Original Notice.

Preproposal statement of inquiry was filed as WSR 99-21-094.

Title of Rule: Chapter 388-800 WAC, Chemical dependency assistance programs.

Purpose: The purpose of this rule is to describe client eligibility and available services for (1) the medical-based alcohol/drug detoxification program; and (2) the Alcoholism and Drug Addiction Treatment and Support Act (ADATSA) program.

Statutory Authority for Adoption: RCW 74.08.090, 74.50.080.

Statute Being Implemented: Chapter 74.50 RCW.

Summary: The chapter has been rewritten and reorganized from its previous chapter 388-240 WAC version, using simple language and question/answer format to clearly describe chemical treatment assistance services.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Jim Friedman, 1949 South State Street, Tacoma, 98405, (253) 593-2663.

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 describes the eligibility criteria and services provided for individuals seeking medical-based alcohol/drug detoxification program, and the Alcoholism and Drug Addition Treatment and Support Act (ADATSA) program.

Proposal Changes the Following Existing Rules: The elimination of the ninety-calendar day limit for ADATSA outpatient treatment within the allowable one hundred eighty days of total treatment in any two-year period.

The deletion of the requirement for eligible individuals to contribute toward the cost of care for ADATSA residential treatment services.

Repeal of chapter 388-240 WAC.

No small business economic impact statement has been prepared under chapter 19.85 RCW. DASA did not prepare a small business economic impact statement because no new costs will be imposed on small businesses.

RCW 34.05.328 applies to this rule adoption. The proposed amendments make significant amendments to the DASA program. A copy of the CBA may be obtained by contacting the person listed above.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on July 11, 2000, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Fred Swenson by June 30, 2000, phone (360) 664-6097, TTY (360) 664-6178, e-mail swensfh@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by July 11, 2000.

Date of Intended Adoption: No sooner than July 12, 2000.

May 16, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

This chapter explains chemical dependency treatment services available through public assistance.

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(1) The department only pays for services that are:

(a) Provided to eligible persons (see WAC 388-800-0030);

(b) Directly related to detoxification; and

(c) Performed by a certified detoxification center or by a general hospital that has a contract with the department to provide detoxification services.

(2) The department limits on paying for detoxification services are:

(a) Three days for an acute alcoholic condition; or

(b) Five days for acute drug addiction.

(3) The department only pays for detoxification services when notified within ten working days of the date detoxification began and all eligibility factors are met.

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(1) The department uses the information you provide on the department's application form to determine if you are eligible for the detoxification program.

(2) The department may require an interview, documents or other verification if the department has questions about or needs to confirm the information you provided on your application.

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(1) You are eligible for detoxification services if you:

(a) Receive benefits from temporary aid for needy families (TANF), general assistance unemployable (GAU), a medical assistance program, or Supplemental Security Income (SSI); or

(b) Do not have a combined nonexempt income and/or resources that exceed the payment standards for TANF.

(2) To determine your financial eligibility for the detoxification program the department deducts or exempts the following:

(a) A home;

(b) Household furnishings and personal clothing essential for daily living;

(c) Other personal property used to reduce need for assistance or for rehabilitation;

(d) A used and useful automobile;

(e) Mandatory expenses of employment;

(f) Total income and resources of a noninstitutionalized SSI beneficiary;

(g) Support payments paid under a court order; and

(h) Payments to a wage earner plan specified by a court in bankruptcy proceedings, or previously contracted major household repairs, when failure to make such payments will result in garnishment of wages or loss of employment.

(2) The following resources are not exempt:

(a) Cash;

(b) Marketable securities; and

(c) Any other resource not specifically exempted that can be converted to cash.

(4) If you receive detoxification services you shall not incur a deductible as a factor of eligibility for the covered period of detoxification.

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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-800-0035
How long am I eligible to receive detoxification services?

You are eligible for detoxification services from the date detoxification begins through the end of the month in which you complete the detoxification.

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(1) ADATSA stands for the Alcohol and Drug Addiction Treatment and Support Act which is a legislative enactment providing state-financed treatment and support to chemically dependent indigent persons.

(2) ADATSA provides eligible people with:

(a) Treatment if you are chemically dependent and would benefit from it; or

(b) A program of shelter services if you are chemically dependent and your chemical dependency has resulted in incapacitating physiological or cognitive impairments.

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If you qualify for the ADATSA program you may be eligible for:

(1) Alcohol/drug treatment services and support described under WAC-388-800-0080.

(2) Shelter services as described under WAC 388-800-0120.

(3) Medical care services as described under WAC 388-86-120 and 388-529-0200.

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To be eligible for ADATSA services you must:

(1) Be eighteen years of age or older;

(2) Be a resident of Washington as defined in WAC 388-468-0005;

(3) Meet citizenship requirements as described in WAC 388-424-0005.

(4) Provide your Social Security Number; and

(5) Meet the same income and resource criteria for the GA-U program; OR be receiving federal assistance under SSI or TANF.

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(1) You are eligible for ADATSA treatment services when you meet the:

(a) Financial eligibility criteria in WAC 388-800-0048; and

(b) Incapacity eligibility criteria in WAC 388-800-0055.

(2) If you are able to access, at no cost, state-approved chemical dependency treatment comparable to ADATSA treatment services, you may choose it rather than ADATSA.

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You are clinically eligible for ADATSA treatment services when you:

(1) Are diagnosed as having a mild, moderate, or severe dependency on a psychoactive substance class other than nicotine or caffeine, using the current criteria for Psychoactive Substance Dependence in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (DSM IV or its successor);

(2) Are clearly diagnosed as currently dependent on psychoactive substances other than nicotine or caffeine;

(3) Have not abstained from alcohol and drug use for the last ninety days, excluding days spent while incarcerated;

(4) Have not been gainfully employed in a job in the competitive labor market at any time during the last thirty days. For the purposes of this chapter, "gainfully employed" means performing in a regular and predictable manner an activity for pay or profit. Gainful employment does not include noncompetitive jobs such as work in a department-approved sheltered workshop or sporadic or part-time work, if the person, due to functional limitation, is unable to compete with unimpaired workers in the same job; and

(5) Are incapacitated, i.e., unable to work. Incapacity exists if you are one or more of the following:

(a) Currently pregnant or up to two months postpartum;

(b) Diagnosed as at least moderately psychoactive substance dependent and referred for treatment by child protective services;

(c) Diagnosed as severely psychoactive substance dependent and currently an intravenous drug user;

(d) Diagnosed as severely psychoactive substance dependent and has at least one prior admission to a department-approved alcohol/drug treatment or detoxification program;

(e) Diagnosed as severely psychoactive substance dependent and have had two or more arrests for offenses directly related to the chemical dependency; or

(f) Lost two or more jobs during the last six months as a direct result of chemical dependency.

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When you are successfully participating in ADATSA outpatient treatment services you are still considered incapacitated and eligible for ADATSA treatment through completion of the planned treatment, even if you:

(1) Become employed;

(2) Abstain from alcohol or drug use; or

(3) Relapse (resumption of your psychoactive substance abuse dependence).

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(1) A department-designated chemical dependency assessment center determines your incapacity based on alcoholism and/or drug addiction.

(2) The assessment center is the department's sole source of medical evidence required for the diagnosis and evaluation of your chemical dependency and its effects on employability.

(3) The assessment center provides a written current assessment needed to determine your eligibility.

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(1) ADATSA/Adult assessment centers:

(a) Provide your diagnostic evaluation and decide your treatment placement;

(b) Conduct a face-to-face diagnostic assessment, according to WAC 388-800-0805, to determine if you:

(i) Are chemically dependent;

(ii) Meet incapacity standards for treatment under WAC 388-800-0055; and

(iii) Are willing, able, and eligible to undergo a course of ADATSA chemical dependency treatment, once determined incapacitated.

(c) Determines a course of treatment based on your individual assessment of alcohol/drug involvement and treatment needs in accordance with RCW 70.96A.100.

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Once your financial and clinical eligibility is established, the assessment center:

(1) Develops your ADATSA treatment plan;

(2) Arranges all your chemical dependency treatment placements taking into account the treatment priorities described under WAC 388-800-0100;

(3) Provides you with written notification of your right to return to the community service office (CSO) at any time while receiving ADATSA treatment;

(4) Provides you with written notification of your right to request a fair hearing to challenge any action affecting eligibility for ADATSA treatment;

(5) Provides ongoing case monitoring of your treatment services; and

(6) Notifies the CSO promptly of your placement or eligibility status changes.

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When evaluating a treatment plan which will benefit you the most, the assessment center considers clinical or medical factors utilizing the American Society of Addiction Medicine (ASAM) Patient Placement Criteria (PPC).

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(1) You are limited to a maximum of six months (one-hundred eighty total calendar days) of chemical dependency treatment in a twenty-four-month period.

(2) The twenty-four-month period begins on the date of your initial entry into treatment.

(3) You are limited to the following time periods for treatment:

(a) Intensive inpatient treatment, no longer than thirty days per admission;

(b) Recovery house treatment, no longer than sixty days per admission;

(c) Long-term care residential treatment, no longer than one hundred eighty days;

(d) ADATSA outpatient treatment no longer than one hundred eighty days.

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Once you have been determined financially eligible to receive ADATSA residential treatment services the department does not require you to contribute toward the cost of care.

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(1) You will be terminated from ADATSA treatment services if you leave treatment.

(2) If you are discharged from treatment for any other reason, you will be referred to the next appropriate level of treatment.

(3) If you are absent from any residential treatment services for less than seventy-two hours you may reenter that program without being considered as having dropped out. This is done at the discretion of the treatment service administrator and without requiring you to apply for re-admittance through the assessment center.

(4) Once you voluntarily leave treatment you must reapply and be referred again to the assessment to receive further ADATSA treatment services.

(5) If you are terminated from treatment you are not eligible for benefits beyond the month in which treatment services end. Rules regarding advance and adequate notice still apply, but you are not eligible for continued assistance pending a fair hearing.

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(1) When assigning treatment admissions, the ADATSA/Adult assessment center:

(a) Gives first priority to you if you are a pregnant woman or a parent with a child under eighteen years old in the home;

(b) Provides priority access for admission if you are:

(i) Referred by the department's children's protective services (CPS) program; and/or

(ii) An injecting drug user (IDU).

(2) If you are completing residential treatment you have priority access to outpatient treatment.

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When you are in ADATSA residential treatment and are below the department payment standard for clothing and personal incidentals (CPI) you are eligible to receive CPI.

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When you are in ADATSA outpatient treatment, you may be eligible for a treatment living allowance for housing and other living expenses.

(1) Your living allowance maximum amount will be based on the current ADATSA payment standard as provided under WAC 388-478-0030.

(2) Your outpatient provider will act as your protective payee and administer your living allowance.

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You are eligible for state-funded medical assistance when you are in one of the following situations:

(1) You meet the requirements in WAC 388-800-0048 and are waiting to receive ADATSA treatment services;

(2) When you are participating in ADATSA residential or outpatient treatment;

(3) You choose opiate dependency (methadone maintenance) chemical dependency treatment services instead of other ADATSA treatment, but only if these treatment services are from a state-approved, publicly funded opiate dependency/methadone maintenance program; or

(4) You meet the requirements of WAC 388-800-0135, for shelter services but choose not to receive shelter assistance.

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(1) Your shelter assistance in independent housing consists of a monthly shelter assistance payment through an intensive protective payee defined under WAC 388-800-0160; and

(2) You continue to receive benefits for ADATSA shelter if you request a fair hearing within the advance notice period before termination is to occur.

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You are eligible for ADATSA shelter services when you meet the:

(1) Financial eligibility criteria in WAC 388-800-0040; and

(2) Incapacity eligibility criteria in WAC 388-800-0140.

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You are eligible for ADATSA shelter services when you:

(1) Are actively addicted, meaning having used alcohol or drugs within the sixty-day period immediately preceding the latest assessment center evaluation, as determined by the ADATSA/Adult assessment center; and

(2) Have resulting physiological or organic damage, or have resulting cognitive impairment not expected to dissipate within sixty days of sobriety or detoxification, which either:

(a) Limits your functioning because of physiological or organic damage that result in a significant restriction on ability to perform work activities, or

(b) At least a moderate impairment of your ability to understand, remember, and follow complex instructions; and

(c) An overall moderate impairment in your ability to:

(i) Learn new tasks;

(ii) Exercise judgment;

(iii) Make decisions, and

(iv) Perform routine tasks without undue supervision.

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The department:

(1) Redetermines your incapacity and financial and medical eligibility for ADATSA shelter every six months or more often; and

(2) Provides you adequate and advance notice of adverse action.

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Your protective payee is either:

(1) Your outpatient treatment provider while in ADATSA treatment; or

(2) An agency under contract with the department to provide you with intensive protective payee services if you are an ADATSA shelter client.

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Your protective payee:

(1) Has the authority and responsibility to make decisions about the expenditure of your outpatient treatment stipends;

(2) Encourages you to participate in the decision-making process. The amount of decision-making the protective payee allows you depends upon the level of responsibility you demonstrate; and

(3) Disburses funds to meet your basic needs of shelter, utilities, food, clothing, and personal incidentals.

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If you are receiving shelter services, your intensive protective payee provides you with case management services including, but not be limited to:

(1) Disbursing payment for shelter and utilities, such as a check directly to the landlord, mortgage company, utility company, etc;

(2) Directing payment to vendors directly for goods or services provided to you including personal and incidental expenses.

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If the relationship with your protective payee is terminated for any reason, the protective payee shall return any remaining funds to the department or its designee.

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     The following sections of the Washington Administrative Code are repealed:

WAC 388-240-0010	Introduction.
WAC 388-240-0020	Definitions.
WAC 388-240-1100	Detoxification services.
WAC 388-240-1200	Detoxification eligibility.
WAC 388-240-2100	ADATSA purposes and programs.
WAC 388-240-2300	ADATSA categorical eligibility.
WAC 388-240-2400	ADATSA treatment--Eligibility requirements.
WAC 388-240-2450	ADATSA treatment--Incapacity requirements.
WAC 388-240-2500	ADATSA shelter--Eligibility requirements.
WAC 388-240-2550	ADATSA shelter--Incapacity requirements.
WAC 388-240-2570	ADATSA shelter--Eligibility determination and review.
WAC 388-240-2600	ADATSA SSI referral requirements.
WAC 388-240-3100	ADATSA assessment center--Role.
WAC 388-240-4100	ADATSA treatment limitations.
WAC 388-240-4200	ADATSA treatment terminations and reinstatements.
WAC 388-240-4400	ADATSA treatment priority groups.
WAC 388-240-4600	ADATSA treatment living allowance.
WAC 388-240-5100	ADATSA shelter services.
WAC 388-240-6100	ADATSA protective payees.

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