Original Notice.

Preproposal statement of inquiry was filed as WSR 01-04-069.

Title of Rule: Chapter 388-448 WAC, Incapacity.

Purpose: To clarify treatment and referral requirements for general assistance unemployable recipients and remove ambiguity from the language in related incapacity rules.

Statutory Authority for Adoption: RCW 74.08.090, 74.04.050, 74.04.055, 74.04.057, 74.04.510.

Statute Being Implemented: Chapters 74.08 and 74.04 RCW.

Summary: These changes are being made to clarify treatment and referral requirements, and to make the related rules more clear.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Carla Gira, Program Manager, Lacey Government Center, 1009 College Street S.E., Lacey, WA 98503, (360) 413-3264.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: These rules will provide information and guidelines regarding the administration of the general assistance unemployable program (incapacity) in the state of Washington.

Proposal Changes the Following Existing Rules: Clarifies treatment and referral requirements for GAU recipients. All changes are intended to make the rules more clear and understandable.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule does not impact small business.

RCW 34.05.328 applies to this rule adoption. The rule meets the definition of a "significant legislative rule" but DSHS is exempt from preparing a cost benefit analysis under RCW 34.05.328(5)(b)(vii).

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on June 26, 2001, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Kelly Cooper, DSHS Rules Coordinator, by June 19, 2001, phone (360) 664-6094, TTY (360) 664-6178, e-mail coopeKD@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by June 26, 2001.

Date of Intended Adoption: No sooner than June 27, 2001.

May 17, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

We accept medical evidence from the sources listed below:

(1) For a physical impairment, we only accept reports from the following licensed medical professionals as primary evidence:

(a) A physician;

(b) An advanced registered nurse practitioner (ARNP) in the ARNP's area of certification;

(c) The chief of medical administration of the Veterans' Administration, or their designee, as authorized in federal law; or

(d) A physician assistant when the report is co-signed by the supervising physician.

(2) For a mental impairment, we only accept reports from one of the following licensed professionals as primary evidence:

(a) A psychiatrist;

(b) A psychologist;

(c) An advanced registered nurse practitioner when certified in psychiatric nursing;

(d) A person who provides mental health services in a community mental health services ((setting)) agency and meets the minimum mental health practitioner qualifications set by ((the local community mental health agency)) them, which consist of having a ((Master of Arts (MA))) Master's degree and two years experience; or

(e) The physician who is currently treating you for a mental disorder.

(3) "Supplemental medical evidence" means a report from a practitioner that can be used to support medical evidence given by any of the practitioners listed in subsections (1) and (2) of this section. We accept as supplemental medical evidence reports from:

(a) A practitioner who is providing on-going treatment to you, such as a chiropractor, nurse, physician assistant; or

(b) ((DSHS)) State institutions and agencies that are providing or have provided services to you.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0020, filed 8/2/00, effective 9/1/00.]

(a) Musculo-skeletal,

(b) Special senses and speech,

(c) Respiratory,

(d) Cardiovascular,

(e) Digestive,

(f) Genito-urinary,

(g) Hemic and lymphatic,

(h) Skin,

(i) Endocrine and obesity,

(j) Neurological,

(k) Mental disorders,

(l) Neoplastic, and

(((l))) (m) Immune systems.

(2) We follow these rules when there are multiple impairments:

(a) We group each diagnosis by body system.

(b) When you have two or more diagnosed impairments that limit work activities, we assign an overall severity rating as follows:

Your Condition	Severity Rating
(i) All impairments are in the same body system, are rated two and there is no cumulative effect on basic work activities.	2
(ii) All impairments are in the same body system, are rated two and there is a cumulative effect on basic work activities. (iii) All impairments are in different body systems, are rated two and there is a cumulative effect on basic work activities.	3
(iv) Two or more impairments are in different body systems and are rated three. (v) Two or more impairments are in different body systems; one is rated three and one is rated four.	4
(vi) Two or more impairments in different body systems are rated four.	5

(c) We deny incapacity when the overall severity rating is two.

(d) We approve incapacity when the overall severity rating is five.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0070, filed 8/2/00, effective 9/1/00.]

(1) ((Thirty-six months when we decide it is evident you meet federal disability criteria to receive Social Security Supplemental Security Income (SSI))) If you are eligible for GAU, a maximum of twelve months; or

(2) ((Twelve months)) If we decide you are eligible for general assistance expedited Medicaid (GAX), a maximum of thirty-six months from the date of the latest incapacity approval.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0120, filed 8/2/00, effective 9/1/00.]

(1) When you are first approved and at each review determination, we give you written information regarding your treatment requirements ((when you are initially approved, and at each redetermination)).

(2) You must accept and follow through on required medical treatment and referrals to other agencies and services, including applying for SSI, unless you have ((a convincing reason)) good cause for not doing so. Examples of good cause are found in WAC 388-448-0140.

(3) ((If your basic claim of incapacity is alcoholism or drug dependency, we refer you for evaluation under the alcoholism and drug addiction treatment and support act (ADATSA).

(4))) We may require you to undergo alcohol or drug treatment before ((re-evaluating)) reviewing your eligibility for GAU.

(((5))) (4) You may request a fair hearing if you disagree with the treatment or referral requirements we set for you. If you request a fair hearing ((we will not reduce or stop your benefits as a result of your refusal to follow the requirement)) before we stop your benefits, you may ask to have your benefits continued until ((the)) there is a fair hearing ((is decided)) decision. If the hearing upholds our decision to stop your benefits, you will have to repay any continued benefits.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0130, filed 8/2/00, effective 9/1/00.]

(1) Valid reasons for refusing treatment referrals:

(a) You are so fearful of the treatment that your fear could interfere with the treatment or reduce its benefits;

(b) Treatment could cause further limitations or loss of a function or an organ and you are not willing to take that risk;

(c) You practice an organized religion that prohibits treatment; or

(d) For treatment ((is)) not ((available without cost to you)) provided through medical care services:

(i) Rates are not set on a sliding fee scale; or

(ii) Rates are on a sliding fee scale but exceed five dollars per month.

(2) Valid reasons for refusing treatment or other agency referrals:

(a) ((You)) We did not ((have)) give you enough information ((on)) about the requirement;

(b) You did not receive written notice of the requirement;

(((b))) (c) The requirement was made in error;

(((c))) (d) You are temporarily unable to participate because of documented interference, or

(((d))) (e) Your medical condition or limitations are consistent with the definition of necessary supplemental accommodation (NSA), WAC ((388-200-1300)), 388-472-0020 and your condition or limitations contributed to your refusal , per WAC 388-472-0050.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0140, filed 8/2/00, effective 9/1/00.]

Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.
AMENDATORY SECTION(Amending WSR 00-16-113, filed 8/2/00, effective 9/1/00)

WAC 388-448-0180   How and when we redetermine your eligibility if ((it is evident you meet federal disability criteria for SSI)) we decide you are eligible for GAX.   When we decide you are eligible for GAX, we may extend your incapacity period up to thirty-six months from the date of the last ((date of)) incapacity ((determination)) decision without requesting additional medical documentation ((when it is evident that you meet federal disability criteria for Supplemental Security Income (SSI) eligibility)).

(1) If you remain on GAX at the end of the thirty-six-month period, we determine your eligibility ((at the end of the thirty-six-month period,)) using current medical evidence.

(2) If ((you applied)) your application for SSI((, were)) is denied, and the denial ((was)) is upheld by an SSI/SSA administrative ((appeal)) hearing before the end of the thirty-six-month incapacity period, we change your program eligibility from GAX to GAU and adjust the incapacity ((period)) review date to be sixty days after the ((SSI denial)) administrative hearing date.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0180, filed 8/2/00, effective 9/1/00.]

(1) Apply for SSI ((and)), follow through with your application, and do not withdraw your application;

(2) Agree to assign the initial or reinstated SSI payment to DSHS as provided under WAC 388-448-0210; and

(3) Are otherwise eligible according to WAC 388-400-0025.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 00-16-113, 388-448-0200, filed 8/2/00, effective 9/1/00.]

Washington State Code Reviser's Office