DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Developmental Disabilities Administration)

The enhanced case management program (ECMP) is a program that facilitates client integration, improves quality of care, and promotes a safe home environment. Funds appropriated for the ECMP supports up to seven hundred clients through increased:

(1) Access to a case manager;

(2) Access to education and resources; and

(3) Frequency of home visits.

The following definitions apply to this chapter.

"CARE assessment" means an inventory and evaluation of abilities and needs based on an in-person interview in the client's home or place of residence.

"Caregiver" means a person contracted with the developmental disabilities administration (DDA) to provide medicaid or waiver personal care, respite care, or attendant care services.

"Client" means a person who has a developmental disability as defined in RCW 71A.10.020 (5) and has been determined eligible to receive services by DDA under chapter 71A.16 RCW.

"Collateral contact" means a person or agency that is involved in the client's life, such as a legal guardian, family member, provider, or friend.

"Independent supports" means an adult, other than the client's paid caregiver, who observes the care a client receives from their paid caregiver.

The developmental disabilities administration (DDA) may enroll a client in the enhanced case management program if the client is largely dependent on a paid caregiver in the client's home and:

(1) The client's CARE assessment indicates the client:

(a) Is not always able to supervise their caregiver;

(b) Has communication barriers and few documented community contacts; and

(c) Lacks additional, independent supports that regularly help the client monitor the care being provided in their home; or

(2) The client lives with the paid caregiver and:

(a) The client has been the subject of an adult protective services or child protective services referral in the past year; or

(b) DDA has concerns that the home environment or quality of care may jeopardize the client's health or safety.

(1) The client's case manager must visit each enhanced case management program (ECMP) client at least once every four months at the client's home, including unannounced visits as needed. Each required visit must not occur more than four months apart.

(2) An unannounced visit may replace a scheduled visit.

(3) If a client declines a visit, announced or unannounced, the case manager must document the declined visit in the ECMP node.

(4) If the case manager is unable to meet with the client for a required visit, the case manager must schedule a follow-up visit as soon as possible and no later than thirty days.

If you no longer meet eligibility criteria for the enhanced case management program under WAC 388-829B-300, DDA will disenroll you from the program.

(1) If you request a review of your enhanced case management program eligibility, the developmental disabilities administration (DDA) will perform an independent quality assurance review. The quality assurance review may include but is not limited to:

(a) An in-home visit or visits;

(b) Review of your CARE assessment; and

(c) Interviews with your collateral contacts, providers, and case manager.

(2) If the quality assurance review determines you meet eligibility criteria, then you will remain in the enhanced case management program.

(3) If the quality assurance review determines you no longer meet eligibility criteria, DDA will disenroll you from the enhanced case management program.

(4) If, following an independent quality assurance review, you disagree with a decision made by DDA, you may request an administrative hearing under RCW 71A.10.050 and chapter 388-02 WAC.