The enhanced case management program is a program that facilitates client integration, improves quality of care, and promotes a safe home environment. Funds appropriated for the enhanced case management program support clients through increased:

(1) Access to a case manager;

(2) Access to education and resources; and

(3) Frequency of home visits.

The following definitions apply to this chapter.

"Caregiver" means a person who provides personal care or respite care services to DDA clients.

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

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

"DDA assessment" means an inventory and evaluation, under chapter 388-828 WAC, of a client's strengths and limitations based on an interview with the client. For the purposes of this chapter, the DDA assessment includes the "DDA assessment details."

"Independent supports" means an adult, other than the client's paid caregiver, who observes the care a client receives from their paid caregiver.

The developmental disabilities administration (DDA) may enroll a client in the enhanced case management program if the client is currently assessed to be eligible for medicaid personal care or community first choice (CFC) services in their home under chapter 388-106 WAC and meets criteria under subsection (1), (2), or (3) of this section.

(1) The client's DDA assessment indicates that the home environment may jeopardize the client's health or safety.

(2) The client's DDA assessment indicates the client:

(a) Has difficulty communicating their needs and wants to their caregiver or informing someone when their needs are not being met;

(b) Has a limited ability to advocate for themselves or express themselves, and has few documented collateral contacts; and

(c) Lacks additional, independent supports that regularly help the client monitor the care being provided in their home.

(3) DDA has concerns that the quality of care may jeopardize the client's health or safety for reasons such as:

(a) The client has been the subject of an adult protective services referral in the past year;

(b) The client has been the subject of a child protective services referral in the past year;

(c) The client's DDA assessment indicates the client is underweight;

(d) The client's DDA assessment indicates that the primary caregiver is age 65 or older or states that they are "very stressed," and the caregiver states that the caregiving situation is at "serious risk of failure" or there is concrete evidence of reduced care; or

(e) The client has experienced a destabilizing event, such as a loss of a primary caregiver, hospitalization, or victimization.

(1) The client's case manager must visit each enhanced case management program client at least once every four months at the client's home, including unannounced visits as needed. Each required visit must not occur more than four months apart.

(2) An unannounced visit may replace a scheduled visit.

(3) If the case manager is unable to meet with the client for a visit, the case manager must:

(a) Schedule a follow-up visit as soon as possible and no later than 30 days; and

(b) Document that the visit did not occur.

If you no longer meet eligibility criteria for the enhanced case management program under WAC 388-829B-300, DDA will disenroll you from the program.

A client does not have a right to appeal:

(1) A decision whether or not to enroll on the enhanced case management program; or

(2) A decision to transfer off the enhanced case management program.