Effective Date of Rule: Immediately.

     Purpose: The department is combining three family support programs into one individual and family services program as directed by the legislature into new sections in chapter 388-832 WAC.

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

     Other Authority: 2SSB 5467.

     Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

     Reasons for this Finding: 2SSB 5467, as amended by the house, directs the department to create the individual and family services program for persons with developmental disabilities by July 1, 2007. A preproposal statement of inquiry (CR-101) was filed as WSR 07-10-018 on April 20, 2007. At that time, the department proposed amending chapter 388-825 WAC but has since decided that a new chapter is required, due to the length of the new rules. This emergency rule extends the emergency rule filed as WSR 07-14-071 while the department obtains input and feedback from the affected stakeholders.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 91, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 91, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 91, Amended 0, Repealed 0.

     Date Adopted: October 23, 2007.

Stephanie E. Schiller

Rules Coordinator

     "Agency Provider" means a licensed and/or ADSA certified business that is contracted with ADSA or a county to provide DDD services (e.g., personal care, respite care, residential services, therapy, nursing, employment, etc.).

     "Allocation" means an amount of funding available to the client & family for a maximum of twelve months, based upon assessed need.

     "Authorization" means DDD approval of funding for a service as identified in the individual support plan or evidence of payment of a service.

     "Back-up Caregiver" is a person who has been identified as an informal caregiver and is available to provide assistance as an informal caregiver when other caregivers are unavailable.

     "Client" means a person who has a developmental disability as defined in RCW 71A.10.020(3) who also has been determined eligible to receive services by the division under chapter 71A.16 RCW.

     "DDD" means the division of developmental disabilities, a division within the aging and disability services administration (ADSA), department of social and health services (DSHS).

     "Department" means the department of social and health services (DSHS).

     "Emergency" means the client's health or safety is in jeopardy.

     "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 Home" means the residence where you and your relatives live.

     "Formal Caregiver" is a person/agency who receives payment from DDD to provide a service.

     "Individual Provider" means an individual who is contracted with DDD to provide medicaid or waiver personal care, respite care, or attendant care services.

     "Individual Support Plan" or "ISP" is a document that authorizes the DDD paid services to meet a client's needs identified in the DDD Assessment.

     "Informal Caregiver" is a person who provides supports without payment from DDD for a service.

     "Legal Guardian" means a person/agency, appointed by a court, which is authorized to make some or all decisions for a person determined by the court to be incapacitated. In the absence of court intervention, parents remain the legal guardian for their child until the child reaches the age of eighteen.

     "Parent family support contract" means a contract between DDD and the parent to reimburse the parent for the purchase of goods and services paid for by the parent.

     "Pass through contract" means a contract between DDD and a third party to reimburse the third party for the purchase of goods and services paid for by the third party.

     "Primary Caregiver" is the formal or informal caregiver who provides the most support.

     "Residential Habilitation Center" or "RHC" is a state operated facility certified to provide ICF/MR and/or nursing facility level of care for persons with developmental disabilities per chapter 71A.20 RCW.

     "State funded services" means services that are funded entirely with state dollars.

     "State supplementary payment" or "SSP" means a state paid cash assistance program for certain DDD clients eligible for supplemental security income per chapter 388-827 WAC.

     "You" means the client.

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     (1) Provides an array of services to families to help maintain and stabilize the family unit; and

     (2) Replaces WAC 388-825-200 through 388-825-242 (the family support opportunity program), WAC 388-825-252 through 388-825-256 (the traditional family support program), WAC 388-825-500 through 388-825-595, (the flexible family support pilot program), and WAC 388-825-244 through 388-825-250 (other family support rules).

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     (1) Form a partnership between the state and families to help support families who have a client of DDD living in the family home; and

     (2) Provide families with a choice of services and allow families more control over the resources allocated to them.

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     (1) You are currently an eligible client of DDD;

     (2) You live in your family home;

     (3) You are not enrolled in a DDD home and community based services waiver defined in chapter 388-845 WAC;

     (4) You are currently enrolled in traditional family support, family support opportunity or the family support pilot or funding has been approved for you to receive IFS program services;

     (5) You are age three or older as of July 1, 2007;

     (6) You have been assessed as having a need for IFS program services as listed in WAC 388-832-0140;

     (7) You are not receiving a DDD residential service; and

     (8) If you are a parent who is an eligible client of DDD, your child lives in your home and requires your support as a parent.

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     (1) Receipt of IFS services is limited by availability of funding and your assessed need.

     (2) WAC 388-832-0085 through 388-832-0090 describes how DDD will determine who will be approved to receive funding.

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     (2) You may request enrollment in a DDD HCBS waiver at any time per WAC 388-845-0050.

     (3) Participation in the IFS program will not affect your potential waiver eligibility.

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     (1) You no longer meet DDD eligibility per WAC 388-823-0010 through 388-823-0170;

     (2) You no longer meet the eligibility criteria for the IFS program per WAC 388-832-0015;

     (3) You have not used an IFS program service during the last twelve calendar months;

     (4) You cannot be located or do not make yourself available for the annual DDD assessment; and/or

     (5) You refuse to participate with DDD in service planning.

     (6) You begin to receive a DDD residential service.

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     (1) Your name and request date will be added to the wait list.

     (2) A notice will be sent to you to let you know your name has been added to the IFS wait list.

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     (1) Clients who have requested RHC respite, emergency services, or residential placement, prior to June 30, 2007.

     (2) Clients with the highest scores in caregiver and behavior status on the mini assessment.

     (3) Clients who have been on the IFS program wait list the longest.

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     (1) Your DDD case/resource manager will contact you, and determine if you meet the eligibility criteria for IFS program per WAC 388-832-0015 (1) though (6);

     (2) If you meet the criteria per (1) above, your case/resource manager will schedule an appointment to complete your DDD assessment or reassessment.

     (3) If you have not been receiving any DDD paid services, your DDD eligibility will need to be reviewed per WAC 388-823-1010(3)

     (4) Your DDD eligibility must be completed prior to completing the DDD assessment.

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     (1) Families of children who are seventeen years of age or younger; and

     (2) All individuals who are receiving state-only funded services.

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     (1) Provide information and referral for non-DDD community-based supports;

     (2) Add your name to the waiver data base, if you have requested enrollment in a DDD HCBS waiver per chapter 388-845 WAC; and

     (3) Authorize short-term emergency services as an exception to rule (ETR) per WAC 388-440-0001.

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     (2) For a reassessment or review of the individual support plan, the plan is effective the date DDD signs and approves it after a signature or verbal consent is obtained.

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     (1) Level 1 - Up to $2,000;

     (2) Level 2 - Up to $3,000;

     (3) Level 3 - Up to $4,000; and

     (4) Level 4 - Up to $6,000.

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     (2) If a significant change occurs, you may contact your DDD case manager for a possible reassessment of your support needs.

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     (1) The service need relates to and results from your developmental disability, and

     (2) The need is identified in your DDD assessment and identified on your ISP.

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     (1) Respite care;

     (2) Therapies:

     (a) Physical therapy (PT);

     (b) Occupational therapy (OT); and

     (c) Speech, language and communication therapy.

     (3) Architectural and vehicular modifications;

     (4) Equipment and supplies;

     (5) Specialized nutrition and clothing;

     (6) Excess medical costs not covered by another source;

     (7) Co-pays for medical and therapeutic services;

     (8) Transportation;

     (9) Training;

     (10) Counseling;

     (11) Behavior management;

     (12) Parent/sibling education;

     (13) Recreational opportunities; and

     (14) Community service grants.

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     (1) You live in a private home and no one living with you is paid to be your caregiver.

     (2) You live with a paid caregiver who is your natural, step, or adoptive parent.

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     (a) Individual's home; or

     (b) Relative's home.

     (2) Respite care can be also be provided in the following location(s) but require a DDD agency respite contract:

     (a) Licensed children's foster home;

     (b) Licensed, contracted and DDD certified group home;

     (c) Licensed boarding home contracted as an adult residential center;

     (d) Licensed and contracted adult family home;

     (e) Children's licensed group home, licensed staffed residential home, or licensed childcare center; or

     (f) Adult day health.

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     (1) Individuals meeting the provider qualifications under chapter 388-825 WAC;

     (2) Homecare/home health agencies, licensed under WAC 246-335-012(1);

     (3) Licensed and contracted group homes, foster homes, child placing agencies, staffed residential homes and foster group care homes;

     (4) Licensed and contracted adult family home;

     (5) Licensed and contracted adult residential care facility;

     (6) Licensed and contracted adult residential rehabilitation center under WAC 246-325-012;

     (7) Licensed childcare center under chapter 388-295 WAC;

     (8) Licensed child daycare center under chapter 388-295 WAC;

     (9) Adult day/health care centers contracted with DDD; or

     (10) Certified provider per chapter 388-101 WAC when respite is provided within the DDD contract for certified residential services.

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     (1) Respite cannot replace:

     (a) Daycare while a parent or guardian is at work; and/or

     (b) Personal care hours available to you. When determining your unmet need, DDD will first consider the personal care hours available to you.

     (2) Respite providers have the following limitations and requirements:

     (a) If respite is provided in a private home, the home must be licensed unless it is the client's home or the home of a relative of specified degree per WAC 388-825-345;

     (b) The respite provider cannot be the spouse of the caregiver receiving respite if the spouse and the caregiver reside in the same residence; and

     (c) If you receive respite from a provider who requires licensure, the respite services are limited to those age-specific services contained in the provider's license.

     (3) Your caregiver cannot receive respite services for you while being paid to provide DDD services for other persons at the same time.

     (4) The need for respite must be identified in your ISP and cannot exceed your IFS allocation.

     (5) If your personal care provider is your parent, your parent provider may not provide respite services to any client in the same month that you receive respite services.

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     (1) Skilled nursing services (ventilation, catheterization, and insulin shots);

     (2) Psychiatric services;

     (3) Medical services related to the persons disability and an allowable medicaid covered expense; and/or

     (4) Prescriptions.

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     (2) Skilled nursing services are paid to the DSHS contracted nurse directly.

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     (1) Physical therapy;

     (2) Occupational therapy; and/or

     (3) Speech, hearing and language therapy.

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     (1) Additional therapy may be authorized as a service only after you have accessed what is available to you under medicaid and any other private health insurance plan or school;

     (2) DDD does not pay for treatment determined by DSHS to be experimental;

     (3) DDD and the treating professional determine the need for and amount of service you can receive;

     (a) DDD may to require a second opinion from a DDD selected provider.

     (b) DDD will require evidence that you have accessed your full benefits through medicaid, private insurance and the school before authorizing this service.

     (4) The need for therapies must be identified in your ISP and cannot exceed your IFS allocations.

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     (a) Ensure the health, welfare and safety of the client and or caregiver; or

     (b) Enable a client who would otherwise require a more restrictive environment to function with greater independence in the home or in the community.

     (2) Architectural modifications include the following:

     (a) Installation of ramps and grab bars;

     (b) Widening of doorways;

     (c) Modification of bathroom facilities; or

     (d) Installing specialized electrical and or plumbing systems necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.

     (3) Vehicular modifications include the following:

     (a) Wheel chair lifts;

     (b) Strap downs; or

     (c) Other access modifications.

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     (1) Prior approval by the director of DDD or designee is required.

     (2) Architectural and vehicular modifications to the home and vehicle are excluded if they are of general utility without direct medical or remedial benefit to the individual, such as carpeting, roof repair, central air conditioning, fencing for the yard, etc.

     (3) Architectural modifications cannot add to the square footage of the home.

     (4) DDD will require evidence that you accessed your full benefits through medicaid, private insurance and the division of vocational rehabilitation (DVR) before authorizing this service.

     (5) Architectural and vehicular modifications must be the most cost effective modification.

     (6) Architectural and vehicular modifications will be prorated by the number of other members in the household who use these modifications.

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     (a) Help clients with their activities of daily living or better participate in their environment;

     (b) Are primarily and customarily used to service a medical purpose; and

     (c) Are generally not useful to a person in the absence of illness, injury, or disability.

     (2) Included are devices, controls, appliances, and items necessary for life support; ancillary supplies and equipment necessary to the proper functioning of such items; and durable and nondurable medical equipment not available through medicaid under the medicaid state plan. Examples are mobility devices such as walkers and wheel chairs, communication devices, and medical supplies. Diapers and wipes may be approved only for those three years and older.

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     (1) Prior approval by the director of DDD or designee is required for each authorization.

     (2) DDD may require a second opinion by a DDD-selected provider.

     (3) Items reimbursed with state funds shall be in addition to any medical equipment and supplies furnished under medicaid or private insurance.

     (4) Items must be of direct medical or remedial benefit to the individual and necessary as a result of the individual's disability.

     (5) Medications, prescribed or nonprescribed, and vitamins/supplements are excluded.

     (6) The need for specialized medical equipment and supplies must be identified in your ISP and cannot exceed your IFS allocation.

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     (2) Specialized clothing is clothing adapted for a physical disability, excessive wear clothing, or specialized footwear for which a written recommendation has been provided by a qualified and appropriate professional (e.g., a podiatrist, physical therapist, or behavior specialist).

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     (2) The co-pays must be for your disability related medical or therapeutic needs.

     (3) Prescribed or nonprescribed vitamins and supplements are excluded.

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     (2) Whenever possible the person must use family, neighbors, friends, or community agencies that can provide this service without charge.

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     (2) Transportation services can be a reimbursable expense through the parent family support contract.

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     (1) Costs of transportation services to/from medical or medically related appointments that are covered by the client's medicaid may not be reimbursed with IFS program funds.

     (2) Transportation is limited to travel to and from an essential medical service.

     (3) Transportation does not include the purchase of a bus pass or transportation to and from school or to and from work.

     (4) Reimbursement for provider mileage requires prior approval by the director of DDD or designee and is paid according to contract.

     (5) This service does not cover the cost of purchase, lease, or rental of vehicles.

     (6) Reimbursement for provider time is not included in this service.

     (7) Reimbursement to the provider is limited to transportation that occurs when you are with the provider.

     (8) You are not eligible for transportation services if the cost and responsibility for transportation is already included in providers' contract and payment.

     (9) Car expenses, maintenance, tires or repairs, or motor vehicle insurance are not covered.

     (10) The need for transportation services must be identified in your ISP and cannot exceed your IFS allocation.

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     (1) Health and medication monitoring;

     (2) Positioning and transfer;

     (3) Augmentative communication systems; and

     (4) Family counseling.

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     (1) Audiologist;

     (2) Licensed practical nurse;

     (3) Marriage and family therapist;

     (4) Mental health counselor;

     (5) Occupational therapist;

     (6) Physical therapist;

     (7) Registered nurse;

     (8) Sex offender treatment provider;

     (9) Speech/language pathologist;

     (10) Social worker;

     (11) Psychologist;

     (12) Certified American sign language instructor;

     (13) Nutritionist;

     (14) Registered counselor; or

     (15) Certified dietician.

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     (2) The need for training and counseling must be identified in your ISP and cannot exceed your IFS allocation.

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     (1) Marriage and family therapist;

     (2) Mental health counselor;

     (3) Psychologist;

     (4) Sex offender treatment provider;

     (5) Social worker;

     (6) Registered nurse (RN) or licensed practical nurse (LPN);

     (7) Psychiatrist;

     (8) Psychiatric advanced registered nurse practitioner (ARNP);

     (9) Physician assistant working under the supervision of a psychiatrist;

     (10) Registered counselor; or

     (11) Polygrapher.

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     (1) DDD and the treating professional will determine the need and amount of service you will receive.

     (2) DDD may require a second opinion from DDD-selected provider.

     (3) Only scientifically proven, nonexperimental methods may be utilized.

     (4) Providers may not use methods that cause pain, threats, isolation or locked settings.

     (5) The need for behavior management must be identified in your ISP and cannot exceed your IFS allocation.

     (6) Psychological testing is not allowed.

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     (2) Viewing of VHS or DVD at home by yourself does not meet the definition of parent or sibling education.

     (3) The need for parent/sibling education must be identified in your ISP and cannot exceed your IFS allocation.

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     (2) The need for recreation opportunities must be identified in your ISP and cannot exceed your IFS allocation.

     (3) DDD does not pay for recreational opportunities that may pose a risk to individuals with disabilities or the community at large.

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     (1) Qualifications for individuals and agencies providing DDD services in the client's residence or the provider's residence or other settings; and

     (2) Conditions under which DDD will pay for the services of an individual provider or a home care agency provider or other provider.

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     (1) IFS program services are authorized only after you have accessed what is available to you under medicaid, including medicaid personal care, and any other private health insurance plan, school, or child development services.

     (2) All IFS program service payments must be agreed to by DDD and the client in your ISP.

     (3) DDD will contract directly with a service provider or parent for the reimbursement of goods or services purchased by the family member.

     (4) DDD will not pay for treatment determined by DSHS/MAA or private insurance to be experimental.

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

     (6) The IFS program 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.

     (7) DDD's authorization period will start when you agree to be in the IFS program and have given written or verbal approval for your ISP. The period will last up to one year and may be renewed if you continue to need and utilize services. If you have not utilized the services within one year period you will be terminated from this program.

     (8) IFS program will not pay for psychological evaluations or testing, DNA or genetic testing.

     (9) Supplies/materials related to community integration or recreational activities are the responsibility of the family.

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     (1) You are not currently authorized for IFS program services in your ISP.

     (2) You meet the eligibility for the IFS program.

     (3) The need is critical to the health or safety of you or your caregiver and you and your family have no other resource to meet the need or your resources do not cover all of the expense.

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     (2) One time awards cannot exceed six thousand dollars in a twenty-four month period.

     (3) One time awards must be approved by the director of DDD or designee.

     (4) Eligibility for a one-time award does not guarantee approval and authorization of the service by DDD. Services are based on availability of funding.

     (5) One time awards will be prorated by the number of other members in the household who use these modifications or specialized equipment.

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     (1) You lose your family caregiver due to care giver hospitalization, or death;

     (2) There are changes in your caregiver's mental or physical status resulting in your family caregiver's inability to perform effectively for the individual; or

     (3) There are significant changes in your emotional or physical condition that require emergency services.

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     (1) Respite per WAC 388-832-0155.

     (2) Behavior Management per WAC 388-832-0285.

     (3) Nursing per WAC 388-845-1705.

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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 388-832-0366   What limitations apply to emergency services?   (1) Emergency service may be granted to individuals and families who are on the IFS wait list and have an emergent need.

     (2) Funds are provided for a limited period not to exceed sixty days.

     (3) All requests are reviewed and approved or denied by the director of DDD or designee.

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     (2) To extend the emergency services, there must be a new or reviewed DDD assessment and approval for service funding.

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     (1) Address one or more of the following topics:

     (a) Provider support and development;

     (b) Parent helping parent; or

     (c) Community resource development for inclusion of all.

     (2) Meet most of the following goals :

     (a) Enable families to use generic resources which are integrated activities and/or, resources community members typically have access to;

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

     (c) Support families in a variety of non crisis-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;

     (h) Benefit families who have children or adults eligible for services from DDD and who do not receive other DDD paid services; and

     (i) Promote community collaboration, joint funding, planning and decision making.

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