Washington Administrative Code

(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 individuals with intellectual disabilities (ICF/…

The purpose of HCBS waivers is to provide services in the community to individuals with ICF/IID level of need to prevent their placement in an ICF/IID.[Statutory Authority: RCW 71A.12.030, 71A.12.120, and 42 C.F.R. 441.301 (c)(6). WSR 23-18-035, § 388-845-0010, filed 8/29/23, eff…

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…

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, …

(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.(b) You have been determined to meet ICF/IID level of care per WAC 388-845-0070, 388-828-3060, and 388-828-3080.(c)…

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.]

(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 availa…

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-…

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, as specified in WAC 388-845-3055, will document:(a) Your identified health and welfare n…

When there is capacity on a waiver, 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 …

(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/IID 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 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 7…

(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 …

(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 12 months to determine if you continue to meet all of these eligibility requi…

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 iden…

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 availabilit…

DDA determines if you need ICF/IID 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, 71A.12.120, and 42 C.F.R. 441.301 (c)(6). WSR 23-18-035, § 388-84…

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…

DDA may assign you to the community protection waiver only if you are at least 18 years of age, not currently residing in a hospital, jail or other institution, and:(1) You have been identified by DDA as a person who meets one or more of the following:(a) You have been charged or…

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 DDA assessment and person-centered service plan.(2) Stabilization services may be added to your person-centered service pl…

The following limits apply to providers of waiver services:(1) Your spouse must not be your paid provider for any waiver service.(2) If you are under age 18, your natural, step, adoptive parent, legal representative, or DCYF out-of-home caregiver must not be your paid provider fo…

(1) Teleservice is a remote service delivery method that uses a HIPAA-compliant technology system approved by DDA.(2) The following services may be delivered through teleservice:(a) Assistive technology;(b) Community engagement;(c) Individual supported employment;(d) Individualiz…

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, an…

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.12.0…

Each of the DDA HCBS waivers has a different scope of service and your person-centered service plan defines the waiver services available to you.[Statutory Authority: RCW 71A.12.030 and 71A.12.120. WSR 21-19-108, § 388-845-0200, filed 9/20/21, effective 10/21/21. Statutory Author…

The following services are available under the basic plus waiver:serviceyearly limitaggregate services:Total costs must not exceed $6,192 per year per participantAssistive technologyExtermination of cimex lectularius (bedbugs)Community engagementEnvironmental adaptationsLife skil…

(1) The following services are available under the core waiver:SERVICEYEARLY LIMITAssistive technologyExtermination of cimex lectularius (bedbugs)Community engagementCommunity transitionEnvironmental adaptationsLife skillsOccupational therapyPhysical therapyRemote supportResident…

(1) The following services are available under the community protection waiver:serviceyearly limitAssistive technology Extermination of cimex lectularius (bedbugs)Determined by the person-centered service planCommunity transitionEnvironmental adaptationsOccupational therapyPhysic…

(1) The following services are available under the children's intensive in-home behavioral support (CIIBS) waiver:SERVICEYEARLY LIMITAssistive technologyEnvironmental adaptationsLife skillsNurse delegationSpecialized clothingSpecialized equipment and suppliesStaff and family cons…

(1) The following services are available under the individual and family services (IFS) waiver:SERVICEYEARLY LIMITAssistive technologyCommunity engagementEnvironmental adaptationsLife skillsNurse delegationOccupational therapyPeer mentoringPerson-centered plan facilitation Physic…

(1) Assistive technology consists of items, equipment, or product systems, not related to a client's physical health, that are used to directly support the client to:(a) Increase, maintain, or improve functional capabilities;(b) Improve client safety; or(c) Increase social engage…

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 mu…

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 a…

(1) Positive behavior support and consultation is a service available only on the community protection waiver. Effective September 1, 2022, this service is no longer available on any other waiver.(2) Positive behavior support and consultation includes the development and implemen…

Under the community protection (CP) waiver, 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)…

(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 nee…

(1) Extermination of cimex lectularius (bedbugs) is professional extermination of bedbugs.(2) DDA covers professional extermination of bedbugs in your primary residence if you:(a) Live with a non-relative primary caregiver; or(b) Live in a private house or apartment for which you…

A qualified provider must be contracted with DDA to provide extermination of bedbugs.[Statutory Authority: RCW 71A.12.030 and 71A.12.120. WSR 21-19-108, § 388-845-0520, filed 9/20/21, effective 10/21/21. Statutory Authority: RCW 71A.12.030, 71A.12.120, 42 C.F.R. 441 Subpart G. WS…

(1) Extermination of bedbugs is available on the following waivers:(a) Core;(b) Basic plus; and(c) Community protection.(2) Extermination of bedbugs services covers only:(a) The assessment or inspection by the qualified provider;(b) The application of chemical-based pesticide or …

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 communi…

You are eligible for community inclusion services if you are enrolled in the basic plus or core waivers and:(1) You are 62 or older; or(2) You meet age requirements under WAC 388-845-2110(1) and: (a) You have participated in supported employment services for at least nine months;…

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 inc…

The maximum hours of community inclusion services you may receive are determined by the developmental disabilities administration assessment under WAC 388-828-9310.[Statutory Authority: RCW 71A.12.030, 71A.12.120, and 71A.12.290. WSR 23-18-034, § 388-845-0610, filed 8/29/23, effe…

(1) Community engagement connects a waiver participant to activities, resources, events, and services in the community that the participant is interested in exploring. It is intended to assist the participant with fully accessing their community and reducing isolation.(2) This se…

Qualified providers of community engagement 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 …

(1) Community engagement is 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 waiver limit the amount of community engagement yo…

(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 …