This chapter establishes rules governing the developmental disabilities administration (DDA) assessment of people determined eligible to be clients of the administration per chapter 71A.16 RCW.

The following definitions apply to this chapter:

"AAIDD" means the American Association on Intellectual and Developmental Disabilities.

"Acuity Scale" refers to an assessment tool that is intended to provide a framework for documenting important assessment elements and for standardizing the key questions that should be asked as part of a professional assessment. The design helps provide consistency from client to client by minimizing subjective bias and assists in promoting objective assessment of a person's support needs.

"Administration" means the developmental disabilities administration of the department of social and health services.

"Adult family home" or "AFH" means a residential home in which a person or entity is licensed to provide personal care, special care, room, and board to more than one but not more than six adults who are not related by blood, adoption, or marriage to a provider, entity representative, resident manager, or caregiver who resides in the home. An adult family home may be licensed to provide care to up to eight adults if the home receives approval under chapter 388-76 WAC.

"Agency provider" means a business that is licensed, certified, or both, and that is contracted with the department or a county to provide DDA services.

"Algorithm" means a numerical formula used by the DDA assessment for one or more of the following:

(1) Calculation of assessed information to identify a client's relative level of need; and

(2) Assignment of a service level to support a client's assessed need.

"Authorization" means DDA approval of funding for a service as identified in the person-centered service plan or evidence of payment for a service.

"CARE" refers to the comprehensive assessment reporting evaluation assessment per chapter 388-106 WAC.

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

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

"Companion home" is a DDA contracted residential service that provides 24-hour training, support, and supervision, to one adult living with a paid provider.

"Contracted provider" means an individual provider contracted with the department, individual provider employed by the consumer directed employer, or an individual or agency who is one or more of the following: Licensed, certified, or contracted by the department to provide services to DDA clients.

"DDA" means the developmental disabilities administration of the department of social and health services.

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

"Group home" or "GH" means a licensed adult family home or assisted living facility contracted and certified to provide residential services and support to adults with developmental disabilities.

"Home visit" means viewing a client's living quarters with the client present.

"ICF/IID" means a medicaid-certified facility operating under Title XIX of the Social Security Act in 42 C.F.R. 440-150 to furnish health or rehabilitation services.

"ICF/IID level of care" is a standardized assessment of a client's need for ICF/IID level of care per 42 C.F.R. Sec. 440 and 42 C.F.R. Sec. 483. In addition, ICF/IID level of care refers to one of the standards used by DDA to determine whether a client meets minimum eligibility criteria for one of the DDA HCBS waivers or the community first choice program.

"Legal guardian" means a person/agency, appointed by a court, who 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 guardians for their child until the child reaches the age of 18.

"Living quarters" means the client's bedroom and main living area(s).

"LOC score" means a level of care score for answers to questions in the support needs assessment for children that are used in determining if a client meets eligibility requirements for ICF/IID level of care.

"Panel" refers to the visual user-interface in the DDA assessment computer application where assessment questions are typically organized by topic and you and your respondents' answers are recorded.

"Person-centered service plan (PCSP)" is a document that identifies your goals and assessed health and welfare needs. Your person-centered service plan also indicates the paid services and natural supports that will assist you to achieve your goals and address your assessed needs.

"Raw score" means the numerical value when adding a person's "frequency of support," "daily support time," and "type of support" scores for each activity in the support needs and supplemental protection and advocacy scales of the supports intensity scale (SIS) assessment.

"Residential habilitation center" or "RHC" is a state-operated facility under RCW 71A.20.020.

"Respondent" means the adult client or another person familiar with the client who participates in the client's DDA assessment by answering questions and providing information. Respondents may include DDA contracted providers.

"Service provider" refers to a department contracted agency or person who provides services to DDA clients. Also refers to state operated living alternative programs (SOLA).

"Significant change assessment" means a DDA assessment completed any time a change is reported in a client's support needs, such as an increased need for medical or behavioral supports.

"SIS" means the supports intensity scale developed by the American Association of Intellectual and Developmental Disabilities (AAIDD).

"SOLA" means a state operated living alternative program for adults that is operated by DDA.

"State supplementary payment" or "SSP" is the state paid cash assistance program for certain DDA eligible Social Security income clients per chapter 388-827 WAC.

"Supported living" or "SL" refers to residential services provided by DDA certified residential agencies to clients living in homes that are owned, rented, or leased by the clients or their legal representatives.

"Waiver respite care" means short-term intermittent relief for persons normally providing care to individuals who are authorized to receive services available in the individual and family services (IFS), children's intensive in-home behavioral support (CIIBS), basic plus, and core waivers per chapter 388-845 WAC.

"You" and "your" means the client.

(1) The DDA assessment is an assessment tool designed to measure the support needs of persons with developmental disabilities.

(2) The DDA assessment consists of:

(a) The support assessment (see WAC 388-828-2000 to 388-828-6020);

(b) The service level assessment (see WAC 388-828-7000 to 388-828-7080); and

(c) The person-centered service plan (PCSP) (see WAC 388-828-8000 to 388-828-8060).

(3) The DDA assessment is part of the comprehensive assessment reporting evaluation system (CARE).

The purpose of the DDA assessment is to provide a comprehensive assessment process that:

(1) Collects a common set of assessment information for reporting purposes to the legislature and the department.

(2) Promotes consistency in evaluating client support needs for purposes of planning, budgeting, and resource management.

(3) Identifies a level of service or number of hours that is used to support the assessed needs of clients who have been authorized to receive DDA services.

Only DDA employees can administer the DDA assessment.

DDA must administer a DDA assessment when you meet any of the following conditions:

(1) You are currently approved by DDA to receive a DDA paid service evidenced by meeting one of the conditions in WAC 388-828-1440;

(2) You request enrollment in one of the DDA HCBS waivers per chapter 388-845 WAC;

(3) You have been determined to be DDA eligible and request a DDA assessment;

(4) You have been determined eligible for categorically needy medical coverage per WAC 388-475-0100 and requested one of the following medicaid state plan services:

(a) You are under age eighteen and have requested an assessment for community first choice or medicaid personal care services under chapter 388-106 WAC; or

(b) You have been approved to receive private duty nursing services for clients seventeen years of age and younger per WAC 388-551-3000.

(5) You are receiving SSP in lieu of a DDA paid service per chapter 388-827 WAC;

(6) You request admission to an RHC per Title 42 C.F.R. 440, Title 42 C.F.R. 483, and Title 71A RCW;

(7) You reside in an RHC or community ICF/IID and you are involved in discharge planning for community placement; or

(8) You do not meet any of the conditions listed in WAC 388-828-1120.

DDA will not administer the DDA assessment when you meet any of the following conditions:

(1) You have not identified a person willing to receive notice or correspondence on your behalf regarding specific DDA decisions as required per RCW 71A.10.060 and DDA does not believe you are capable of understanding department decisions that may affect your care (see WAC 388-828-1140);

(2) A respondent cannot be identified to participate in your DDA assessment (see WAC 388-828-1540(c));

(3) You reside in an RHC and are not currently involved in discharge planning for community placement; or

(4) You reside in a community ICF/IID and are not authorized by DDA to receive employment/community services paid through the counties.

If there is no one available to receive notice or correspondence on your behalf regarding specific DDA decisions, DDA will do all of the following:

(1) Consult with the assistant attorney general to determine if:

(a) You are able to represent yourself; or

(b) You require a legal representative/guardian.

(2) Continue current services until the issue is resolved per section (1) above.

If you complete the DDA assessment and are assessed to have an unmet need and there is no approved funding to support that need, DDA will offer you referral information for ICF/IID services per Title 71A RCW, chapter 388-825 WAC, and chapter 388-837 WAC. In addition, DDA may:

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

(2) Add your name to the waiver database, if you have requested enrollment in a DDA HCBS waiver per chapter 388-845 WAC.

If you are approved to receive a DDA paid service and refuse to have a DDA assessment administered, DDA is unable to authorize new or current DDA paid services and will do all of the following:

(1) Explain what happens if you refuse to allow DDA to administer the DDA assessment to you, your respondents, and the person you have identified to receive notice on your behalf per RCW 71A.10.060.

(2) Consult with the assistant attorney general when you have not identified a person to receive notice on your behalf per RCW 71A.10.060 to determine if:

(a) You are able to represent yourself; or

(b) You require a legal representative/guardian.

(3) Terminate existing DDA paid services when they reach their authorized end date.

(4) Provide you notice and appeal rights for a denied or terminated service under WAC 388-825-100 and 388-825-120.

(5) Provide you with information on how to contact DDA in case you later decide you want a DDA assessment administered.

DDA will inform you of the services you are eligible to receive no more than thirty days after DDA administers your assessment.

You will begin receiving a service for which you have been determined eligible after:

(1) Your DDA assessment is complete;

(2) You are found financially and functionally eligible for services;

(3) You have given consent for services and approved your plan of care;

(4) You have chosen a qualified provider; and

(5) DDA has authorized the qualified provider to provide services.

You or your legal representative/guardian has the responsibility of choosing a provider. DDA will provide you information on contracted and qualified providers. If you are receiving services through a county, the county will provide you with information on contracted providers.

For the purpose of this chapter, a DDA paid service is defined as an authorization of a program and/or service as evidenced by one or more of the following:

(1) An open ProviderOne authorization within the past ninety days used for payment of a service or SSP;

(2) A current county service authorization;

(3) Documentation of DDA approval of your absence from DDA paid services for more than ninety days with available funding for your planned return to services;

(4) Evidence of approval for funding of a DDA service or enrollment in a DDA HCBS waiver; or

(5) Authorization and payment of services using form A-19 state of Washington invoice voucher.

DDA must administer a DDA assessment when:

(1) You are receiving a DDA paid service and your annual reassessment is due for continuation of the DDA paid service;

(2) You are receiving a DDA paid service and a reassessment is needed due to a significant change that may affect your support needs;

(3) You are receiving SSP in lieu of a DDA paid service and your eligibility for SSP needs to be redetermined per WAC 388-827-0120;

(4) You are approved for funding of a DDA paid service and an assessment must be performed prior to the authorization of services;

(5) You make a request to have a DDA assessment administered and meet the criteria in WAC 388-828-1100; or

(6) You are contacted by DDA and offered an opportunity to have a DDA assessment.

During the year prior to July 2009, due to staff resources, DDD may authorize or reauthorize the following services before a DDD assessment is administered:

(1) Funding from the legislature that provides resources for services to be available by a certain date; or

(2) Emergency services as determined by DDD as critical to the client's health and safety.

(1) DDA must conduct a reassessment:

(a) On an annual basis if you are receiving a paid service;

(b) When a significant change is reported that may affect your need for support;

(c) Before the next person-centered service plan date of your current assessment; or

(d) At your request.

(2) DDA will provide you with notice in advance of your next person-centered service plan date so you may schedule the assessment at a time that is convenient to you.

(1) Initial, annual, and significant change assessments are administered at a location and in a way that is convenient to you, such as:

(a) In-person at your home;

(b) In-person in another setting;

(c) Remotely using approved technology; or

(d) A combination of in-person and remote.

(2) If your initial, annual, or significant change assessment is not completed face-to-face in your home, DDA must still see you in person. DDA must ask permission to view your living quarters during a home visit.

(3) DDA may conduct a home visit:

(a) During your assessment;

(b) Up to 30 days before or after your assessment;

(c) Up to 30 days after you move from an institutional setting to a community-based setting.

(1) You choose the people who participate in your assessment and person-centered service plan meeting.

(2) DDA requires that at a minimum: You, one of your respondents, and a DDA employee participate in your DDA assessment interview. In addition:

(a) If you are under the age of eighteen, your parent(s) or legal guardian(s) must participate in your DDA assessment interview.

(b) If you are age eighteen or older, your court appointed legal representative/guardian must be consulted if he/she does not attend your DDA assessment interview.

(c) If you are age eighteen and older and have no legal representative/guardian, DDA will assist you to identify a respondent.

(d) DDA may consult with other people who were not present at your DDA assessment interview, if needed, to obtain complete and accurate information.

DDA requires an assessment because:

(1) DDA assesses clients with a common, standardized assessment process that measures the support needs of individuals with developmental disabilities.

(2) The DDA assessment algorithms are designed to:

(a) Determine acuity scores and acuity levels for a variety of client needs; and

(b) Provide a valid measure of each client's support needs relative to the support needs of other clients who have received the DDA assessment.

If you refuse to answer a DDA assessment question that is necessary to determine your service level and DDA is unable to complete your DDA assessment, DDA will send you or your legal representative notice of denial or termination of eligibility for services as required under chapter 388-825 WAC.

The support assessment is the:

(1) Supports intensity scale for clients sixteen and older; and

(2) Support assessment for children under sixteen.

The purpose of the support assessment is to:

(1) Collect a common set of assessment information that is scored for all persons who are eligible to receive a DDA assessment per WAC 388-828-1100;

(2) Promote a consistent process to evaluate client support needs; and

(3) Determine whether a person meets the ICF/IID level of care standard for potential waiver eligibility.

The support assessment contains the following components:

(1) The support assessment for children;

(2) The supports intensity scale (SIS) assessment;

(3) DDA protective supervision acuity scale;

(4) DDA caregiver status acuity scale;

(5) DDA activities of daily living (ADL) acuity scale;

(6) DDA behavioral acuity scale;

(7) DDA medical acuity scale;

(8) DDA interpersonal support acuity scale;

(9) DDA mobility acuity scale;

(10) DDA respite assessment; and

(11) Programs and services component.

Age guidelines are incorporated into the support assessment to exclude age appropriate supports unrelated to a disability. The following table illustrates which components DDA includes in your support assessment based on your assessment age:

If you are within thirty calendar days of your next birthday, DDA determines your assessment age to be that of your next birthday.

The support assessment for children measures the support needs of children from birth to age fifteen.

The purpose of the support assessment for children ages fifteen or younger is to determine:

(1) Your ICF/IID level of care score for DDA HCBS waiver eligibility;

(2) The health and welfare needs that must be addressed in your individual support plan if you are enrolled in a DDA HCBS waiver; and

(3) Your support need levels for:

(a) The DDA activities of daily living acuity scale;

(b) The DDA interpersonal support acuity scale; and

(c) The DDA mobility acuity scale.

DDA scores the answers to each of the following questions in the support assessment for children based on the respondent information:

(1) Dress and groom self: What support does the child need to dress and groom self as expected of others of same age?

(2) Toilet self: What support does the child need to toilet self as expected of others in his/her age group?

(3) Eat at age level: What support does the child need to eat at age level?

(4) Move around: What support does the child need to move around in the same ways as other children of same age?

(5) Communicate: What support does the child need to communicate as others of same age?

(6) Learn about and use money: What support does the child need to learn about and use money?

(7) Make choices and take responsibility: What support does the child need to make choices and take responsibility?

(8) Explore environment: What support does the child need to explore environment?

(9) Meet therapy health needs: What supports are necessary to get child's therapy health needs met?

(10) Help family continue to meet child's needs: What support services should the system provide to help family continue to meet child's needs?

(11) Have relationships with family members: What support does the child need to make the kind of relationships with family members expected of nondisabled children of the same age?

(12) Explore and use typical community resources: What support does the child need to explore and use typical community resources such as stores, parks, and playgrounds?

(13) Play with others: What supports are needed for the child to develop age-level skills in playing with others?

(14) Have opportunities to play with typically developing children: What supports does the child need to have opportunities to play with typically developing children?

(15) Identify and respond safely to emergencies: What support does the child need to identify and respond safely to emergencies?

(16) Practice age-level safety measures: What support does the child need to practice age-level safety measures?

(17) Effectively relate to other students/peers: What support does the child need to most effectively relate to fellow students and/or peers?

(18) Have behaviors which promote being included: What support is needed for this child to have behaviors which promote being included?

DDA determines your total LOC score for ICF/IID level of care by adding all of your LOC scores on questions one through eighteen in the support assessment for children.

DDA determines you are eligible for ICF/IID level of care when:

(1) You are age birth through five years old and the total of your LOC scores is five or more; or

(2) You are age six through fifteen years old and the total of your LOC scores is seven or more.

The supports intensity scale assessment is a standardized tool developed by the American Association on Intellectual and Developmental Disabilities (AAIDD), to measure the relative intensity of support needs for persons age sixteen and older.

The purpose of the supports intensity scale assessment in the DDA assessment is to determine all of the following:

(1) Your ICF/IID level of care score for DDA HCBS waiver eligibility;

(2) The health and welfare needs that must be addressed in your individual support plan if you are enrolled in a DDA HCBS waiver;

(3) Your DDA behavioral and medical acuity levels regardless of your age; and

(4) Your support need acuity levels specific to the:

(a) DDA activities of daily living acuity scale;

(b) DDA interpersonal support acuity scale; and

(c) DDA mobility acuity scale.

The supports intensity scale assessment contains the following:

(1) The support needs scale;

(2) The supplemental protection and advocacy scale;

(3) Exceptional medical support needs scale; and

(4) Exceptional behavioral support needs scale.

The support needs scale contains the following subscales:

(1) Home living activities;

(2) Community living activities;

(3) Health and safety activities;

(4) Lifelong learning activities;

(5) Work activities;

(6) Social activities; and

(7) Advocacy activities.

The SIS measures your support needs in the support needs and supplemental protection and advocacy scales using the following three dimensions of support intensity:

(1) Type of support;

(2) Frequency of support; and

(3) Daily support time.

DDD scores the type of support you need to perform the assessed activity using the following rating scale:

DDD scores how frequently support is needed for you to perform the assessed activity using the following rating scale:

DDD scores the amount of daily support time you need to perform the assessed activity using the following rating scale:

DDD adds the three dimensions of support intensity scores for each activity to determine your raw score for the activity.

(1) DDD adds the raw scores (WAC 388-828-4160) for each activity assessed in each subscale of the SIS support needs scale to determine your total raw score for that subscale.

(2) The raw score for question number 9 in the home living activities subscale (WAC 388-828-4200) "using currently prescribed equipment or treatment" is not included in the total raw score for the home living activities subscale.

Some questions in the support needs and supplemental protection and advocacy scales have scoring limitations and some scores are not available for selection related to the standardization process per AAIDD.

The home living activities subscale measures your personal support needs for the following home living activities:

The community living activities subscale measures your personal support needs for the following community living activities:

The lifelong learning activities subscale measures your personal support needs for the following lifelong learning activities:

The work activities subscale measures your personal support needs for the following work activities:

The health and safety activities subscale measures your personal support needs for the following health and safety activities:

The social activities subscale measures your personal support needs for the following social activities:

The advocacy activities subscale measures your personal support needs for the following advocacy activities:

DDD examines the amount of support you need for medical treatments and behavioral support using the following rating scale:

The SIS exceptional medical support needs scale measures your personal support needs for the following medical support need(s) activities:

The SIS exceptional behavioral support needs scale measures your personal support needs for the following behaviors:

If you are age 16 or older, DDA determines you to be eligible for ICF/IID level-of-care from your SIS scores. Eligibility for ICF/IID level-of-care requires that your scores meet at least one of the following:

(1) You have a percentile rank over nine percent for three or more of the six subscales in the SIS support needs scale;

(2) You have a percentile rank over 25% for two or more of the six subscales in the SIS support needs scale;

(3) You have a percentile rank over 50% in at least one of the six subscales in the SIS support needs scale;

(4) You have a support score of one or two for any of the questions listed in the SIS exceptional medical support needs scale;

(5) You have a support score of one or two for at least one of the following items in the SIS exceptional behavior support needs scale:

(a) Prevention of assaults or injuries to others;

(b) Prevention of property destruction (e.g., fire setting, breaking furniture);

(c) Prevention of self-injury;

(d) Prevention of PICA (ingestion of inedible substances);

(e) Prevention of suicide attempts;

(f) Prevention of sexual aggression; or

(g) Prevention of wandering.

(6) You have a support score of two for any of the questions listed in the SIS exceptional behavior support needs scale; or

(7) You meet or exceed any of the qualifying scores for one or more of the following SIS questions:

DDD uses the following table to convert your total raw score for each subscale into a percentile ranking:

(1) DDA determines your SIS support needs index percentile ranking by adding together the standard scores (WAC 388-828-4420) for the following supports intensity scale assessment subscales:

(a) Home living activities in WAC 388-828-4200.

(b) Community living activities in WAC 388-828-4220.

(c) Health and safety activities in WAC 388-828-4280.

(d) Lifelong learning activities in WAC 388-828-4240.

(e) Work activities in WAC 388-828-4260.

(e) Social activities in WAC 388-828-4300.

(2) Your standard scores for the above scales are added together to determine the sum of the standard scores.

(3) The advocacy activities scale, and the exceptional medical and behavioral supports scales are not used in determining your support needs index percentile ranking.

(4) The sum of the standard scores is converted to your support needs index percentile ranking using the following table:

The DDD protective supervision acuity scale is an assessment of your protective supervision support need(s).

(1) Information obtained in the protective supervision acuity scale is one of the factors used by DDD to determine:

(a) The amount of waiver respite, if any, that you are authorized to receive;

(b) Your individual and family services level, if you are authorized to receive individual and family services per chapter 388-832 WAC; and

(c) Your residential service level of support, if you are authorized to receive a residential service listed in WAC 388-828-9510.

(2) The protective supervision acuity scale is not used when determining your medicaid personal care or waiver personal care; and

(3) The information is used for reporting purposes to the legislature and the department.

The three questions that are asked for the DDD protective supervision acuity scale are in WAC 388-828-5060.

DDD selects one answer per each question that best describes your reported need.

(1) What level of monitoring does the client typically require during awake hours?

(2) What assistance does the client need to handle unfamiliar or unexpected situations?

(3) Is client able to summon help?

DDD determines your adjusted protective supervision acuity score by applying the following age-based score adjustments to your level of monitoring score for question number one in WAC 388-828-5060: