WSR 97-18-089

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Aging and Adult Services Administration)

(Public Assistance)

[Filed September 3, 1997, 11:42 a.m., effective September 4, 1997]

Date of Adoption: September 2, 1997.

Purpose: To implement E2SHB 1850 (1997), which mandates the Department of Social and Health Services to put into place a limited moratorium on the licensing of adult family homes. Rules are necessary to implement the moratorium, and specifically to describe a process for granting exceptions to the moratorium on a case-by-case basis. The legislature further required that, during the moratorium, the department review, and if necessary, amend, existing safety and quality of care standards, and that the secretary determine that they reasonably protect the life, safety and health of residents.

The purpose of this analysis is to assist members of the public to understand the rules and to fulfill the requirements of RCW 34.05.328.

What is an adult family home?

Adult family homes provide a choice to consumers who need long-term care, yet want to remain in the community in a homelike setting. Adult family homes are residential homes licensed to care for up to six residents. The homes provide room, board, laundry, necessary supervision, assistance with activities of daily living, personal care and social services.

The number of licensed adult family homes has been steadily increasing since the inception of the program in the early 1970s. In 1973 there were 546 homes. In June of 1997, there were 2,253 licensed adult family homes in Washington state, with a capacity to provide services to approximately 9,000 persons. Approximately twelve months ago, the total number of licensed homes was growing by 30 to 50 homes per month for a number of months. In the last several months, however, the number of homes has leveled, with newly licensed homes evenly replacing homes that go out of business.

Approximately 2,700, or thirty percent of the residents of adult family homes, receive state funds to support their care.

How do adult family homes fit into the long-term care system?

Adult family homes have largely grown out of a demand for residential long-term care in a noninstitutional setting. It has long been acknowledged through polls and surveys that Americans want to remain in their own homes as they age, rather than in institutions¹. It is similarly acknowledged that nursing home care, which is generally equated with institutional care, can be a relatively expensive long-term care option.

While a majority of persons in Washington state receive long-term care services in their homes, some people lack the support networks that enable them to continue receiving care at home, or their needs become so complex that home care becomes impractical. These people often seek long-term care services in residential settings.

Responding to the need for a variety of long-term care services, the 1995 Washington state legislature enacted E2SHB 1908 (now codified in part in chapter 74.39A RCW). This guided the Department of Social and Health Services to increase the number of cost-effective long-term care options for persons enrolled in Medicaid and other programs in which the state participates in the cost of care. These options include adult family homes, and other alternatives to nursing homes, such as assisted living. The legislation also directed the department to promote the most appropriate level of physical, mental, and psychosocial well-being consistent with client choice, in an environment that is appropriate to the care and safety needs of the individual. The legislation further required the department to reduce the number of state-pay clients residing in nursing homes by a minimum of 1,600 persons over the ensuing two-year period.

What are the general goals and specific objectives of the statute that this rule implements?

The 1997 legislature passed E2SHB 1850 (Section 402, chapter 392, Laws of 1997), which directs the department to implement a limited moratorium on the licensure of new adult family homes.

The new statute contains three major requirements related to these rules:

(1) The department must implement a limited moratorium on the authorization of new adult family home licenses.

(2) The moratorium will be in effect until December 12, 1997, or until such time as the secretary of the department determines that the safety and quality of care standards have been reviewed by the department, and determined that they reasonably protect the life, safety and health of residents.

(3) The department must develop a process for determining, on a case-by-case basis, if applications for licenses should be accepted in order to accommodate the needs of eligible persons within particular geographical or ethnic communities.

Why are these rules needed to achieve these goals and objectives?

The legislature authorized the department to adopt rules to implement the moratorium. The rules are needed to define the time frame for the moratorium and the criteria for accommodating the needs of a particular geographic or ethnic community.

How were the effective dates selected?

The department determined that the legislature intended the moratorium to become effective as early as is practical. The beginning date for the moratorium was selected to be as soon as possible after the conclusion of the rule-making process. The end date is mandated in the law.

How was the system developed for the department's review of requests for accommodations?

The legislature directed the department to establish a limited moratorium on the authorization of adult family home licenses to ensure health and safety standards are met, but stipulated that this moratorium "shall in no way prevent a person eligible to receive service from receiving the same or equivalent long-term care service." Section 402 of E2SHB 1850 requires the department to "develop a process for determining the availability of chronic long-term care residential services on a case-by-case basis, to determine if an adult family home license should be granted to accommodate the needs of a particular geographical or ethnic community."

The department relied on input from the public and from knowledgeable staff to develop a process for how the department should fulfill the requirements of the moratorium.

Management staff of the Aging and Adult Services Administration, along with a representative from the Division of Development Disabilities, formed a work group to make recommendations throughout the rule development process. These managers have a broad range of responsibilities, including licensure of adult family homes, quality assurance oversight, policy development, and the administration of case management for clients who are reliant on state resources.

Once an informal draft of the rules had been developed, the department asked interested parties to provide comment on the proposed rules. Department staff received telephone calls and letters with comment from providers, a provider association, and representatives of the office of the long-term care ombudsman. The department also hosted a stakeholder meeting, which was well attended by consumer advocates and representatives of long-term care provider associations. A number of significant comments were received. Below is a list of the most frequently raised comments, followed by a brief discussion of actions taken by the department to address them.

The following comments were received in response to the initial informal draft of the rule:

(1) The moratorium should be state-wide, and should not allow for blanket geographical accommodations.

Discussion: The rules were revised and do not allow any blanket geographical accommodations. Any accommodations will be approved only after a case-by-case review.

(2) Accommodations should only be granted in order to serve persons eligible for state-supported services.

Discussion: The rules only allow for accommodations to be granted in order to serve persons eligible for state-supported services. The law states that accommodations shall be made so that "eligible persons" will be able to receive the same or equivalent services during the moratorium. Due to this language in the law, the department determined that only the needs of persons eligible for public support should be considered during the moratorium. There are no other persons for whom eligibility for adult family home services is determined.

(3) Accommodations should be considered in order to meet the needs of all persons eligible for state-supported long-term care services, regardless of age or disability.

Discussion: The rules provide for this consideration.

(4) When considering the need for accommodations, the department should look at the availability of nursing homes, as well as other residential long-term care facilities.

Discussion: The department will consider the availability of nursing homes and other residential long-term care facilities when considering the need for accommodations. The department has been mandated to serve state-supported clients in the least restrictive, most cost efficient residential setting.² For this reason, an assessment will be made of each state client before determining which residential placement will best fulfill these requirements.

The following comments were received after the development of the formal proposed rules:

(1) The department should not provide accommodations only for the purpose of providing service for Medicaid clients. The accommodation process should include an assessment of need of all persons who would be most appropriately served in an adult family home, regardless of whether they pay from private or public funds.

Discussion: The law states that accommodations shall be made so that "eligible persons" will be able to receive the same or equivalent services during the moratorium. Due to this language in the law, the department determined that only the needs of persons eligible for public support should be considered during the moratorium. There are no other persons for whom eligibility for adult family home services is determined.

(2) When determining need for persons who would be isolated from family and friends if they relocated across a long distance in order to receive residential services, consideration should be given to whether the client or the client's family considers the existing residential facilities to be acceptable.

Discussion: The needs of individual state clients are assessed by a case manager relying on a comprehensive assessment tool. Client preferences are considered in the assessment process.

(3) When determining need for additional adult family homes, all types of residential options should be considered as potential alternative placements.

Discussion: All types of residential options will be considered as potential alternative placements. The department will use the comprehensive assessment process to determine which residential placement will best meet the client's needs, and to determine the client's preference.

(4) Accommodations should be granted with a focus on the client and not on the provider.

Discussion: Accommodations will be granted with a focus on the needs of clients, as defined in the rules.

(5) The rules should indicate why the moratorium is in effect and what the conditions are for lifting the moratorium.

Discussion: The rules being put into effect comply with the legislative mandate of E2SHB 1850, section 402. This is stated in the rules. The statute (E2SHB 1850, section 402) determines the conditions for lifting the moratorium.

(6) The rule should allow the transfer of a license when adult family homes are sold.

Discussion: E2SHB 1850, section 402 does not give the department authority to write such a rule.

(7) During the moratorium, applications should be accepted for homes that are relocating anywhere in the state, not just within the same county.

Discussion: The department revised the rules to reflect this comment.

(8) A case-by-case determination should exist to accommodate providers who will be unable to open second homes during the moratorium, and who will lose earnest money.

Discussion: E2SHB 1850, section 402 does not give the department authority to write such a rule.

(9) An adult family home advisory council should be formed.

Discussion: The statute requires an analysis of establishing such a council, which the department will complete.

(10) An accommodation should not be granted to provide service to Medicaid clients. There are already enough adult family homes available to provide services.

Discussion: The department will determine that need exists before granting an accommodation. Some communities have greater numbers of residential care options than others.

(11) Persons who are owners of only one home should be the only persons to receive adult family home licenses.

Discussion: E2SHB 1850, section 402 does not give the department authority to write such a rule.

(12) The rules should state that the moratorium will end on December 12, 1997.

Discussion: Such rules would contradict the requirements of E2SHB 1850, section 402.

How will requests for accommodations be reviewed?

The work group considered the public comment and devised a system to review requests for accommodation. First, work group members recognized that the licensing process takes about ninety days and that state clients ordinarily require immediate placement when a residential facility is needed. For these reasons, the work group acknowledged that any case-by-case accommodations made under the moratorium would not likely result in a placement for a particular person in need of service. Instead of focusing on service to individual clients, work group members considered ways to look ahead ninety days to determine more generally how many state-supported clients would be eligible for adult family home care and how many would be in need of a residential placement.

The rules include a method to review each request for an accommodation according to specific criteria, and on a case-by-case basis. The rules require the department to analyze the anticipated care requirements of Medicaid clients in relation to the availability of existing residential providers, and determine whether a need exists for an additional adult family home in order to provide for the future needs of the eligible clients.

What alternative versions of the rule were considered?

The department originally proposed an informal version of the rules, and based on input from stakeholders and legislative staff, the informal draft rules were revised in two key areas:

(1) The informal draft rules provided for the moratorium to be in effect in certain counties, and not in others, based on the number of existing adult family homes in each county. After the revision, the rules include the entire state in the moratorium.

(2) The informal draft rules allowed for accommodations to be granted in order to provide needed adult family home service to public clients and privately paying clients. After the revision, accommodations are made only to serve the needs of "eligible persons," which the department has interpreted to mean state-supported clients.

The department then proposed a formal version of the rules. Following public input, two changes were made to these rules. They are:

(1) The rules were revised in order to clarify that the director of residential care services, or the director's designee, shall evaluate the need for any new licenses, based on the definition of need contained in the rules.

(2) The rules were revised to allow current licensees to submit applications for licenses during the moratorium, for the purpose of changing the location of their home anywhere in the state. The rules previously allowed such a move only "within the same county of residence." Also, an additional sentence was added to require such applicants to make a notation on the first page of their application, indicating that they have a current license and plan to relocate.

Who is affected?

Listed below are the major groups affected by the moratorium. The sections that follow provide an analysis of how they are affected.

Privately paying and publicly supported consumers of adult family home service

Taxpayers

Existing adult family home providers

Prospective adult family home providers

Other long-term care providers

Are large and small businesses involved?

In reviewing current licensed adult family home providers, the department determined that the vast majority of adult family home providers satisfy the definition of a small business found in RCW 19.85.020; "any business entity, including a sole proprietorship, corporation, partnership, or other legal entity, that is owned and operated independently from all other businesses, that has the purpose of making a profit, and that has fifty or fewer employees." However, several adult family home providers own more than one home or operate other businesses. These providers may be considered large businesses by the above definition, because they have fifty or more employees.

What is the impact on business?

The major cost impact of the moratorium will be incurred by applicants for new adult family home licenses, who, due solely to the moratorium, may be unable to obtain a license. Prospective adult family home providers who are unable to obtain a license will be unable to admit residents, thereby will not earn revenue from the daily rate that they might otherwise have earned.

The potential impact on a provider based on the inability to start a business can be estimated as follows:

Typical daily adult family home state payment rate: $50.52

Typical number of clients: 4

Number of days the moratorium is likely to last: 100

Based on these assumptions, a provider may be unable to earn $50.52 in revenue for each of four clients for 100 days. The total in revenue would be $20,208.00. This amount represents the potential unearned gross income.

(Note: This exercise is only a sample of the revenue that may not be earned. Adult family homes vary a great deal: They may be licensed for between 2 and 6 residents; vacancy rates vary across the state; it can take many months before some homes are filled to capacity, and some may never have full occupancy in their home; the state payment rate is an estimate of the daily rate for state fiscal year 1998³, and there is a wide range of public and private daily rates. Also, every prospective provider may not actually forego earning revenue during the moratorium. For example, an applicant may have been found to have a disqualifying criminal history, and thereby would never have received a license.)

There may be additional impacts to individual businesses, depending on their individual stage of development at the time of the moratorium. For example, a prospective provider who has placed earnest money on a home may lose that earnest money due to an inability to apply for a license, and therefore, an inability to maintain the rent or purchase of the home.

Are there disproportionate impacts to large and small business?

All prospective providers in the industry will be equally impacted by these rules. Those fitting the definition for a small business will experience a disproportionate impact, however, because any unearned revenue would constitute a greater proportion of their income.

How did the department mitigate these costs?

The rules are needed in order to accomplish the goal of the legislative mandate. For this reason, the department cannot feasibly mitigate all impacts that will be disproportionately experienced by small businesses. The following steps have been taken to minimize the proportionately higher economic burden to small businesses:

(1) The rules establish clear guidance to persons choosing to request an accommodation to the moratorium; and

(2) The rules specify time-certain deadlines for the notification of persons requesting an accommodation, thus avoiding delays; and

(3) The moratorium on licensure of new homes is time limited.

What are the probable costs and probable benefits of these rules?

Costs:

In addition to the costs to small business, the probable costs associated with the moratorium fall into four broad categories, which are discussed in more detail below:

(1) The potential reduction of the supply of adult family home beds.

(2) The potential to drive up the rates charged by nursing homes and other long-term care providers.

(3) The cost of state resources in managing the workload of a case-by-case review of requests for accommodations.

(4) The potential loss of contractors who provide required training to new adult family home providers.

(1) The potential reduction of the supply of adult family home beds.

Some prospective adult family home providers may not be able to receive a license and operate their business during the moratorium. This is likely to result in a reduction in the rate of growth of homes, and may result in an overall reduction of the number of homes. These trends would reduce the supply of homes.

(Note: The department will allow for case-by-case accommodations based on need. This strategy will reduce the moratorium's impact on supply.)

There are two general categories of payment for adult family home services. These are services purchased with private funds and services purchased with state and federal tax dollars. Consumers of both privately and publicly supported adult family home services would presumably seek services in another setting, such as a nursing home or an assisted living facility. These consumers would experience the loss of a choice of residential setting, which can only be partly measured by a review of the financial costs. The potential dollar cost impact on a consumer of the loss of the choice of a setting can be estimated as follows:

Daily nursing home rate: $113.15

Daily assisted living rate: $57.77

Daily adult family home rate: $50.52

Difference each day ranges from: $7.22 to $62.63

(Note: The state payment rates are estimates of the daily rate for nursing homes, assisted living, and adult family homes for state fiscal year 1998, and used as "proxies" for what the population at large might pay. In fact, there is a wide range of daily rates, which vary by type of facility and by region.)

(2) The potential to drive up the rates charged by nursing homes and other long-term care providers.

Over the last decade, an increasing number of alternatives to nursing homes have been developed, many of which are less expensive than nursing home care. To the extent that the moratorium reduces the supply of alternative placements, there is a risk that nursing home rates, along with rates for other long-term care services, could be driven up, based on a continuing demand with fewer resources available to meet the demand.

(3) The cost of state resources in managing the workload of a case-by-case review of requests for accommodations.

The daily management of the case-by-case review of requests for accommodation will require state staff resources. To the extent that staff are busy with this task, they are unable to perform other tasks. The extent of the workload impact is unknown, as the department does not yet know how many persons will make requests for accommodation.

(4) The potential loss of contractors who provide required training to new adult family home providers.

The department has existing contracts for professionals who offer training required for new adult family home licensees and persons hired to provide care in the adult family homes. If there is a significant reduction in the number of new homes, the trainers may not have sufficient numbers of enrollees in their classes to make holding the training worthwhile. The moratorium could create a reduction in the number of professionals willing to continue contracting with the state to provide this training.

Benefits:

The following are broad categories of probable benefits, which are described in more detail below:

(1) The opportunity for a review of safety and quality of care standards.

(2) An ability to focus on quality assurance in adult family homes.

(3) A capacity for the department to communicate its quality of care standards.

(4) The fulfillment of the legislative mandate.

(1) The opportunity for a review of safety and quality of care standards.

A predominant benefit of the moratorium is the opportunity that it provides the department to conduct a review of the safety and quality of care standards that govern the operation of adult family homes. This review will include an assessment of whether these standards reasonably protect the life, safety, and health of residents, and the modification of any standards as necessary.

(2) An ability to focus on quality assurance in adult family homes.

As discussed in the cost section, one possible outcome of the moratorium is that it will reduce the overall supply of homes, resulting in fewer choices for consumers. A benefit is also derived from reduced supply, however, because it affords the opportunity to focus on quality assurance across a smaller number of providers. Because the department has limited resources, this smaller focus could potentially enhance the quality outcomes. In addition, the long-term care ombudsman program could more effectively use its limited resources if focusing on a smaller pool of providers.

(3) A capacity for the department to communicate its quality of care standards.

The moratorium will provide an opportunity for the department to communicate about its quality assurance efforts. This communication will help consumers and the public at large to have confidence in the standards and practices that exist in adult family homes.

(4) The fulfillment of the legislative mandate.

The implementation of the moratorium offers the clear benefit of fulfilling the mandate of the legislature.

Are these rules the least burdensome alternative for those required to comply with them?

Among the alternatives considered, these rules are considered to put a relatively lower burden on individuals requesting accommodations. The rules provide clear instructions to individuals, and they contain very time-certain deadlines. The moratorium is also limited in duration.

Will the probable benefits of the rules outweigh the probable costs?

During the development of the rules, the department considered the fulfillment of the legislative mandate to be its foremost goal.

There are a number of important costs and benefits associated with the rules. These cannot be realistically measured until the moratorium has been in effect for a period of time. Over time, it will become clear whether the supply of adult family homes is reduced, and whether this reduction causes significant problems, such as those discussed above. Any costs must then be analyzed in light of the benefits that are derived from the moratorium.

Do the rules require those to whom they apply to take an action that violates the requirements of another statute or law?

No, the rules do not require those to whom they apply to take an action that violates the requirements of another statute or law.

Do the rules differ from any federal regulation or statute applicable to the same activity or subject matter?

No, there is no federal regulation or statute relating to the adult family home program.

How will the department coordinate the rules, to the maximum extent practicable, with other federal, state and local laws applicable to the same activity or subject matter?

The only laws applicable to the same activity are the state laws governing the licensing of adult family homes. The department is responsible for the rules on licensing, and, as a result, it will be convenient for the department to closely coordinate the process for reviewing accommodations with the licensing process. Information on both topics will be provided at adult family home orientation, which means that interested persons can receive information through one source and at one time. (The orientation is a routine means for the department to educate prospective providers about running adult family homes. The rules specify how interested persons may sign up for an orientation.)

How will the agency implement and enforce the rules?

The rules under discussion, WAC 388-76-9970 through 388-76-9980 provide a detailed description of the implementation process.

How will the agency encourage voluntary compliance?

The department will educate prospective applicants about the process for applying for an accommodation. This will be accomplished through the adult family home orientations, sponsored in regional offices throughout the state.

Do the rules impose more stringent performance requirements on private entities than on public entities?

No, the rules do not impose more stringent performance requirements on private entities than on public entities.

How have members of the public been notified of the rules, and how have they been able to participate in the rule-making process?

The department has used the following approaches:

Mailing of Preproposal Statement of Inquiry (CR-101) to interested parties, and publishing in the Washington State Register

Hosting a stakeholder meeting for the purpose of receiving feedback

Making copies of the informal draft rules available through mail or FAX

Accepting verbal comments via telephone calls, and written comment through letters

Mailing Proposed Rules to interested parties and to all current adult family home providers, and publishing in the Washington State Register and on the DSHS rule-making web page

Public Hearing

After filing the CR-103, the department will:

Mail final rules to interested parties and to all current adult family home providers

Notify prospective providers through adult family home orientations

Notify adult family home providers and interested persons of the end of the moratorium

How will the department evaluate whether the rules achieve the purpose for which they were adopted?

The department will track all requests for accommodation and keep statistics on the following:

How many accommodations were granted and denied in each county

Reasons for granting or denying

Length of time taken to review requests and notify interested persons

Do the rules achieve the goals and objectives of the statute?

These rules will achieve the three requirements of this section of the statute:

(1) The rules implement a limited moratorium on the authorization of new adult family home licenses; and

(2) The rules establish effective dates for the moratorium; and

(3) The rules establish a system for the department to determine, on a case-by-case basis, if applications for licenses should be accepted in order to accommodate the needs of eligible persons within particular geographical or ethnic communities.

¹ Barbara Coleman, "New Directions for State Long-Term Care Systems, Volume I: Overview", AARP Public Policy Institute, 1996.

² RCW 74.39A.008.

³ Woolley, John, "DSHS, Aging and Adult Services 1997-1999 Spending Plan," 1997.

Statutory Authority for Adoption: Section 403, chapter 392, Laws of 1997 (E2SHB 1850).

Other Authority: Sections 402, 403 and 532, chapter 392, Laws of 1997.

Adopted under notice filed as WSR 97-15-132 on July 23, 1997.

Changes Other than Editing from Proposed to Adopted Version: (1) WAC 388-76-9976(4) was revised to add the following sentence: "The director of residential care services, or the director's designee, shall evaluate the need for the home, based on the definition of need in WAC 388-76-9972."

(2) WAC 388-76-9978 [(1)](d) was revised to eliminate the words "within the same county of residence." Also, an additional sentence is added to this section: "Applicants who are planning to relocate shall make a notation on the first page of their application, indicating that they have a current license and plan to relocate."

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 6, 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 0, repealed 0.

Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: These rules will become effective on September 4, 1997, in order to comply with the legislative intent of sections 402, 403 and 532, chapter 392, Laws of 1997, that the limited moratorium be implemented promptly. The potentially short term of the moratorium (most likely to end on December 12) and the legislative history of the moratorium indicate a legislative intent that the department implement the moratorium expeditiously. This intent is shown not only by the short term of the moratorium, but also by the legislature's effort to grant additional emergency rule-making authority to implement the moratorium.

Effective Date of Rule: September 4, 1997.

September 2, 1997

Merry A. Kogut, Manager

Rules and Policies Assistance Unit

NEW SECTION

WAC 388-76-9970 Purpose. The purpose of WAC 388-76-9970 through 388-76-9980 is to satisfy the legislative requirements of section 402, chapter 392, Laws of 1997.

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NEW SECTION

WAC 388-76-9972 Definitions. For purposes of WAC 388-76-9970 through 388-76-9980, the following definitions shall apply:

"Accommodation" means a determination by the department to accept an application for a new adult family home license, based on a case-by-case review of requests.

"Long distance" means a distance of thirty miles or more, or requiring thirty minutes or more of travel time between existing licensed residential long-term care facilities.

"Moratorium" means a temporary stoppage of the acceptance of new adult family home applications received during the dates specified in WAC 388-76-9974. The moratorium is limited because accommodations may be granted by the department to allow for the application for new licenses, in individual cases in which the department finds that a need exists.

"Need" means the necessity for long-term care services by persons enrolled in Medicaid whose care requirements have been assessed to be most appropriately served in a residential long-term care setting. To meet this definition, the department must find that a need exists for one of the following:

(1) Services for persons who reside in a geographical area which has a lack of available providers; a need will be found by the department based on consultation with case managers and on a review of the availability of existing residential facilities; or

(2) Services for persons whose requirements are distinctive, and require special expertise by care providers; a need will be found by the department based on consultation with case managers or specialized departmental staff, such as staff serving persons with developmental disabilities or with mental health disabilities; or

(3) Services for persons of particular ethnic groups whose cultural lifestyle can only be maintained by care providers with knowledge of their culture; a need will be found by the department based on consultation with case managers or specialized departmental staff, such as staff serving persons with developmental disabilities, or persons with mental health disabilities; or

(4) Services for persons who would be isolated from family and friends if they relocated across a long distance in order to receive residential services; a need will be found by the department based on a review of the proximity of existing residential facilities.

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NEW SECTION

WAC 388-76-9974 Effective date of the moratorium. The moratorium shall be effective beginning at 8:00 a.m., September 4, 1997, and extend through 5:00 p.m., December 12, 1997, or until such time as the secretary removes the moratorium. After the moratorium is lifted by the secretary, WAC 388-76-9970 through 388-76-9980 will no longer be effective.

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NEW SECTION

WAC 388-76-9976 Process for requesting an individual accommodation. (1) Before submitting an application for adult family home licensure, a person must request an individual accommodation to the moratorium by writing a letter to the director of residential care services, aging and adult services administration, at the following address:

Aging and Adult Services Administration

Director, Residential Care Services

PO Box 45600

Olympia, WA 98504-5600

(2) Any requests for individual accommodations that do not contain all of the requirements listed in subsection (3) of this section, will be returned to the individual making the request without action.

(3) The letter requesting an individual accommodation shall contain all of the following:

(a) A statement that the letter is a request for an individual accommodation to the moratorium on the licensure of new adult family homes; and

(b) A statement of which type of need, as defined in WAC 388-76-9972, the adult family home proposes to address; and

(c) A statement that the applicant will contract with the state to provide service to a client or clients who have been determined to be Medicaid eligible; and

(d) A photocopy of one of the following:

(i) For persons who do not currently have an adult family home license: The certificate of attendance at an adult family home orientation. The certificate of attendance can be obtained by attending an orientation session sponsored by a local adult family home area office. Information about the orientations may be obtained by calling the phone numbers listed in subsection (6) of this section; or

(ii) For persons who currently operate a licensed home and are requesting consideration of an additional license, and therefore do not need to attend orientation: A current adult family home license.

(4) The director of residential care services, or the director's designee, shall evaluate the need for the home, based on the definition of need in WAC 388-76-9974. The department shall respond in writing, within fifteen working days, with a decision to grant or deny the request for the individual accommodation. Individuals who receive a letter granting their request for accommodation may then apply for an adult family home license.

(5) The letter requesting the accommodation should not be accompanied by an adult family home application. Any applications or accompanying checks sent with letters will be returned to the applicant without action.

(6) The adult family home area offices are:

Southeast Washington

Phone: 360/493-2546

Address: Residential Care Services/

Adult Family Home Area Office

PO Box 45600

Olympia, WA 98504-5600

Counties: Clark, Cowlitz, Klickitat, Lewis, Pacific, Skamania, Thurston, Wahkiakum.

King County

Phone: 206/587-4285

Address: Residential Care Services/

Adult Family Home Area Office

1737 Airport Way S, Suite 160

Seattle, WA 98134

County: King (excluding north King County zip codes).

Northwest Washington

Phone: 360/653-0591

Address: Residential Care Services/

Adult Family Home Area Office

PO Box 3504

Arlington, WA 98036

Counties: Island, San Juan, Skagit, Snohomish, Whatcom (and including north King County zip codes).

Northeast Washington

Phone: 509/456-3911

Address: Residential Care Services/

Adult Family Home Area Office

316 W. Boone, Suite 170

Spokane, WA 99201-2351

Counties: Adams, Asotin, Benton, Chelan, Columbia, Douglas, Ferry, Franklin, Garfield, Grant, Kittitas, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens, Walla Walla, Whitman, Yakima.

Pierce County and the Olympic Peninsula

Phone: 253/597-4160

Address: Residential Care Services/

Adult Family Home Area Office

1949 S. State Street

Tacoma, WA 98405-2850

Counties: Clallam, Grays Harbor, Jefferson, Kitsap, Mason, Pierce.

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NEW SECTION

WAC 388-76-9978 Applications that will be processed during the moratorium. (1) Applications received under any one of the following conditions shall be processed according to the usual departmental licensure process:

(a) Applications postmarked on or before September 3, 1997, to:

Aging and Adult Services Administration

Residential Care Services

PO Box 45600

Olympia, WA 98504-5600; or

(b) Applications hand delivered no later than 5:00 p.m., September 3, 1997, to:

Aging and Adult Services Administration

Residential Care Services/Adult Family Home Licensing

Building A, 600 Woodland Square Loop

Lacey, WA 98503

With the delivery confirmed by a receipt from Aging and Adult Services staff; or

(c) Applications received with an attached letter from the director of residential care services, or the director's designee, stating that an individual accommodation has been granted; or

(d) Applications for licensed homes that are relocating. Applicants who are planning to relocate shall make a notation on the first page of their application, indicating that they have a current license and plan to relocate. This does not include applications for licenses for homes where the license is being transferred from one individual or entity to another individual or entity.

(2) All other applications shall be returned to the applicant without action.

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NEW SECTION

WAC 388-76-9980 Notification of the end of the moratorium. Persons currently holding an adult family home license, and persons on the department's interested parties mailing list will be notified of the date that the moratorium is no longer in effect, as determined by the secretary.