WSR 06-06-040

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed February 23, 2006, 4:34 p.m. , effective March 26, 2006 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: These new rules in chapter 388-825 WAC are necessary to implement ESSB 6090, 2005-2007 conference budget (section 205 (1)(e), chapter 518, Laws of 2005), which establishes a flexible family support pilot program for families who are providing care and support for family members with developmental disabilities. The family support pilot program is funded through June 30, 2007. The division of developmental disabilities (DDD) determined that new sections of chapter 388-825 WAC are necessary to implement the legislature's directive in ESSB 6090. When effective, these rules replace the emergency rules filed as WSR 06-02-042 on December 29, 2005.

Statutory Authority for Adoption: RCW 71A.12.030, 71A.12.040.

Other Authority: Section 205 (1)(e), chapter 518, Laws of 2005; Title 71A RCW.

Adopted under notice filed as WSR 05-24-090 on December 6, 2005.

Changes Other than Editing from Proposed to Adopted Version: WAC 388-825-538 has been modified to expand the definition of a sibling to include a sibling under the age of twenty-two if the sibling is still in school. The text follows:

WAC 388-825-538 What is the definition of household? For the purpose of determining household size and gross annual household income, the definition of household follows:

(1) If you are under age eighteen, your household includes:

(a) You;

(b) Your natural or adoptive parent(s) or stepparent(s) living with you;

(c) Your full, half, step, or adoptive siblings living with you if they are:

(i) Not married;

(ii) Not the head of a household; and

(iii) Under age eighteen, or under age twenty-two if they are students regularly attending school or college or training that is designed to prepare the siblings for a paying job.

(2) If you are age eighteen or older, your household includes only you.


WAC 388-825-534 has been expanded to include the federal poverty levels, which became effective on April 1, 2006. The text follows:

WAC 388-825-534 What are the annual federal poverty levels? (1) The annual federal poverty levels (FPL) are based on household size and established by the federal Office of Management and Budget.

(2) Effective April 2005, the annual federal poverty levels are:


Household

Size

100%

FPL

200%

FPL

300%

FPL

400%

FPL

One $9,570 $19,140 $28,710 $38,280
Two $12,830 $25,660 $38,490 $51,320
Three $16,090 $32,180 $48,270 $64,360
Four $19,350 $38,700 $58,050 $77,400
Five $22,610 $45,220 $67,830 $90,440
Six $25,870 $51,740 $77,610 $103,480
Seven $29,130 $58,260 $87,390 $116,520
Eight $32,390 $64,780 $97,170 $129,560
Nine $35,650 $71,300 $106,950 $142,600
Ten $38,910 $77,820 $116,730 $155,640

For each household member over ten, add the following amounts to the ten-person standard:


100% FPL 200% FPL 300% FPL 400% FPL
$3,260 $6,520 $9,780 $13,040

(3) Effective April 2006, the annual federal poverty levels are:


Household

Size

100%

FPL

200%

FPL

300%

FPL

400%

FPL

One $9,800 $19,600 $29,400 $39,200
Two $13,200 $26,400 $39,600 $52,800
Three $16,600 $33,200 $49,800 $66,400
Four $20,000 $40,000 $60,000 $80,000
Five $23,400 $46,800 $70,200 $93,600
Six $26,800 $53,600 $80,400 $107,200
Seven $30,200 $60,400 $90,600 $120,800
Eight $33,600 $67,200 $100,800 $134,400
Nine $37,000 $74,000 $111,000 $148,000
Ten $40,400 $80,800 $121,200 $161,600

For each household member over ten, add the following amounts to the ten-person standard:


100% FPL 200% FPL 300% FPL 400% FPL
$3,400 $6,800 $10,200 $13,600

This change was made because the department received the revised federal poverty levels subsequent to the hearing.

A final cost-benefit analysis is available by contacting Steve Brink, P.O. Box 45310, Olympia, WA 98507-5310, phone (360) 725-3416, fax (360) 407-0955, e-mail brinksc@dshs.wa.gov.

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 33, 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 33, Amended 0, Repealed 0.

Date Adopted: February 15, 2006.

Andy Fernando, Manager

Rules and Policies Assistance Unit

3615.5
NEW SECTION
WAC 388-825-500   What is the family support pilot?   (1) The Family Support Pilot (FSP) is a new state-only program funded by the legislature to provide services in a new program through June 2007.

(2) The purpose of the Family Support Pilot is to provide paid services in a flexible manner to eligible DDD clients.

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NEW SECTION
WAC 388-825-505   What is the statutory authority for the family support pilot?   The legislature directed DDD to implement the Family Support Pilot in the 2005-2007 conference budget, chapter 518, Laws of 2005 Section 205(1)(e).

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NEW SECTION
WAC 388-825-510   Who is eligible to participate in the family support pilot?   To be eligible to participate in the Family Support Pilot (FSP), you must meet all of the following criteria:

(1) Be a client of DDD.

(a) Your eligibility must be current.

(b) WAC 388-823-1010 may require a review of your eligibility prior to any approval of paid services.

(2) Be in DDD's current database as having requested FSP.

(3) Live with family as defined in WAC 388-825-512.

(4) Not be receiving any other DDD paid services as defined in WAC 388-825-516.

(5) Have been determined ineligible for Medicaid Personal Care (MPC).

(6) Have a gross household annual income of less than or equal to 400% of federal poverty level (FPL).

(7) Have completed a mini-assessment per chapter 388-824 WAC.

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NEW SECTION
WAC 388-825-512   What is the definition of family?   Family means relatives who live in the same home with the eligible client. Relatives include parents, grandparents, brother, sister, step-parent, step-brother, step-sister, uncle, aunt, first cousin, niece or nephew.

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NEW SECTION
WAC 388-825-513   What is the definition of an "award"?   (1) An award is the dollar amount of services performed by a provider for an eligible client.

(2) The award will be paid directly to the provider.

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NEW SECTION
WAC 388-825-514   If I participate in the FSP, will I be eligible for services through the DDD home and community based services (HCBS) waiver?   You may request to be served in the DDD HCBS waiver per WAC 388-845-0050 but waiver enrollment is limited by waiver capacity and funding. Participation in the FSP will not affect your potential waiver eligibility.

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NEW SECTION
WAC 388-825-516   If I receive other DDD funded services do I qualify for the FSP?   You do not qualify for the FSP if any of the following apply:

(1) You receive other DDD funded services identified in WAC 388-823-1015, including services through the DDD HCBS waiver per WAC 388-845-0050;

(2) You are eligible for Medicaid Personal Care;

(3) You receive the State Supplementary Payment administered by DDD; or

(4) You are under age three. (All children under age three receive or are eligible to receive services through the Infant Toddler Early Intervention Program and/or child development services through DDD.)

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NEW SECTION
WAC 388-825-520   If I qualify for and receive an FSP award, will my name remain on the family support waitlist?   Participation in the FSP does not remove your name from the family support waitlist.

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NEW SECTION
WAC 388-825-524   How do I apply for the FSP?   You may apply for the FSP by completing and returning an FSP questionnaire that DDD will send to individuals and families who are on the family support waitlist as of August 1, 2005.

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NEW SECTION
WAC 388-825-528   What will DDD do with the FSP questionnaire that you return?   When you return the FSP questionnaire, DDD will determine your eligibility according to the criteria contained in WAC 388-825-510 and notify you of its decision according to WAC 388-825-588.

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NEW SECTION
WAC 388-825-532   How does DDD determine the federal poverty level (FPL) for my household?   DDD determines the federal poverty level (FPL) for your household by asking you for your gross annual household income and the number of people living in your household.

(1) DDD cannot determine your financial eligibility for FSP without this information.

(2) If you do not provide this information, you will not be eligible for FSP services.

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NEW SECTION
WAC 388-825-534   What are the annual federal poverty levels?   (1) The annual federal poverty levels (FPL) are based on household size and established by the federal Office of Management and Budget.

(2) Effective April 2005, the annual federal poverty levels are:


Household

Size

100%

FPL

200%

FPL

300%

FPL

400%

FPL

One $9,570 $19,140 $28,710 $38,280
Two $12,830 $25,660 $38,490 $51,320
Three $16,090 $32,180 $48,270 $64,360
Four $19,350 $38,700 $58,050 $77,400
Five $22,610 $45,220 $67,830 $90,440
Six $25,870 $51,740 $77,610 $103,480
Seven $29,130 $58,260 $87,390 $116,520
Eight $32,390 $64,780 $97,170 $129,560
Nine $35,650 $71,300 $106,950 $142,600
Ten $38,910 $77,820 $116,730 $155,640

For each household member over ten, add the following amounts to the ten-person standard:


100% FPL 200% FPL 300% FPL 400% FPL
$3,260 $6,520 $9,780 $13,040

(3) Effective April 2006, the annual federal poverty levels are:


Household

Size

100%

FPL

200%

FPL

300%

FPL

400%

FPL

One $9,800 $19,600 $29,400 $39,200
Two $13,200 $26,400 $39,600 $52,800
Three $16,600 $33,200 $49,800 $66,400
Four $20,000 $40,000 $60,000 $80,000
Five $23,400 $46,800 $70,200 $93,600
Six $26,800 $53,600 $80,400 $107,200
Seven $30,200 $60,400 $90,600 $120,800
Eight $33,600 $67,200 $100,800 $134,400
Nine $37,000 $74,000 $111,000 $148,000
Ten $40,400 $80,800 $121,200 $161,600

For each household member over ten, add the following amounts to the ten-person standard:


100% FPL 200% FPL 300% FPL 400% FPL
$3,400 $6,800 $10,200 $13,600

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NEW SECTION
WAC 388-825-536   What is "gross annual household income"?   Gross annual household income means total unearned and earned income prior to any deductions or taxes for the past calendar year.

(1) Ownership of income is defined in WAC 388-450-0005.

(2) Income that is not counted is defined in WAC 388-450-0015.

(3) Unearned income is defined in WAC 388-450-0025.

(4) Earned income is defined in WAC 388-450-0030.

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NEW SECTION
WAC 388-825-538   What is the definition of household?   For the purpose of determining household size and gross annual household income, the definition of household follows:

(1) If you are under age eighteen, your household includes:

(a) You;

(b) Your natural or adoptive parent(s) or stepparent(s) living with you;

(c) Your full, half, step, or adoptive siblings living with you if they are:

(i) Not married;

(ii) Not the head of a household; and

(iii) Under age eighteen, or under age twenty-two if they are students regularly attending school or college or training that is designed to prepare the siblings for a paying job.

(2) If you are age eighteen or older, your household includes only you.

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NEW SECTION
WAC 388-825-540   Who must declare their income?   If you are a child under age of eighteen at the time you are declaring income, your custodial, natural/step/adoptive parent(s) or guardian(s) must declare income.

(2) If you are age eighteen or older, you are the only household member to declare income. You must report all unearned and earned income.

(3) Income is subject to verification upon department request.

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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 388-825-544   If I meet eligibility for FSP, will I receive paid services?   You will have access to an amount of paid services called an "FSP Award" if:

(1) You are determined eligible by DDD to participate in FSP;

(2) You meet one of the priority groups in WAC 388-825-554; and

(3) There is funding available.

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NEW SECTION
WAC 388-825-548   What is the amount of the FSP awards?   FSP Awards are based on your gross household income and the annual Federal Poverty Level (FPL) based on your household size and income.


Amount of Annual Income Amount of Award
Equal to or less than 100% FPL Up to $4,000 per year
Greater than 100% but equal to or less than 200% FPL Up to $3,000 per year
Greater than 200% but equal to or less than 300% FPL Up to $2,000 per year
Greater than 300% but equal to or less than 400% FPL Up to $1,000 per year

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NEW SECTION
WAC 388-825-552   What if there are two or more family members who qualify for FSP?   Each family member who is eligible will be considered for an award.

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NEW SECTION
WAC 388-825-554   How will DDD determine who will receive awards for FSP?   Within the availability of staff time, DDD will distribute the awards to eligible FSP clients in order of the following priorities:

(1) Client or caregiver with health and safety needs that places the client at immediate risk of out-of-home placement in a nursing facility or ICF/MR.

(2) Clients living in single parent households;

(3) Clients with multiple disabilities; and

(4) Clients who are at least twenty-one years old and graduated from high school who need employment services.

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NEW SECTION
WAC 388-825-558   What FSP services can my family and I receive?   You and your family can use your FSP Award to pay for any of the following services identified and agreed to in your FSP service plan with DDD:

(1) Respite care which is intermittent relief to your caregiver.

(a) Respite care may be provided in your home or the home of a relative or licensed provider, or community setting/activity contracted for respite care.

(b) The respite provider must be a qualified individual or agency per WAC 388-825-300 through WAC 388-825-400.

(c) Respite care may be provided by a registered or licensed nurse if you require a licensed health professional as determined by DDD.

(2) Training and consultation for you or your family, including:

(a) Counseling related to your disability or genetic counseling.

(b) Parenting classes and disability related support groups.

(c) Behavior management/counseling.

(3) Assistive technologies or specialized or adaptive equipment related to your development disability:

(a) Mobility devices such as walkers and wheelchairs are included, as well as communication devices and medical supplies such as diapers for children three years of age or older.

(b) Professional justifications may be required by the department.

(4) Employment services for those clients twenty-one years of age and older. See chapter 388-850 WAC.

(5) Extraordinary household expenses resulting from the client's developmental disability such as a portion of the power bill for a ventilator dependent client.

(a) The expense is limited to the total cost divided by the total number of persons living in the family.

(b) This will not include the purchase of any appliances, furniture, or floor coverings.

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NEW SECTION
WAC 388-825-560   What department restrictions apply to FSP?   The following department restrictions apply to FSP:

(1) FSP services are authorized only after you have accessed what is available to you under Medicaid, and any other private health insurance plan, school or child development services.

(2) All FSP service payments must be agreed to by DDD and the client in a written service plan.

(3) The department will contract directly with providers. FSP funding cannot be authorized for services or treatments determined by the department to be experimental.

(4) Your choice of qualified providers and services is limited to the most cost effective option that meets your assessed need.

(5) Respite care cannot be a replacement for child care while the parent or guardian is at work regardless of the age of the child.

(6) The department shall not authorize a birth parent, adoptive parent, step-parent or any other primary caregiver or their spouse living in the same household with the client to provide respite, nursing, therapy or counseling services.

(7) FSP will not pay for conference registrations.

(8) FSP will not pay for behavior management/counseling procedures, modifications, or equipment that are restrictive.

(9) FSP will not pay for services provided after the death of the eligible client. Payment may occur after the date of death, but not the service.

(10) FSP will not pay for employment services if you are under age twenty-one or are designated to receive DDD funded transition services.

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NEW SECTION
WAC 388-825-562   What is an FSP plan?   (1) An FSP plan is a written plan you develop with your DDD case resource manager that identifies the services you will purchase with your FSP Award.

(2) The FSP plan will last for up to twelve months, but cannot extend beyond June 30, 2007.

(3) The department has the final approval over service authorization.

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NEW SECTION
WAC 388-825-564   Does my family have a choice of FSP services?   The individual and family identify and choose FSP services per WAC 388-825-558 through the department's assessment and planning process. Adult clients are included in the choice of FSP services.

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NEW SECTION
WAC 388-825-572   What if I have needs that exceed my FSP award limit?   If you have needs that exceed your FSP award limit, DDD may approve additional funding to meet certain extraordinary needs as "one-time award". This approval is an exception to your award limit and you cannot appeal the amount of the exception or denial of an exception.

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NEW SECTION
WAC 388-825-575   What are one-time awards?   A one-time award is limited to extraordinary support for individuals receiving FSP funding.

(1) The one-time award can only be approved for the following services performed by a DDD contracted provider:

(a) Respite care; and/or

(b) Behavior management/counseling.

(2) A one-time award may be approved only once during the period of time covered by your FSP plan.

(3) Providers of the services in subsection (1) of this section must be contracted with and paid directly by DDD.

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NEW SECTION
WAC 388-825-576   How do I apply for a one-time award?   You may apply for a one-time award by following the procedures contained in WAC 388-825-236.

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NEW SECTION
WAC 388-825-578   What amount of one-time funding is available for my family?   The maximum amount of one-time funding available for respite care and/or behavior management/counseling is the same as the amount of your award, determined by WAC 388-825-548.

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NEW SECTION
WAC 388-825-581   How long do I remain eligible for the FSP?   (1) If you are approved for an FSP award, your FSP plan will be reviewed annually for continued funding as long as FSP funding is available.

(2) The Family Support Pilot ends June 30, 2007.

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NEW SECTION
WAC 388-825-584   Can I be terminated from FSP?   You will be terminated from FSP if any of the following occur:

(1) Your DDD eligibility is terminated per chapter 388-823 WAC;

(2) You no longer live with a family as defined in WAC 388-825-512;

(3) You begin living independently or with a spouse;

(4) You begin to receive other DDD funded services;

(5) Your household income exceeds 400% of the FPL;

(6) You become eligible for Medicaid Personal Care; and or

(7) FSP funding is no longer available.

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NEW SECTION
WAC 388-825-586   When are changes in my circumstances considered effective?   (1) Except for changes in income and/or household size, changes are effective immediately.

(2) Changes in gross annual household income and changes in household size are effective at the time your FSP plan is reviewed.

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NEW SECTION
WAC 388-825-588   How will the department notify me of their decisions?   The department will provide written notification to you and your legal representative of all eligibility and service decisions per WAC 388-825-100 through WAC 388-825-105. These notices will include your appeal rights.

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NEW SECTION
WAC 388-825-591   What are my appeal rights under the FSP?   You have appeal rights under WAC 388-825-120 to the following decisions:

(1) Denial of eligibility to participate in the FSP per WAC 388-825-510.

(2) A denial, reduction or termination of FSP services.

(3) A denial or termination of your choice of a qualified provider.

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NEW SECTION
WAC 388-825-595   How do I appeal a department action?   Your appeal rights and procedures to appeal a department decision are in WAC 388-825-120 through WAC 388-825-165.

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Washington State Code Reviser's Office