WSR 20-22-032
EMERGENCY RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Developmental Disabilities Administration)
[Filed October 26, 2020, 3:25 p.m., effective October 26, 2020, 3:25 p.m.]
Effective Date of Rule: Immediately upon filing.
Purpose: The developmental disabilities administration is enacting these changes to align chapter 388-845 WAC with home and community based services waiver amendments approved by the Centers for Medicare and Medicaid Services (CMS).
Citation of Rules Affected by this Order: New WAC 388-845-0920, 388-845-0930, 388-845-0940, 388-845-1101, 388-845-1161, 388-845-1162, 388-845-1163, 388-845-1870, 388-845-1880, 388-845-1890, 388-845-2145, 388-845-2150 and 388-845-2155; repealing WAC 388-845-0300, 388-845-0305, 388-845-0310, 388-845-0400, 388-845-0405, 388-845-0410, 388-845-0700, 388-845-0705, 388-845-0710, 388-845-1300, 388-845-1305, 388-845-1310, 388-845-1400, 388-845-1405, 388-845-1410, 388-845-1900, 388-845-1905, 388-845-1910, 388-845-2160, 388-845-2165 and 388-845-2170; and amending WAC 388-845-0001, 388-845-0055, 388-845-0060, 388-845-0110, 388-845-0210, 388-845-0215, 388-845-0220, 388-845-0225, 388-845-0230, 388-845-0425, 388-845-0500, 388-845-0510, 388-845-0515, 388-845-0520, 388-845-0525, 388-845-0650, 388-845-0800, 388-845-0810, 388-845-0820, 388-845-0900, 388-845-0905, 388-845-0910, 388-845-1100, 388-845-1105, 388-845-1110, 388-845-1150, 388-845-1155, 388-845-1160, 388-845-1505, 388-845-1607, 388-845-1700, 388-845-1800, 388-845-1805, 388-845-1810, 388-845-2000, 388-845-2005, 388-845-2010, and 388-845-3070.
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: Filing these amendments on an emergency basis is necessary to ensure federal compliance and maintain federal funding for the state. This second emergency filing supersedes emergency rules filed as WSR 20-20-068 on October 1, 2020, and is necessary to correct some language that does not align with the CMS-approved waiver amendments that were unintentionally missed on the first filing. The department filed a CR-101 Preproposal statement of inquiry as WSR 20-20-100 on October 5, 2020, to begin the permanent rule-making process.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.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 the 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 13, Amended 38, Repealed 21.
Date Adopted: October 22, 2020.
Katherine I. Vasquez
Rules Coordinator
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0001Definitions.
"Aggregate services" means a combination of services subject to the dollar limits in the basic plus waiver.
"Allocation" means the amount of individual and family services (IFS) waiver funding available to a client for a maximum of twelve months.
"CARE" means comprehensive assessment and reporting evaluation.
"Client" means a person who has a developmental disability under RCW
71A.10.020(5) and has been determined eligible to receive services from the administration under chapter
71A.16 RCW.
"Community crisis stabilization services" or "CCSS" means a state-operated program that provides short-term supports to clients who are in crisis, or who are at risk of hospitalization or institutional placement.
"DDA" means the developmental disabilities administration, of the department of social and health services.
"DDA assessment" refers to the standardized assessment tool under chapter 388-828 WAC, used by DDA to measure the support needs of people with developmental disabilities.
"Department" means the department of social and health services (DSHS).
"Evidence-based treatment" means the use of physical, mental, and behavioral health interventions for which systematic, empirical research has provided evidence of statistically significant effectiveness as treatments for specific conditions. Alternate terms with the same meaning are evidence-based practice (EBP) and empirically supported treatment (EST).
"Family" means one or more of the following relatives: Spouse or registered domestic partner; natural, adoptive or step parent; grandparent; child; stepchild; sibling; stepsibling; uncle; aunt; first cousin; niece; or nephew.
"Family home" means the residence where you and your family live.
"Gainful employment" means employment that reflects achievement of or progress towards a living wage.
"HCBS waiver" is a DDA 1915(c) home and community based services waiver program.
"Home" means present ((or intended)) place of residence.
"ICF/IID" means an intermediate care facility for individuals with intellectual disabilities.
"Integrated business settings" means a setting that enables participants to either work alongside or interact with individuals who do not have disabilities, or both.
"Integrated settings" mean typical community settings not designed specifically for individuals with disabilities in which the majority of persons employed and participating are individuals without disabilities.
"Legal representative" means a parent of a person who is under eighteen years of age, a person's legal guardian, a person's limited guardian when the subject matter is within the scope of limited guardianship, a person's attorney at law, a person's attorney in fact, or any other person who is authorized by law to act for another person.
"Living wage" means the amount of earned wages needed to enable an individual to meet or exceed his or her living expenses.
"Necessary supplemental accommodation representative" means an individual who receives copies of DDA planned action notices (PANs) and other department correspondence in order to help a client understand the documents and exercise the client's rights. A necessary supplemental accommodation representative is identified by a client of DDA when the client does not have a legal guardian and the client is requesting or receiving DDA services.
"Participant" means a client who is enrolled in a home and community based services waiver program.
"Person-centered service plan" is a document that identifies your goals and assessed health and welfare needs. Your person-centered service plan also indicates the paid services and natural supports that will assist you to achieve your goals and address your assessed needs.
"Primary caregiver" means the person who provides the majority of your care and supervision.
"Provider" means an individual or agency who meets the provider qualifications and is contracted with DSHS to provide services to you.
"Respite assessment" means an algorithm within the DDA assessment that determines the number of hours of respite care you may receive per year if you are enrolled in the basic plus, children's intensive in-home behavioral support, or core waiver.
"SSI" means supplemental security income, an assistance program administered by the federal Social Security Administration for blind, disabled and aged individuals.
"SSP" means state supplementary payment program, a state-paid cash assistance program for certain clients of the developmental disabilities administration.
"State-funded services" means services that are funded entirely with state dollars.
"You" means the client or participant.
"Waiver year" means the twelve-month period starting from the initial or annual plan effective date in the client's person-centered service plan.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-0055How do I remain eligible for the waiver?
(1) Once you are enrolled in a DDA 1915(c) HCBS waiver, you can remain eligible if you continue to meet eligibility criteria in WAC 388-845-0030, and:
(a) You complete a reassessment with DDA at least once every twelve months to determine if you continue to meet all of these eligibility requirements;
(b) You must either receive a waiver service at least once in every thirty consecutive days, as specified in WAC 182-513-1320(3), or your health and welfare needs require monthly monitoring, which will be documented in your client record;
(c) You complete an in-person DDA assessment/reassessment interview per WAC 388-828-1520.
(2) For the children's intensive in-home behavioral supports waiver, you must meet the criteria in subsection (1) of this section and you must:
(a) Be under age twenty-one;
(b) Live with your family; ((and))
(c) Have an annual participation agreement signed by your parent/guardian(s) and primary caregiver(s), if other than parent/guardian(s); and
(d) Continue to participate in the program as outlined in the annual participation agreement.
(3) For the individual and family services waiver, you must meet the criteria in subsection (1) of this section and live in your family home.
AMENDATORY SECTION(Amending WSR 16-17-009, filed 8/4/16, effective 9/4/16)
WAC 388-845-0060Can your waiver enrollment be terminated?
DDA may terminate your waiver enrollment if DDA determines that:
(1) Your health and welfare needs cannot be met in your current waiver or for one of the following reasons:
(a) You no longer meet one or more of the requirements listed in WAC 388-845-0030;
(b) You do not have an identified need for a waiver service at the time of your annual person-centered service ((plan/individual support)) plan;
(c) You do not use a waiver service at least once in every thirty consecutive days and your health and welfare do not require monthly monitoring;
(d) You are on the community protection waiver and:
(i) You choose not to be served by a certified residential community protection provider-intensive supported living services (CP-ISLS);
(ii) You engage in any behaviors identified in WAC 388-831-0240 (1) through (4); and
(iii) DDA determines that your health and safety needs or the health and safety needs of the community cannot be met in the community protection program;
(e) You choose to unenroll from the waiver;
(f) You reside out-of-state;
(g) You cannot be located or do not make yourself available for the annual waiver reassessment of eligibility;
(h) You refuse to participate with DDA in:
(i) Service planning;
(ii) Required quality assurance and program monitoring activities; or
(iii) Accepting services agreed to in your person-centered service plan((/individual support plan)) as necessary to meet your health and welfare needs;
(i) You are ((residing)) in a hospital, jail, prison, nursing facility, ICF/IID, or other institution ((and remain in residence))for at least one full calendar month, and ((are still in residence))are under the care of that setting:
(i) At the end of that full calendar month((,))and there is no immediate plan for you to return to the community;
(ii) At the end of the twelfth month following the effective date of your current person-centered service ((plan/individual support)) plan, as described in WAC 388-845-3060; or
(iii) At the end of the waiver fiscal year, whichever date occurs first;
(j) Your needs exceed the maximum funding level or scope of services under the basic plus waiver as specified in WAC 388-845-3080; or
(k) Your needs exceed what can be provided under WAC 388-845-3085.
(2) Services offered on a different waiver can meet your health and welfare needs and DDA enrolls you on a different waiver.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0110What are the limits to the waiver services you may receive?
The following limits apply to the waiver services you may receive:
(1) A service must be available in your waiver and address an unmet need identified in your person-centered service plan.
(2) ((Behavioral health))Stabilization services may be added to your person-centered service plan after the services have been provided.
(3) Waiver services are limited to services required to prevent placement in an intermediate care facility for individuals with intellectual disabilities (ICF/IID).
(4) The daily cost of your waiver services must not exceed the average daily cost of care in an ICF/IID.
(5) Waiver services must not replace or duplicate other available paid or unpaid supports or services. Before DDA will cover a service through waiver services, you must first request and be denied all applicable services through private insurance, medicare, the medicaid state plan, and other resources.
(6) Waiver funding must not be authorized for treatments determined by DSHS to be experimental or investigational under WAC 182-531-0050.
(7) For the individual and family services (IFS) ((and))waiver, basic plus ((waivers))waiver, and children's intensive in-home behavior support waiver, services must not exceed the yearly limits specified in these programs for specific services or combinations of services.
(8) Your choice of qualified providers and services is limited to the most cost-effective option that meets your unmet need identified in your person-centered service plan.
(9) Services provided out-of-state, other than in recognized bordering cities, are limited to respite care and personal care during vacations of not more than thirty consecutive days.
(10) You may receive services in a recognized out-of-state bordering city under WAC 182-501-0175.
(11) Other out-of-state waiver services require an approved exception to rule before DDA will authorize payment.
(12) Waiver services do not cover:
(a) Copays;
(b) Deductibles;
(c) Dues;
(d) Membership fees; or
(e) Subscriptions.
(13) Waiver services do not cover a product unless the product is:
(a) Necessary to meet a basic health and safety need; ((and))
(b) The least restrictive means for meeting that need; and
(c) Requested by the waiver participant.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0210What services are available under the basic plus waiver?
The following services are available under the basic plus waiver:
service | yearly limit |
aggregate services: | Total costs must not exceed six thousand one hundred ninety-two dollars per year per participant |
((Chemical))Extermination of cimex lectularius (bedbugs) |
Community ((guide))engagement |
Environmental adaptations |
Occupational therapy | |
Physical therapy | |
Positive behavior support and consultation | |
Skilled nursing | |
Specialized ((medical)) equipment and supplies | |
Specialized ((psychiatric services))habilitation | |
Speech, hearing, and language services | |
Staff and family consultation ((and training)) | |
Transportation | |
Wellness education | |
Therapeutic adaptations | Limited to a single one-time authorization every five years and limited to funds available in the client's aggregate and emergency funding |
employment services: | |
Individual technical assistance | Limits determined by DDA assessment and employment status((; no new enrollment in prevocational services after September 1, 2015)) |
((Prevocational services)) |
Supported employment |
Community inclusion | Limits determined by ((DDA assessment))the person-centered service plan |
((behavioral health)) stabilization services: | Limits determined by a ((behavioral health professional or DDA))the person-centered service plan |
((Behavioral health))Crisis diversion bed ((services Positive behavior support and consultation))Specialized habilitation Staff and family consultation |
((Specialized psychiatric services)) | |
((Personal care)) | ((Limits determined by the CARE tool used as part of the DDA assessment)) |
Respite care | Limits determined by DDA assessment |
Risk assessment | Limits determined by DDA |
((Emergency assistance is only for basic plus waiver aggregate services)) Community engagement Environmental adaptions Occupational therapy Physical therapy Positive behavior support Specialized equipment and supplies Speech, hearing, and language services Skilled nursing Staff and family consultation Transportation | Six thousand dollars per year((; preauthorization required))for emergency assistance funding |
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0215What services are available under the core waiver?
(1) The following services are available under the core waiver:
SERVICE | YEARLY LIMIT |
((Chemical))Extermination of cimex lectularius (bedbugs) Community ((guide))engagement Community transition Environmental ((adaptions))adaptations Occupational therapy Physical therapy Positive behavior support and consultation Residential habilitation Risk assessment Skilled nursing Specialized ((medical)) equipment and supplies ((Specialized psychiatric services)) Speech, hearing, and language services Staff and family consultation ((and training)) Transportation Wellness education | Determined by the person-centered service plan |
Specialized habilitation | Limited to four thousand dollars per waiver year |
EMPLOYMENT SERVICES: Individualized technical assistance ((Prevocational services)) Supported employment | Limits determined by DDA assessment and employment status((; no new enrollment in prevocational services after September 1, 2015)) |
Community inclusion | Limits determined by ((DDA assessment))the person-centered service plan |
((BEHAVIORAL HEALTH)) STABILIZATION SERVICES: ((Behavioral health))Crisis diversion bed ((services)) ((Positive behavior support and consultation)) Specialized ((psychiatric services))habilitation Staff and family consultation | Limits determined by ((a behavioral health professional or DDA))the person-centered service plan |
Respite care | Limits determined by DDA assessment |
(2) A participant's core waiver services are subject to additional limits under this chapter.
(3) The total cost of a participant's core waiver services must not exceed the average cost of care at an intermediate care facility for individuals with intellectual disabilities (ICF/IID).
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0220What services are available under the community protection waiver?
(1) The following services are available under the community protection waiver:
service | yearly limit |
((Chemical))Extermination of cimex lectularius (bedbugs) | Determined by the person-centered service plan |
Community transition |
Environmental adaptations |
Occupational therapy |
Physical therapy |
Positive behavior support and consultation | |
Residential habilitation | |
Risk assessment | |
Skilled nursing | |
Specialized ((medical)) equipment and supplies | |
((Specialized psychiatric services)) | |
Speech, hearing, and language services | |
Staff and family consultation ((and training)) | |
Transportation | |
EMPLOYMENT SERVICES: Individual technical assistance ((Prevocational services)) Supported employment | Limits determined by DDA assessment and employment status((; no new enrollment in prevocational services after September 1, 2015)) |
((behavioral health)) stabilization services: ((Behavioral health))Crisis diversion bed ((services)) ((Positive behavior support and consultation)) Specialized ((psychiatric services))habilitation Staff and family consultation | Limits determined by ((a behavioral health professional or DDA))the person-centered service plan |
(2) A participant's community protection waiver services are subject to additional limits under this chapter.
(3) The total cost of a participant's community protection waiver services must not exceed the average cost of care at an intermediate care facility for individuals with intellectual disabilities (ICF/IID).
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0225What services are available under the children's intensive in-home behavioral support (CIIBS) waiver?
(1) The following services are available under the children's intensive in-home behavioral support (CIIBS) waiver:
SERVICE | YEARLY LIMIT |
Assistive technology Environmental adaptations Nurse delegation ((Positive behavior support and consultation)) Specialized clothing Specialized ((medical)) equipment and supplies Specialized habilitation Staff and family consultation ((and training)) ((Therapeutic equipment and supplies)) Transportation Vehicle modifications | ((Determined by the person-centered service plan. Total cost of waiver services must not exceed the average cost of four thousand dollars per month per participant.))Fifteen thousand dollars per year for any combination of services |
Respite care | Limits determined by the DDA assessment. ((Costs are included in the total average cost of four thousand dollars per month per participant for all waiver services.)) |
((BEHAVIORAL HEALTH)) STABILIZATION SERVICES: ((Behavioral health))Crisis diversion ((bed services Positive behavior support and consultation )) Specialized habilitation Staff and family consultation | Limits determined by ((behavioral health professional or DDA))the person-centered service plan |
Risk assessment Positive behavior support | Limits determined by DDA |
Environmental adaptations (Accessibility and repairs) Specialized habilitation Staff and family consultation Vehicle modifications | Six thousand dollars per year for emergency assistance funding |
Music therapy Equine therapy | Five thousand dollars per year for combination of services |
Therapeutic adaptations | Limited to a single, one-time authorization not to exceed fifteen thousand dollars every five waiver years |
(2) A participant's CIIBS waiver services are subject to additional limits under this chapter.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-0230What services are available under the individual and family services (IFS) waiver?
(1) The following services are available under the individual and family services (IFS) waiver:
SERVICE | YEARLY LIMIT |
Assistive technology Community engagement Environmental ((adaptions))adaptations Occupational therapy Peer mentoring Person-centered plan facilitation Physical therapy Positive behavior support and consultation Respite care Skilled nursing Specialized clothing Specialized ((medical)) equipment and supplies | Total cost of waiver services must not exceed annual allocation determined by the person-centered service plan |
Specialized ((psychiatric services))habilitation Speech, hearing, and language services Staff and family consultation ((and training)) Supported parenting services Transportation Vehicle modifications Wellness education | |
Therapeutic adaptations | Limited to a one-time authorization every five years and limited to funds available in the client's aggregate and emergency services |
Risk assessment | Limits determined by ((DDA. Costs are excluded from the annual allocation.))the person-centered service plan |
((BEHAVIORAL HEALTH STABILIZATION SERVICES:)) Crisis diversion bed ((services)) ((Positive behavior support and consultation)) Specialized ((psychiatric services))habilitation Staff and family consultation | Limits determined by ((behavioral health professional or DDA))the person-centered service plan. Costs are excluded from the annual allocation. |
(2) Your IFS waiver services annual allocation is based upon the DDA assessment under chapter 388-828 WAC. The DDA assessment determines your service level and annual allocation based on your assessed need. Annual allocations are as follows:
(a) Level 1 = one thousand two hundred dollars;
(b) Level 2 = one thousand eight hundred dollars;
(c) Level 3 = two thousand four hundred dollars; or
(d) Level 4 = three thousand six hundred dollars.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-0425Are there limits to the assistive technology you may receive?
The assistive technology you may receive has the following limits:
(1) Assistive technology is limited to additional services not otherwise covered under the medicaid state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
(2) Clinical and support needs for assistive technology must be identified in your DDA assessment and documented in the person-centered service plan.
(3) DDA requires ((your))a treating professional's written recommendation regarding your need for the technology. This recommendation must take into account that:
(a) The treating professional has personal knowledge of and experience with the requested assistive technology; and
(b) The treating professional has recently examined you, reviewed your medical records, and conducted a functional evaluation of your use of the equipment and determined its effectiveness in meeting your identified need.
(4) Assistive technology requires prior approval by the DDA regional administrator or designee.
(5) DDA may require a written second opinion from a DDA-selected professional.
(6) The dollar amounts for your individual and family services (IFS) waiver annual allocation limit the amount of assistive technology you are authorized to receive.
(7) Assistive technology excludes any item that is for recreational or diversion purposes such as a television, cable, or DVD player.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0500What is positive behavior support and consultation?
(1) Positive behavior support and consultation ((may be provided to persons on any))is available on all of the DDA HCBS waivers ((and)). A participant is eligible for positive behavior support and consultation if the participant is:
(a) Under age 21 and currently authorized to receive positive behavior support and consultation for the support of behavioral health or autism treatment when unable to access through the medicaid state plan; or
(b) On the community protection waiver and require behavior support to address sexual aggression, arson, or assaultive behaviors which make the client eligible for the community protection waiver.
(2) Positive behavior support and consultation includes the development and implementation of programs designed to support waiver participants using:
(a) Individualized strategies for effectively relating to caregivers and other people in the waiver participant's life; and
(b) Direct interventions with the person to decrease aggressive, destructive, and sexually inappropriate or other behaviors that compromise their ability to remain in the community (i.e., training, specialized cognitive counseling, conducting a functional assessment, and development and implementation of a positive behavior support plan).
(((2) Positive behavior support and consultation may also be provided as a behavioral health stabilization service in accordance with WAC 388-845-1150 through 388-845-1160.))
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0510Are there limits to the positive behavior support and consultation you may receive?
(1) Clinical and support needs for positive behavior support and consultation must be identified in your DDA assessment and documented in the person-centered service plan.
(2) DDA determines the amount of positive behavior support and consultation you may receive based on your needs and information from your treating professional.
(3) The dollar amounts for aggregate services in your basic plus waiver or the dollar amounts in the annual allocation for the individual and family services (IFS) waiver limit the amount of service unless provided as a ((behavioral health)) stabilization service.
(4) DDA may require a second opinion from a DDA-selected provider.
(5) Positive behavior support and consultation ((not provided as a behavioral health stabilization service)) requires prior approval by the DDA regional administrator or designee for the following waivers:
(a) Basic plus;
(b) Core;
(c) Children's intensive in-home behavior support (CIIBS); and
(d) IFS.
(6) Positive behavior support and consultation services are limited to services:
(a) Consistent with waiver objectives of avoiding institutionalization; and
(b) Not otherwise covered under the medicaid state plan.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0515What is ((chemical)) extermination of bedbugs?
(1) ((Chemical))Extermination of cimex lectularius (bedbugs) is professional ((chemical)) extermination of bedbugs.
(2) DDA covers professional ((chemical)) extermination of bedbugs in your primary residence if you:
(a) Receive residential habilitation services; or
(b) Live in a private house or apartment for which you are financially responsible.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0520Who are qualified providers of ((chemical)) extermination of bedbugs?
A qualified ((chemical)) extermination provider must be((:
(1) Licensed as a chemical pesticide applicator by the Washington state department of agriculture; and
(2)))contracted with DDA to provide ((chemical)) extermination of bedbugs.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0525Are there limits to the ((chemical)) extermination of bedbugs services I may receive?
(1) ((Chemical))Extermination services covers only:
(a) The assessment or inspection by the qualified provider;
(b) Application of chemical-based pesticide; and
(c) One follow-up visit.
(2) ((Chemical))Extermination of bedbugs is limited to two treatments per plan year.
(3) ((Chemical))Extermination of bedbugs excludes:
(a) Lodging during the ((chemical)) extermination process; and
(b) Preparatory housework associated with the extermination process.
(4) DDA does not cover ((chemical)) extermination of bedbugs for a participant who lives:
(a) With their family; or
(b) In an adult family home, assisted living, group home, group training home, licensed staffed residential home, or other facility contractually obligated to provide housing.
(5) DDA requires prior approval by the regional administrator or designee for ((chemical)) extermination of bedbugs.
AMENDATORY SECTION(Amending WSR 16-17-009, filed 8/4/16, effective 9/4/16)
WAC 388-845-0650What are community engagement services?
(1) Community engagement ((services are services))is designed to increase a waiver participant's connection to and engagement in formal and informal community supports by connecting the participant to community resources.
(2) Services are designed to develop creative, flexible, and supportive community resources and relationships for individuals with developmental disabilities.
(3) Waiver participants are introduced to the community resources and supports that are available in their area.
(4) Participants are supported to develop identified skills that will facilitate integration into their community as described in the person-centered service plan.
(5) ((Outcomes for this service include skill development, opportunities for socialization, valued community roles, and involvement in community activities, organizations, groups, projects, and other resources.
(6))) This service is available ((in))on the:
(a) IFS waiver;
(b) Basic plus waiver; and
(c) Core waiver when the participant is not receiving residential habilitation services.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0800What is emergency assistance funding?
Emergency assistance funding is a temporary increase, ninety days or less, to the yearly basic plus or CIIBS waiver aggregate dollar limit when additional waiver aggregate services are required to prevent placement in an intermediate care facility for individuals with intellectual disabilities (ICF/IID).
AMENDATORY SECTION(Amending WSR 13-24-045, filed 11/26/13, effective 1/1/14)
WAC 388-845-0810How do I qualify for emergency assistance funding?
You qualify for emergency assistance only if you have used all of your waiver aggregate funding and your current situation meets one of the following criteria:
(1) You involuntarily lose your present residence for any reason either temporary or permanent;
(2) You lose your present caregiver for any reason, including death;
(3) There are changes in your caregiver's mental or physical status resulting in the caregiver's inability to perform effectively for the individual; or
(4) There are significant changes in your emotional or physical condition that requires a temporary increase in the amount of a waiver service.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-0820Are there limits to your use of emergency assistance funding?
All of the following limits apply to the emergency assistance you may receive((:)).
(1) Prior approval by the DDA regional administrator or designee is required based on a reassessment of your person-centered service plan to determine the need for emergency services((;)).
(2) Payment authorizations are reviewed every thirty days and must not exceed six thousand dollars per twelve months based on the effective date of your current person-centered service plan((;)).
(3) Emergency assistance ((services are))funding is limited to the following ((basic plus waiver)) aggregate services when on the basic plus waivers:
(a) Community ((guide))engagement;
(b) Environmental adaptations;
(c) Occupational therapy;
(d) Physical therapy;
(e) Positive behavior support and consultation;
(f) Skilled nursing;
(g) Specialized ((medical)) equipment and supplies;
(h) ((Specialized psychiatric services;
(i))) Speech, hearing, and language services;
(((j)))(i) Staff and family consultation ((and training)), which excludes individual and family counseling;
(((k)))(j) Transportation; and
(k) Therapeutic adaptations.
(4) Emergency assistance funding is limited to the following services when on the CIIBS waiver:
(a) Environmental adaptations;
(b) Specialized habilitation;
(c) Staff and family consultation; and
(d) Vehicle modifications.
(5) Emergency assistance funding may be used for interim services until:
(a) The emergency situation has been resolved;
(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 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-0900What are environmental adaptations?
(1) Environmental adaptations provide basic physical adaptations to the ((dwelling))existing home and existing rooms within the home required by the individual's person-centered service plan needed to:
(a) Ensure the health, welfare, and safety of the individual;
(b) Enable the individual who would otherwise require institutionalization to function with greater independence in the dwelling; and
(c) Increase the individual's independence inside ((the dwelling)) or outside the dwelling to ((provide access to the dwelling))allow the individual to physically enter and move within the home.
(2) Examples of environmental ((adaptions))adaptations include installing stair lifts, installing ramps and grab bars, widening doorways, modifying the individual's primary bathroom, or installing specialized electrical or plumbing systems necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.
(3) Environmental ((adaptions))adaptations are available in all of the DDA HCBS waivers.
(4) Only the children's intensive in-home behavioral support (CIIBS) and individual and family services (IFS) waivers may include adaptations to the dwelling necessary to prevent or repair ((property destruction))damage to the structure of the home caused by the participant's behavior, as addressed in the participant's ((positive)) behavior support plan.
AMENDATORY SECTION(Amending WSR 16-17-009, filed 8/4/16, effective 9/4/16)
WAC 388-845-0905Who is a qualified provider for environmental adaptations?
(((1) For adaptations that do not require installation, qualified providers are retail vendors with a valid business license contracted with DDA to provide this service.
(2) For adaptations requiring installation,))
A qualified ((
providers))
provider must be a registered contractor per chapter
18.27 RCW and contracted with DDA. The contractor ((
or subcontractor)) must be licensed and bonded to perform the specific type of work ((
they are providing))
being provided.
(((3) For debris removal, qualified providers must be contracted with DDA.))
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-0910What limits apply to environmental adaptations?
The following service limits apply to environmental adaptations:
(1) Clinical and support needs for an environmental adaptation must be identified in the waiver participant's DDA assessment and documented in the person-centered service plan.
(2) Environmental adaptations require prior approval by the DDA regional administrator or designee and must be supported by itemized and written bids from licensed contractors. For an adaptation that costs:
(a) One thousand five hundred dollars or less, one bid is required;
(b) More than one thousand five hundred dollars and equal to or less than five thousand dollars, two bids are required; or
(c) More than five thousand dollars, three bids are required.
(3) All bids must include:
(a) The cost of all required permits and sales tax; and
(b) An itemized and clearly outlined scope of work.
(4) DDA may require an occupational therapist, physical therapist, or ((construction consultant))other professional to review and recommend an appropriate environmental adaptation statement of work prior to the waiver participant soliciting bids or purchasing adaptive equipment.
(5) Environmental adaptations to the home are excluded if they are of general utility without direct benefit to the individual as related to the individual's developmental disability, such as cosmetic improvements to the dwelling, or general home improvements, such as carpeting, roof repair, or central air conditioning.
(6) Environmental adaptations must meet all local and state building codes. Evidence of any required completed inspections must be submitted to DDA prior to final payment for work.
(7) ((The condition of the dwelling or other projects in progress in the dwelling may prevent or limit some or all environmental adaptations at the discretion of DDA))Environmental adaptations must not be performed while other adaptations or remodeling projects are in process.
(8) Environmental adaptations must not be approved if the existing residence condition is impacted by mold, asbestos, or dwelling dilapidation.
(9) Location of the dwelling in a flood plain, landslide zone, or other hazardous area may limit or prevent any environmental adaptations at the discretion of DDA.
(((9)))(10) Written consent from the dwelling landlord is required prior to starting any environmental adaptations for a rental property. The landlord must not require removal of the environmental adaptations at the end of the waiver participant's tenancy as a condition of the landlord approving the environmental adaptation to the waiver participant's dwelling.
(((10)))(11) Environmental adaptations must not add to the total square footage of the dwelling, convert nonliving space to living space, or create a new room.
(((11)))(12) The dollar amounts for aggregate services in your basic plus, CIIBS waiver or the dollar amount of your annual IFS allocation limit the amount of service you may receive.
(((12)))(13) For core, community protection, ((and CIIBS waivers,)) annual environmental adaptation costs must not exceed twelve thousand one hundred ninety-two dollars.
(((13)))(14) Damage prevention and repairs under the CIIBS and IFS waivers are subject to the following restrictions:
(a) Limited to the cost of restoration to the original function;
(b) Limited to the dollar amounts of the ((IFS waiver)) participant's annual allocation;
(c) Behaviors of waiver participants that resulted in damage to the dwelling must be addressed in a positive behavior support plan prior to the repair of damages;
(d) Repairs to personal property such as furniture and appliances are excluded; and
(e) Repairs due to normal wear and tear are excluded.
(((14)))(15) The following adaptations are not covered as an environmental adaption:
(a) Building fences and fence repairs;
(b) Carpet or carpet replacement;
(c) Air conditioning, heat pumps, generators, or ceiling fans;
(d) Roof repair or siding;
(e) Deck construction or repair; and
(f) Jetted tubs or saunas.
(((15)))(16) Environmental ((adaptions))adaptations are limited to additional services not otherwise covered under the medicaid state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
NEW SECTION
WAC 388-845-0920What is equine therapy?
(1) Equine therapy is the use of horses to provide experiences that support mental health and emotional well-being.
(2) Services may include horsemanship as part of a therapeutic team and participation in other activities associated with preparing a horse for a client's riding lesson.
(3) Equine therapy is available in the CIIBS waiver.
NEW SECTION
WAC 388-845-0930Who are qualified providers of equine therapy?
(1) The provider of equine therapy must be a certified therapeutic horseback riding instructor and contracted with DDA to provide this service.
(2) The provider of equine therapy must have one year of experience working with individuals with developmental disabilities.
NEW SECTION
WAC 388-845-0940Are there limits to the equine therapy I may receive?
The following limits apply to your receipt of equine therapy:
(1) Support needs for equine therapy are limited to those identified in your DDA assessment and documented in the person-centered service plan.
(2) The department requires your behavior specialist's written recommendation regarding your need for the service. This recommendation must take into account that the service is expected to complement the existing behavior support plan to address behavior support needs.
(3) Equine therapy requires prior approval by the DDA regional administrator or designee.
(4) DDA may require a second opinion by the department-selected provider.
(5) Equine therapy services must not exceed the CIIBS combined specialized-hourly services allocation of five thousand dollars per plan year.
(6) Equine therapy services must not be used to provide hippotherapy, which is an occupational therapy service.
(7) The department reserves the right to terminate the authorization for service if there is not a demonstrable improvement in behavior as documented by the contracted equine therapist or other treatment provider.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-1100What are ((behavioral health))stabilization services - crisis diversion ((bed services))?
((Behavioral health))(1) Crisis diversion ((bed services))beds are ((short-term emergent residential services that may be provided in a client's home, licensed or certified setting, or state operated setting. These services are available to eligible clients whose current living situation is disrupted and the client is at risk of institutionalization. These services are)) available in all five HCBS waivers administered by DDA as ((behavioral health))a stabilization ((services))service in accordance with WAC 388-845-1150 through 388-845-1160.
(2) Crisis diversion beds are short-term residential habilitative supports provided by trained specialists and include direct care, supervision or monitoring, habilitative supports, referrals, and consultation. Crisis diversion beds are available to individuals determined by DDA to be at risk of institutionalization.
NEW SECTION
WAC 388-845-1101Where may stabilization services - crisis diversion be provided?
Stabilization services - crisis diversion beds may be provided in a client's home or a licensed or certified setting.
AMENDATORY SECTION(Amending WSR 13-24-045, filed 11/26/13, effective 1/1/14)
WAC 388-845-1105Who is a qualified provider of ((behavioral health))stabilization services - crisis diversion ((bed services))?
Providers of ((behavioral health))stabilization services - crisis diversion ((bed services))beds must be:
(1) DDA certified residential agencies per chapter 388-101 WAC;
(2) Other department licensed or certified agencies; or
(3) State-operated ((agency))agencies.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-1110What are the limits of ((behavioral health))stabilization services - crisis diversion ((bed services))?
(1) Clinical and support needs for ((behavioral health))stabilization services - crisis diversion ((bed services))beds are limited to those identified in the waiver participant's DDA assessment and documented in the person-centered service plan.
(2) ((Behavioral health))Stabilization services - crisis diversion ((bed services))beds are intermittent and temporary. A behavioral health professional may make a recommendation about your need for ((behavioral health))stabilization services - crisis diversion ((bed services))beds. DDA determines the duration and amount of ((behavioral health))stabilization services - crisis diversion ((bed services))beds you will receive.
(3) The costs of ((behavioral health))stabilization services - crisis diversion ((bed services))beds do not count toward the dollar amounts for aggregate services in the basic plus or CIIBS waiver or the annual allocation in the individual and family services waiver.
(4) Stabilization services - crisis diversion beds are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-1150What are ((behavioral health)) stabilization services?
(1) ((Behavioral health))Stabilization services assist persons who are experiencing a behavioral health crisis.
(2) ((Behavioral health))Stabilization services are available in the basic plus, core, children's intensive in-home behavior support (CIIBS), individual and family services (IFS), and community protection waivers.
(3) A participant may be eligible for ((behavioral health)) stabilization services if:
(a) A behavioral health professional ((or))and DDA has determined the participant is at risk of institutionalization or hospitalization; and
(b) The participant needs:
(i) ((Positive behavior support and consultation))Specialized habilitation;
(ii) ((Specialized psychiatric services for people age twenty-one and older))Staff and family consultation; or
(iii) ((Behavioral health))Crisis diversion ((bed services available to participants on the individual and family services, basic plus, core, CIIBS, and community protection waivers))beds.
AMENDATORY SECTION(Amending WSR 13-04-005, filed 1/24/13, effective 2/24/13)
WAC 388-845-1155Who are qualified providers of ((behavioral health)) stabilization services?
Providers of these ((behavioral health)) stabilization services are listed in the rules in this chapter governing the specific services listed in WAC 388-845-1150.
AMENDATORY SECTION(Amending WSR 16-17-009, filed 8/4/16, effective 9/4/16)
WAC 388-845-1160Are there ((limitations))limits to the ((behavioral health)) stabilization services that you can receive?
(1) ((Clinical and support needs for behavioral health))Stabilization services are limited to those identified in your DDA assessment and documented in the person-centered service ((plan/individual support)) plan.
(2) ((Behavioral health))Stabilization services are intermittent and ((temporary))ninety days or less. ((The duration and amount of services you need to stabilize your crisis is determined by a behavioral health professional and/or DDA.))
(3) The costs of ((behavioral health)) stabilization services do not count toward the dollar amounts for aggregate services in the basic plus or CIIBS waiver or the annual allocation in the IFS waiver.
(((4) Behavioral health stabilization services require prior approval by DDA or its designee.))
NEW SECTION
WAC 388-845-1161What is music therapy?
(1) Music therapy is the use of musical interventions to promote the accomplishment of individualized goals within a therapeutic relationship.
(2) Services may include music improvisation, receptive music listening, song writing, lyric discussion, music and imagery, music performance, or other expressive musical forms.
(3) Music therapy is available in the CIIBS waiver.
NEW SECTION
WAC 388-845-1162Who are qualified providers of music therapy?
(1) Qualified providers of music therapy are agencies or individuals who are or employ board certified music therapists (MT-BC) as defined by the certification board for music therapists;
(2) Are contracted with DDA to provide this service; and
(3) Have one year of experience working with individuals with developmental disabilities.
NEW SECTION
WAC 388-845-1163 Are there limits to the music therapy I may receive?
The following limits apply to your receipt of music therapy:
(1) Support needs for music therapy are limited to those identified in your DDA assessment and documented in the person-centered service plan.
(2) The department requires your behavior specialist's written recommendation regarding your need for the service. This recommendation must take into account that the service is expected to complement the existing behavior support plan to address behavior support needs.
(3) Music therapy requires prior approval by the DDA regional administrator or designee.
(4) DDA may require a second opinion by a department-selected provider.
(5) Music therapy services must not exceed the CIIBS combined specialized-hourly services allocation of five thousand dollars per year.
(6) The department reserves the right to terminate the authorization for service if there is not a demonstrable improvement in behavior as documented by the certified music therapist or other treatment provider.
AMENDATORY SECTION(Amending WSR 13-24-045, filed 11/26/13, effective 1/1/14)
WAC 388-845-1505Who are qualified providers of residential habilitation services for the core waiver?
Providers of residential habilitation services for participants in the core waiver must be one of the following:
(1) Individuals contracted with DDA to provide residential support as a "companion home" provider;
(2) Individuals contracted with DDA to provide training as an "alternative living provider";
(3) Agencies contracted with DDA and certified per chapter 388-101 WAC;
(4) State-operated living alternatives (SOLA);
(5) Licensed and contracted group care homes, foster homes, child ((placing))placement agencies or staffed residential homes per chapter ((388-148))110-148 WAC.
AMENDATORY SECTION(Amending WSR 16-17-009, filed 8/4/16, effective 9/4/16)
WAC 388-845-1607Can someone who lives with you be your respite provider?
((Someone))A person who lives with you may be your respite care provider as long as ((he or she))that person is not your primary care provider and is not ((contracted to provide))providing any other DSHS paid service to you in the month that person provides respite care to you. The ((limitations))limits listed in WAC 388-845-0111 also apply.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-1700What is waiver skilled nursing?
(1) Waiver skilled nursing means long-term, intermittent, and hourly skilled nursing services consistent with waiver objectives of avoiding institutionalization.
(2) Waiver skilled nursing services are available in the basic plus, community protection (CP), core, and individual and family services (IFS) waivers, and are limited to participants age twenty-one and older unless skilled nursing is authorized as nurse delegation.
(3) Waiver skilled nursing services include nurse delegation services provided by a registered nurse under WAC 388-845-1170.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-1800What are specialized ((medical)) equipment and supplies?
(1) Specialized ((medical)) equipment and supplies are durable and nondurable medical equipment, or equipment necessary to prevent institutionalization, not available through the medicaid state plan or are in excess of what is available through the medicaid state plan benefit which enables individuals:
(a) To increase their abilities to perform their activities of daily living;
(b) To perceive, control, or communicate with the environment in which they live; or
(c) On the IFS and CIIBS waiver only, to improve daily functioning through sensory integration when prescribed in a written therapeutic plan by the current treating professional.
(2) Specialized equipment and supplies are available in all DDA HCBS waivers.
(3) Durable medical equipment and medical supplies are defined in WAC 182-543-1000 and 182-543-5500 respectively.
(((3)))(4) Also included are items necessary for life support and ancillary supplies and equipment necessary to the proper functioning of the equipment and supplies described in subsection (1) of this section.
(((4)))(5) Specialized ((medical)) equipment and supplies include the maintenance and repair of specialized ((medical)) equipment not covered through the medicaid state plan.
(((5) Specialized medical equipment and supplies are available in all DDA HCBS waivers.))
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-1805Who are the qualified providers of specialized ((medical)) equipment and supplies?
(1) The provider of specialized ((medical)) equipment and supplies must be a medical equipment supplier contracted with DDA or ((have))having a state contract as a Title XIX vendor((.));
(2) ((For IFS only,))A provider contracted with DDA as a goods and services shopper; or
(3) The provider of specialized ((medical)) equipment and supplies under WAC 388-845-1800(1)(c) ((must))may be contracted with DDA as a provider of specialized goods and services or specialized equipment and supplies for IFS and CIIBS waiver clients only.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-1810Are there limits to the specialized ((medical)) equipment and supplies you may receive?
The following limits apply to the specialized ((medical)) equipment and supplies you may receive:
(1) Habilitative support needs for specialized ((medical)) equipment and supplies are limited to those identified in your DDA person-centered assessment and documented in your person-centered service plan.
(2) Specialized ((medical)) equipment and supplies require prior approval by the DDA regional administrator or designee for each authorization.
(3) DDA may require a second opinion by a DDA-selected provider.
(4) Items must be of direct medical or remedial benefit to you and necessary as a result of your disability.
(5) Medications, personal hygiene products, supplements, and vitamins are excluded.
(6) The dollar amounts for aggregate services in your basic plus waiver limit the amount of service you may receive.
(7) The dollar amounts for your annual allocation in your individual and family services (IFS) waiver limit the amount of service you may receive.
(8) Items excluded from specialized equipment and supplies include nonspecialized recreational or exercise equipment, ((such as))including but not limited to trampolines, treadmills, swing sets, and hot tubs.
(9) Specialized equipment and supplies are limited to additional services not otherwise covered under the medicaid state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
(10) For a participant on the IFS or CIIBS waiver, specialized equipment and supplies are limited to those items needed to improve daily functioning through sensory integration. The item must be in a written therapeutic plan by the participant's current treating professional.
NEW SECTION
WAC 388-845-1870What are specialized habilitation services?
(1) Specialized habilitation services provide community-based and individualized support with the intent of reaching an identified habilitative goal in the person-centered service plan.
(2) Service must assist a client to learn or maintain skills in the category of self-empowerment, safety awareness, self-advocacy, interpersonal effectiveness, effective social communication, appropriate, coping strategies for everyday life changes, managing daily tasks, or adaptive skills.
(3) Specialized habilitation must promote inclusion in the community
(4) Specialized habilitation services are available on the basic plus, IFS, core and CIIBS waivers.
(5) Specialized habilitation, when authorized as a stabilization service, is available on all five HCBS waivers.
NEW SECTION
WAC 388-845-1880Who are qualified providers of specialized habilitation services?
To provide specialized habilitation services, a provider must be contracted with DDA for this service, have one year of experience working with people with a developmental or intellectual disability, and be one of the following licensed, registered, or certified professionals:
(1) Certified life skills coach;
(2) Individuals with bachelor's, master's, or doctoral degrees in social work, sociology, psychology, education; child development, gerontology, nursing or other related field; or
(3) In a university internship program for social work, sociology, psychology, education, child development, gerontology, sociology, gerontology, or nursing.
NEW SECTION
WAC 388-845-1890Are there limits to the specialized habilitation services I may receive?
The following limits apply to your receipt of specialized habilitation services:
(1) Specialized habilitation services are limited to address a maximum of three goals at a time.
(2) Support needs for specialized habilitation, and must be identified in your DDA assessment and documented in the person-centered service plan.
(3) Specialized habilitation services must not exceed:
(a) Four-thousand dollars of your basic plus aggregate funding;
(b) Your IFS annual allocation in combination with other waiver services;
(c) Fifteen thousand dollars within your total CIIBS aggregate budget and six thousand dollars emergency funding when eligible per WAC 388-845-0800 and 388-845-0820.
(4) Specialized habilitation services do not cover education, vocational, skills acquisition training through community first choice, behavioral health, ABA, skilled nursing, occupational therapy, physical therapy, or speech, language, and hearing services that are covered benefits through the medicaid state plan, including early and periodic screening, diagnosis, and treatment and part B special education services.
(5) Specialized habilitation must not be authorized to clients enrolled in residential habilitation.
(6) Habilitation plans must be documented as formal plans as outlined in the provider's contract.
(7) Specialized habilitation services, not provided as a stabilization service, require prior approval by the DDA regional administrator or designee.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-2000What is staff and family consultation ((and training))?
(1) Staff and family consultation ((and training)) is ((professional)) assistance, not covered by the medicaid state plan, to families or direct service providers to help them meet the individualized and specific needs of a participant as outlined in the participant's person-centered service plan and necessary to improve the participant's independence and inclusion in their community.
(2) Staff and family consultation ((and training)) is available in all DDA HCBS waivers.
(3) Staff and family consultation ((and training)) is consultation and guidance to a staff member or family member about one or more of the following:
(a) Health and medication monitoring to track and report to healthcare provider;
(b) Positioning and transfer;
(c) Basic and advanced instructional techniques;
(d) ((Positive behavior support))Consultation with potential referral resources;
(e) Augmentative communication systems;
(f) Diet and ((nutrition))nutritional guidance;
(g) Disability information and education;
(h) Strategies for effectively and therapeutically interacting with the participant;
(i) Environmental ((safety))consultation;
(j) Assistive technology safety; ((and))
(k) Consultation to an existing plan of care; and
(l) For the basic plus, IFS, and CIIBS waivers only, individual and family counseling.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-2005Who is a qualified provider of staff and family consultation ((and training))?
To provide staff and family consultation ((and training)), a provider must be contracted with DDA and be one of the following licensed, registered, or certified professionals:
(1) Audiologist;
(2) Licensed practical nurse;
(3) Marriage and family therapist;
(4) Mental health counselor;
(5) Occupational therapist;
(6) Physical therapist;
(7) Registered nurse;
(8) Sex offender treatment provider;
(9) Speech-language pathologist;
(10) Social worker;
(11) Psychologist;
(12) Certified American sign language instructor;
(13) Nutritionist;
(14) Counselors registered or certified in accordance with chapter
18.19 RCW;
(15) Certified dietician;
(16) Recreation therapist registered in Washington and certified by the national council for therapeutic recreation;
(17) Providers listed in WAC 388-845-0506 and contracted with DDA to provide CIIBS intensive services;
(18) Certified music therapist (for CIIBS only);
(19) Psychiatrist;
(20) Professional advocacy organization; or
(21) Teacher certified under chapter 181-79A WAC.
AMENDATORY SECTION(Amending WSR 20-05-080, filed 2/18/20, effective 3/20/20)
WAC 388-845-2010Are there limits to the staff and family consultation ((and training)) you may receive?
(1) Staff and family consultation ((and training)) are limited to supports identified in your DDA assessment and documented in the person-centered service plan.
(2) Expenses to the family or provider for room and board or attendance, including registration, at conferences are excluded as a service under staff and family consultation ((and training)).
(3) The dollar amounts for aggregate service in your basic plus waiver or the dollar amount of the annual allocation in your individual and family services (IFS) waiver limit the amount of staff and family consultation ((and training)) you may receive.
(4) Under the basic plus waiver, individual and family counseling is limited to family members who:
(a) Live with the participant; and
(b) Have been assaulted by the participant and the assaultive behavior was:
(i) Documented in the participant's person-centered service plan; and
(ii) Addressed in the participant's positive behavior support plan or therapeutic plan.
(5) Staff and family consultation ((and training))does not provide training or consultation necessary to meet a provider's or staff's contractual licensing or certification requirements or to complete the necessary functions of their job.
NEW SECTION
WAC 388-845-2145What are therapeutic adaptations?
(1) Therapeutic adaptions are modifications to an existing room in the waiver participant's current home and are necessary to reduce or eliminate environmental sensory stressors, enable effective social support, or give a sense of control to the waiver participant in order for a therapeutic plan to be implemented.
(2) Therapeutic adaptions include on-time room modifications not related to physical accessibility such as:
(a) Noise reduction or enhancement;
(b) Lighting adjustment;
(c) Wall softening;
(d) Anchored and nonremovable tactile accents; or
(e) Anchored and nonremovable visual accents.
NEW SECTION
WAC 388-845-2150Who is a qualified provider of therapeutic adaptations?
(1) A qualified provider of therapeutic adaptations is a person who is contracted with DDA and:
(a) A registered contractor per chapter
18.27 RCW and licensed and bonded to perform the specific type of work they are providing; or
(b) A medical equipment supplier with a state contract as a Title XIX vendor.
(2) A qualified provider of therapeutic adaptations may also be someone who is contracted with DDA as:
(a) A purchasing goods and services contractor; or
(b) A CIIBS goods and services contractor.
NEW SECTION
WAC 388-845-2155Are there limits to the therapeutic adaptations I may receive?
The following limits apply to your receipt of therapeutic adaptations:
(1) Therapeutic adaptations are limited to one adaptation request every five waiver years.
(2) Funding is limited to the aggregate budget in the basic plus and IFS waiver or fifteen thousand dollars on the CIIBS waiver.
(3) Modifications may not add square footage to the home or convert nonliving space into living space.
(4) The department requires a written recommendation by a behavioral health provider, occupational therapist, or physical therapist within the waiver participant's current therapeutic plan.
(5) Therapeutic adaptations are limited to items not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
(6) Therapeutic adaptations require prior approval by the DDA regional administrator or designee.
(7) Therapeutic adaptations are limited to those identified in the client's person-centered service plan.
AMENDATORY SECTION(Amending WSR 18-14-001, filed 6/20/18, effective 7/21/18)
WAC 388-845-3070What happens if you do not sign your person-centered service plan?
(1) If you do not sign your initial person-centered service plan (PCSP), DDA must not provide waiver services to you until you sign the PCSP.
(2) If you do not sign your PCSP and it is a reassessment or review, DDA will:
(a) Continue providing services identified in your current PCSP until the end of the notice period under WAC 388-825-105; and
(b) Return your PCSP to you for your signature.
(3) If you do not return your signed PCSP within two months of your reassessment or review, DDA ((must))may terminate your services.
(4) Your appeal rights are under:
(a) WAC 388-845-4000; and
(b) WAC 388-825-120 through 388-825-165.
REPEALER
The following sections of the Washington Administrative Code are repealed:
WAC 388-845-0300 | What are adult family home (AFH) services? |
WAC 388-845-0305 | Who is a qualified provider of AFH services? |
WAC 388-845-0310 | Are there limits to the AFH services I can receive? |
WAC 388-845-0400 | What are adult residential care (ARC) services? |
WAC 388-845-0405 | Who is a qualified provider of ARC services? |
WAC 388-845-0410 | Are there limits to the ARC services I can receive? |
WAC 388-845-0700 | What are community guide services? |
WAC 388-845-0705 | Who may be a qualified provider of community guide services? |
WAC 388-845-0710 | Are there limits to the community guide services I may receive? |
WAC 388-845-1300 | What are personal care services? |
WAC 388-845-1305 | Who are the qualified providers of personal care services? |
WAC 388-845-1310 | Are there limits to the personal care services you can receive? |
WAC 388-845-1400 | What are prevocational services? |
WAC 388-845-1405 | Who are the qualified providers of prevocational services? |
WAC 388-845-1410 | Are there limits to the prevocational services you may receive? |
WAC 388-845-1900 | What are specialized psychiatric services? |
WAC 388-845-1905 | Who are qualified providers of specialized psychiatric services? |
WAC 388-845-1910 | Are there limitations to the specialized psychiatric services you can receive? |
WAC 388-845-2160 | What is therapeutic equipment and supplies? |
WAC 388-845-2165 | Who are qualified providers of therapeutic equipment and supplies? |
WAC 388-845-2170 | Are there limits to your receipt of therapeutic equipment and supplies? |