WSR 18-12-065

PROPOSED RULES

[Filed June 1, 2018, 9:39 a.m.]

Preproposal statement of inquiry was filed as WSR 18-09-027.

Title of Rule and Other Identifying Information: The department is proposing to amend WAC 388-828-4200 What activities are assessed in the home living activities subscale of the support needs scale?, 388-828-4220 What activities are assessed in the community living activities subscale of the support needs scale?, 388-828-4240 What activities are assessed in the lifelong learning activities subscale of the support needs scale?, 388-828-4260 What activities are assessed in the employment activities subscale of the support needs scale?, 388-828-4280 What activities are assessed in the health and safety activities subscale of the support needs scale?, 388-828-4300 What activities are assessed in the social activities subscale of the support needs scale?, 388-828-4320 What activities are assessed in the supplemental protection and advocacy activities subscale?, 388-828-4360 What exceptional medical support activities are evaluated to assess your medical support needs?, 388-828-4380 What exceptional behavioral support activities are evaluated to assess your behavioral support needs?, 388-828-4400 How does DDD determine if you meet the eligibility requirements for ICF/MR level of care if you are age sixteen or older?, 388-828-5700 How does DDD determine your medical acuity level?, 388-828-5800 How does DDD determine your interpersonal support needs score if you are age sixteen or older?, and 388-828-5900 How does DDD determine your mobility acuity level if you are age sixteen or older?.

Hearing Location(s): On July 10, 2018, at 10:00 a.m., at Office Building 2, Department of Social and Health Services (DSHS) Headquarters, 1115 Washington, Olympia, WA 98504. Public parking at 11th and Jefferson. A map is available at https://www.dshs.wa.gov/sesa/rules-and-policies-assistance-unit/driving-directions-office-bldg-2.

Date of Intended Adoption: Not earlier than July 11, 2018.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, email DSHSRPAURulesCoordinator@dshs.wa.gov, fax 360-664-6185, by 5:00 p.m., July 10, 2018.

Assistance for Persons with Disabilities: Contact Jeff Kildahl, DSHS rules consultant, phone 360-664-6092, fax 360-664-6185, TTY 711 relay service, email Kildaja@dshs.wa.gov, by June 26, 2018.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The developmental disabilities administration (DDA) is amending these rules to align DDA's current supports intensity scale (SIS) with the American Association on Intellectual and Developmental Disabilities' (AAIDD) latest version of the Supports Intensity Scale-Adult Version (SIS–A).

Reasons Supporting Proposal: These rules have not been updated since 2007. These amendments align DDA's current SIS with the AAIDD's latest version of the SIS-A in a way that clarifies language and reorders the assessment questions without changing the effect of the rules.

Statutory Authority for Adoption: RCW 71A.12.030.

Name of Proponent: DSHS, governmental.

Name of Agency Personnel Responsible for Drafting: Chantelle Diaz, P.O. Box 45310, Olympia, WA 98504-5310, 360-407-1589; Implementation and Enforcement: Bob Morris, P.O. Box 45310, Olympia, WA 98504-5310, 360-407-1513.

A cost-benefit analysis is not required under RCW 34.05.328. This rule making is exempt from cost-benefit analysis requirements because the proposed amendments, as described under RCW 34.05.328 (5)(b)(iv), clarify the language of the rule without changing its effect.

Is exempt under RCW 19.85.025(4) because the rules do not affect small businesses.

Explanation of exemptions: The proposed amendments impose no new or disproportionate costs on small businesses so a small business economic impact statement is not required.

May 25, 2018

Katherine I. Vasquez

Rules Coordinator

#	Home living activities	Type of support					Frequency of support					Daily support time					Raw score
A1	((Using the toilet)) Operating home appliances/electronics	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
A2	Bathing and taking care of ((clothes (includes laundering))) personal hygiene and grooming needs	0	1	2	3	4	0	1	2	3	((4)) *	0	1	2	3	4
A3	((Preparing food)) Using the toilet	0	1	2	3	4	0	1	2	3	((*)) 4	0	1	2	3	4
A4	((Eating food)) Dressing	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
A5	((Housekeeping and cleaning)) Preparing food	0	1	2	3	4	0	1	2	3	((4)) *	0	1	2	((*)) 3	((*)) 4
A6	((Dressing)) Eating food	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
A7	((Bathing and)) Taking care of ((personal hygiene and grooming needs)) clothes, including laundering	0	1	2	3	4	0	1	2	3	((*)) 4	0	1	2	3	4
A8	((Operating home appliances)) Housekeeping and cleaning	0	1	2	3	4	0	1	2	3	4	0	1	2	((3)) *	((4)) *
A9	Using currently prescribed equipment or treatment	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
Total raw score for home living activities:
* = Score is not an option per AAIDD. Note: Question A9 is a question added by ((DDD)) DDA. It is for ((information)) informational purposes only and is not used to calculate scores or levels for service determination.

#	Community living activities	Type of support					Frequency of support					Daily support time					Raw score
B1	Getting from place to place throughout the community (transportation)	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
B2	Participating in recreation/leisure activities in community ((settings))	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
B3	((Using public services in the)) Participating in preferred community activities (churches, volunteer, etc.)	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
B4	((Going to visit friends and family)) Accessing public buildings and settings	0	1	2	3	4	0	1	2	3	((*)) 4	0	1	2	3	4
B5	((Participating)) Using public services in ((preferred)) the community ((activities (church, volunteer, etc.)))	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
B6	Shopping and purchasing goods and services	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
B7	Interacting with community members	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
B8	((Accessing public buildings and settings)) Going to visit friends and family	0	1	2	3	4	0	1	2	3	((4)) *	0	1	2	3	4
Total raw score for community living activities:
* = Score is not an option per AAIDD.

#	Lifelong learning activities	Type of support					Frequency of support					Daily support time					Raw score
C1	((Interacting with others in learning activities)) Learning and using problem-solving strategies	0	1	2	3	4	0	1	2	3	((*)) 4	0	1	2	3	4
C2	((Participating in training/educational decisions)) Learning functional academics (reading signs, counting change, etc.)	0	1	2	3	4	0	1	2	3	((*)) 4	0	1	2	3	((*)) 4
C3	Learning ((and using problem-solving strategies)) health and physical education skills	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
C4	((Using technology for)) Learning self-determination skills	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
C5	((Accessing training/educational settings)) Learning self-management strategies	0	1	2	3	4	0	1	2	3	((4)) *	0	1	2	3	4
C6	((Learning functional academics (reading signs, counting change, etc.))) Participating in training/educational decisions	0	1	2	3	4	0	1	2	3	((4)) *	0	1	2	3	((4)) *
C7	((Learning health and physical education skills)) Accessing training/educational settings	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
C8	Interacting with others in learning ((self-determination skills)) activities	0	1	2	3	4	0	1	2	3	((4)) *	0	1	2	3	4
C9	Using technology for learning ((self-management strategies))	0	1	2	3	4	0	1	2	3	((*)) 4	0	1	2	3	4
Total raw score for lifelong learning activities:
* = Score is not an option per AAIDD.

#	Employment activities	Type of support					Frequency of support					Daily support time					Raw score
D1	((Accessing/receiving/job/tasks accommodations)) Learning and using specific job skills	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
D2	((Learning and using specific job skills)) Accessing/receiving job/task accommodations	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
D3	Interacting with co-workers	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
D4	Interacting with supervisors ((and/or)) /coaches	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
D5	Completing work-related tasks with acceptable speed	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
D6	Completing work-related tasks with acceptable quality	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
D7	Changing job assignments	0	1	2	3	4	0	1	2	*	*	0	1	2	3	4
D8	Seeking information and assistance from an employer	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
Total raw score for employment activities:
* = Score is not an option per AAIDD.

#	Health and safety activities	Type of support					Frequency of support					Daily support time					Raw score
E1	Taking medications	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
E2	((Avoiding health)) Ambulating and ((safety hazards)) moving about	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
E3	((Obtaining health care services)) Avoiding health and safety hazards	0	1	2	3	4	0	1	2	3	4	0	1	2	((*)) 3	((*)) 4
E4	((Ambulating and moving about)) Obtaining health care services	0	1	2	3	4	0	1	2	3	4	0	1	2	((3)) *	((4)) *
E5	Learning how to access emergency services	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
E6	Maintaining a nutritious diet	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
E7	Maintaining physical health and fitness	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
E8	Maintaining emotional well-being	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
Total raw score for health and safety activities:
* = Score is not an option per AAIDD.

#	Social activities	Type of support					Frequency of support					Daily support time					Raw score
F1	((Socializing within the household)) Using appropriate social skills	0	1	2	3	4	0	1	2	3	((*)) 4	0	1	2	3	4
F2	Participating in recreation ((and/or)) /leisure activities with others	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
F3	Socializing outside the household	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
F4	Making and keeping friends	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
F5	((Communicating with others about personal needs)) Engaging in loving and intimate relationships	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
F6	((Using appropriate social skills)) Socializing within the household	0	1	2	3	4	0	1	2	3	((4)) *	0	1	2	3	4
F7	((Engaging in loving and intimate relationships)) Communicating with others about personal needs	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
F8	Engaging in volunteer work	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
Total raw score for social activities:
* = Score is not an option per AAIDD.

#	Protection and advocacy activities	Type of support					Frequency of support					Daily support time					Raw score
G1	Advocating for self	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
G2	((Managing money)) Making choices and ((personal finances)) decisions	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
G3	Protecting self from exploitation	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
G4	Exercising legal/civic responsibilities	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
G5	Belonging to and participating in self-advocacy/support organizations	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
G6	Obtaining legal services	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
G7	((Making choices)) Managing money and ((decisions)) personal finances	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
G8	Advocating for others	0	1	2	3	4	0	1	2	3	*	0	1	2	3	4
Total raw score for protection and advocacy activities:
* = Score is not an option for AAIDD.

#	Medical supports needed	No support needed	Some support needed	Extensive support needed
1.	Inhalation or oxygen therapy	0	1	2
2.	Postural drainage	0	1	2
3.	Chest PT	0	1	2
4.	Suctioning	0	1	2
5.	Oral stimulation or jaw positioning	0	1	2
6.	Tube feeding (e.g., nasogastric)	0	1	2
7.	Parenteral feeding (e.g., IV)	0	1	2
8.	Turning or positioning	0	1	2
9.	Dressing of open wound(s)	0	1	2
10.	Protection from infectious diseases due to immune system impairment	0	1	2
11.	Seizure management	0	1	2
12.	Dialysis	0	1	2
13.	Ostomy care	0	1	2
14.	Lifting and/or transferring	0	1	2
15.	Therapy services	0	1	2
16.	((Diabetes Management*)) Hypertension	0	1	2
17.	((Other(s) - Specify:)) Allergies	0	1	2
18.	Diabetes	0	1	2
19.	Other(s) - specify	0	1	2
Subtotal scores of 1s and 2s:
Add subtotals scores for 1s and 2s for total exceptional medical support needs score:
((* #16 is a question added by DDD. It is used as part of the DDD medical acuity scale and is not used to calculate SIS percentiles.))

#	Behavioral supports needed	No support needed	Some support Needed	Extensive support needed
1.	Prevention of ((assaults or injuries to others)) emotional outbursts	0	1	2
2.	Prevention of ((property destruction (e.g., fire setting, breaking furniture))) assault or injury to others	0	1	2
3.	Prevention of ((stealing)) property destruction (e.g. fire setting, breaking furniture)	0	1	2
4.	Prevention of ((self-injury)) stealing	0	1	2
5.	Prevention of ((PICA (ingestion of inedible substances))) self-injury	0	1	2
6.	Prevention of suicide attempts	0	1	2
7.	Prevention of ((sexual aggression)) PICA (ingestion of inedible substances)	0	1	2
8.	Prevention of nonaggressive but inappropriate behavior (e.g., exposes self in public, exhibitionism, inappropriate touching or gesturing)	0	1	2
9.	Prevention of ((tantrums or emotional outbursts)) sexual aggression	0	1	2
10.	Prevention of ((wandering)) substance abuse	0	1	2
11.	Prevention of ((substance abuse)) wandering	0	1	2
12.	Maintenance of mental health treatments	0	1	2
13.	Managing attention-seeking behavior*	0	1	2
14.	Managing uncooperative behavior*	0	1	2
15.	Managing agitated/over reactive behavior*	0	1	2
16.	Managing obsessive/repetitive behavior*	0	1	2
17.	Prevention of other serious behavior problem(s) - Specify:	0	1	2
Subtotal scores of 1s and 2s:
Add subtotals scores for 1s and 2s for total exceptional behavioral support needs scores:
* #13-16 are questions added by ((DDD)) DDA. They are used as part of the ((DDD)) DDA behavior acuity scale and are not used to calculate SIS percentiles.

Question # of SIS support needs scale	Text of question	Your score for "Type of support" is:	And your score for "Frequency of support" is:
((A1)) A2	((Using the toilet)) Bathing and take care of personal hygiene and grooming needs	2 or more	4
		3 or more	2
((A2)) A3	((Taking care of clothes)) Using the toilet	2 or more	((2 or more)) 4
		3 or more	((1)) 2
((A3)) A4	((Preparing food)) Dressing	2 or more	4
		3 or more	2
((A4)) A5	((Eating)) Preparing food	2 or more	4
		3 or more	2
((A5)) A6	((Housekeeping and cleaning)) Eating food	2 or more	((2 or more)) 4
		3 or more	((1)) 2
((A6)) A7	((Dressing)) Taking care of clothes, including laundering	2 or more	((4)) 2 or more
		3 or more	((2)) 1
((A7)) A8	((Bathing and taking care of personal hygiene)) Housekeeping and ((grooming needs)) cleaning	2 or more	((4)) 2 or more
		3 or more	((2)) 1
((C3)) B6	((Learning)) Shopping and ((using problem-solving strategies)) purchasing goods and services	2 or more	((3)) 2 or more
		3 or more	((2)) 1
((C9)) C1	Learning ((self-management)) and using problem-solving strategies	2 or more	3 or more
		3 or more	2
((B6)) C5	((Shopping and purchasing goods and services)) Learning self-management strategies	2 or more	((2)) 3 or more
		3 or more	((1)) 2
E1	Taking medications	2 or more	4
		3 or more	2
E2	((Avoiding health)) Ambulating and ((safety hazards)) moving about	2 or more	((3 or more)) 4
		3 or more	2
((E4)) E3	((Ambulating)) Avoiding health and ((moving about)) safety hazards	2 or more	((4)) 3 or more
		3 or more	2
E6	Maintaining a nutritious diet	2 or more	2 or more
		3 or more	1
E8	Maintaining emotional well-being	2 or more	3 or more
		3 or more	2
((F6)) F1	Using appropriate social skills	2 or more	3 or more
		3 or more	2
((G2)) G7	Managing money and personal finances	2 or more	2 or more
		3 or more	1

If you meet the following criteria:	Then your medical acuity level is:	Value
(1) If you have a score of 2 on questions 1, 4, and 7;	High	3
(2) If you have a score of 2 on any two of the following questions: 2, 3, 5, 6, 8, 9, 10, 11, 12, 13, 14, 16, ((or)) 17, 18, or 19;	High	3
(3) If your total exceptional medical support needs score is 8 or higher;	High	3
(4) If you have a score of 2 on any of the following questions: 2, 3, 5, 6, 8, 9, 10, 11, 12, 13, 14, 16, ((or)) 17, 18, or 19 and do not meet the criteria for a high medical acuity level;	Medium	2
(5) If your total exceptional medical support needs score is 6 or 7 and you do not meet the criteria for a high medical acuity level;	Medium	2
(6) If your total exceptional medical support needs score is 5 or less, but greater than zero, and you do not have a score of 2 on any questions excluding number 15;	Low	1
(7) If your total exceptional medical support needs score equals zero.	None	0

Interpersonal support needs questions from the SIS assessment
Question #	Text of interpersonal support needs questions:
B7	Interacting with community members
((C1)) C8	Interacting with others in learning activities
D3	Interacting with co-workers
D4	Interacting with supervisors/coaches
D8	Seeking information and assistance from an employer
F1	((Socializing within the household)) Using appropriate social skills
F3	Socializing outside the household
((F5)) F6	((Communicating with others about personal needs)) Socializing within the household
((F6)) F7	((Using appropriate social skills)) Communicating with others about personal needs

If you score for "Frequency of Support" is:	And your score for "Type of Support" is:	Then your Mobility Acuity Level is:	Value
3 or 4	4	High	3
3 or 4	3	Medium	2
If your raw score for question ((E4 or)) E2 is 5 or more and you do not meet the criteria for a high or medium mobility acuity level		Low	1
If your raw score for question ((E4)) E2 is 4 or less		None	0