Washington Administrative Code

Yes, you may request an administrative hearing based on the rules outlined in WAC 388-106-1305 to contest the department's decisions regarding MAC or TSOA services except for presumptive eligibility determinations described in WAC 388-106-1905(2) and 388-106-1910(2).[Statutory Au…

Yes. You, as the care receiver, may choose to apply for traditional medicaid long term services and supports such as community first choice, community option program entry system (COPES), new freedom, and residential support waiver, instead of services under the MAC program. You …

"Aging and long-term support administration (ALTSA)" is an administration within the department of social and health services that promotes choice, independence, and safety through innovative services and partnerships with tribes, advocates, providers, and caregivers to support s…

You are eligible to apply for services under the civil transitions program if you:(1) Are referred to ALTSA from the BHA starting December 1, 2023;(2) Have been determined by a court as not competent to stand trial due to a diagnosis of dementia, a traumatic brain injury, or an i…

(1) If you meet the criteria in WAC 388-106-2005 but are not functionally eligible for medicaid personal care level of care under WAC 388-106-0210 or nursing facility level of care under WAC 388-106-0355, or you are not financially eligible for Washington apple health, you may re…

If you are referred to ALTSA for services under the civil transitions program and you are both functionally eligible for long-term services and supports under chapter 388-106 WAC and financially eligible for medicaid-funded long-term services and supports, you are eligible for an…

The legislature has appropriated specific funding for the civil transitions program for the provision of conditional services. If you meet the criteria in WAC 388-106-2005 you are eligible for conditional services as described below, subject to available funding.(1) If you do not…

The following types of providers can provide conditional services under the civil transitions program:(1) Individual providers (IPs) who provide services to clients in their own home as defined in WAC 388-106-0040 and 388-106-0010.(2) Home care agencies that provide services to c…

You can receive conditional services under the civil transitions program:(1) In your own home as defined in WAC 388-106-0030, or an interim setting while you secure permanent housing; and(2) While you are out of your home accessing the community or working while:(a) within the st…

Within available funds, the department will authorize conditional services under the civil transitions program when you have:(1) Completed an assessment of your functional eligibility using the comprehensive assessment reporting evaluation (CARE) tool under WAC 388-106-0050;(2) A…

(1) If, at the time of your initial assessment you were found ineligible for medicaid-funded long-term services and supports, your civil transitions program conditional services, except supportive housing, will end the earlier of:(a) The date you are found both functionally and f…

You have a right to an administrative hearing if you disagree with a decision made by the department about your eligibility for services under the civil transitions program. The department will notify you in writing of the right to contest a decision and provide you with informat…

If you receive conditional services under the civil transitions program, an exception to rule under WAC 388-440-0001 will not be granted.[Statutory Authority: RCW 10.77.202, 74.08.090, and 74.09.520. WSR 24-16-002, § 388-106-2050, filed 7/24/24, effective 8/24/24.]

(1) Subject to available state only funds, the department of social and health services (DSHS) pays for certain fees and costs for professional guardianship and conservatorship services for eligible persons as described in WAC 388-106-2110.(2) The amounts paid and which services …

(1) "Aging and long-term support administration" or "ALTSA" means an administration within DSHS.(2) "Client" means a person who is an applicant for, or recipient of, any Washington apple health program, including managed care and long-term care. See definitions for "applicant" an…

(1) To be eligible to participate as a contractor in the program a person must:(a) Hold certification as a professional guardian and conservator approved by the state of Washington supreme court;(b) Be in good standing with the certified professional guardian and conservator revi…

(1) An acute care hospital may submit a referral to home and community services under the following circumstances:(a) Acute care hospital clinicians have determined that the person likely needs a guardian or conservator;(b) The acute care hospital has a good faith belief that the…

(1) Within available resources, home and community services will accept a person into the guardianship and conservatorship assistance program if DSHS determines that the person meets the eligibility requirements, the referral packet is complete, and there is a program slot availa…

A referring acute care hospital may request that DSHS reconsider its decision to accept a person onto the guardianship and conservatorship assistance program. A request for reconsideration must be supported by the referring acute care hospital submission of supplemental documenta…

DSHS will provide an applicant or participant in the program, and their guardian or conservator as applicable, with written notice about department decisions about eligibility for acceptance onto, or continuation on, the program.[Statutory Authority: RCW 43.17.060, 43.20B.030, an…

The person who is the subject of a referral for acceptance into or a recipient of services under the guardianship and conservatorship assistance program may request an administrative hearing to contest a department decision that they are not eligible for acceptance or continuatio…

If DSHS or the guardian or conservator discovers that the person's estate has available and adequate resources to pay for guardianship fees or costs, the payments made under this program on behalf of the client are overpayments to the extent a court determines that the person's e…

If a client ceases to remain financially eligible as required by WAC 182-513-1315 (1)-(3) while occupying a program slot, their program slot can be held for up to a maximum of 90 days from the date it is discovered the client is overresourced. This process is referred to as a "pr…

Services provided under this program are exempt from estate recovery as outlined in WAC 182-527-2742. [Statutory Authority: RCW 43.17.060, 43.20B.030, and 74.08.090. WSR 24-16-044, § 388-106-2150, filed 7/30/24, effective 8/30/24.]

Services provided under this program are exempt from the exception to rule process in WAC 388-440-0001.[Statutory Authority: RCW 43.17.060, 43.20B.030, and 74.08.090. WSR 24-16-044, § 388-106-2155, filed 7/30/24, effective 8/30/24.]

Services provided under this program are paid by state only funds. While DSHS is paying for services under this contract for a client, there will be no reduction in the amount a client must pay towards client responsibility to account for costs and fees associated with establishi…

This program only pays for guardianship and conservatorship services of one contractor per case. In the event that the court orders a split appointment amongst multiple contracted providers, DSHS will only pay the guardian.[Statutory Authority: RCW 43.17.060, 43.20B.030, and 74.0…

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise."Abandonment" means action or inaction by a person with a duty of care for a vulnerable adult that leaves the vulnerable person without the means or ability to obtain neces…

This implements chapter 70.97 RCW and sets the minimum health and safety standards for licensure and operations of enhanced services facilities. An enhanced services facility will provide treatment and services to a maximum of sixteen residents for whom acute inpatient treatment …

(1) Chapter 70.97 RCW authorizes the department to develop rules to implement the chapter, and to license enhanced services facilities. At a minimum the rules are to be written to promote safe treatment and necessary care of individuals residing in each facility, to provide for s…

The enhanced services facility will only admit residents who:(1) Are at least eighteen years old; and(2) Require:(a) Daily care by or under the supervision of a mental health professional, chemical dependency professional, or nurse; or(b) Assistance with three or more activities …

(1) The enhanced services facility must complete a face to face preadmission assessment at the hospital with each potential resident prior to admission which includes the following minimum information:(a) Resident identification information such as but not limited to the name, ad…

The assessor must complete the preadmission assessment of the prospective resident before the resident moves into the enhanced services facility.[Statutory Authority: Chapter 70.97 RCW. WSR 14-19-071, § 388-107-0050, filed 9/12/14, effective 10/13/14.]

(1) The enhanced services facility must complete a comprehensive assessment for each resident within fourteen days of admission.(2) The assessment will be repeated when there is a significant change in the resident's condition or, at a minimum, every one hundred eighty days if th…

The enhanced services facility must obtain sufficient information to be able to assess the capabilities, needs, and preferences for each resident, and must complete a comprehensive assessment. The assessment addresses the following, within fourteen days of the resident's move-in …

(1) The department amended portions of this rule from January 18, 2022, through June 8, 2023, in response to the state of emergency related to the COVID-19 pandemic. For requirements in place during that time, see WAC 388-107-0081.(2) The enhanced services facility must:(a) Compl…

(1) In response to the state of emergency related to the COVID-19 pandemic, the department adopted emergency rules under RCW 34.05.320 on January 18, 2022, to amend a portion of WAC 388-107-0080. The emergency rules remained in effect until June 8, 2023. The amended rules in plac…

(1) The enhanced services facility must ensure that an assessor performing an assessment for any potential or admitted resident has experience working with residents who have severe behavioral issues due to but not limited to functional or cognitive disabilities, mental health or…

The enhanced services facility must develop and maintain a person-centered service planning team for each resident. The ESF must:(1) Ensure the person-centered service planning team includes the resident, the resident's representative when applicable, individuals chosen by the re…

The enhanced services facility must develop the initial person-centered service plan prior to the resident's admission to the ESF, using information from the resident, the resident's representative if the resident has one, the comprehensive assessment reporting evaluation (CARE) …

(1) The enhanced services facility must ensure that when the person-centered service planning team develops the initial comprehensive person-centered service plan, the team integrates the information contained in the following documents:(a) The resident's preadmission assessment;…

(1) The enhanced services facility must ensure the person-centered service planning team reviews and updates each resident's comprehensive person-centered service plan as follows:(a) Within a reasonable time consistent with the resident's needs following any significant change in…

(1) The enhanced services facility must provide the care and services as agreed upon or outlined in the initial and comprehensive person-centered service plan to each resident unless a deviation from the plan is mutually agreed upon between the medicaid client's department case m…

When the department is paying for a resident's services, the enhanced services facility must give the department case manager a copy of the comprehensive person-centered service plan each time it is completed or updated. The ESF must keep a copy of the person-centered service pla…

The enhanced services facility must ensure that each resident's person-centered service plan has interventions for behavioral support that are used immediately when a resident's behavior escalates in the ESF or community. The behavioral support plan must include, at the minimum t…

(1) For the purposes of this section "residency agreement" means a legally enforceable written document prepared by the enhanced services facility that contains the rights and responsibilities of the facility and the resident specific to transfer and discharge and is signed by bo…

(1) The enhanced services facility must ensure that:(a) Resident care is provided in a manner to enhance each resident's dignity and quality of life including a safe, clean, comfortable and homelike environment, and to respect and recognize his or her individuality; and(b) Each r…