Definitions.
"Aggregate services" means a combination of services subject to the dollar limits in the basic plus waiver.
"Allocation" means the amount of individual and family services (IFS) waiver funding available to a client for a maximum of twelve months.
"CARE" means comprehensive assessment and reporting evaluation.
"Client" means a person who has a developmental disability under RCW
71A.10.020(5) and has been determined eligible to receive services from the administration under chapter
71A.16 RCW.
"Community crisis stabilization services" or "CCSS" means a state-operated program that provides short-term supports to clients who are in crisis, or who are at risk of hospitalization or institutional placement.
"DDA" means the developmental disabilities administration, of the department of social and health services.
"DDA assessment" refers to the standardized assessment tool under chapter
388-828 WAC, used by DDA to measure the support needs of people with developmental disabilities.
"Department" means the department of social and health services (DSHS).
"Evidence-based treatment" means the use of physical, mental, and behavioral health interventions for which systematic, empirical research has provided evidence of statistically significant effectiveness as treatments for specific conditions. Alternate terms with the same meaning are evidence-based practice (EBP) and empirically supported treatment (EST).
"Family" means one or more of the following relatives: Spouse or registered domestic partner; natural, adoptive or step parent; grandparent; child; stepchild; sibling; stepsibling; uncle; aunt; first cousin; niece; or nephew.
"Family home" means the residence where you and your family live.
"Gainful employment" means employment that reflects achievement of or progress towards a living wage.
"Home" means present or intended place of residence.
"ICF/IID" means an intermediate care facility for individuals with intellectual disabilities.
"Integrated business settings" means a setting that enables participants to either work alongside or interact with individuals who do not have disabilities, or both.
"Integrated settings" mean typical community settings not designed specifically for individuals with disabilities in which the majority of persons employed and participating are individuals without disabilities.
"Legal representative" means a parent of a person who is under eighteen years of age, a person's legal guardian, a person's limited guardian when the subject matter is within the scope of limited guardianship, a person's attorney at law, a person's attorney in fact, or any other person who is authorized by law to act for another person.
"Living wage" means the amount of earned wages needed to enable an individual to meet or exceed his or her living expenses.
"Necessary supplemental accommodation representative" means an individual who receives copies of DDA planned action notices (PANs) and other department correspondence in order to help a client understand the documents and exercise the client's rights. A necessary supplemental accommodation representative is identified by a client of DDA when the client does not have a legal guardian and the client is requesting or receiving DDA services.
"Participant" means a client who is enrolled in a home and community based services waiver program.
"Person-centered service plan" 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.
"Primary caregiver" means the person who provides the majority of your care and supervision.
"Provider" means an individual or agency who meets the provider qualifications and is contracted with DSHS to provide services to you.
"Respite assessment" means an algorithm within the DDA assessment that determines the number of hours of respite care you may receive per year if you are enrolled in the basic plus, children's intensive in-home behavioral support, or core waiver.
"SSI" means supplemental security income, an assistance program administered by the federal Social Security Administration for blind, disabled and aged individuals.
"SSP" means state supplementary payment program, a state-paid cash assistance program for certain clients of the developmental disabilities administration.
"State-funded services" means services that are funded entirely with state dollars.
"You" means the client or participant.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0001, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0001, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0001, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-0001, filed 8/1/12, effective 9/1/12. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0001, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-0001, filed 9/22/08, effective 10/23/08; WSR 07-20-050, § 388-845-0001, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0001, filed 12/13/05, effective 1/13/06.]
What are home and community based services (HCBS) waivers?
(1) Home and community based services (HCBS) waivers are services approved by the Centers for Medicare and Medicaid Services (CMS) under section 1915(c) of the Social Security Act as an alternative to intermediate care facility for the individuals with intellectual disabilities (ICF/ID).
(2) Certain federal regulations are "waived" enabling the provision of services in the home and community to individuals who would otherwise require the services provided in an ICF/ID as defined in chapters
388-835 and
388-837 WAC.
[Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0005, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0005, filed 12/13/05, effective 1/13/06.]
What is the purpose of HCBS waivers?
The purpose of HCBS waivers is to provide services in the community to individuals with ICF/ID level of need to prevent their placement in an ICF/ID.
[Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0010, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0010, filed 12/13/05, effective 1/13/06.]
What HCBS waivers are provided by the developmental disabilities administration (DDA)?
DDA provides services through five HCBS waivers:
(1) Basic plus waiver;
(2) Core waiver;
(3) Community protection (CP) waiver;
(4) Children's intensive in-home behavioral support waiver (CIIBS); and
(5) Individual and family services (IFS) waiver.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0015, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0015, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0015, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0015, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0015, filed 12/13/05, effective 1/13/06.]
When were the HCBS waivers effective?
Basic plus, children's intensive in-home behavioral support, core and community protection waivers were effective September 1, 2012. Individual and family services waiver was effective June 1, 2015.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0020, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0020, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0020, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0020, filed 12/13/05, effective 1/13/06.]
Do I meet criteria for HCBS waiver-funded services?
(1) You meet criteria for DDA HCBS waiver-funded services if you meet all of the following:
(a) You have been determined eligible for DDA services per RCW
71A.10.020.
(c) You meet disability criteria established in the Social Security Act.
(d) You meet financial eligibility requirements as defined in WAC
182-515-1510.
(e) You choose to receive services in the community rather than in an ICF/IID facility.
(f) You have a need for monthly waiver services or monthly monitoring as identified in your person-centered service plan/individual support plan.
(g) You are not residing in hospital, jail, prison, nursing facility, ICF/IID, or other institution.
(h) Additionally, for the children's intensive in-home behavioral support (CIIBS) waiver-funded services:
(i) You are age eight or older and under the age of eighteen for initial enrollment and under age twenty-one for continued enrollment;
(ii) You have been determined to meet CIIBS program eligibility per chapter
388-828 WAC prior to initial enrollment only;
(iii) You live with your family; and
(iv) Your parent/guardian(s) and primary caregiver(s), if other than parent/guardian(s), have signed the participation agreement.
(2) For the individual and family services waiver, you must meet the criteria in subsection (1) of this section and also live in your family home.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0030, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0030, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0030, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0030, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0030, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0030, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0030, filed 12/13/05, effective 1/13/06.]
Can I be enrolled in more than one HCBS waiver?
You cannot be enrolled in more than one HCBS waiver at the same time.
[Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0031, filed 9/26/07, effective 10/27/07.]
Am I guaranteed placement on a waiver if I meet waiver criteria?
(1) If you are not currently enrolled in a waiver, meeting criteria for the waiver does not guarantee access to or receipt of waiver services.
(2) If you are currently on a waiver and you have been determined to have health and welfare needs that can be met only by services available on a different waiver, you are not guaranteed enrollment in that different waiver.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0035, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0035, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0035, filed 12/13/05, effective 1/13/06.]
Is there a limit to the number of people who can be enrolled in each HCBS waiver?
Each waiver has a capacity limit on the number of people who can be served in a waiver year. In addition, DDA has the authority to limit capacity based on availability of funding for new waiver participants.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0040, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0040, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0040, filed 12/13/05, effective 1/13/06.]
What is DDA's responsibility to provide your services under the DDA HCBS waivers administered by DDA?
If you are enrolled in an HCBS waiver administered by DDA.
(1) DDA will provide an annual comprehensive assessment to evaluate your health and welfare needs. Your person-centered service plan/individual support plan, as specified in WAC
388-845-3055, will document:
(a) Your identified health and welfare needs; and
(b) Your HCBS waiver services and nonwaiver services authorized to meet your assessed need.
(2) You have access to DDA paid services that are provided within the scope of your waiver, subject to the limitations in WAC
388-845-0110 and
388-845-0115.
(3) DDA will provide waiver services you need and qualify for within your waiver.
(4) DDA will not deny or limit, based on lack of funding, the number of waiver services for which you are eligible.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0041, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0041, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-0041, filed 8/1/12, effective 9/1/12. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0041, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0041, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0041, filed 12/13/05, effective 1/13/06.]
When there is capacity to add people to a waiver, how does DDA determine who will be enrolled?
When there is capacity on a waiver and available funding for new waiver participants, DDA may enroll people from the statewide database in a waiver based on the following priority considerations:
(1) First priority will be given to current waiver participants assessed to require a different waiver because their identified health and welfare needs have increased and these needs cannot be met within the scope of their current waiver.
(2) DDA may also consider any of the following populations in any order:
(a) Priority populations as identified and funded by the legislature.
(b) Persons DDA has determined to be in immediate risk of ICF/IID admission due to unmet health and welfare needs.
(c) Persons identified as a risk to the safety of the community.
(d) Persons currently receiving services through state-only funds.
(e) Persons on an HCBS waiver that provides services in excess of what is needed to meet their identified health and welfare needs.
(f) Persons who were previously on an HCBS waiver since April 2004 and lost waiver eligibility per WAC
388-845-0060 (1)(i).
(3) DDA may consider persons who need the waiver services available in the basic plus or IFS waivers to maintain them in their family's home or in their own home.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0045, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0045, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0045, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0045, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-0045, filed 9/22/08, effective 10/23/08; WSR 07-20-050, § 388-845-0045, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0045, filed 12/13/05, effective 1/13/06.]
How do I request to be enrolled in a waiver?
(1) You can contact DDA and request to be enrolled in a waiver or to enroll in a different waiver at any time.
(2) If you are assessed as meeting ICF/ID level of care as defined in WAC
388-845-0070 and chapter
388-828 WAC, your request for waiver enrollment will be documented by DDA in a statewide database.
(3) For the children's intensive in-home behavioral support (CIIBS) waiver only, if you are assessed as meeting both ICF/ID level of care and CIIBS eligibility as defined in WAC
388-845-0030 and chapter
388-828 WAC, your request for waiver enrollment will be documented by DDA in a statewide database.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0050, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0050, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0050, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0050, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0050, filed 12/13/05, effective 1/13/06.]
How will I be notified of the decision by DDA to enroll me in a waiver?
DDA will notify you in writing of its decision to enroll you in a waiver or its decision to deny your request to be enrolled in a waiver.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0051, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0051, filed 12/13/05, effective 1/13/06.]
What is the process if I am already on a DDA HCBS waiver and request enrollment onto a different DDA HCBS waiver?
(1) If you are already enrolled in a DDA HCBS waiver and you request to be enrolled in a different waiver DDA will do the following:
(a) Assess your needs to determine whether your health and welfare needs can be met with services available on your current waiver or whether those needs can only be met through services offered on a different waiver.
(b) If DDA determines your health and welfare needs can be met by services available on your current waiver your enrollment request will be denied.
(c) If DDA determines your health and welfare needs can only be met by services available on a different waiver your service need will be reflected in your person-centered service plan/individual support plan.
(d) If DDA determines there is capacity on the waiver that is determined to meet your needs, DDA will place you on that waiver.
(2) You will be notified in writing of DDA's decision under subsection (1)(a) of this section and if your health and welfare needs cannot be met on your current waiver, DDA will notify you in writing whether there is capacity on the waiver that will meet your health and welfare needs and whether you will be enrolled on that waiver. If current capacity on that waiver does not exist, your eligibility for enrollment onto that different waiver will be tracked on a statewide database.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0052, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0052, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0052, filed 9/26/07, effective 10/27/07.]
How do I remain eligible for the waiver?
(1) Once you are enrolled in a DDA HCBS waiver, you can remain eligible if you continue to meet eligibility criteria in WAC
388-845-0030, and:
(a) You complete a reassessment with DDA at least once every twelve months to determine if you continue to meet all of these eligibility requirements;
(b) You must either receive a waiver service at least once in every thirty consecutive days, as specified in WAC
182-513-1320(3), or your health and welfare needs require monthly monitoring, which will be documented in your client record;
(c) You complete an in-person DDA assessment/reassessment interview per WAC
388-828-1520.
(2) For the children's intensive in-home behavioral supports waiver, you must meet the criteria in subsection (1) of this section and:
(a) Be under age twenty-one;
(b) Live with your family; and
(c) Have an annual participation agreement signed by your parent/guardian(s) and primary caregiver(s), if other than parent/guardian(s).
(3) For the individual and family services waiver, you must meet the criteria in subsection (1) of this section and live in your family home.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0055, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0055, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0055, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0055, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0055, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0055, filed 12/13/05, effective 1/13/06.]
Can your waiver enrollment be terminated?
DDA may terminate your waiver enrollment if DDA determines that:
(1) Your health and welfare needs cannot be met in your current waiver or for one of the following reasons:
(a) You no longer meet one or more of the requirements listed in WAC
388-845-0030;
(b) You do not have an identified need for a waiver service at the time of your annual person-centered service plan/individual support plan;
(c) You do not use a waiver service at least once in every thirty consecutive days and your health and welfare do not require monthly monitoring;
(d) You are on the community protection waiver and:
(i) You choose not to be served by a certified residential community protection provider-intensive supported living services (CP-ISLS);
(ii) You engage in any behaviors identified in WAC
388-831-0240 (1) through (4); and
(iii) DDA determines that your health and safety needs or the health and safety needs of the community cannot be met in the community protection program;
(e) You choose to unenroll from the waiver;
(f) You reside out-of-state;
(g) You cannot be located or do not make yourself available for the annual waiver reassessment of eligibility;
(h) You refuse to participate with DDA in:
(i) Service planning;
(ii) Required quality assurance and program monitoring activities; or
(iii) Accepting services agreed to in your person-centered service plan/individual support plan as necessary to meet your health and welfare needs;
(i) You are residing in a hospital, jail, prison, nursing facility, ICF/IID, or other institution and remain in residence at least one full calendar month, and are still in residence:
(i) At the end of that full calendar month, there is no immediate plan for you to return to the community;
(ii) At the end of the twelfth month following the effective date of your current person-centered service plan/individual support plan, as described in WAC
388-845-3060; or
(iii) The end of the waiver fiscal year, whichever date occurs first;
(j) Your needs exceed the maximum funding level or scope of services under the basic plus waiver as specified in WAC
388-845-3080; or
(k) Your needs exceed what can be provided under WAC
388-845-3085.
(2) Services offered on a different waiver can meet your health and welfare needs and DDA enrolls you on a different waiver.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0060, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0060, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0060, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, and Title
71A RCW. WSR 09-10-021, § 388-845-0060, filed 4/28/09, effective 5/29/09; WSR 07-20-050, § 388-845-0060, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0060, filed 12/13/05, effective 1/13/06.]
What happens if I am terminated or choose to disenroll from a waiver?
If you are terminated from a waiver or choose to disenroll from a waiver, DDA will notify you.
(1) DDA cannot guarantee continuation of your current services, including medicaid eligibility.
(2) Your eligibility for nonwaiver state-only funded DDA services is based upon availability of funding and program eligibility for a particular service.
(3) If you are terminated from the CIIBS waiver due to turning age twenty-one, DDA will assist with transition planning at least twelve months prior to your twenty-first birthday.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0065, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0065, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0065, filed 12/13/05, effective 1/13/06.]
What determines if I need ICF/ID level of care?
DDA determines if you need ICF/ID level of care based on your need for waiver services. To reach this decision, DDA uses the DDA assessment as specified in chapter
388-828 WAC.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0070, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0070, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0070, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0070, filed 12/13/05, effective 1/13/06.]
What determines which waiver I am assigned to?
DDA will assign you to the waiver with the minimum service package necessary to meet your health and welfare needs, based on its evaluation of your DDA assessment as described in chapter
388-828 WAC and the following criteria:
(1) For the individual and family services waiver, you:
(a) Live in your family home; and
(b) Are assessed to need a waiver service to remain in the family home.
(2) For the basic plus waiver your health and welfare needs require a waiver service to remain in the community.
(3) For the core waiver:
(a) You are at immediate risk of out-of-home placement; or
(b) You have an identified health and welfare need for residential services that cannot be met by the basic plus waiver.
(5) For the children's intensive in-home behavioral support waiver, you:
(a) Are age eight or older but under age eighteen;
(b) Live with your family;
(c) Are assessed at high or severe risk of out-of-home placement due to challenging behavior per chapter
388-828 WAC; and
(d) Have a signed participation agreement from your parent or guardian and primary caregiver, if other than parent or guardian.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0100, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0100, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0100, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0100, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0100, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0100, filed 12/13/05, effective 1/13/06.]
What criteria determine assignment to the community protection waiver?
DDA may assign you to the community protection waiver only if you are at least eighteen years of age, not currently residing in a hospital, jail or other institution, and meet the following criteria:
(1) You have been identified by DDA as a person who meets one or more of the following:
(a) You have been convicted of or charged with a crime of sexual violence as defined in chapter
71.09 RCW;
(b) You have been convicted of or charged with acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization, or persons of casual acquaintance with whom no substantial personal relationship exists;
(c) You have been convicted of or charged with a sexually violent offense and/or predatory act, and may constitute a future danger as determined by a qualified professional;
(d) You have not been convicted and/or charged, but you have a history of stalking, violent, sexually violent, predatory and/or opportunistic behavior which demonstrates a likelihood to commit a sexually violent and/or predatory act based on current behaviors that may escalate to violence, as determined by a qualified professional; or
(e) You have committed one or more violent offense, as defined in RCW
9.94A.030;
(2) You receive or agree to receive residential services from certified residential community protection provider-intensive supported living services (CP-ISLS); and
(3) You comply with the specialized supports and restrictions in one or more of the following:
(a) Your person-centered service plan/individual support plan;
(b) Your individual instruction and support plan (IISP); or
(c) Your treatment plan provided by DDA approved certified individuals and agencies.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0105, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0105, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0105, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0105, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0105, filed 12/13/05, effective 1/13/06.]
What are the limits to the waiver services you may receive?
The following limits apply to the waiver services you may receive:
(1) A service must be available in your waiver and address an unmet need identified in your person-centered service plan.
(2) Behavioral health stabilization services may be added to your person-centered service plan after the services have been provided.
(3) Waiver services are limited to services required to prevent placement in an intermediate care facility for individuals with intellectual disabilities (ICF/IID).
(4) The daily cost of your waiver services must not exceed the average daily cost of care in an ICF/IID.
(5) Waiver services must not replace or duplicate other available paid or unpaid supports or services. Before DDA will cover a service through waiver services, you must first request and be denied all applicable services through private insurance, medicare, the medicaid state plan, and other resources.
(6) Waiver funding must not be authorized for treatments determined by DSHS to be experimental or investigational under WAC
182-531-0050.
(7) For the individual and family services (IFS) and basic plus waivers, services must not exceed the yearly limits specified in these programs for specific services or combinations of services.
(8) Your choice of qualified providers and services is limited to the most cost-effective option that meets your unmet need identified in your person-centered service plan.
(9) Services provided out-of-state, other than in recognized bordering cities, are limited to respite care and personal care during vacations of not more than thirty consecutive days.
(10) You may receive services in a recognized out-of-state bordering city under WAC
182-501-0175.
(11) Other out-of-state waiver services require an approved exception to rule before DDA will authorize payment.
(12) Waiver services do not cover:
(a) Copays;
(b) Deductibles;
(c) Dues;
(d) Membership fees; or
(e) Subscriptions.
(13) Waiver services do not cover a product unless the product is:
(a) Necessary to meet a basic health and safety need; and
(b) The least restrictive means for meeting that need.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0110, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0110, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0110, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0110, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0110, filed 12/13/05, effective 1/13/06.]
Are there limitations regarding who can provide services?
The following limitations apply to providers for waiver services:
(1) Your spouse must not be your paid provider for any waiver service.
(2) If you are under age eighteen, your natural, step, or adoptive parent must not be your paid provider for any waiver service.
(3) If you are age eighteen or older, your natural, step, or adoptive parent must not be your paid provider for any waiver service with the exception of:
(a) Personal care;
(b) Transportation to and from a waiver service;
(c) Residential habilitation services per WAC
388-845-1510 if your parent is certified as a residential agency per chapter
388-101 WAC; or
(d) Respite care if you and the parent who provides the respite care live in separate homes.
(4) If you receive CIIBS waiver services, your legal representative or family member per WAC
388-845-0001 must not be your paid provider for any waiver service with the exception of:
(a) Transportation to and from a waiver service; and
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0111, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0111, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0111, filed 9/26/07, effective 10/27/07.]
Does your waiver eligibility limit your access to DDA nonwaiver services?
If you are enrolled in a DDA HCBS waiver:
(1) You are not eligible for state-only funding for DDA services; and
(2) You may be eligible for medicaid personal care or community first choice services.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0115, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0115, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0115, filed 12/13/05, effective 1/13/06.]
Will I continue to receive state supplementary payments (SSP) if I am on the waiver?
Your participation in one of the DDA HCBS waivers may affect your continued receipt of state supplemental payment from DDA. To continue to receive SSP, you must meet DDA/SSP programmatic eligibility requirements as identified in WAC
388-827-0115.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0120, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-0120, filed 8/1/12, effective 9/1/12. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0120, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0120, filed 12/13/05, effective 1/13/06.]
What waiver services are available to you?
Each of the DDA HCBS waivers has a different scope of service and your person-centered service plan/individual support plan defines the waiver services available to you.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0200, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0200, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0200, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0200, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0200, filed 12/13/05, effective 1/13/06.]
What services are available under the basic plus waiver?
The following services are available under the basic plus waiver:
service | yearly limit |
aggregate services: | Total costs must not exceed six thousand one hundred ninety-two dollars per year per participant |
Chemical extermination of cimex lectularius (bedbugs) |
Community guide |
Environmental adaptations |
Occupational therapy | |
Physical therapy | |
Positive behavior support and consultation | |
Skilled nursing | |
Specialized medical equipment and supplies | |
Specialized psychiatric services | |
Speech, hearing, and language services | |
Staff and family consultation and training | |
Transportation | |
Wellness education | |
employment services: | |
Individual technical assistance | Limits determined by DDA assessment and employment status; no new enrollment in prevocational services after September 1, 2015 |
Prevocational services |
Supported employment |
Community inclusion | Limits determined by DDA assessment |
behavioral health stabilization services: | Limits determined by a behavioral health professional or DDA |
Behavioral health crisis diversion bed services Positive behavior support and consultation |
Specialized psychiatric services | |
Personal care | Limits determined by the CARE tool used as part of the DDA assessment |
Respite care | Limits determined by DDA assessment |
Risk assessment | Limits determined by DDA |
Emergency assistance is only for basic plus waiver aggregate services | Six thousand dollars per year; preauthorization required |
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0210, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0210, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0210, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-0210, filed 9/22/08, effective 10/23/08; WSR 07-20-050, § 388-845-0210, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030,
71A.12.120. WSR 07-05-014, § 388-845-0210, filed 2/9/07, effective 3/12/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0210, filed 12/13/05, effective 1/13/06.]
What services are available under the core waiver?
(1) The following services are available under the core waiver:
SERVICE | YEARLY LIMIT |
Chemical extermination of cimex lectularius (bedbugs) Community guide Community transition Environmental adaptions Occupational therapy Physical therapy Positive behavior support and consultation Residential habilitation Risk assessment Skilled nursing Specialized medical equipment and supplies Specialized psychiatric services Speech, hearing, and language services Staff and family consultation and training Transportation Wellness education | Determined by the person-centered service plan |
EMPLOYMENT SERVICES: Individualized technical assistance Prevocational services Supported employment | Limits determined by DDA assessment and employment status; no new enrollment in prevocational services after September 1, 2015 |
Community inclusion | Limits determined by DDA assessment |
BEHAVIORAL HEALTH STABILIZATION SERVICES: Behavioral health crisis diversion bed services Positive behavior support and consultation Specialized psychiatric services | Limits determined by a behavioral health professional or DDA |
Respite care | Limits determined by DDA assessment |
(2) A participant's core waiver services are subject to additional limits under this chapter.
(3) The total cost of a participant's core waiver services must not exceed the average cost of care at an intermediate care facility for individuals with intellectual disabilities (ICF/IID).
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0215, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0215, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0215, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0215, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0215, filed 12/13/05, effective 1/13/06.]
What services are available under the community protection waiver?
(1) The following services are available under the community protection waiver:
service | yearly limit |
Chemical extermination of cimex lectularius (bedbugs) | Determined by the person-centered service plan |
Community transition |
Environmental adaptations |
Occupational therapy |
Physical therapy |
Positive behavior support and consultation | |
Residential habilitation | |
Risk assessment | |
Skilled nursing | |
Specialized medical equipment and supplies | |
Specialized psychiatric services | |
Speech, hearing, and language services | |
Staff and family consultation and training | |
Transportation | |
EMPLOYMENT SERVICES: Individual technical assistance Prevocational services Supported employment | Limits determined by DDA assessment and employment status; no new enrollment in prevocational services after September 1, 2015 |
behavioral health stabilization services: Behavioral health crisis diversion bed services Positive behavior support and consultation Specialized psychiatric services | Limits determined by a behavioral health professional or DDA |
(2) A participant's community protection waiver services are subject to additional limits under this chapter.
(3) The total cost of a participant's community protection waiver services must not exceed the average cost of care at an intermediate care facility for individuals with intellectual disabilities (ICF/IID).
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0220, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0220, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0220, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0220, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0220, filed 12/13/05, effective 1/13/06.]
What services are available under the children's intensive in-home behavioral support (CIIBS) waiver?
(1) The following services are available under the children's intensive in-home behavioral support (CIIBS) waiver:
SERVICE | YEARLY LIMIT |
Assistive technology Environmental adaptations Nurse delegation Positive behavior support and consultation Specialized clothing Specialized medical equipment and supplies Staff and family consultation and training Therapeutic equipment and supplies Transportation Vehicle modifications | Determined by the person-centered service plan. Total cost of waiver services must not exceed the average cost of four thousand dollars per month per participant. |
Respite care | Limits determined by the DDA assessment. Costs are included in the total average cost of four thousand dollars per month per participant for all waiver services. |
BEHAVIORAL HEALTH STABILIZATION SERVICES: Behavioral health crisis diversion bed services Positive behavior support and consultation | Limits determined by behavioral health professional or DDA |
Risk assessment | Limits determined by DDA |
(2) A participant's CIIBS waiver services are subject to additional limits under this chapter.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0225, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0225, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0225, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0225, filed 11/1/10, effective 12/2/10.]
What services are available under the individual and family services (IFS) waiver?
(1) The following services are available under the individual and family services (IFS) waiver:
SERVICE | YEARLY LIMIT |
Assistive technology Community engagement Environmental adaptions Occupational therapy Peer mentoring Person-centered plan facilitation Physical therapy Positive behavior support and consultation Respite care Skilled nursing Specialized clothing Specialized medical equipment and supplies | Total cost of waiver services must not exceed annual allocation determined by the person-centered service plan |
Specialized psychiatric services Speech, hearing, and language services Staff and family consultation and training Supported parenting services Transportation Vehicle modifications Wellness education | |
Risk assessment | Limits determined by DDA. Costs are excluded from the annual allocation. |
BEHAVIORAL HEALTH STABILIZATION SERVICES: Crisis diversion bed services Positive behavior support and consultation Specialized psychiatric services | Limits determined by behavioral health professional or DDA. Costs are excluded from the annual allocation. |
(2) Your IFS waiver services annual allocation is based upon the DDA assessment under chapter
388-828 WAC. The DDA assessment determines your service level and annual allocation based on your assessed need. Annual allocations are as follows:
(a) Level 1 = one thousand two hundred dollars;
(b) Level 2 = one thousand eight hundred dollars;
(c) Level 3 = two thousand four hundred dollars; or
(d) Level 4 = three thousand six hundred dollars.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0230, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0230, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0230, filed 8/4/16, effective 9/4/16.]
What are adult family home (AFH) services?
Per RCW
70.128.010 an adult family home (AFH) is a regular family abode in which a person or persons provide personal care, special care, room, and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the service. Adult family homes (AFH) may provide residential care to adults in the basic plus waiver.
[Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0300, filed 12/13/05, effective 1/13/06.]
Who is a qualified provider of AFH services?
The provider of AFH services must be licensed and contracted with DSHS as an AFH who has successfully completed the DDA specialty training provided by the department.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0305, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0305, filed 12/13/05, effective 1/13/06.]
Are there limits to the AFH services I can receive?
Adult family homes services are limited by the following:
(1) AFH services are defined and limited per chapter
388-106 WAC governing medicaid personal care and the comprehensive assessment and reporting evaluation (CARE).
(2) Rates are determined by and limited to department published rates for the level of care generated by CARE.
(3) AFH reimbursement cannot be supplemented by other department funding.
[Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0310, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0310, filed 12/13/05, effective 1/13/06.]
What are adult residential care (ARC) services?
Adult residential care (ARC) facilities may provide residential care to adults. This service is available in the basic plus waiver.
(1) An ARC is a licensed assisted living facility for seven or more unrelated adults.
(2) Services include, but are not limited to, individual and group activities; assistance with arranging transportation; assistance with obtaining and maintaining functional aids and equipment; housework; laundry; self-administration of medications and treatments; therapeutic diets; cuing and providing physical assistance with bathing, eating, dressing, locomotion and toileting; stand-by one person assistance for transferring.
[Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0400, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0400, filed 12/13/05, effective 1/13/06.]
Who is a qualified provider of ARC services?
The provider of ARC services must:
(1) Be a licensed assisted living facility;
(2) Be contracted with DSHS to provide ARC services; and
(3) Have completed the required and approved DDA specialty training.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0405, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0405, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0405, filed 12/13/05, effective 1/13/06.]
Are there limits to the ARC services I can receive?
ARC services are limited by the following:
(1) ARC services are defined and limited by assisted living facility licensure and rules in chapter
388-78A WAC, and chapter
388-106 WAC governing medicaid personal care and the comprehensive assessment and reporting evaluation (CARE).
(2) Rates are determined and limited to department published rates for the level of care generated by CARE.
(3) ARC reimbursement cannot be supplemented by other department funding.
[Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0410, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0410, filed 12/13/05, effective 1/13/06.]
What is assistive technology?
Assistive technology consists of items, equipment, or product systems, not related to a client's physical health, that are used to increase, maintain, or improve functional capabilities of waiver participants, as well as supports to directly assist the participant to select, acquire, and use the technology. Assistive technology is available in the CIIBS and IFS waivers, and includes the following:
(1) The evaluation of the needs of the waiver participant, including a functional evaluation of the participant in the participant's customary environment;
(2) Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices;
(3) Selecting, designing, fitting, customizing, adapting, applying, retaining, repairing, or replacing assistive technology devices;
(4) Coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;
(5) Training or technical assistance for the participant and/or if appropriate, the participant's family; and
(6) Training or technical assistance for professionals, including individuals providing education and rehabilitation services, employers, or other individuals who provide services to, employ, or are otherwise involved in the assistive technology related life functions of individuals with disabilities.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0415, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0415, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0415, filed 11/1/10, effective 12/2/10.]
Who may be a qualified provider of assistive technology?
The provider of assistive technology must be an entity contracted with DDA to provide assistive technology, or one of the following professionals contracted with DDA and licensed, registered, or certified as:
(1) An audiologist;
(2) A behavior health professional;
(3) A certified music therapist;
(4) An occupational therapist;
(5) A physical therapist;
(6) A rehabilitation counselor;
(7) A speech and language pathologist; or
(8) A speech therapist.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0420, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0420, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0420, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0420, filed 11/1/10, effective 12/2/10.]
Are there limits to the assistive technology you may receive?
The assistive technology you may receive has the following limits:
(1) Assistive technology is limited to additional services not otherwise covered under the medicaid state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
(2) Clinical and support needs for assistive technology must be identified in your DDA assessment and documented in the person-centered service plan.
(3) DDA requires your treating professional's written recommendation regarding your need for the technology. This recommendation must take into account that:
(a) The treating professional has personal knowledge of and experience with the requested assistive technology; and
(b) The treating professional has recently examined you, reviewed your medical records, and conducted a functional evaluation of your use of the equipment and determined its effectiveness in meeting your identified need.
(4) Assistive technology requires prior approval by the DDA regional administrator or designee.
(5) DDA may require a written second opinion from a DDA-selected professional.
(6) The dollar amounts for your individual and family services (IFS) waiver annual allocation limit the amount of assistive technology you are authorized to receive.
(7) Assistive technology excludes any item that is for recreational or diversion purposes such as a television, cable, or DVD player.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0425, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0425, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0425, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0425, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0425, filed 11/1/10, effective 12/2/10.]
What is positive behavior support and consultation?
(1) Positive behavior support and consultation may be provided to persons on any of the DDA HCBS waivers and includes the development and implementation of programs designed to support waiver participants using:
(a) Individualized strategies for effectively relating to caregivers and other people in the waiver participant's life; and
(b) Direct interventions with the person to decrease aggressive, destructive, and sexually inappropriate or other behaviors that compromise their ability to remain in the community (i.e., training, specialized cognitive counseling, conducting a functional assessment, and development and implementation of a positive behavior support plan).
(2) Positive behavior support and consultation may also be provided as a behavioral health stabilization service in accordance with WAC
388-845-1150 through
388-845-1160.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0500, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0500, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0500, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0500, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0500, filed 12/13/05, effective 1/13/06.]
What is included in positive behavior support and consultation for the children's intensive in-home behavioral support (CIIBS) waiver?
(1) In addition to the definition in WAC
388-845-0500, positive behavior support and consultation in the children's intensive in-home behavioral support (CIIBS) waiver must include:
(a) Treatments that are evidence based, driven by individual outcome data, and consistent with DDA's positive behavior support guidelines as outlined in contract;
(b) Objective and measurable treatment goals that decrease challenging behaviors and increase skills that promote quality of life for the child and family;
(c) Behavioral support strategies individualized and coordinated across all environments, such as home, school, and community, in order to promote a consistent approach among all involved persons; and
(d) The following components developed with the child, family, and a behavior specialist under WAC
388-845-0506:
(i) A functional behavioral assessment; and
(ii) A positive behavior support plan based on the functional behavioral assessment.
(2) Positive behavior support and consultation in the CIIBS waiver may include:
(a) Positive behavior support plans implemented by a behavioral technician under WAC
388-845-0506, which may include 1:1 behavior interventions and skill development activity;
(b) Recommendations from a music therapist under WAC
388-845-2005; and
(c) Recommendations from a recreation therapist under WAC
388-845-2005.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0501, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0501, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0501, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0501, filed 11/1/10, effective 12/2/10.]
Who is a qualified provider of positive behavior support and consultation?
Under the basic plus, core, community protection (CP), and individual and family services (IFS) waivers, the provider of positive behavior support and consultation must be one of the following professionals contracted with DDA and duly licensed, registered, or certified as a:
(1) Marriage and family therapist;
(2) Mental health counselor;
(3) Psychologist;
(4) Sex offender treatment provider;
(5) Social worker;
(6) Registered nurse (RN) or licensed practical nurse (LPN);
(7) Psychiatrist;
(8) Psychiatric advanced registered nurse practitioner (ARNP);
(9) Physician assistant working under the supervision of a psychiatrist;
(10) Counselor registered or certified under chapter
18.19 RCW;
(11) Polygrapher; or
(12) State-operated positive behavior support agency qualified to provide behavioral health stabilization services.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0505, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0505, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0505, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0505, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0505, filed 12/13/05, effective 1/13/06.]
Who is a qualified provider of positive behavior support and consultation for the children's intensive in-home behavioral support (CIIBS) waiver?
Under the children's intensive in-home behavioral support (CIIBS) waiver, providers of positive behavior support and consultation must be contracted with DDA to provide CIIBS intensive services as a:
(1) Master's or PhD-level behavior specialist who is licensed, certified, or registered to provide behavioral assessments, interventions, and training; or
(2) Behavior technician, licensed, certified, or registered to provide behavioral intervention and training under the supervision of the behavior specialist.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0506, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0506, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-0506, filed 8/1/12, effective 9/1/12. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0506, filed 11/1/10, effective 12/2/10.]
Are there limits to the positive behavior support and consultation you may receive?
(1) Clinical and support needs for positive behavior support and consultation must be identified in your DDA assessment and documented in the person-centered service plan.
(2) DDA determines the amount of positive behavior support and consultation you may receive based on your needs and information from your treating professional.
(3) The dollar amounts for aggregate services in your basic plus waiver or the dollar amounts in the annual allocation for the individual and family services (IFS) waiver limit the amount of service unless provided as a behavioral health stabilization service.
(4) DDA may require a second opinion from a DDA-selected provider.
(5) Positive behavior support and consultation not provided as a behavioral health stabilization service requires prior approval by the DDA regional administrator or designee for the following waivers:
(a) Basic plus;
(b) Core;
(c) Children's intensive in-home behavior support (CIIBS); and
(d) IFS.
(6) Positive behavior support and consultation services are limited to services:
(a) Consistent with waiver objectives of avoiding institutionalization; and
(b) Not otherwise covered under the medicaid state plan.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0510, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0510, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0510, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0510, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0510, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0510, filed 12/13/05, effective 1/13/06.]
What is chemical extermination of bedbugs?
(1) Chemical extermination of cimex lectularius (bedbugs) is professional chemical extermination of bedbugs.
(2) DDA covers professional chemical extermination of bedbugs in your primary residence if you:
(a) Receive residential habilitation services; or
(b) Live in a private house or apartment for which you are financially responsible.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0515, filed 6/20/18, effective 7/21/18.]
Who are qualified providers of chemical extermination of bedbugs?
A qualified chemical extermination provider must be:
(1) Licensed as a chemical pesticide applicator by the Washington state department of agriculture; and
(2) Contracted with DDA to provide chemical extermination of bedbugs.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0520, filed 6/20/18, effective 7/21/18.]
Are there limits to the chemical extermination of bedbugs services I may receive?
(1) Chemical extermination services covers only:
(a) The assessment or inspection by the qualified provider;
(b) Application of chemical-based pesticide; and
(c) One follow-up visit.
(2) Chemical extermination of bedbugs is limited to two treatments per plan year.
(3) Chemical extermination of bedbugs excludes:
(a) Lodging during the chemical extermination process; and
(b) Preparatory housework associated with the extermination process.
(4) DDA does not cover chemical extermination of bedbugs for a participant who lives with their family.
(5) DDA requires prior approval by the regional administrator or designee for chemical extermination of bedbugs.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0525, filed 6/20/18, effective 7/21/18.]
What are community inclusion services?
Community inclusion services:
(1) Are provided in typical, integrated community settings;
(2) Are individualized services that promote skill development, independent living, and community integration for individuals learning how to actively and independently engage in their community; and
(3) Provide opportunities for individuals to develop relationships and increase independence.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0600, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.040, 2015 3rd sp.s. c 4, and 42 C.F.R. § 441.301 (c)(4)-(5). WSR 18-03-174, § 388-845-0600, filed 1/23/18, effective 2/23/18. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-0600, filed 8/1/12, effective 9/1/12. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-0600, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0600, filed 12/13/05, effective 1/13/06.]
Who is eligible to receive community inclusion services?
You are eligible for community inclusion services if you are enrolled in the basic plus or core waivers and:
(1) You are sixty-two or older; or
(2) You meet age requirements under WAC
388-845-2110(1) and:
(a) You have participated in developmental disabilities administration (DDA) supported employment services for nine consecutive months; or
(b) DDA has determined that you are exempt from the nine-month DDA supported employment service requirement because:
(i) Your medical or behavioral health records document a condition that prevents you from completing nine consecutive months of DDA supported employment services; or
(ii) You were referred to and were available for DDA supported employment services, but the service was not delivered within ninety days of the referral.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0603, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030. WSR 17-12-002, § 388-845-0603, filed 5/24/17, effective 6/24/17. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0603, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-0603, filed 8/1/12, effective 9/1/12.]
Who are qualified providers of community inclusion services?
Providers of community inclusion services must be:
(1) A county contracted with the developmental disabilities administration (DDA) to provide community inclusion services; or
(2) An individual or agency contracted with a county that is contracted with DDA to provide community inclusion services.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0605, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.040, 2015 3rd sp.s. c 4, and 42 C.F.R. § 441.301 (c)(4)-(5). WSR 18-03-174, § 388-845-0605, filed 1/23/18, effective 2/23/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0605, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-0605, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0605, filed 12/13/05, effective 1/13/06.]
Are there limits to community inclusion services you may receive?
(1) You must not receive community inclusion services if you are receiving prevocational or supported employment services.
(2) The maximum hours of community inclusion services you may receive are determined by the developmental disabilities administration (DDA) assessment under WAC
388-828-9310.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0610, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.040, 2015 3rd sp.s. c 4, and 42 C.F.R. § 441.301 (c)(4)-(5). WSR 18-03-174, § 388-845-0610, filed 1/23/18, effective 2/23/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0610, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-0610, filed 8/1/12, effective 9/1/12. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-0610, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0610, filed 12/13/05, effective 1/13/06.]
What are community engagement services?
(1) Community engagement services are services designed to increase a waiver participant's connection to and engagement in formal and informal community supports.
(2) Services are designed to develop creative, flexible, and supportive community resources and relationships for individuals with developmental disabilities.
(3) Waiver participants are introduced to the community resources and supports that are available in their area.
(4) Participants are supported to develop skills that will facilitate integration into their community.
(5) Outcomes for this service include skill development, opportunities for socialization, valued community roles, and involvement in community activities, organizations, groups, projects, and other resources.
(6) This service is available in the IFS waiver.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0650, filed 8/4/16, effective 9/4/16.]
Who are qualified providers of community engagement services?
Qualified providers of community engagement services must be contracted with DSHS to provide this service and must be an individual or organization that has specialized training to provide services to people with developmental disabilities. Qualified provider types include:
(1) Registered recreational therapists in the state of Washington; or
(2) Organizations that provide services that promote skill development, improved functioning, increased independence, as well as reducing or eliminating the effects of illness or disability, including, but not limited to:
(a) Community centers;
(b) Municipal parks and recreation programs;
(c) Therapeutic recreation camps and programs; and
(d) Organizations that provide supports for individuals with developmental disabilities.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0655, filed 8/4/16, effective 9/4/16.]
Are there limits to the community engagement services you may receive?
(1) Community engagement services are limited to the support needs identified in your DDA assessment and documented in your person-centered service plan.
(2) The dollar amounts in the annual allocation for the individual and family services (IFS) waiver limit the amount of community engagement services you may receive.
(3) Community engagement services are limited to the community where you live.
(4) Community engagement services do not cover:
(a) Membership fees or dues;
(b) Equipment related to activities; or
(c) The cost of any activities.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0660, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0660, filed 8/4/16, effective 9/4/16.]
What are community guide services?
Community guide services increase access to informal community supports. Community guide services are short-term services designed to develop creative, flexible, and supportive community resources for individuals with developmental disabilities to meet a goal identified in the waiver participant's person-centered service plan. These services are available in basic plus and core waivers.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0700, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0700, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0700, filed 12/13/05, effective 1/13/06.]
Who may be a qualified provider of community guide services?
Any individual or agency contracted with DDA as a community guide may be qualified to provide community guide services.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0705, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0705, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0705, filed 12/13/05, effective 1/13/06.]
Are there limits to the community guide services I may receive?
(1) You must not receive community guide services if you are receiving residential habilitation services under WAC
388-845-1500.
(2) You may receive community guide services up to the aggregate services dollar amount available to you in your basic plus waiver.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0710, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0710, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0710, filed 12/13/05, effective 1/13/06.]
What are community transition services?
(1) Community transition services are reasonable costs (necessary expenses in the judgment of the state for you to establish your basic living arrangement) associated with moving from:
(a) An institutional setting to a community setting in which you are living in your own home or apartment, responsible for your own living expenses and receiving services from a DDA certified residential habilitation services provider as defined in WAC
388-845-1505 and
388-845-1510; or
(b) A provider operated setting, such as a group home, staffed residential, adult family home or companion home in the community to a community setting in which you are living in your own home or apartment, responsible for your own living expenses, and receiving services from a DDA certified residential habilitation services provider as defined in WAC
388-845-1505 and
388-845-1510.
(2) Community transition services include:
(a) Security deposits (not to exceed the equivalent of two month's rent) that are required to obtain a lease on an apartment or home;
(b) Essential furnishings such as a bed, a table, chairs, window blinds, eating utensils and food preparation items;
(c) Moving expenses required to occupy your own home or apartment;
(d) Set-up fees or deposits for utility or service access (e.g., telephone, electricity, heating); and
(e) Health and safety assurances, such as pest eradication, allergen control or one-time cleaning prior to occupancy.
(3) Community transition services are available in the CORE and community protection waivers.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0750, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0750, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-0750, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0750, filed 12/13/05, effective 1/13/06.]
Who are qualified providers of community transition services?
(1) Providers of community transition services for individuals in the core waiver must meet the requirements as a provider of residential habilitation services contained in WAC
388-845-1505.
(2) Providers of community transition services for individuals in the community protection waiver must meet the requirements as a provider of residential habilitation services contained in WAC
388-845-1510.
[Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0755, filed 12/13/05, effective 1/13/06.]
Are there limits to community transition services I can receive?
Community transition services does not include:
(a)[(1)] Diversional or recreational items such as televisions, cable TV access, VCRs, MP3, CD, or DVD players;
(2) Computers, if primarily used as a diversion or for recreation; or
(3) Rent assistance.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0760, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-0760, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0760, filed 12/13/05, effective 1/13/06.]
What is emergency assistance?
Emergency assistance is a temporary increase to the yearly basic plus waiver aggregate dollar limit when additional waiver aggregate services are required to prevent placement in an intermediate care facility for individuals with intellectual disabilities (ICF/IID).
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0800, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0800, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0800, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0800, filed 12/13/05, effective 1/13/06.]
Who is a qualified provider of emergency assistance?
The provider of the service you need to meet your emergency must meet the provider qualifications for that service.
[Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0805, filed 12/13/05, effective 1/13/06.]
How do I qualify for emergency assistance?
You qualify for emergency assistance only if you have used all of your waiver aggregate funding and your current situation meets one of the following criteria:
(1) You involuntarily lose your present residence for any reason either temporary or permanent;
(2) You lose your present caregiver for any reason, including death;
(3) There are changes in your caregiver's mental or physical status resulting in the caregiver's inability to perform effectively for the individual; or
(4) There are significant changes in your emotional or physical condition that requires a temporary increase in the amount of a waiver service.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0810, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0810, filed 12/13/05, effective 1/13/06.]
Are there limits to your use of emergency assistance?
All of the following limits apply to the emergency assistance you may receive:
(1) Prior approval by the DDA regional administrator or designee is required based on a reassessment of your person-centered service plan to determine the need for emergency services;
(2) Payment authorizations are reviewed every thirty days and must not exceed six thousand dollars per twelve months based on the effective date of your current person-centered service plan;
(3) Emergency assistance services are limited to the following basic plus waiver aggregate services:
(a) Community guide;
(b) Environmental adaptations;
(c) Occupational therapy;
(d) Physical therapy;
(e) Positive behavior support and consultation;
(f) Skilled nursing;
(g) Specialized medical equipment and supplies;
(h) Specialized psychiatric services;
(i) Speech, hearing, and language services;
(j) Staff and family consultation and training, which excludes individual and family counseling;
(k) Transportation; and
(4) Emergency assistance may be used for interim services until:
(a) The emergency situation has been resolved;
(b) You are transferred to alternative supports that meet your assessed needs; or
(c) You are transferred to an alternate waiver that provides the service you need.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0820, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0820, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0820, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0820, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0820, filed 12/13/05, effective 1/13/06.]
What are environmental adaptations?
(1) Environmental adaptations provide physical adaptations to the dwelling required by the individual's person-centered service plan needed to:
(a) Ensure the health, welfare, and safety of the individual;
(b) Enable the individual who would otherwise require institutionalization to function with greater independence in the dwelling; and
(c) Increase the individual's independence inside the dwelling or outside the dwelling to provide access to the dwelling.
(2) Examples of environmental adaptions include installing stair lifts, installing ramps and grab bars, widening doorways, modifying the individual's primary bathroom, or installing specialized electrical or plumbing systems necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.
(3) Environmental adaptions are available in all of the DDA HCBS waivers.
(4) Only the children's intensive in-home behavioral support (CIIBS) and individual and family services (IFS) waivers may include adaptations to the dwelling necessary to prevent or repair property destruction caused by the participant's behavior, as addressed in the participant's positive behavior support plan.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0900, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0900, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0900, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0900, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-0900, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0900, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0900, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0900, filed 12/13/05, effective 1/13/06.]
Who is a qualified provider for environmental adaptations?
(1) For adaptations that do not require installation, qualified providers are retail vendors with a valid business license contracted with DDA to provide this service.
(2) For adaptations requiring installation, qualified providers must be a registered contractor per chapter
18.27 RCW and contracted with DDA. The contractor or subcontractor must be licensed and bonded to perform the specific type of work they are providing.
(3) For debris removal, qualified providers must be contracted with DDA.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0905, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0905, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0905, filed 12/13/05, effective 1/13/06.]
What limits apply to environmental adaptations?
The following service limits apply to environmental adaptations:
(1) Clinical and support needs for an environmental adaptation must be identified in the waiver participant's DDA assessment and documented in the person-centered service plan.
(2) Environmental adaptations require prior approval by the DDA regional administrator or designee and must be supported by itemized and written bids from licensed contractors. For an adaptation that costs:
(a) One thousand five hundred dollars or less, one bid is required;
(b) More than one thousand five hundred dollars and equal to or less than five thousand dollars, two bids are required; or
(c) More than five thousand dollars, three bids are required.
(3) All bids must include:
(a) The cost of all required permits and sales tax; and
(b) An itemized and clearly outlined scope of work.
(4) DDA may require an occupational therapist, physical therapist, or construction consultant to review and recommend an appropriate environmental adaptation statement of work prior to the waiver participant soliciting bids or purchasing adaptive equipment.
(5) Environmental adaptations to the home are excluded if they are of general utility without direct benefit to the individual as related to the individual's developmental disability, such as cosmetic improvements to the dwelling, or general home improvements, such as carpeting, roof repair, or central air conditioning.
(6) Environmental adaptations must meet all local and state building codes. Evidence of any required completed inspections must be submitted to DDA prior to final payment for work.
(7) The condition of the dwelling or other projects in progress in the dwelling may prevent or limit some or all environmental adaptations at the discretion of DDA.
(8) Location of the dwelling in a flood plain, landslide zone, or other hazardous area may limit or prevent any environmental adaptations at the discretion of DDA.
(9) Written consent from the dwelling landlord is required prior to starting any environmental adaptations for a rental property. The landlord must not require removal of the environmental adaptations at the end of the waiver participant's tenancy as a condition of the landlord approving the environmental adaptation to the waiver participant's dwelling.
(10) Environmental adaptations must not add to the total square footage of the dwelling.
(11) The dollar amounts for aggregate services in your basic plus waiver or the dollar amount of your annual IFS allocation limit the amount of service you may receive.
(12) For core, community protection, and CIIBS waivers, annual environmental adaptation costs must not exceed twelve thousand one hundred ninety-two dollars.
(13) Damage prevention and repairs under the CIIBS and IFS waivers are subject to the following restrictions:
(a) Limited to the cost of restoration to the original function;
(b) Limited to the dollar amounts of the IFS waiver participant's annual allocation;
(c) Behaviors of waiver participants that resulted in damage to the dwelling must be addressed in a positive behavior support plan prior to the repair of damages;
(d) Repairs to personal property such as furniture and appliances are excluded; and
(e) Repairs due to normal wear and tear are excluded.
(14) The following adaptations are not covered as an environmental adaption:
(a) Building fences and fence repairs;
(b) Carpet or carpet replacement;
(c) Air conditioning, heat pumps, generators, or ceiling fans;
(d) Roof repair or siding;
(e) Deck construction or repair; and
(f) Jetted tubs or saunas.
(15) Environmental adaptions are limited to additional services not otherwise covered under the medicaid state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-0910, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0910, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-0910, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0910, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-0910, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-0910, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-0910, filed 12/13/05, effective 1/13/06.]
What are individualized technical assistance services?
Individualized technical assistance services:
(1) Provide short-term, professional expertise to identify and address barriers to employment services; and
(2) Are available in addition to supports received through supported employment services for an individual who has not yet achieved his or her goal.
[Statutory Authority: RCW
71A.12.030,
71A.12.040, 2015 3rd sp.s. c 4, and 42 C.F.R. § 441.301 (c)(4)-(5). WSR 18-03-174, § 388-845-1030, filed 1/23/18, effective 2/23/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1030, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-1030, filed 8/1/12, effective 9/1/12.]
Who are qualified providers of individualized technical assistance services?
Providers of individualized technical assistance service must be a county or an individual or agency contracted with a county or DDA.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1035, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-1035, filed 8/1/12, effective 9/1/12.]
Are there limits to the individualized technical assistance services you may receive?
(1) The developmental disabilities administration (DDA) may authorize a maximum of three months of individualized technical assistance at a time, not to exceed six months in the plan year.
(2) Individualized technical assistance services are available on the basic plus, core, and community protection waivers.
(3) Individualized technical assistance services are available only to individuals who are receiving supported employment services, unless approved by the regional administrator or his or her designee.
(4) Individualized technical assistance services are limited to additional hours under WAC
388-828-9355 and
388-828-9360.
[Statutory Authority: RCW
71A.12.030,
71A.12.040, 2015 3rd sp.s. c 4, and 42 C.F.R. § 441.301 (c)(4)-(5). WSR 18-03-174, § 388-845-1040, filed 1/23/18, effective 2/23/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1040, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1040, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-1040, filed 8/1/12, effective 9/1/12.]
What are behavioral health crisis diversion bed services?
Behavioral health crisis diversion bed services are short-term emergent residential services that may be provided in a client's home, licensed or certified setting, or state operated setting. These services are available to eligible clients whose current living situation is disrupted and the client is at risk of institutionalization. These services are available in all five HCBS waivers administered by DDA as behavioral health stabilization services in accordance with WAC
388-845-1150 through
388-845-1160.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-1100, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1100, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1100, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1100, filed 12/13/05, effective 1/13/06.]
Who is a qualified provider of behavioral health crisis diversion bed services?
Providers of behavioral health crisis diversion bed services must be:
(1) DDA certified residential agencies per chapter
388-101 WAC;
(2) Other department licensed or certified agencies; or
(3) State operated agency.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1105, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1105, filed 12/13/05, effective 1/13/06.]
What are the limits of behavioral health crisis diversion bed services?
(1) Clinical and support needs for behavioral health crisis diversion bed services are limited to those identified in the waiver participant's DDA assessment and documented in the person-centered service plan.
(2) Behavioral health crisis diversion bed services are intermittent and temporary. A behavioral health professional may make a recommendation about your need for behavioral health crisis diversion bed services. DDA determines the duration and amount of behavioral health crisis diversion bed services you will receive.
(3) The costs of behavioral health crisis diversion bed services do not count toward the dollar amounts for aggregate services in the basic plus waiver or the annual allocation in the individual and family services waiver.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-1110, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1110, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1110, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1110, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1110, filed 12/13/05, effective 1/13/06.]
What are behavioral health stabilization services?
(1) Behavioral health stabilization services assist persons who are experiencing a behavioral health crisis.
(2) Behavioral health stabilization services are available in the basic plus, core, children's intensive in-home behavior support (CIIBS), individual and family services (IFS), and community protection waivers.
(3) A participant may be eligible for behavioral health stabilization services if:
(a) A behavioral health professional or DDA has determined the participant is at risk of institutionalization or hospitalization;
(b) The participant needs:
(i) Positive behavior support and consultation;
(ii) Specialized psychiatric services for people age twenty-one and older; or
(iii) Behavioral health crisis diversion bed services available to participants on the individual and family services, basic plus, core, CIIBS, and community protection waivers.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-1150, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1150, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1150, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1150, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1150, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1150, filed 12/13/05, effective 1/13/06.]
Who are qualified providers of behavioral health stabilization services?
Providers of these behavioral health stabilization services are listed in the rules in this chapter governing the specific services listed in WAC
388-845-1150.
[Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1155, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1155, filed 12/13/05, effective 1/13/06.]
Are there limitations to the behavioral health stabilization services that you can receive?
(1) Clinical and support needs for behavioral health stabilization services are limited to those identified in your DDA assessment and documented in the person-centered service plan/individual support plan.
(2) Behavioral health stabilization services are intermittent and temporary. The duration and amount of services you need to stabilize your crisis is determined by a behavioral health professional and/or DDA.
(3) The costs of behavioral health stabilization services do not count toward the dollar amounts for aggregate services in the basic plus waiver or the annual allocation in the IFS waiver.
(4) Behavioral health stabilization services require prior approval by DDA or its designee.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1160, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1160, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1160, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1160, filed 12/13/05, effective 1/13/06.]
What is nurse delegation?
(1) Nurse delegation services are services in compliance with WAC
246-840-910 through
246-840-970 by a registered nurse to provide training and nursing management for nursing assistants who perform delegated nursing tasks.
(2) Delegated nursing tasks include, but are not limited to, administration of noninjectable medications except for insulin, blood glucose testing, and tube feedings.
(3) Services include the initial visit, care planning, competency testing of the nursing assistant, consent of the client, additional instruction and supervisory visits.
(4) Clients who receive nurse delegation services must be considered "stable and predictable" by the delegated nurse.
(5) Nurse delegation services are available on all DDA HCBS waivers.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1170, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1170, filed 11/1/10, effective 12/2/10.]
Who is a qualified provider of nurse delegation?
Providers of nurse delegation are registered nurses contracted with DDA to provide this service or employed by a nursing agency contracted with DDA to provide this service.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1175, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1175, filed 11/1/10, effective 12/2/10.]
Are there limitations to the nurse delegation services that you receive?
The following limitations apply to receipt of nurse delegation services:
(1) Clinical and support needs for nurse delegation are limited to those identified in your DDA assessment and documented in the person-centered service plan/individual support plan.
(2) The department requires the delegating nurse's written recommendation regarding your need for the service. This recommendation must take into account that the nurse has recently examined you, reviewed your medical records, and conducted a nursing assessment.
(3) The department may require a written second opinion from a department selected nurse delegator that meets the same criteria in subsection (2) of this section.
(4) The following tasks must not be delegated:
(a) Injections, other than insulin;
(b) Central lines;
(c) Sterile procedures; and
(d) Tasks that require nursing judgment.
(5) The dollar amounts for aggregate services in your basic plus waiver or the dollar amounts for your annual allocation in your IFS waiver limit the amount of nurse delegation service you are authorized to receive.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1180, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1180, filed 11/1/10, effective 12/2/10.]
What is occupational therapy?
(1) Occupational therapy is a service provided to improve, maintain, or maximize the waiver participant's abilities for independent functioning and health maintenance.
(2) Occupational therapy is available under the basic plus, community protection, core, and individual and family services waivers.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1181, filed 6/20/18, effective 7/21/18.]
Who may be a qualified provider of occupational therapy?
A qualified provider of occupational therapy must:
(1) Be licensed, registered, and certified as required by law;
(2) Be contracted with the developmental disabilities administration to provide occupational therapy; and
(3) Have a core provider agreement with the health care authority.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1182, filed 6/20/18, effective 7/21/18.]
Are there limits to occupational therapy?
(1) Occupational therapy is limited to:
(a) Waiver participants age twenty-one or older;
(b) Services identified in your developmental disabilities administration (DDA) assessment and documented in your person-centered service plan;
(c) The dollar amounts for aggregate services in your basic plus waiver or the dollar amounts in the annual allocation for the individual and family services waiver; and
(d) An amount determined by DDA based on your needs and information from your treating professional.
(2) DDA may require a second opinion from a DDA-selected provider.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1183, filed 6/20/18, effective 7/21/18.]
What is peer mentoring?
(1) Peer mentoring is a form of mentorship that takes place between a person who has lived through an experience (peer mentor) and a person who is new to that experience (mentee). Peer mentors use their experience to inform, support, and train mentees to successfully navigate new experiences related to or impacted by their disability.
(2) A peer mentor may provide support and guidance to a waiver participant and the participant's family.
(3) A peer mentor may connect a waiver participant to local community services, programs, and resources and answer participant questions or suggest other sources of support.
(4) Peer mentoring is available in the IFS waiver.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-1190, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1190, filed 8/4/16, effective 9/4/16.]
Who are qualified providers of peer mentoring?
An individual or organization must contract with DDA to provide peer mentoring support and training to people with developmental disabilities or to families with a member with a developmental disability.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-1191, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1191, filed 8/4/16, effective 9/4/16.]
What limits apply to peer mentoring?
(1) Support needs for peer mentoring are limited to those identified in the waiver participant's DDA assessment and documented in the person-centered service plan.
(2) DDA does not contract with a peer mentor to mentor a member of the mentor's own family.
(3) A waiver participant's peer mentoring services are limited to the participant's annual IFS waiver allocation.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-1192, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1192, filed 8/4/16, effective 9/4/16.]
What is person-centered plan facilitation?
(1) Person-centered plan facilitation is an approach to forming life plans that is centered on the individual. It is used as a life planning process to enable individuals with disabilities to increase personal self-determination. Person-centered plan facilitation is available in the IFS waiver.
(2) Person-centered plan facilitation typically includes:
(a) Identifying and developing a potential circle of people who know and care about the individual;
(b) Exploring what matters to the waiver participant by listening to and learning from the person;
(c) Developing a vision for a meaningful life, as defined by the waiver participant, which may include goals for education, employment, housing, relationships, and recreation;
(d) Discovering capacities and assets of the waiver participant, and his or her family, neighborhood, and support network;
(e) Generating an action plan; and
(f) Facilitating follow-up meetings to track progress toward goals.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1195, filed 8/4/16, effective 9/4/16.]
Who are qualified providers of person-centered plan facilitation?
Qualified providers include organizations and individuals who are contracted with DDA to provide person-centered plan facilitation to individuals with developmental disabilities.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1196, filed 8/4/16, effective 9/4/16.]
What limitations are there for person-centered plan facilitation?
(1) Support needs for person-centered planning facilitation are limited to those identified in the waiver participant's DDA assessment and documented in the person-centered service plan/individual support plan.
(2) Person-centered plan facilitation may include follow up contacts with the waiver participant and his or her family to consult on plan implementation.
(3) The dollar amounts for the waiver participants' annual allocation in the IFS waiver limit the amount of person-centered plan facilitation service the individual is authorized to receive.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1197, filed 8/4/16, effective 9/4/16.]
What are personal care services?
Personal care services as defined in WAC
388-106-0010 are the provision of assistance with personal care tasks. These services are available in the basic plus waiver if:
(1) You do not meet the programmatic eligibility requirements for community first choice services in chapter
388-106 WAC; and
(2) You meet the programmatic eligibility requirements for medicaid personal care in chapter
388-106 WAC.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1300, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1300, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1300, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-1300, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1300, filed 12/13/05, effective 1/13/06.]
Who are the qualified providers of personal care services?
(1) Qualified providers of personal care services may be individuals or licensed homecare agencies contracted with DSHS.
(2) All individual providers and homecare agency providers must meet provider qualifications for in-home caregivers in WAC
388-71-0500 through
388-71-0556.
(3) Providers of personal care services for adults must comply with the training requirements in these rules governing medicaid personal care providers in WAC
388-71-0841 through
388-71-1006. Additionally, providers must meet the certification requirements in WAC
388-71-0975 through
388-71-0980 and WAC
246-980-010 through
246-980-990.
(4) Natural, step, or adoptive parents can be the personal care provider of their adult child age eighteen or older.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1305, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-1305, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1305, filed 12/13/05, effective 1/13/06.]
Are there limits to the personal care services you can receive?
(1) Clinical and support needs for personal care services are limited to those identified in your DDA assessment and documented in your person-centered service plan/individual support plan.
(2) You must meet the programmatic eligibility for medicaid personal care in chapter
388-106 WAC governing medicaid personal care (MPC) using the current department approved assessment form: Comprehensive assessment reporting evaluation (CARE).
(3) The maximum hours of personal care you may receive are determined by the CARE tool used as part of the DDA assessment.
(a) Provider rates are limited to the department established hourly rates for in-home medicaid personal care.
(b) Homecare agencies must be licensed through the department of health and contracted with DSHS.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1310, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1310, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1310, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-1310, filed 9/22/08, effective 10/23/08; WSR 07-20-050, § 388-845-1310, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1310, filed 12/13/05, effective 1/13/06.]
What is physical therapy?
(1) Physical therapy is the evaluation and treatment of functional limitations in movement to facilitate self-care and reintegration into the home, community, or work.
(2) Physical therapy is available under the basic plus, community protection, core, and individual and family services waivers.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1315, filed 6/20/18, effective 7/21/18.]
Who may be a qualified provider of physical therapy?
A qualified provider of physical therapy must:
(1) Be licensed, registered, and certified as required by law;
(2) Be contracted with the developmental disabilities administration to provide physical therapy; and
(3) Have a core provider agreement with the health care authority.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1316, filed 6/20/18, effective 7/21/18.]
Are there limits to physical therapy?
(1) Physical therapy is limited to:
(a) Waiver participants age twenty-one and older;
(b) Services identified in your developmental disabilities administration (DDA) assessment and documented in your person-centered service plan;
(c) The dollar amounts for aggregate services in your basic plus waiver or the dollar amounts in the annual allocation for the individual and family services waiver; and
(d) An amount determined by DDA based on your needs and information from your treating professional.
(2) DDA may require a second opinion from a DDA-selected provider.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1317, filed 6/20/18, effective 7/21/18.]
What are prevocational services?
(1) Prevocational services typically occur in a specialized or segregated setting and include individualized monthly employment related activities in the community. Prevocational services are designed to prepare those interested in gainful employment in an integrated setting through training and skill development.
(2) Prevocational services are available in the basic plus, core and community protection waivers.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1400, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1400, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-1400, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1400, filed 12/13/05, effective 1/13/06.]
Who are the qualified providers of prevocational services?
Providers of prevocational services must be a county or an individual or agency contracted with a county or DDA to provide prevocational services.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1405, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1405, filed 12/13/05, effective 1/13/06.]
Are there limits to the prevocational services you may receive?
The following limits apply to your receipt of prevocational services:
(1) Effective September 1, 2015, no new referrals are accepted for prevocational services.
(2) Effective March 1, 2019, prevocational services are no longer available.
(3) Clinical and support needs for prevocational services are limited to those identified in your developmental disabilities administration (DDA) assessment and documented in your person-centered service plan.
(4) You must be age twenty and graduating from high school before your July or August twenty-first birthday, age twenty-one and graduated from high school, or age twenty-two or older to receive prevocational services.
(5) Prevocational services are a time limited step on the pathway toward individual employment and are dependent on your demonstrating steady progress toward gainful employment over time. Your annual employment plan will include exploration of integrated settings within your next service year. Criteria that would trigger a review of your need for these services include, but are not limited to:
(a) Compensation at more than fifty percent of the prevailing wage;
(b) Significant progress made toward your defined goals; and
(c) Recommendation by your individual support plan team.
(6) You will not be authorized to receive prevocational services in addition to community inclusion services or supported employment services.
(7) Your service hours are determined by the assistance you need to reach your employment outcomes as described in WAC
388-828-9325.
[Statutory Authority: RCW
71A.12.030,
71A.12.120 and 42 C.F.R. 441.301 (c)(4). WSR 19-11-061, § 388-845-1410, filed 5/15/19, effective 6/15/19. Statutory Authority: RCW
71A.12.030,
71A.12.040, 2015 3rd sp.s. c 4, and 42 C.F.R. § 441.301 (c)(4)-(5). WSR 18-03-174, § 388-845-1410, filed 1/23/18, effective 2/23/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1410, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1410, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-1410, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1410, filed 12/13/05, effective 1/13/06.]
What are residential habilitation services?
Residential habilitation services (RHS) are available in the core and community protection waivers.
(1) Residential habilitation services include assistance:
(a) With personal care and supervision; and
(b) To learn, improve or retain social and adaptive skills necessary for living in the community.
(2) Residential habilitation services may provide instruction and support addressing one or more of the following outcomes:
(a) Health and safety;
(b) Personal power and choice;
(c) Competence and self-reliance;
(d) Positive recognition by self and others;
(e) Positive relationships; and
(f) Integration into the physical and social life of the community.
[Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1500, filed 12/13/05, effective 1/13/06.]
Who are qualified providers of residential habilitation services for the core waiver?
Providers of residential habilitation services for participants in the core waiver must be one of the following:
(1) Individuals contracted with DDA to provide residential support as a "companion home" provider;
(2) Individuals contracted with DDA to provide training as an "alternative living provider";
(3) Agencies contracted with DDA and certified per chapter
388-101 WAC;
(4) State-operated living alternatives (SOLA);
(5) Licensed and contracted group care homes, foster homes, child placing agencies or staffed residential homes per chapter
388-148 WAC.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1505, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-1505, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1505, filed 12/13/05, effective 1/13/06.]
Who are qualified providers of residential habilitation services for the community protection waiver?
Providers of residential habilitation services for participants of the community protection waiver are limited to state operated living alternatives (SOLA) and supported living providers who are contracted with DDA and certified under chapter
388-101 WAC as a residential community protection provider intensive supported living services (CP-ISLS).
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1510, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1510, filed 12/13/05, effective 1/13/06.]
Are there limits to the residential habilitation services I may receive?
(1) You may only receive one type of residential habilitation service at a time.
(2) None of the following may be paid for under the core or community protection waiver:
(a) Room and board;
(b) The cost of building maintenance, upkeep, improvement, modifications or adaptations required to assure the health and safety of residents, or to meet the requirements of the applicable life safety code;
(c) Activities or supervision already being paid for by another source;
(d) Services provided in your parent's home unless you are receiving alternative living services for a maximum of six months to transition you from your parent's home into your own home.
(3) Alternative living services in the core waiver cannot:
(a) Exceed forty hours per month;
(b) Provide personal care or protective supervision.
(4) The following persons cannot be paid providers for your service:
(a) Your spouse;
(b) Your natural, step, or adoptive parents if you are a child age seventeen or younger;
(c) Your natural, step, or adoptive parent unless your parent is certified as a residential agency per chapter
388-101 WAC or is employed by a certified or licensed agency qualified to provide residential habilitation services.
(5) The initial authorization of residential habilitation services requires prior approval by the DDA regional administrator or designee.
(6) If you are under age eighteen, the residential habilitation services you receive are subject to requirements under chapter
388-826 WAC.
[Statutory Authority: RCW
71A.12.030 and
74.13.350. WSR 18-23-004, § 388-845-1515, filed 11/7/18, effective 12/8/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1515, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-1515, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1515, filed 12/13/05, effective 1/13/06.]
What is respite care?
(1) Respite care is short-term intermittent care to provide relief for a person who lives with you, is your primary care provider, and is:
(a) Your family member and your paid or unpaid care provider;
(b) A nonfamily member who is not paid to provide care for you;
(c) A contracted companion home provider paid by DDA to provide support to you; or
(d) A licensed children's foster home provider paid by DDA to provide support to you.
(2) Respite care is available in the:
(a) Basic plus waiver;
(b) Children's intensive in-home behavioral support (CIIBS);
(c) Core waiver; and
(d) Individual and family services (IFS) waiver.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1600, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1600, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1600, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1600, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1600, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-1600, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1600, filed 12/13/05, effective 1/13/06.]
Who is eligible to receive respite care?
You are eligible to receive respite care if you are in the basic plus, CIIBS, core, or IFS waiver and meet the criteria in WAC
388-845-1600.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1605, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1605, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1605, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1605, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.30 [71A.12.030],
71A.12.120, and Title
71A RCW. WSR 08-03-109, § 388-845-1605, filed 1/22/08, effective 2/22/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1605, filed 12/13/05, effective 1/13/06.]
Can someone who lives with you be your respite provider?
Someone who lives with you may be your respite provider as long as he or she is not your primary care provider and is not contracted to provide any other DSHS paid service to you. The limitations listed in WAC
388-845-0111 also apply.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1607, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1607, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1607, filed 1/24/13, effective 2/24/13.]
Where may respite care be provided?
(1) Respite care may be provided in any of the following licensed or certified settings that have a respite contract with the developmental disabilities administration (DDA):
(a) Adult family home;
(b) Assisted living facility;
(c) Child care center;
(d) Children's foster home;
(e) Children's group home;
(f) Group home;
(g) Group training home;
(h) Staffed residential home.
(2) Respite care may also be provided in:
(a) The individual's home or place of residence;
(b) The individual's relative's home; and
(c) Other DDA-contracted community settings such as a camp, senior center, and adult day care center.
(3) Your respite care provider may take you into the community while providing respite services.
[Statutory Authority: RCW
71A.12.030. WSR 17-12-011, § 388-845-1610, filed 5/26/17, effective 6/26/17. Statutory Authority: RCW
71A.12.030,
71A.12.120, and 2015 3rd sp.s. c 4. WSR 16-17-003, § 388-845-1610, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1610, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1610, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-1610, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1610, filed 12/13/05, effective 1/13/06.]
Who may be qualified providers of respite care?
Providers of respite care may be any of the following individuals or agencies contracted with the developmental disabilities administration (DDA) for respite care:
(1) Individuals who meet the provider qualifications under chapter
388-825 WAC;
(2) Home health agencies licensed under chapter
246-335 WAC, Part 1;
(3) Homecare agencies licensed under chapter
246-335 WAC, Part 1 and contracted with the area agencies on aging (AAA);
(4) Licensed and contracted group homes, foster homes, child placing agencies, staffed residential homes, and foster group care homes;
(5) Licensed and contracted adult family homes;
(6) Licensed and contracted adult residential care facilities;
(7) Licensed and contracted adult residential treatment facilities under chapter
246-337 WAC;
(8) Licensed child care centers under chapter
110-300A WAC;
(9) Licensed child day care centers under chapter
110-300A WAC;
(10) Adult day care providers under chapter
388-71 WAC contracted with DDA;
(11) Certified providers under chapter
388-101 WAC when respite is provided within the DDA contract for certified residential services;
(12) A licensed practical nurse (LPN) or registered nurse (RN) acting within the scope of the standards of nursing conduct or practice under chapter
246-700 WAC and contracted with DDA to provide this service; or
(13) Other DDA contracted providers such as a community center, senior center, parks and recreation, and summer programs.
[Statutory Authority: RCW
71A.12.030,
71A.12.120 and 42 C.F.R. 302 (a)(2). WSR 19-04-090, § 388-845-1615, filed 2/5/19, effective 3/8/19. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1615, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030. WSR 17-12-011, § 388-845-1615, filed 5/26/17, effective 6/26/17. Statutory Authority: RCW
71A.12.030,
71A.12.120, and 2015 3rd sp.s. c 4. WSR 16-17-003, § 388-845-1615, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1615, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1615, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-1615, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1615, filed 12/13/05, effective 1/13/06.]
Are there limits to the respite care you may receive?
The following limits apply to the respite care you may receive:
(1) For basic plus, core, and the children's intensive in-home behavioral support (CIIBS) waivers, the developmental disabilities administration (DDA) assessment will determine how much respite you may receive under chapter
388-828 WAC.
(2) For the individual and family services (IFS) waiver, the dollar amount for your annual allocation in your IFS waiver limits the amount of respite care you may receive.
(3) Respite must not replace:
(a) Day care while your parent or guardian is at work; or
(b) Personal care hours available to you.
(4) If you receive respite in a private home, the home must be licensed to provide respite care unless the home is:
(a) Your private home; or
(5) If you receive respite from a provider who requires licensure, the respite services are limited to activities and age-specific criteria contained in the provider's license.
(6) Your individual respite provider must not provide:
(a) Other DDA services for you during your respite care hours; or
(b) DDA paid services to other persons during your respite care hours.
(7) Your primary caregivers must not provide other DDA services for you during your respite care hours.
(8) If your personal care provider is your parent and you live in your parent's adult family home you must not receive respite.
(9) DDA must not pay for fees - Such as a membership or insurance fee - Associated with your respite care.
(10) If you require respite care from a licensed practical nurse (LPN) or a registered nurse (RN), respite services may be authorized using an LPN or RN. Respite services are limited to the assessed respite care hours identified in your person-centered service plan. Respite provided by an LPN or RN requires a prior approval by the regional administrator or designee.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1620, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1620, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1620, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1620, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1620, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-1620, filed 9/22/08, effective 10/23/08; WSR 07-20-050, § 388-845-1620, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1620, filed 12/13/05, effective 1/13/06.]
What is a risk assessment?
(1) A risk assessment is a professional evaluation that:
(a) Assesses a person's needs and the person's level of risk of sexual predatory behavior or aggression;
(b) Determines the need for psychological, medical, or therapeutic services; and
(c) Provides treatment recommendations to mitigate any assessed risk.
(2) A risk assessment is available in all DDA HCBS waivers.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1650, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1650, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1650, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-1650, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1650, filed 12/13/05, effective 1/13/06.]
Who is a qualified provider of a risk assessment?
The provider of a risk assessment must be a:
(1) Licensed psychologist under chapter
246-924 WAC; or
(2) Certified sexual offender treatment provider (SOTP) and meet requirements under WAC
246-930-030 and WAC
246-930-040 if the provider is performing a risk assessment for sexually aggressive behavior.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1655, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1655, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-1655, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1655, filed 12/13/05, effective 1/13/06.]
Are there limits to the risk assessment you may receive?
(1) Clinical and support needs for a risk assessment are limited to those identified in your DDA assessment and documented in your person-centered service plan.
(2) A risk assessment must meet requirements under WAC
246-930-320.
(3) A risk assessment requires prior approval by the DDA regional administrator or designee.
(4) The cost of a risk assessment does not count toward the:
(a) Dollar limit for aggregate services in the basic plus waiver;
(b) Annual allocation in the individual and family services waiver; or
(c) Monthly average cost limit in the children's intensive in-home behavior support waiver.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1660, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1660, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1660, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-1660, filed 9/22/08, effective 10/23/08; WSR 07-20-050, § 388-845-1660, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1660, filed 12/13/05, effective 1/13/06.]
What is waiver skilled nursing?
(1) Waiver skilled nursing means long-term, intermittent, and hourly skilled nursing services consistent with waiver objectives of avoiding institutionalization.
(2) Waiver skilled nursing services are available in the basic plus, community protection (CP), core, and individual and family services (IFS) waivers.
(3) Waiver skilled nursing services include nurse delegation services provided by a registered nurse under WAC
388-845-1170.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1700, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1700, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1700, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1700, filed 12/13/05, effective 1/13/06.]
Who is a qualified provider of skilled nursing services?
The provider of skilled nursing services must be a licensed practical nurse (LPN) or registered nurse (RN) acting within the scope of the standards of nursing conduct or practice chapter
246-700 WAC and contracted with DDA to provide this service.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1705, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1705, filed 12/13/05, effective 1/13/06.]
Are there limits to the skilled nursing services you may receive?
The following limits apply to skilled nursing services you may receive:
(1) Clinical and support needs for skilled nursing services are limited to those identified in your DDA assessment and documented in your person-centered service plan.
(2) Skilled nursing services, except for nurse delegation and nursing evaluations, require prior approval by the DDA regional administrator or designee.
(3) Skilled nursing hours must not exceed the number of hours determined by the nursing care consultant's skilled nursing assessment.
(4) DDA may require a second opinion by a DDA-selected provider.
(5) The dollar amount for aggregate services in your basic plus waiver or the dollar amount of your annual allocation in your IFS waiver limits the amount of skilled nursing services you may receive.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1710, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1710, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1710, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1710, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-1710, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1710, filed 12/13/05, effective 1/13/06.]
What are specialized medical equipment and supplies?
(1) Specialized medical equipment and supplies are durable and nondurable medical equipment, or equipment necessary to prevent institutionalization, not available through the medicaid state plan or are in excess of what is available through the medicaid state plan benefit which enables individuals:
(a) To increase their abilities to perform their activities of daily living;
(b) To perceive, control, or communicate with the environment in which they live; or
(c) On the IFS waiver only, to improve daily functioning through sensory integration when prescribed in a written therapeutic plan by the current treating professional.
(3) Also included are items necessary for life support and ancillary supplies and equipment necessary to the proper functioning of the equipment and supplies described in subsection (1) of this section.
(4) Specialized medical equipment and supplies include the maintenance and repair of specialized medical equipment not covered through the medicaid state plan.
(5) Specialized medical equipment and supplies are available in all DDA HCBS waivers.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-1800, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1800, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1800, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1800, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1800, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-1800, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1800, filed 12/13/05, effective 1/13/06.]
Who are the qualified providers of specialized medical equipment and supplies?
(1) The provider of specialized medical equipment and supplies must be a medical equipment supplier contracted with DDA or have a state contract as a Title XIX vendor.
(2) For IFS only, the provider of specialized medical equipment and supplies under WAC
388-845-1800(1)(c) must be contracted with DDA as a provider of specialized goods and services or specialized equipment and supplies.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-1805, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1805, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1805, filed 12/13/05, effective 1/13/06.]
Are there limits to the specialized medical equipment and supplies you may receive?
The following limits apply to the specialized medical equipment and supplies you may receive:
(1) Habilitative support needs for specialized medical equipment and supplies are limited to those identified in your DDA person-centered assessment and documented in your person-centered service plan.
(2) Specialized medical equipment and supplies require prior approval by the DDA regional administrator or designee for each authorization.
(3) DDA may require a second opinion by a DDA-selected provider.
(4) Items must be of direct medical or remedial benefit to you and necessary as a result of your disability.
(5) Medications and vitamins are excluded.
(6) The dollar amounts for aggregate services in your basic plus waiver limit the amount of service you may receive.
(7) The dollar amounts for your annual allocation in your individual and family services (IFS) waiver limit the amount of service you may receive.
(8) Items excluded from specialized equipment and supplies include nonspecialized recreational equipment, such as trampolines, swing sets, and hot tubs.
(9) Specialized equipment and supplies are limited to additional services not otherwise covered under the medicaid state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-1810, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1810, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1810, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1810, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-1810, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1810, filed 12/13/05, effective 1/13/06.]
What is specialized clothing?
Specialized clothing is available to you in the CIIBS and IFS waivers and is defined as nonrestrictive clothing adapted to your individual needs and related to your disability, such as weighted clothing, clothing designed for tactile defensiveness, specialized footwear, or reinforced clothing.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1855, filed 8/4/16, effective 9/4/16.]
Who are qualified providers of specialized clothing?
Qualified providers of specialized clothing are specialized clothing vendors contracted with DDA to provide this service.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1860, filed 8/4/16, effective 9/4/16.]
Are there limits to your receipt of specialized clothing?
(1) The following limits apply to specialized clothing you may receive:
(a) Clinical and support needs for specialized clothing are limited to those identified in your DDA assessment and documented in your person-centered service plan.
(b) DDA requires written documentation from an appropriate health professional regarding your need for the service. This recommendation must take into account that the health professional has recently examined you, reviewed your medical records, and conducted an assessment.
(c) DDA may require a second opinion from a DDA-selected provider.
(2) For the IFS waiver, the dollar amount for your annual allocation limits the amount of service you may receive.
(3) You must receive prior approval from the DDA regional administrator or designee to receive specialized clothing.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1865, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1865, filed 8/4/16, effective 9/4/16.]
What are specialized psychiatric services?
(1) Specialized psychiatric services are specific to the individual needs of persons with developmental disabilities who are experiencing behavioral health symptoms. These services are available to people age twenty-one and older.
(2) Specialized psychiatric services includes:
(a) Psychiatric evaluation;
(b) Medication evaluation and monitoring; and
(c) Psychiatric consultation.
(3) Specialized psychiatric services are also available as a behavioral health stabilization service under WAC
388-845-1150 through
388-845-1160.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1900, filed 6/20/18, effective 7/21/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1900, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1900, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-1900, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1900, filed 12/13/05, effective 1/13/06.]
Who are qualified providers of specialized psychiatric services?
Providers of specialized psychiatric services must be one of the following licensed or registered, and contracted health care professionals:
(1) Psychiatrist;
(2) Psychiatric advanced registered nurse practitioner (ARNP); or
(3) Physician assistant working under the supervision of a psychiatrist.
[Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1905, filed 12/13/05, effective 1/13/06.]
Are there limitations to the specialized psychiatric services you can receive?
(1) Clinical and support needs for specialized psychiatric services are limited to those identified in your DDA assessment and documented in the person-centered service plan/individual support plan.
(2) Specialized psychiatric services are excluded if they are available through other medicaid programs.
(3) DDA and the treating professional will determine the need and amount of service you will receive in the IFS, basic plus, core, CIIBS, and CP waivers, subject to the limitations in subsection (4) of this section.
(4) The dollar amounts for aggregate service in your basic plus waiver or the dollar amount of your annual allocation in your IFS waiver limit the amount of specialized psychiatric services you are authorized to receive, unless provided as a behavioral health stabilization service.
(5) Specialized psychiatric services require prior approval by the DDA regional administrator or designee.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-1910, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-1910, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-1910, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-1910, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-1910, filed 12/13/05, effective 1/13/06.]
What are speech, hearing, and language services?
(1) Speech, hearing, and language services are services provided to a person with speech, hearing, and language disorders by or under the supervision of a speech pathologist or audiologist.
(2) Speech, hearing, and language services are available under the basic plus, community protection, core, and individual and family services waivers.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1915, filed 6/20/18, effective 7/21/18.]
Who may be a qualified provider of speech, hearing, and language services?
To be a qualified provider of speech, hearing, and language services, a person must:
(1) Be licensed, registered, and certified as an audiologist or speech pathologist as required by law or work under the supervision of a qualified speech pathologist or audiologist;
(2) Be contracted with the developmental disabilities administration to provide speech, hearing, and language services; and
(3) Have a core provider agreement with the health care authority.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1916, filed 6/20/18, effective 7/21/18.]
Are there limits to the speech, hearing, and language services you may receive?
(1) Speech, hearing, and language services are limited to:
(a) Waiver participants age twenty-one and older;
(b) Services identified in your developmental disabilities administration (DDA) assessment and documented in your person-centered service plan;
(c) The dollar amounts for aggregate services in your basic plus waiver or the dollar amounts in the annual allocation for the individual and family services waiver; and
(d) An amount determined by DDA based on your needs and information from your treating professional.
(2) DDA may require a second opinion from a DDA-selected provider.
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-1917, filed 6/20/18, effective 7/21/18.]
What is staff and family consultation and training?
(1) Staff and family consultation and training is professional assistance, not covered by the medicaid state plan, to families or direct service providers to help them meet the individualized and specific needs of a participant as outlined in the participant's person-centered service plan and necessary to improve the participant's independence and inclusion in their community.
(2) Staff and family consultation and training is available in all DDA HCBS waivers.
(3) Staff and family consultation and training is consultation and guidance about one or more of the following:
(a) Health and medication;
(b) Positioning and transfer;
(c) Basic and advanced instructional techniques;
(d) Positive behavior support;
(e) Augmentative communication systems;
(f) Diet and nutrition;
(g) Disability information and education;
(h) Strategies for effectively and therapeutically interacting with the participant;
(i) Environmental safety;
(j) Assistive technology safety; and
(k) For the basic plus, IFS, and CIIBS waivers only, individual and family counseling.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-2000, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-2000, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2000, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2000, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-2000, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2000, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-2000, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-2000, filed 12/13/05, effective 1/13/06.]
Who is a qualified provider of staff and family consultation and training?
To provide staff and family consultation and training, a provider must be contracted with DDA and be one of the following licensed, registered, or certified professionals:
(1) Audiologist;
(2) Licensed practical nurse;
(3) Marriage and family therapist;
(4) Mental health counselor;
(5) Occupational therapist;
(6) Physical therapist;
(7) Registered nurse;
(8) Sex offender treatment provider;
(9) Speech-language pathologist;
(10) Social worker;
(11) Psychologist;
(12) Certified American sign language instructor;
(13) Nutritionist;
(14) Counselors registered or certified in accordance with chapter
18.19 RCW;
(15) Certified dietician;
(16) Recreation therapist registered in Washington and certified by the national council for therapeutic recreation;
(17) Providers listed in WAC
388-845-0506 and contracted with DDA to provide CIIBS intensive services;
(18) Certified music therapist (for CIIBS only);
(19) Psychiatrist;
(20) Professional advocacy organization; or
(21) Teacher certified under chapter
181-79A WAC.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-2005, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2005, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2005, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-2005, filed 8/1/12, effective 9/1/12. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2005, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-2005, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-2005, filed 12/13/05, effective 1/13/06.]
Are there limits to the staff and family consultation and training you may receive?
(1) Staff and family consultation and training are limited to supports identified in your DDA assessment and documented in the person-centered service plan.
(2) Expenses to the family or provider for room and board or attendance, including registration, at conferences are excluded as a service under staff and family consultation and training.
(3) The dollar amounts for aggregate service in your basic plus waiver or the dollar amount of the annual allocation in your individual and family services (IFS) waiver limit the amount of staff and family consultation and training you may receive.
(4) Under the basic plus waiver, individual and family counseling is limited to family members who:
(a) Live with the participant; and
(b) Have been assaulted by the participant and the assaultive behavior was:
(i) Documented in the participant's person-centered service plan; and
(ii) Addressed in the participant's positive behavior support plan or therapeutic plan.
(5) Staff and family consultation and training does not provide training necessary to meet contractual licensing or certification requirements.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-2010, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-2010, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2010, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2010, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-2010, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-2010, filed 12/13/05, effective 1/13/06.]
What are supported employment services?
(1) Supported employment services are for those interested in integrated gainful employment and should facilitate paid employment that is covered by the Washington State Minimum Wage Act under chapter
49.46 RCW and the Fair Labor Standards Act under 29 U.S.C. Section 201. These services provide you with intensive ongoing support if you need individualized assistance to gain employment, maintain employment, or both. These services are tailored to your individual needs, interests, abilities, and promote your career development. These services are provided in individual or group settings and are available in the basic plus, core, and community protection waivers.
(2) Individual supported employment services include activities needed to sustain Washington state's minimum wage pay or higher. These services are conducted in integrated business environments and include the following:
(a) Intake: An initial meeting to gather and share basic information and a general overview of employment supports, resources in the community, and the type of available supports that the individual may receive;
(b) Discovery: A person-centered approach to learn the individual's likes and dislikes, job preferences, and employment goals and skills;
(c) Job preparation: Includes activities of work readiness resume development, work experience, volunteer support transportation training;
(d) Marketing: A method to identify and negotiate jobs, build relationships with employers, and customize employment development;
(e) Job coaching: The supports needed to keep the job; and
(f) Job retention: The supports needed to keep the job, maintain a relationship with employer, identify opportunities, and negotiate a raise in pay, promotion, or increased benefits.
(3) Group supported employment services are a step on your pathway toward gainful employment in an integrated setting and include:
(a) Supports and paid training in an integrated business setting;
(b) Supervision by a qualified employment provider during working hours;
(c) Groupings of no more than eight workers with disabilities; and
(d) Individualized supports to obtain gainful employment.
[Statutory Authority: RCW
71A.12.030,
71A.12.040,
71A.12.120, and
34.05.330. WSR 19-06-053, § 388-845-2100, filed 3/4/19, effective 4/4/19. Statutory Authority: RCW
71A.12.030,
71A.12.040, 2015 3rd sp.s. c 4, and 42 C.F.R. § 441.301 (c)(4)-(5). WSR 18-03-174, § 388-845-2100, filed 1/23/18, effective 2/23/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2100, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2100, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-2100, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-2100, filed 12/13/05, effective 1/13/06.]
Who are qualified providers of supported employment services?
Providers of supported employment services must be a county, or agency or an individual contracted with a county or DDA.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2105, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-2105, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-2105, filed 12/13/05, effective 1/13/06.]
Are there limits to the supported employment services you may receive?
The following limits apply to your receipt of supported employment services:
(1) You must be age twenty and graduating from high school before your July or August twenty-first birthday, age twenty-one and graduated from high school, or age twenty-two or older to receive supported employment services;
(2) Payment for individual supported employment services excludes the supervisory activities rendered as a normal part of the business setting;
(3) You will not be authorized to receive supported employment services in addition to community access or prevocational services; and
(4) Your service hours are determined by the assistance you need to reach your employment outcomes as described in WAC
388-828-9325 and might not equal the number of hours you spend on the job or in job related activities.
[Statutory Authority: RCW
71A.12.030,
71A.12.040, 2015 3rd sp.s. c 4, and 42 C.F.R. § 441.301 (c)(4)-(5). WSR 18-03-174, § 388-845-2110, filed 1/23/18, effective 2/23/18. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2110, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-2110, filed 9/22/08, effective 10/23/08. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-2110, filed 12/13/05, effective 1/13/06.]
What are supported parenting services?
(1) Supported parenting services are professional services offered to participants who are parents or expectant parents.
(2) Services may include teaching, parent coaching, and other supportive strategies in areas critical to parenting, including child development, nutrition and health, safety, child care, money management, time and household management, and housing.
(3) Supported parenting services are designed to build parental skills around the child's developmental domains of cognition, language, motor, social-emotional, and self-help.
(4) Supported parenting services are offered in the IFS waiver.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2130, filed 8/4/16, effective 9/4/16.]
Who are qualified providers of supported parenting services?
Qualified providers of supported parenting services must:
(1) Have an understanding of individual learning styles related to child development and family dynamics;
(2) Have skills in child development and family dynamics;
(3) Have a supported parenting contract with DDA; and
(4) Be one or more of the following licensed, registered or certified professionals:
(a) Audiologist;
(b) Licensed practical nurse;
(c) Marriage and family therapist;
(d) Mental health counselor;
(e) Occupational therapist;
(f) Physical therapist;
(g) Registered nurse or licensed practical nurse;
(h) Speech/language pathologist;
(i) Social worker;
(j) Psychologist;
(k) Certified American sign language instructor;
(l) Nutritionist;
(m) Counselors registered or certified in accordance with chapter
18.19 RCW;
(n) Certified dietician;
(o) Recreation therapist registered in Washington and certified by the national council for therapeutic recreation;
(p) Psychiatrist;
(q) Professional advocacy organization.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2135, filed 8/4/16, effective 9/4/16.]
Are there any limitations on your receipt of supported parenting services?
The following limitations apply to your receipt of supported parenting services:
(1) Clinical and support needs for supported parenting services are limited to those identified in your DDA assessment and documented in your person-centered service plan/individual support plan; and
(2) The dollar amount of your annual allocation in your IFS waiver limit the amount of supported parenting service you are authorized to receive.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2140, filed 8/4/16, effective 9/4/16.]
What is therapeutic equipment and supplies?
(1) Therapeutic equipment and supplies are only available in the CIIBS waiver.
(2) Therapeutic equipment and supplies are equipment and supplies that are necessary to implement a behavioral support plan or other therapeutic plan, designed by an appropriate professional, such as a sensory integration or communication therapy plan, and necessary in order to fully implement the therapy or intervention.
(3) Included are items such as a weighted blanket, supplies that assist to calm or redirect the individual to a constructive activity, or a vestibular swing.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-2160, filed 2/18/20, effective 3/20/20. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2160, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2160, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2160, filed 11/1/10, effective 12/2/10.]
Who are qualified providers of therapeutic equipment and supplies?
Providers of therapeutic equipment and supplies are therapeutic equipment and supply vendors contracted with DDA to provide this service.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2165, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2165, filed 11/1/10, effective 12/2/10.]
Are there limits to your receipt of therapeutic equipment and supplies?
The following limits apply to your receipt of therapeutic equipment and supplies under the children's intensive in-home behavior support (CIIBS) waiver:
(1) DDA requires your treating professional's written recommendation regarding your need for the service. This recommendation must take into account that the treating professional has recently examined you, reviewed your medical records, and conducted a functional evaluation.
(2) DDA may require a second opinion from a DDA-selected professional.
(3) Therapeutic equipment and supplies require prior approval by the DDA regional administrator or designee.
(4) Therapeutic equipment and supplies do not include nonspecialized recreational items such as trampolines, swing sets, and hot tubs.
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 20-05-080, § 388-845-2170, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-2170, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2170, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
74.08.090,
74.09.520, and 2012 c 49. WSR 12-16-095, § 388-845-2170, filed 8/1/12, effective 9/1/12. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2170, filed 11/1/10, effective 12/2/10.]
What are transportation services?
Transportation services provide reimbursement to a provider when the transportation is required and specified in the waiver individual support plan. This service is available in all DDA HCBS waivers if the cost and responsibility for transportation is not already included in your provider's contract and payment.
(1) Transportation provides you access to waiver services, specified by your individual support plan.
(2) Whenever possible, you must use family, neighbors, friends, or community agencies that can provide this service without charge.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2200, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-2200, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2200, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-2200, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-2200, filed 12/13/05, effective 1/13/06.]
Who is qualified to provide transportation services?
(1) The provider of transportation services can be an individual or agency contracted with DDA whose contract includes transportation in the statement of work.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2205, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-2205, filed 12/13/05, effective 1/13/06.]
Are there limitations to the transportation services you can receive?
The following limitations apply to transportation services:
(1) Support needs for transportation services are limited to those identified in your DDA assessment and documented in your person-centered service plan/individual support plan.
(2) Transportation is limited to travel to and from a waiver service. When the waiver service is supported employment, transportation is limited to days when you receive employment support services.
(3) Transportation does not include the purchase of a bus pass.
(4) Reimbursement for provider mileage requires prior authorization by DDA and is paid according to contract.
(5) This service does not cover the purchase or lease of vehicles.
(6) Reimbursement for provider travel time is not included in this service.
(7) Reimbursement to the provider is limited to transportation that occurs when you are with the provider.
(8) You are not eligible for transportation services if the cost and responsibility for transportation is already included in your provider's contract and payment.
(9) The dollar limitations for aggregate services in your basic plus waiver or the dollar amount of your annual allocation in the IFS waiver limit the amount of service you may receive.
(10) If your individual waiver personal care provider uses his or her own vehicle to provide transportation to you for essential shopping and medical appointments as a part of your personal care service, your provider may receive up to one hundred miles per month in mileage reimbursement. If you work with more than one individual personal care provider, your limit is still a total of one hundred miles per month. This cost is not counted toward the dollar limitation for aggregate services in the basic plus waiver.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2210, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2210, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 08-20-033, § 388-845-2210, filed 9/22/08, effective 10/23/08; WSR 07-20-050, § 388-845-2210, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-2210, filed 12/13/05, effective 1/13/06.]
What are vehicle modifications?
(1) Vehicle modifications are adaptations or alterations to a vehicle required in order to accommodate the unique needs of the participant, enable full integration into the community, and ensure the health, welfare, and safety of the participant or the safety of a caregiver.
(2) Vehicle modifications require prior approval from the DDA regional administrator or designee.
(3) Examples of vehicle modifications include:
(a) Manual hitch-mounted carrier and hitch for all wheelchair types;
(b) Wheelchair cover;
(c) Wheelchair strap-downs;
(d) Portable wheelchair ramp;
(e) Accessible running boards and steps;
(f) Assist poles and grab handles.
(g) Power activated carrier for all wheelchair types;
(h) Permanently installed wheelchair ramps;
(i) Repairs and maintenance to vehicular modifications as needed for client safety; and
(j) Other access modifications.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2260, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2260, filed 11/1/10, effective 12/2/10.]
Who are providers of vehicle modifications?
Providers of vehicle modifications are:
(1) Vehicle service providers contracted with DDA to provide this service; or
(2) Vehicle adaptive equipment vendors contracted with DDA to provide this service.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2265, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2265, filed 11/1/10, effective 12/2/10.]
Are there limitations to your receipt of vehicle modification services?
Vehicle modification services are only available on the CIIBS or IFS waiver. The following limitations apply:
(1) Clinical and support needs for vehicle modification services are limited to those identified in your DDA assessment and documented in the person-centered service plan/individual support plan.
(2) Vehicle modifications are excluded if they are of general utility without direct medical or remedial benefit to you.
(3) If you are eligible for or enrolled with division of vocational rehabilitation (DVR) you must pursue this benefit through DVR first.
(4) Vehicle modifications must be the most cost effective modification based upon a comparison of contractor bids as determined by DDA.
(5) Modifications will only be approved for a vehicle that serves as your primary means of transportation and is owned by you, your family, or both.
(6) DDA requires your treating professional's written recommendation regarding your need for the service. This recommendation must take into account that the treating professional has recently examined you, reviewed your medical records, and conducted a functional evaluation.
(7) The department may require a second opinion from a department selected provider that meets the same criteria as subsection (6) of this section.
(8) The dollar amount for your annual allocation in your IFS waiver limits the amount of vehicle modification service you are authorized to receive.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-2270, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-2270, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-2270, filed 11/1/10, effective 12/2/10.]
What is wellness education?
Wellness education provides you with monthly individualized printed educational materials designed to assist you in managing health related issues and achieving wellness goals identified in your person-centered service plan that address your health and safety issues. Individualized educational materials are developed by the state, other content providers, and the contracted wellness education provider. This service is available on the basic plus, individual and family services, and core waivers.
[Statutory Authority: RCW
71A.12.030 and CMS. WSR 16-19-031, § 388-845-2280, filed 9/13/16, effective 10/14/16. Statutory Authority: RCW
71A.12.030. WSR 16-05-053, § 388-845-2280, filed 2/11/16, effective 3/13/16.]
How are my wellness educational materials selected?
Individualized educational materials are selected for you by the wellness education provider's algorithm and are based on your DDA assessment. Goals, diagnoses, treatments, conditions and other factors identified in your DDA assessment provide the basis for the algorithm to select educational materials for you. These goals, diagnoses, treatments, conditions and other factors may include, but are not limited to the following:
(1) Diabetes - IDDM;
(2) Diabetes - NIDDM;
(3) COPD;
(4) Cardiovascular disease;
(5) Rheumatoid arthritis;
(6) Traumatic brain injury;
(7) Cerebral palsy;
(8) Alzheimer's disease;
(9) Anxiety disorder;
(10) Asthma;
(11) Autism;
(12) Stroke;
(13) Congestive heart failure;
(14) Decubitus ulcer;
(15) Depression;
(16) Emphysema;
(17) GERD;
(18) Hypertension;
(19) Hypotension;
(20) Down's syndrome;
(21) Fragile X syndrome;
(22) Prader-Willi;
(23) ADD;
(24) ADHD;
(25) Post-traumatic stress disorder;
(26) Asperger's syndrome;
(27) Hepatitis;
(28) Paraplegia;
(29) Quadriplegia;
(30) Fetal alcohol syndrome/fetal alcohol effect;
(31) Epilepsy;
(32) Seizure disorder;
(33) Sleep apnea;
(34) Urinary tract infection;
(35) Multiple sclerosis;
(36) Falls;
(37) Smoking;
(38) Alcohol abuse;
(39) Substance abuse;
(40) Bowel incontinence;
(41) Bladder incontinence;
(42) Diabetic foot care;
(43) Pain daily;
(44) Sleep issues;
(45) BMI = or greater than 25;
(46) BMI less than 18.5;
(47) Skin care (pressure ulcers, abrasions, burns, rashes);
(48) Seasonal allergies;
(49) Edema;
(50) Poor balance;
(51) Recent loss/grieving;
(52) Conflict management;
(53) Importance of regular dental visits;
(54) ADA diet;
(55) Cardiac diet;
(56) Celiac diet;
(57) Low sodium diet;
(58) Goals; and
(59) Parkinson's disease.
[Statutory Authority: RCW
71A.12.030. WSR 16-05-053, § 388-845-2283, filed 2/11/16, effective 3/13/16.]
Are there limits to wellness education?
Wellness education is a once a month service. In the basic plus waiver, you are limited to the aggregate service expenditure limits defined in WAC
388-845-0210. The dollar amount for your individual and family services (IFS) waiver annual allocation defined in WAC
388-845-0230 limits the amount of service you may receive.
[Statutory Authority: RCW
71A.12.030 and CMS. WSR 16-19-031, § 388-845-2285, filed 9/13/16, effective 10/14/16. Statutory Authority: RCW
71A.12.030. WSR 16-05-053, § 388-845-2285, filed 2/11/16, effective 3/13/16.]
Who are qualified providers of wellness education?
The wellness education provider must have the ability and resources to:
(1) Receive and manage client data in compliance with all applicable federal HIPPA regulations, state law and rules and ensure client confidentiality and privacy;
(2) Translate materials into the preferred language of the participant;
(3) Ensure that materials are targeted to the participant's assessment and person-centered service plan;
(4) Manage content sent to participants to prevent duplication of materials;
(5) Deliver newsletters and identify any undeliverable client/representative addresses prior to each monthly mailing and manage any returned mail in a manner that ensures participants receive the monthly information; and
(6) Contract with ALTSA or DDA to provide this service.
[Statutory Authority: RCW
71A.12.030. WSR 16-05-053, § 388-845-2290, filed 2/11/16, effective 3/13/16.]
What is the process for determining the services you need?
Your service needs are determined through the DDA assessment and the service planning process as defined in chapter
388-828 WAC. Only identified health and welfare needs will be authorized for payment in the person-centered service plan/individual support plan.
(1) You receive an initial and annual assessment of your needs using a department-approved form.
(a) You meet the eligibility requirements for ICF/IID level of care.
(b) The comprehensive assessment reporting evaluation (CARE) tool will determine your eligibility and amount of personal care services.
(c) If you are in the basic plus, CIIBS, or core waiver, the DDA assessment will determine the amount of respite care available to you.
(2) From the assessment, DDA develops your waiver person-centered service plan/individual support plan (ISP) with either you, or you and your legal representative, and others who are involved in your life such as your parent or guardian, advocate, and service providers.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3000, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3000, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3000, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-3000, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3000, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3000, filed 12/13/05, effective 1/13/06.]
How is the waiver respite assessment administered?
The waiver respite assessment is administered by department staff during an in-person interview with you if you choose to be present, and at least one other person with knowledge of you, such as your primary caregiver.
[Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3015, filed 12/13/05, effective 1/13/06.]
Who can be the respondent for the waiver respite assessment?
The respondent for your waiver respite assessment must be an adult who is well acquainted with you and can provide the information needed to complete the assessment, such as your primary caregiver.
(1) You cannot be the respondent for your own respite assessment.
(2) The department may select and interview additional respondents as needed to get complete and accurate information.
[Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3020, filed 12/13/05, effective 1/13/06.]
What is a waiver person-centered service plan/individual support plan (ISP)?
(1) The person-centered service plan/individual support plan (ISP) is the primary tool DDA uses to determine and document your needs and to identify the services to meet those needs.
(2) Your person-centered service plan/ISP must include:
(a) Your identified health and welfare needs;
(b) Both paid and unpaid services and supports approved to meet your identified health and welfare needs as identified in WAC
388-828-8040 and
388-828-8060; and
(c) How often you will receive each waiver service, how long you will need it, and who will provide it.
(3) For any person-centered service plan/ISP, you or your legal representative must sign the plan indicating your agreement to the receipt of services.
(4) You may choose any qualified provider for the service, who meets all of the following:
(a) Is able to meet your needs within the scope of their contract, licensure, and certification;
(b) Is reasonably available;
(c) Meets provider qualifications in chapters
388-845 and
388-825 WAC for contracting; and
(d) Agrees to provide the service at department rates.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3055, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3055, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3055, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3055, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3055, filed 12/13/05, effective 1/13/06.]
What if you need assistance to understand your person-centered service plan/individual support plan?
If you are unable to understand your person-centered service plan/individual support plan and the individual who has agreed to provide assistance to you as your necessary supplemental accommodation representative is unable to assist you with understanding your individual support plan, DDA will take the following steps:
(1) Consult with the office of the attorney general to determine if you require a legal representative or guardian to assist you with your individual support plan;
(2) Continue your current waiver services; and
(3) If the office of the attorney general or a court determines that you do not need a legal representative, DDA will continue to try to provide necessary supplemental accommodations in order to help you understand your person-centered service plan/individual support plan.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3056, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3056, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3056, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3056, filed 9/26/07, effective 10/27/07.]
When is your person-centered service plan/individual support plan effective?
Your person-centered service plan/individual support plan is effective the last day of the month in which DDA signs and dates it.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3060, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3060, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3060, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3060, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3060, filed 12/13/05, effective 1/13/06.]
Can a change in your person-centered service plan/individual support plan be effective before you sign it?
If you verbally request a change in service to occur immediately, DDA can sign the person-centered service plan/individual support plan and approve it prior to receiving your signature.
(1) Your person-centered service plan/individual support plan will be mailed to you for signature.
(2) You retain the same appeal rights as if you had signed the person-centered service plan/individual support plan.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3061, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3061, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3061, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3061, filed 9/26/07, effective 10/27/07.]
Who is required to sign the person-centered service plan/individual support plan?
(1) If you do not have a legal representative, you must sign the person-centered service plan/individual support plan.
(2) If you have a legal representative, your legal representative must sign the person-centered service plan/individual support plan.
(3) If you need assistance to understand your person-centered service plan/individual support plan, DDA will follow the steps outlined in WAC
388-845-3056 (1) and (3).
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3062, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3062, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3062, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3062, filed 9/26/07, effective 10/27/07.]
Can your person-centered service plan/individual support plan be effective before the end of the month?
You may request to DDA to have your person-centered service plan/individual support plan effective prior to the end of the month. The effective date will be the date DDA signs and dates it.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3063, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3063, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3063, filed 1/24/13, effective 2/24/13.]
How long is your plan effective?
Your person-centered service plan/individual support plan is effective through the last day of the twelfth month following the effective date or until another ISP is completed, whichever occurs sooner.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3065, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3065, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3065, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3065, filed 12/13/05, effective 1/13/06.]
What happens if you do not sign your person-centered service plan?
(1) If you do not sign your initial person-centered service plan (PCSP), DDA must not provide waiver services to you until you sign the PCSP.
(2) If you do not sign your PCSP and it is a reassessment or review, DDA will:
(a) Continue providing services identified in your current PCSP until the end of the notice period under WAC
388-825-105; and
(b) Return your PCSP to you for your signature.
(3) If you do not return your signed PCSP within two months of your reassessment or review, DDA must terminate your services.
(4) Your appeal rights are under:
[Statutory Authority: RCW
71A.12.030,
71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-3070, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3070, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3070, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3070, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3070, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3070, filed 12/13/05, effective 1/13/06.]
What if your needs change?
You may request a review of your person-centered service plan/individual support plan at any time by calling your case manager. If there is a significant change in your condition or circumstances, DDA must reassess your person-centered service plan/individual support plan with you and amend the plan to reflect any significant changes. This reassessment does not affect the end date of your annual person-centered service plan/individual support plan.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3075, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3075, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3075, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3075, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3075, filed 12/13/05, effective 1/13/06.]
What if my needs exceed the maximum yearly funding limit or the scope of services under the basic plus waiver?
(1) If you are on the basic plus waiver and your assessed need for services exceeds the maximum permitted, DDA will make the following efforts to meet your health and welfare needs:
(a) Identify more available natural supports;
(b) Initiate an exception to rule to access available nonwaiver services not included in the basic plus waiver other than natural supports;
(c) Authorize emergency assistance up to six thousand dollars per year if your needs meet the definition of emergency assistance in WAC
388-845-0800.
(2) If emergency assistance and other efforts are not sufficient to meet your needs, you will be offered:
(a) An opportunity to apply for an alternate waiver that has the services you need;
(b) Priority for placement on the alternative waiver when there is capacity to add people to that waiver;
(c) Placement in an ICF/ID.
(3) If none of the options in subsections (1) and (2) above is successful in meeting your health and welfare needs, DDA may terminate your waiver eligibility.
(4) If you are terminated from a waiver, you will remain eligible for nonwaiver DDA services but access to state-only funded DDA services is limited by availability of funding.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3080, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3080, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3080, filed 12/13/05, effective 1/13/06.]
What if your needs exceed what can be provided under the IFS, CIIBS, core, or community protection waiver?
(1) If you are on the IFS, CIIBS, core, or community protection waiver and your assessed need for services exceeds the scope of services provided under your waiver, DDA will make one or more of the following efforts to meet your health and welfare needs:
(a) Identify more available natural supports;
(b) Initiate an exception to rule to access available nonwaiver services not included in the IFS, CIIBS, core, or community protection waiver other than natural supports;
(c) Offer you the opportunity to apply for an alternate waiver that has the services you need, subject to WAC
388-845-0045; or
(d) Offer you placement in an ICF/IID.
(2) If none of the above options is successful in meeting your health and welfare needs, DDA may terminate your waiver eligibility.
(3) If you are terminated from a waiver, you will remain eligible for nonwaiver DDA services but access to state-only funded DDA services is limited by availability of funding.
[Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW
71A.12.030, and
71A.12.120. WSR 16-17-009, § 388-845-3085, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3085, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-3085, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-3085, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3085, filed 12/13/05, effective 1/13/06.]
What if my identified health and welfare needs are less than what is provided in my current waiver?
If your identified health and welfare needs are less than what is provided in your current waiver, DDA may terminate you from your current waiver and enroll you in a waiver that meets but does not exceed your assessed need for waiver services.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3090, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3090, filed 12/13/05, effective 1/13/06.]
Will I have to pay toward the cost of waiver services?
(1) You are required to pay toward board and room costs if you live in a licensed facility or in a companion home as room and board is not considered to be a waiver service.
(2) You will not be required to pay towards the cost of your waiver services if you receive SSI.
(3) You may be required to pay towards the cost of your waiver services if you do not receive SSI. DDA determines what amount, if any, you pay in accordance with WAC
182-515-1510.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-3095, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-3095, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-3095, filed 12/13/05, effective 1/13/06.]
What are my appeal rights under the waiver?
In addition to your appeal rights under WAC
388-825-120, you have the right to appeal the following decisions:
(1) Disenrollment from a waiver under WAC
388-845-0060, including a disenrollment from a waiver and enrollment in a different waiver.
(2) A denial of your request to receive ICF/ID services instead of waiver services; or
(3) A denial of your request to be enrolled in a waiver, subject to the limitations described in WAC
388-845-4005.
[Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-4000, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-4000, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-4000, filed 12/13/05, effective 1/13/06.]
Can I appeal a denial of my request to be enrolled in a waiver?
(1) If you are not enrolled in a waiver and your request to be enrolled in a waiver is denied, your appeal rights are limited to the decision that you are not eligible to have your request documented in a statewide database due to the following:
(b) You requested enrollment in the CIIBS waiver and do not meet CIIBS eligibility per WAC
388-828-8500 through
388-828-8520.
(2) If you are enrolled in a waiver and your request to be enrolled in a different waiver is denied, your appeal rights are limited to the following:
(a) DDA's decision that the services contained in a different waiver are not necessary to meet your health and welfare needs and that the services available on your current waiver can meet your health and welfare needs; or
(b) DDA's decision that you are not eligible to have your request documented in a statewide database because you requested enrollment in the CIIBS waiver and do not meet CIIBS eligibility per WAC
388-828-8500 through
388-828-8520.
(3) If DDA determines that the services offered in a different waiver are necessary to meet your health and welfare needs, but there is not capacity on the different waiver, you do not have the right to appeal any denial of enrollment on a different waiver when DDA determines there is not capacity to enroll you on a different waiver.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-4005, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030,
74.08.090 and 2012 c 49. WSR 13-04-005, § 388-845-4005, filed 1/24/13, effective 2/24/13. Statutory Authority: RCW
71A.12.030,
71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title
71A RCW. WSR 10-22-088, § 388-845-4005, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW
71A.12.030,
71A.12.120 and Title
71A RCW. WSR 07-20-050, § 388-845-4005, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-4005, filed 12/13/05, effective 1/13/06.]
How do I appeal a department action?
(1) Your rights to appeal a department decision are in RCW
71A.10.050 and WAC
388-825-120 and are limited to an applicant, recipient, or former recipient of services from the DDA.
(2) If you want to appeal a department action, you must request an appeal within ninety days from receipt of the department notice of the action you are disputing.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-4010, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-4010, filed 12/13/05, effective 1/13/06.]
Will my services continue during an appeal?
Services may continue according to the provisions contained in WAC
388-825-145.
[Statutory Authority: RCW
71A.12.030 and 2012 c 49. WSR 13-24-045 , § 388-845-4015, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW
71A.12.030, 71A.12.12 [71A.12.120] and chapter
71A.12 RCW. WSR 06-01-024, § 388-845-4015, filed 12/13/05, effective 1/13/06.]
