The GAP agreement must be signed by the applicant and the department before the court establishes the guardianship and must include the following:

(1) The amount of any GAP cash payment the department must make to the guardian on behalf of the child or youth;

(2) A statement that includes:

(a) The child or youth is eligible for medical services through medicaid;

(b) GAP subsidy will continue as long as the child or youth is eligible, regardless of where the guardianship family resides;

(c) A change in the guardianship family's circumstances or the child's or youth's needs may warrant further renegotiation and adjustment of the GAP cash payment as mutually agreed by the guardian and the department. The terms of the agreement may be modified under the requirements of WAC 110-85-0140;

(d) The basis for termination or suspension of subsidy under the agreement; and

(e) The name of a successor guardian in the event of the guardian's incapacity or death.