(1) In order for services, supports, and/or items to be purchased under New Freedom, they must:
(a) Be for your sole benefit;
(b) Be at a reasonable cost;
(c) Meet your identified needs and outcomes in the CARE assessment and address your health, safety, and welfare; and
(d) Be documented on your New Freedom spending plan defined in WAC 388-106-0010
. The spending plan, which is established with the Care Consultant, documents how you will spend your service budget dollars.
(2) Your consultant may require a physician or other licensed professional, such as an occupational or physical therapist to recommend a specific purchase in writing. This recommendation is needed to ensure the service, support and/or item will increase, maintain, or delay decline of functional abilities, and to ensure the purchase supports your health and welfare.
(3) Medicare or medicaid state plan benefits must be used prior to using New Freedom funds if the goods or services are covered under these programs.
(4) You may use your individual budget to purchase services, supports, and/or items that fall into the following service categories:
(a) Personal assistance services, defined as supports involving the labor of another person to assist you to carry out activities you are unable to perform independently. Services may be provided in your home or in the community and may include:
(i) Direct personal care services defined as assistance with activities of daily living, as defined in WAC 388-106-0010
. These must be provided by a qualified individual provider or AAA-contracted homecare agency as described in WAC 388-106-0040
(1) and (2);
(iii) Other tasks or assistance with activities that support independent functioning, and are necessary due to your functional disability;
(iv) Personal assistance with transportation or assistance with instrumental activities of daily living (essential shopping, housework, and meal preparation).
(b) Treatment and health maintenance, defined as treatments or activities that are beyond the scope of the medicaid state plan that are necessary to promote your health and ability to live independently in the community and:
(i) Are provided for the purpose of preventing further deterioration of your level of functioning, or improving or maintaining your current level of functioning; and
(ii) Are performed or provided by people with specialized skill, registration, certification or licenses as required by state law.
(c) Individual directed goods, services and supports, defined as services, equipment or supplies not otherwise provided through this waiver or through the medicaid state plan; and
(i) Will allow you to function more independently; or
(ii) Increase your safety and welfare; or
(iii) Allow you to perceive, control, or communicate with your environment; or
(iv) Assist you to transition from an institutional setting to your home. Transition services may include safety deposits, utility set-up fees or deposits, health and safety assurances such as pest eradication, allergen control or one-time cleaning prior to occupancy, moving fees, furniture, essential furnishings and basic items essential for basic living outside the institution. Transition services do not include rent, recreational or diverting items such as TV, cable or VCR/DVDs.
(d) Environmental or vehicle modifications, defined as alterations to your residence or vehicle that are necessary to accommodate your disability and promote your functional independence, health, safety, and/or welfare.
(i) Environmental modifications cannot be adaptations or improvements that are of general utility or merely add to the total square footage of the home.
(ii) Vehicles subject to modification must be owned by you or a member of your family who resides with you; must be in good working condition, licensed, and insured according to Washington state law; and be cost effective when compared to available alternative transportation.
(e) Training and educational supports, defined as supports beyond the scope of medicaid state plan services that are necessary to promote your health and ability to live and participate in the community and maintains, slows decline, or improves functioning and adaptive skills. Examples include:
(i) Training or education on your health issues, or personal skill development;
(ii) Training or education to paid or unpaid caregivers related to your needs.
(5) You may receive comprehensive adult dental services as defined in WAC 388-106-0300
(15) through December 31, 2013. The cost of the dental services will not be deducted from your individual budget.
[Statutory Authority: RCW 74.08.090
and 74.09.520. WSR 13-18-039 and 13-17-125, § 388-106-1400, filed 8/29/13 and 8/21/13, effective 10/1/13; WSR 10-08-074, § 388-106-1400, filed 4/6/10, effective 5/7/10. Statutory Authority: RCW 74.08.090
, 74.09.520, 74.39A.030. WSR 06-16-035, § 388-106-1400, filed 7/25/06, effective 8/25/06.]