PDFWAC 182-559-150
Definitions.
The following definitions and those found in chapter 182-500 WAC apply to this chapter.
"Adverse benefit determination" means one or more of the following:
(a) The denial or limited authorization of a requested foundational community support services, including determinations based on the type of service, requirements for medical necessity, appropriateness, setting, or effectiveness of a service;
(b) The reduction, suspension, or termination of a previously authorized service;
(c) The denial, in whole or in part, of payment for a service;
(d) The failure to provide services in a timely manner, as defined by the state; or
(e) The failure of the third-party administrator (TPA) to act within the time frames provided in WAC 182-559-600 for standard resolution of grievances and appeals.
"Community support services (also called supportive housing services)" means active search and promotion of access to, and choice of, safe and affordable housing that is appropriate to the client's age, culture and needs. These services include:
(a) Providing services to eligible clients who are homeless or at risk of becoming homeless through outreach, engagement and coordination of services with shelter and housing;
(b) Ensuring the availability of community support services, with an emphasis on supporting clients in their own home or where they live in the community; and
(c) Coordinating with public housing entities, homeless continuums of care and affordable housing developers.
"Individual placement and support (IPS)" refers to an evidence-based approach to supported employment services based on the following principles:
(a) Services are open to all eligible clients who wish to work;
(b) Competitive employment is the goal;
(c) Integrated with other services provided to the client;
(d) Personalized benefits planning;
(e) Job search begins soon after the client expresses interest in working;
(f) Job search based on client preferences;
(g) Supports are not time-limited; and
(h) Client preferences are honored.
"Supported employment" means coordination with state and local entities to provide assistance and support, such as skills assessment, training, education and counseling to eligible clients who want to work.