WSR 13-17-122 EMERGENCY RULES DEPARTMENT OF SOCIAL AND HEALTH SERVICES (Developmental Disabilities Administration) [Filed August 21, 2013, 11:41 a.m., effective August 21, 2013, 11:41 a.m.] Effective Date of Rule: Immediately upon filing.
Purpose: To amend and add new sections to chapter 388-845 WAC, DDD home and community-based services (HCBS) 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 is a subsequent request to the previous CR-103E filed as WSR 13-10-020.
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; and 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: The amendments in this filing were originally adopted by emergency rule on September 1, 2012, in order to add dental care as an additional HCBS waiver service and to modify community access services as required by SSB 6384. Because changes to department rules regarding HCBS waivers need to be coordinated with the CMS, and because related rules in chapter 388-828 WAC need amendment, these amendments could not be adopted as permanent before the expiration of the previous emergency filing. A CR-102 has been filed as WSR 13-17-112 and a hearing is scheduled for October 22, 2013.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 17, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.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 0, Amended 17, Repealed 0.
Date Adopted: August 21, 2013.
Katherine I. Vasquez
Rules Coordinator
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0110 Are there limitations to the waiver services I can receive?
There are limitations to waiver services. In addition to the limitations to your access to nonwaiver services cited for specific services in WAC 388-845-0115, the following limitations apply: (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.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-0205 Basic waiver services.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-0210 Basic Plus waiver services.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0215 CORE waiver services.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0220 Community protection waiver services.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0225 Children's intensive in-home behavioral support (CIIBS) waiver services.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-0505 Who is a qualified provider of behavior ((management)) support and consultation?
Under the Basic, Basic Plus, Core, and Community Protection waivers, the provider of behavior ((management)) support and consultation must be one of the following professionals contracted with DDD and duly licensed, registered or certified to provide this service: (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.
NEW SECTION
WAC 388-845-0780 What is adult dental services?
Adult dental services are provided to individuals age twenty-one years and older. Dental services provide comprehensive dental coverage as defined in chapter 182-535 WAC. Adult dental service coverage is limited to individuals on the Basic Plus, Core and Community Protection waivers.
NEW SECTION
WAC 388-845-0785 Who are qualified providers of adult dental services?
Providers for adult dental services covered under the waiver program must have a current state license and have core provider agreement with the state medicaid agency.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0800 What is emergency assistance?
Emergency assistance is a temporary increase to the yearly aggregate services and((/or employment/day program services)) dollar limit specified in the Basic and Basic Plus waiver when additional waiver services are required to prevent ICF/MR placement. These additional services are limited to the services provided in your waiver.
AMENDATORY SECTION (Amending WSR 07-20-050, filed 9/26/07, effective 10/27/07)
WAC 388-845-0820 Are there limits to my use of emergency assistance?
All of the following limitations apply to your use of emergency assistance: (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.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-1105 Who is a qualified provider of mental health crisis diversion bed services?
Providers of mental health crisis diversion bed services must be: (1) DDD certified residential agencies per chapter 388-101 WAC; ((or)) (2) Other department licensed or certified agencies; or (3) State operated agency.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1110 What are the limits of mental health crisis diversion bed services?
(1) Mental health crisis diversion bed services are intermittent and temporary. The duration and amount of services you need to stabilize your crisis is determined by a mental health professional and/or DDD. (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.
AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1150 What are mental health stabilization services?
Mental health stabilization services assist persons who are experiencing a mental health crisis. These services are available in the Basic, Basic Plus, Core, CIIBS and Community Protection waivers to ((adults)) individuals determined by mental health professionals or DDD to be at risk of institutionalization in a psychiatric hospital without one of more of the following services: (1) Behavior management and consultation; (2) Specialized psychiatric services; or (3) Mental health crisis diversion bed services.
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. AMENDATORY SECTION (Amending WSR 10-22-088, filed 11/1/10, effective 12/2/10)
WAC 388-845-1400 What are prevocational services?
(1) Prevocational services occur in a specialized or segregated settings and include monthly employment related activities in the community. Prevocational services are designed to prepare you for gainful employment in an integrated setting through training and skill development. (2) Prevocational services are available in the Basic, Basic Plus, Core and Community Protection waivers.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-1410 Are there limits to the prevocational services I can receive?
The following limitations apply to your receipt of prevocational services: (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.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-2110 Are there limits to the supported employment services I can receive?
The following limitations apply to your receipt of supported employment services: (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.
AMENDATORY SECTION (Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)
WAC 388-845-2205 Who is qualified to provide transportation services?
(1) The provider of transportation services can be an individual or agency contracted with DDD. (2) For adult dental services only, provider can be contracted as a transportation broker through medicaid.
AMENDATORY SECTION (Amending WSR 08-20-033, filed 9/22/08, effective 10/23/08)
WAC 388-845-2210 Are there limitations to the transportation services I can receive?
The following limitations apply to transportation services: (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.
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