of assessment tools, which results in inconsistency;

• the failure of current assessment tools to link the assessment of service need with a service plan;

In October 2002 the DSHS announced the creation of an Aging and Disability Services Administration, which combined DDD and Aging and Adult Services under one administration.

For individuals waiting for services, the DSHS is required to identify priority populations based upon assessed need. Priorities will be based on the severity of an individuals' disability and include an evaluation of any extraordinary behavioral issues, severe physical impairments, and the conditions surrounding the individual's caregiver.

The DSHS will establish a single point of referral for persons with developmental disabilities and develop a tool for the comprehensive assessment of need for services for persons with developmental disabilities. The DSHS is not required to meet all needs of a person with a developmental disability. The tool must identify natural supports and any services that would supplement the natural supports.

The DSHS will produce and maintain an individual service plan, which is reviewed annually and revised as needed, for each person with a developmental disability. It will identify which individuals and entities are responsible for providing services and must be developed collaboratively with the person with a developmental disability and his or her natural supports, and any other person considered integral to the service planning process. The service plan must be developed within a reasonable period of time following the needs assessment and authorization that the person with a developmental disability receive services. In addition, the DSHS must ensure that intake, eligibility, and the individual assessment process is implemented uniformly and completed within established time frames.

The DSHS must emphasize to the persons and entities with which it contracts the importance of recognizing the rights of a person with a developmental disability established under federal law. The DSHS must require contractees to post these rights and make them readily available to persons with a developmental disability.

The Secretary of the DSHS is required to establish minimum standards for services through the development of a quality assurance system.

Nonresidential services exceeding the cost of caring for an average individual at home, if they are reasonably necessary for the care, treatment, maintenance, support, and training of persons with developmental disabilities, are to be prioritized to individuals identified as a priority population by the DSHS.

The duty of the DSHS to provide a service to a person with a developmental disability is limited by the funds specifically appropriated for that purpose. Limitations in funding can be the basis for denying services to a person with a developmental disability not enrolled in a federal Medicaid waiver program, and limitations in funding can be the basis for denying non-waiver services to a person with a developmental disability enrolled in Medicaid or a Medicaid waiver program.

An applicant for services who is enrolled in a Medicaid waiver or receiving waiver services must be eligible for Intermediate Care Facilities for People with Mental Retardation services. Accessing Medicaid for an applicant by enrolling an applicant in a Medicaid waiver is prohibited, unless the applicant is assessed to need waiver services and is a person assessed to meet the criteria of a priority population. The DSHS is required to evaluate Medicaid cost-sharing options for applicants enrolled in a Medicaid waiver, as well as available cost-effective options for covering an applicant assessed to need medical coverage.

The DSHS is required to coordinate with the Office of the Superintendent of Public Instruction to access funding to the fullest extent possible so that a person with a disability can achieve the maximum level of self-sufficiency, including employability. The DSHS is also required to coordinate with all other state agencies to achieve early intervention that may prevent the need for more complex and costly services later in the person's development.

The substitute bill does not require parents of children with a developmental disability placed in out-of-home care to pay a portion of their child's care. This exemption includes developmentally disabled children who are abused, neglected, or abandoned by their parents, and developmentally disabled children voluntarily placed out of the home where no abuse or neglect is involved.

Effective Date of Substitute Bill: The bill contains an emergency clause and takes effect immediately.

Testimony For: The changes proposed to Title 71A RCW in this bill will give the DSHS the tools needed to improve the management and operation of services to people with developmental disabilities. It will improve services to people with developmental disabilities, and improve compliance with federal and state service standards.

Testimony Against: Parents of children with developmental disabilities should not be forced to contribute to the cost of services provided through the DSHS services for their child. The physical, emotional, and financial burden of raising a child with a developmental disability is already very high. Additional financial costs will be a burden for parents of a child with a developmental disability.

Testified: (In support) Sue Elliott, Association of Retired Citizens of Washington.