WSR 98-23-095

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

[Filed November 18, 1998, 10:51 a.m.]



Original Notice.

Preproposal statement of inquiry was filed as WSR 98-10-040.

Title of Rule: Family support opportunity.

WAC 275-27-020 Definitions.

WAC 275-27-180 What is the purpose of the family support opportunity program?

WAC 275-27-185 Who is eligible to participate in the family support opportunity program?

WAC 275-27-190 What basic services can my family receive from the family support opportunity program?

WAC 275-27-191 What is the purpose of community guide services?

WAC 275-27-192 Who can become a community guide?

WAC 275-27-193 Does my family have a choice in selecting its community guide?

WAC 275-27-194 Can the family support opportunity program help my family obtain financial assistance for community guide services?

WAC 275-27-195 How can short-term intervention services help my family?

WAC 275-27-196 Specifically how can short-term intervention funds be used?

WAC 275-27-197 How can serious need funds help my family? WAC 275-27-198 How can my family qualify for serious need funds?

WAC 275-27-199 How does my family request serious need funds?

WAC 275-27-200 What amount of serious need funding is available to my family?

WAC 275-27-202 Who determines what family support services my family can receive?

WAC 275-27-204 What department restrictions apply to family support payments?

WAC 275-27-211 What are regional family support advisory councils?

WAC 275-27-212 What are community service grants?

WAC 275-27-213 Who is covered under these rules?

Purpose: Pilot rules have been in existence since 1996. Because the program has been operating successfully as a pilot, rules for the project, now called the family support opportunity are proposed for permanent adoption. These rules cover the purpose, eligibility, and basic service elements of the program as well as the formation of regional family support advisory councils and community service grants. The rules state that all family support clients starting June 1996 or later will be covered under these rules.

Statutory Authority for Adoption: RCW 71A.12.030.

Statute Being Implemented: RCW 71A.12.040.

Summary: The family support opportunity establishes a new way of delivering family support services to persons with developmental disabilities who live with their families. There is an emphasis on use of informal and community resources, use of a "community guide" to assist families, provision of a package of basic services to families as well as options for emergencies and serious need. The family support opportunity was established as a pilot project in 1996 and has been operating under pilot rules.

Reasons Supporting Proposal: This method of service delivery maximizes federal funding and stretches state dollars for use by more families.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Rita Dickey, P.O. Box 45310, Olympia, WA 98504, (360) 902-8451.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: This rule has been in existence as a pilot rule since 1996. The program has been operating successfully. It has been evaluated by the University of Washington with positive results. All new families whose family members have developmental disabilities and who need family support services will receive them under these rules. Existing family support clients and services will remain under WAC 275-27-220 - 275-27-223.

Proposal Changes the Following Existing Rules: Adds definitions in WAC 275-27-020.

No small business economic impact statement has been prepared under chapter 19.85 RCW. There is no appreciable cost to small business.

RCW 34.05.328 applies to this rule adoption. The rules do meet the definition of significant legislative rules and the Department of Social and Health Services has prepared a cost benefit analysis. To obtain a copy contact Rita Dickey at P.O. Box 45310, Olympia, WA 98504 or call (360) 902-8451.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on December 22, 1998, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by December 11, 1998, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 902-8292, by December 22, 1998.

Date of Intended Adoption: December 23, 1998.

November 16, 1998

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

SHS-2516.1

AMENDATORY SECTION (Amending WSR 98-20-044, filed 9/30/98, effective 10/7/98)



WAC 275-27-020  Definitions. (((1))) "Adolescent" means a DDD eligible child age thirteen through seventeen years.

(((2))) "Best interest" includes, but is not limited to, client-centered benefits to:

(((a))) (1) Prevent regression or loss of skills already acquired;

(((b))) (2) Achieve or maintain economic self-support;

(((c))) (3) Achieve or maintain self-sufficiency;

(((d))) (4) Prevent or remedy neglect, abuse, or exploitation of individuals unable to protect their own interest;

(((e))) (5) Preserve or reunite families; and

(((f))) (6) Provide the least-restrictive setting that will meet the person's medical and personal needs.

(((3))) "Client or person" means a person the division determines under RCW 71A.16.040 and WAC 275-27-026 eligible for division-funded services.

(((4))) "Community support services" means one or more of the services listed in RCW 71A.12.040 including, but not limited to the following services: Architectural, case management, early childhood intervention, employment, counseling, family support, respite care, information and referral, health services and equipment, therapy services, and residential support.

(((5))) "Department" means the department of social and health services of the state of Washington.

(((6))) "Director" means the director of the division of developmental disabilities.

(((7))) "Division or DDD" means the division of developmental disabilities of the department of social and health services.

(((8))) "Emergency" means a sudden, unexpected occurrence demanding immediate action.

(((9))) "Exemption" means the department's approval of a written request for an exception to a rule in this chapter.

(((10))) "Family" means individuals, of any age, living together in the same household and related by blood, marriage, adoption or as a result of sharing legal custody of a minor child.

"Family resources coordinator" means the person who is:

(1) Recognized by the IDEA Part C lead agency; and

(2) Responsible for:

(a) Providing family resources coordination;

(b) Coordinating services across agencies; and

(c) Serving as a single contact to help families receiving assistance and services for their eligible children who are under three years of age.

"ICF/MR" means a facility certified as an intermediate care facility for the mentally retarded by Title XIX to provide services to the mentally retarded or persons with related conditions.

(((11))) "ICF/MR Eligible" for admission to an ICF/MR means a person is determined by DDD as needing active treatment as defined in CFR 483.440. Active treatment requires:

(((a))) (1) Twenty-four hour supervision; and

(((b))) (2) Continuous training and physical assistance in order to function on a daily basis due to deficits in the following areas: Toilet training, personal hygiene, dental hygiene, self-feeding, bathing, dressing, grooming, and communication.

(((12))) "Individual" means a person applying for services from the division.

(((13))) "Intelligence quotient score" means a full scale score on the Wechsler, or the intelligence quotient score on the Stanford-Binet or the Leiter International Performance Scale.

(((14))) "Nonresidential programs" means programs including, but not limited to, county-funded habilitation services.

(((15))) "Nursing facility eligible" means a person is assessed by DDD as meeting the requirements for admission to a licensed nursing home as defined in WAC 388-97-235. The person must require twenty-four hour care provided by or under the supervision of a licensed nurse.

(((16))) "Other resources" means resources that may be available to the client, including but not limited to:

(1) Private insurance;

(2) Medicaid;

(3) Indian health care;

(4) Public school services through the office of the superintendent of public instruction; and

(5) Services through the department of health.

"Part C" means early intervention for children from birth through thirty-five months of age as defined in the Individuals with Disabilities Education Act (IDEA), Part C and 34 CFR, Part 303 and Washington's federally approved grant.

"Residential habilitation center" or "RHC" means a state-operated facility certified to provide ICF/MR and/or nursing facility level of care for persons with developmental disabilities.

(((17))) "RHC capacity" means the maximum number of eligible persons that can reside in a residential habilitation center without exceeding its 1997 legislated budgeted capacity.

(((18))) "Residential programs" means programs providing domiciliary care or other residential services, including, but not limited to, state residential facilities, group homes, nursing facilities, ICF/MRs, tenant support services, congregate care facilities, boarding homes, children's foster homes, adult family homes, and group training homes.

(((19))) "Respite care" means temporary residential services provided to a person and/or the person's family on an emergency or planned basis.

(((20))) "Secretary" means the secretary of the department of social and health services or the secretary's designee.

(((21))) "Vacancy" means an opening at a RHC, which when filled, would not require the RHC to exceed its 1997 biannually budgeted capacity, minus:

(((a))) (1) Twenty-six beds designated for respite care use; and

(((b))) (2) Any downsizing related to negotiations with the Department of Justice regarding community placements.



[Statutory Authority: RCW 74.12A.030 and 71A.16.030. 98-20-044, 275-27-020, filed 9/30/98, effective 10/7/98. Statutory Authority: RCW 71A.14.030 and 71A.16.020. 92-09-115 (Order 3373), 275-27-020, filed 4/21/92, effective 5/22/92. Statutory Authority: RCW 71A.16.020. 91-17-005 (Order 3230), 275-27-020, filed 8/9/91, effective 9/9/91. Statutory Authority: RCW 71.20.070. 89-06-049 (Order 2767), 275-27-020, filed 2/28/89; 84-15-058 (Order 2124), 275-27-020, filed 7/18/84. Statutory Authority: RCW 72.01.090, 72.33.040, 72.33.125 and 72.33.165. 78-04-033 (Order 1280), 275-27-020, filed 3/16/78; Order 1143, 275-27-020, filed 8/11/76.]



NEW SECTION



WAC 275-27-180  What is the purpose of the family support opportunity program? The purpose of the family support opportunity program is to:

(1) Strengthen family functioning through use of the program elements;

(2) Provide a wide range of supports that will assist and stabilize families;

(3) Encourage individuals and local communities to provide support for the persons with developmental disabilities that live with families;

(4) Complement other public and private resources in providing supports;

(5) Recognize the ability of communities can participate in a variety of ways;

(6) Allow families to make use of all program elements according to the individual and family needs; and

(7) Provide assistance to as many families as possible.



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NEW SECTION



WAC 275-27-185  Who is eligible to participate in the family support opportunity program? (1) All individuals living with their families determined to be developmentally disabled according to WAC 275-27-026 are eligible to participate in the program if their family requires assistance in meeting their needs. However, the program will fund or provide support services only as funding is available.

(2) Persons currently receiving services under WAC 275-27-220 and 275-27-223, Family support services, may volunteer to participate in the program.

(3) Families will receive program services based on the date of application.



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NEW SECTION



WAC 275-27-190  What basic services can my family receive from the family support opportunity program? A number of basic services are available. Some services have their own eligibility requirements. Specific services are:

(1) Case management services: Your family will benefit from case management services. A family support plan will be developed which includes needs assessment, referral, service coordination, service authorization, case monitoring and coordination for community guide services.

(2) Community guide services: Once your case manager assesses your family situation, they may refer you to a community guide. The community guide will assist your family in using the natural and informal community supports relevant to the age of your family member with developmental disabilities and the specific needs of your family. Community guide services will support your family and help develop connections to your community.

(3) Short-term intervention services: Your family may be eligible for up to eleven hundred dollars in short-term intervention funding if necessary services are not otherwise available. This funding is not intended to cover basic subsistence such as food or shelter costs. Short-term intervention funding is available only for those specialized costs directly related to and resulting from your child's disability.

(4) Personal care services: Medicaid personal care can provide your family with long-term in-home personal assistance. (See WAC 388-15-880 and 388-15-890.) In home personal assistance may be available through Medicaid personal care or through a state-funded alternative.

(5) Community alternatives program (CAP) waiver: If eligible, your family may participate in the CAP waiver program. The CAP waiver gives eligible clients the opportunity to participate in the federal Medicaid program and DDD the opportunity to obtain federal funds for community based services. (See WAC 275-27-800, 275-27-810 and 275-27-820.)

(6) Early intervention services: These services are for your children (from birth through thirty-five months old) and include early childhood programs, birth through two public school programs, children with special health care needs programs, and Part C services (IDEA).

(7) Emergency services: Your family can request emergency funds to be used to respond to a single incident, situation or short term crisis such as care giver hospitalization, absence, or incapacity. Your request must be made through your case manager and include an explanation of how you plan to resolve the emergency situation. Your request will be reviewed by the regional administrator or designee. If approved, you will receive emergency services for a limited time period, not to exceed two months.

(8) Serious need services: Your family may request serious need funds to take care of needs not met by other basic services, including short-term intervention services, personal care services or use of a community guide. Serious need funds are usually short-term funds used to provide additional support to allow the individual with disabilities to continue living at home.



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NEW SECTION



WAC 275-27-191  What is the purpose of community guide services? (1) Community guide services are available to support your family and help you become well connected to resources or supports in your community. After an assessment, your case manager may refer you to a community guide.

(2) This guide will assist your family in using the natural and informal community supports relevant to the age of your child with developmental disabilities and your family's specific needs.



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NEW SECTION



WAC 275-27-192  Who can become a community guide? To be a guide, a person must demonstrate his/her connections to the informal structures of their community. The department may contract with an individual, agency or organization. Guides must be knowledgeable about resources in their community and comfortable assisting families and persons with developmental disabilities.



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NEW SECTION



WAC 275-27-193  Does my family have a choice in selecting its community guide? Your family will be offered a choice of community guides that best meets the needs of your family. At your family's discretion, your family resources coordinator may serve as your community guide if your developmentally disabled child is thirty-five months of age or younger.



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NEW SECTION



WAC 275-27-194  Can the family support opportunity program help my family obtain financial assistance for community guide services? The program will authorize up to two hundred dollars per year for community guide services for your family.



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NEW SECTION



WAC 275-27-195  How can short-term intervention services help my family? If your family is eligible, you may receive up to eleven hundred dollars per year in short-term intervention funds to pay for necessary services not otherwise available. Short-term intervention funding cannot be used for basic subsistence such as food or shelter but is available for those specialized costs directly related to and resulting from your child's disability. Short-term intervention funds can be authorized for a one-time only need or for an episodic service need that occurs over a one-year period.



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NEW SECTION



WAC 275-27-196  Specifically how can short-term intervention funds be used? Short-term intervention funds can be used to purchase a wide range of services and supports, such as:

(1) Respite care, including community activities providing respite, attendant care or nursing care;

(2) Training such as parenting classes and supports such as disability related support groups;

(3) The purchase, rental, loan or refurbishment of specialized equipment, adaptive equipment or supplies not covered by other resources, including Medicaid. Specific examples would be mobility devices such as walkers and wheelchairs, communication devices and medical supplies. Diapers may be approved only for those four years of age and older.

(4) Environmental modifications including home damage repairs and home modifications made necessary because of a family member's disability;

(5) Occupational therapy, physical therapy, communication therapy, behavior management, visual and auditory services, or counseling needed by developmentally disabled individuals but not covered by another resource such as public schools and child development services funding;

(6) Medical/dental services not covered by any other resource. These services may include the payment of insurance premiums and deductibles but are limited to the portion of the premium or deduction that applies to the client.

(7) Nursing services, not covered by another resource, that cannot be provided by an unlicensed care giver but can only be rendered by a registered or licensed practical nurse. Examples of such services are ventilation, catheterization, and insulin shots;

(8) Special formulas or specially prepared foods necessary because of the client's disability;

(9) Parent/family counseling for diagnosis of grief and loss issues, genetic counseling or behavior management;

(10) Specialized clothing adapted for a physical disability, excessive wear clothing, or specialized footwear;

(11) Specialized utility costs including extraordinary utility costs resulting from the client's disability or medical condition;

(12) If another resource is not available, transportation costs, including gas, ferry fare or transit cost, so a client can receive essential services and maintain appointments; per diem costs may be reimbursed for medical appointments; and

(13) Other services approved by a DDD regional administrator or designee, according to established department guidelines.



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NEW SECTION



WAC 275-27-197  How can serious need funds help my family? Your family may need extraordinary support for children or adults with developmental disabilities living in your home in addition to the basic family support services. The purpose of serious need funds is to help you get that support when you need it. If funding is available, it will usually be short-term in nature and can be used for services such as additional personal care, respite care, behavior management and licensed nursing care.



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NEW SECTION



WAC 275-27-198  How can my family qualify for serious need funds? Your family may qualify for serious need funds if the following conditions are met:

(1) The basic program services outlined in WAC 275-27-190 (community guide, personal care services, short-term intervention services, etc.) are currently being used by your family or they have been exhausted;

(2) You and your case manager have examined other resources like the medically intensive home care program; private insurance, local mental health programs and programs available through the public schools and has found them either unavailable, inappropriate or insufficient for your needs;

(3) The support is crucial for the child or adult with developmental disabilities to continue living in your home; and

(4) By receiving serious need funds, your family's future need for DDD expenditures will be reduced.



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NEW SECTION



WAC 275-27-199  How does my family request serious need funds? You must contact your case manager who will submit a written request to the appropriate DDD regional administrator. The request must:

(1) Indicate the type of services your family needs;

(2) Explain why those services can only be obtained through the use of serious need funds;

(3) Outline the changes you anticipate in your family situation if the requested services are not received;

(4) Estimate the length of time your family will need the requested services; and

(5) Propose funding review dates.



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NEW SECTION



WAC 275-27-200  What amount of serious need funding is available to my family? (1) The maximum amount of funding available is four hundred dollars per month or two thousand four hundred dollars in a six-month period, unless the department determines your family member requires licensed nursing care. If licensed care is required, the maximum funding level is two thousand four hundred dollars per month.

(2) REMEMBER:

(a) Funding must be available in order to receive serious need services.

(b) Serious need funds are usually short-term funds.

(c) Services paid for by serious needs funds will be reviewed by DDD every six months.



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NEW SECTION



WAC 275-27-202  Who determines what family support services my family can receive? Your family and your case manager determine what services your family needs. The department has final approval over service authorization.



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NEW SECTION



WAC 275-27-204  What department restrictions apply to family support payments? (1) All family support service payments must be authorized by the department.

(2) The department may contract directly with:

(a) A service provider, or

(b) A parent for the reimbursement of goods or services purchased by the parent, or

(c) An agency to purchase goods and services on behalf of a client.

(3) The department's authorization period will start when you agree to be in this program. The period will last one year and may be renewed if you continue to need services.



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NEW SECTION



WAC 275-27-211  What are regional family support advisory councils? (1) Each developmental disabilities division regional administrator must appoint a family support advisory council to serve as a subcommittee of the regional advisory council. The membership of this family support advisory council must include at least one parent representatives and at least one case manager.

(2) The purpose of these family support advisory councils is to advise the regional administrator regarding:

(a) Family support issues;

(b) Guidelines for approving or denying short term intervention requests;

(c) Community needs; and

(d) Recommendations for community service grants.

(3) Family support advisory councils must meet at twice a year.



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NEW SECTION



WAC 275-27-212  What are community service grants? (1) Community service grants are funded by the division of developmental disabilities family support program to promote community oriented projects that benefit families. Community service grants may fund long-term or short-term projects that benefit children and/or adults.

Agencies or individuals may apply for funding. The department will announce the availability of funding.

(2) To qualify for funding, a proposed project must address one or more of the following topics:

(a) Provider support and development;

(b) Parent helping parent; or

(c) Community resource development.

(3) Goals for community service projects are as follows:

(a) Enable families to use generic resources;

(b) Reflect geographic, cultural and other local differences;

(c) Support families in a variety of noncrisis-oriented ways;

(d) Prioritize support for unserved families;

(e) Address the diverse needs of Native Americans, communities of color and limited or non-English speaking groups;

(f) Be family focused;

(g) Increase inclusion of persons with developmental disabilities; and

(h) Benefit families who have children or adults eligible for services from DDD.

(4) Decisions to approve or reject community service grant requests are made by DDD regional administrators considering the recommendations of their regional family support advisory councils. The DDD director has the discretion to award community service grants that have statewide significance.

(5) DDD may sponsor two family support conferences in different areas of the state each year. The purpose of these conferences is to discuss areas addressed by community service grants and other issues of importance to families.



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NEW SECTION



WAC 275-27-213  Who is covered under these rules? These sections (WAC 275-27-180 through 275-27-212) apply to persons enrolled in family support after June 1996. Those enrolled before June 1996 are covered under WAC 275-27-220 through 275-27-223.



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