Date of Adoption: July 5, 2001.

     Purpose: The department is establishing a new section for rules pertaining to the first steps childcare program, WAC 388-533-1000. The program pays for childcare provided to children of pregnant or postpartum women while they attend appointments for outpatient medical assistance administration-covered services and at time of delivery. It also pays for childcare provided to children of eligible clients who require bedrest, or are visiting their newborns in a neonatal intensive care unit (NICU). The program's overall goal is to reduce barriers for low-income women so that they may receive prenatal care that will lead to improved birth outcomes.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.800.

      Adopted under notice filed as WSR 01-11-097 on May 18, 2001.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

July 5, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     (1) For the purposes of this section, the following terms and definitions apply:

     (a) "Postpregnancy" or "postpartum" means the period of time after the pregnancy ends (includes live birth, still birth, miscarriage or pregnancy termination), through the end of the month that includes the sixtieth day from the end of the pregnancy; and

     (b) "Background check central unit (BCCU)" means the centralized unit established by the department of social and health services (DSHS) that performs background checks as directed by the Washington state legislature.

     (2) First Steps childcare is available for the children of either a managed care or fee-for-service client. Subject to the restrictions and limitations listed in this section, a client is eligible to receive First Steps childcare for her children if she:

     (a) Meets one of the following criteria:

     (i) Is pregnant; or

     (ii) Is within the postpregnancy period.

     (b) Is currently eligible under one of the following programs:

     (i) Categorically needy program (CNP);

     (ii) CNP - emergency medical only;

     (iii) Children's health insurance program (CHIP); or

     (iv) Children's health.

     (c) Requires one or more of the covered services listed in subsection (4) and (5) of this section;

     (d) Demonstrates a need for childcare; and

     (e) Shows that no other childcare resources are available.

     (3) The following persons are eligible to authorize First Steps childcare, subject to the restrictions and limitations in this chapter and other published WAC:

     (a) Maternity support services (MSS) professional/paraprofessional agency staff members. See WAC 388-533-0300 (3) and (7);

     (b) Maternity case management (MCM) providers. See WAC 388-533-0350;

     (c) Community services office (CSO) social workers or designated staff members; and

     (d) Other MAA-designated professional/paraprofessional persons.

     (4) First Steps childcare may be authorized for a client's children during the client's pregnancy or postpregnancy period when the client pursues any of the following covered services for herself or her newborn children:

     (a) Childbirth education classes;

     (b) Delivery/birth (during the mother's hospitalization);

     (c) Dental care;

     (d) Hospital procedures;

     (e) Laboratory tests;

     (f) Maternity case management (MCM) visits;

     (g) Maternity support services (MSS) visits, including nursing, social work, nutrition, and community health worker visits; and

     (h) Medical visits.

     (5) First Steps childcare authorized for a client's children for the following special needs requires approval by the MAA First Steps childcare coordinator or designee prior to providing the childcare (see subsection (6) of this section for the prior approval process):

     (a) Bedrest for the pregnant client; or

     (b) The newborn(s) is in a neonatal intensive care unit (NICU) and the parent(s) is visiting the NICU.

     (6) The prior approval process for a request for First Steps childcare for either of the reasons stated in subsection (5) of this section is as follows:

     (a) The authorizer completes appropriate sections of the DSHS 14-316(X) form and submits the form to the MAA First Steps childcare coordinator or designee.

     (i) If the reason for the request is for bedrest for the pregnant client, the authorizer documents in the client's file that the prenatal caregiver has verified that bedrest is necessary; or

     (ii) If the reason for the request is to enable a parent(s) to visit the newborn(s) in a NICU, the authorizer documents in the client's file that hospital staff has verified the parent(s) is visiting the newborn(s) regularly.

     (b) The MAA First Steps childcare coordinator or designee:

     (i) Approves the special needs request and signs and dates the form in the appropriate section and returns the form to the authorizer; or

     (ii) Informs the authorizer in writing if the request is denied and payment will not be made.

     (7) MAA reimburses for authorized First Steps childcare when provided by any of the following, subject to the limitations and restrictions listed:

     (a) A licensed childcare home, center, facility, or foster home; and

     (b) A friend, neighbor, or relative, other than those listed in subsection (8) of this section, who is unlicensed and:

     (i) Has qualified based on a background check conducted prior to providing the childcare (see subsection (9) of this section for information on the background check process);

     (ii) Is eighteen years of age or older; and

     (iii) Has a valid social security number; or

     (iv) Is authorized to work in the United States.

     (8) The following individuals are not eligible to provide First Steps childcare:

     (a) The spouse of the client;

     (b) The partner of the client;

     (c) The father of the baby, babies, or unborn(s);

     (d) An unlicensed childcare provider:

     (i) Whose background check is pending; or

     (ii) Who was disqualified due to the background check; and

     (e) Any person under age eighteen.

     (9) Each unlicensed individual childcare provider who a client designates to be a First Steps childcare provider is subject to a background check under RCW 43.20A.710 and 74.15.030. First Steps childcare will not be authorized by the MSS or MCM agency or CSO, or reimbursed by MAA, until MAA's background check has been completed on the unlicensed childcare provider. Each unlicensed First Steps childcare provider is subject to a new background check every two years from the date of the first background check.

     (a) MAA's background check process includes all of the following:

     (i) The unlicensed childcare provider completes and signs the First Steps childcare background check form and returns it to the MSS or MCM agency or CSO, or sends it directly to the department's background check central unit (BCCU). The childcare provider's signature on the First Steps childcare background check form authorizes the department's BCCU to perform the background check.

     (ii) BCCU performs a background check on the individual.

     (iii) BCCU provides the appropriate MSS or MCM agency or CSO with the results of the background check.

     (iv) For cases needing further review, BCCU notifies MAA and MAA:

     (A) Follows the criteria described in this subsection to determine if the individual is approved or disqualified to provide First Steps childcare; and

     (B) Notifies the MSS or MCM agency or CSO, in writing, of the decision.

     (v) The MSS or MCM agency or CSO notifies the client, in writing, of the results of the designated childcare provider's background check.

     (b) The department conducts the background check and may include a review of:

     (i) Records of criminal convictions and pending criminal charges as listed by the Washington state patrol (WSP);

     (ii) Department findings of abuse, neglect, and/or exploitation to children of vulnerable adults; and

     (iii) Disciplinary board final decisions.

     (c) The department's background check may include a review of law enforcement records of convictions and pending charges in other states or locations when the need for further information is indicated by:

     (i) A person's prior residences;

     (ii) Reports from credible community sources; or

     (iii) An identification number indicating the subject has a record on file with the Federal Bureau of Investigation.

     (d) For the purpose of conducting criminal history portions of background checks as required by chapters 43.20A and 74.15 RCW, the department:

     (i) Considers only a person's convictions and pending charges; and

     (ii) Does not solicit or use as the sole basis for disqualification, information about:

     (A) Arrests not resulting in charges; and

     (B) Dismissed charges.

     (e) The department maintains a listing of offenses which, because of their seriousness, automatically disqualifies prospective childcare providers from being authorized to provide First Steps childcare to children of eligible clients. See chapter 388-06 WAC for categories of offenses or, if jurisdiction is outside of the state of Washington, their equivalents.

     (f) If a criminal history check reveals a designated First Steps childcare provider has been charged with or convicted of an offense, or is found to have abused, neglected or exploited children of vulnerable adults, MAA takes the following actions:

     (i) If the check reveals charges are pending against the subject for any of the offenses listed in chapter 388-06 WAC, or their equivalents in other jurisdictions, MAA withholds approval to provide First Steps childcare until dismissal or acquittal occurs. Pending charges for other offenses may be grounds for withholding approval to provide childcare;

     (ii) If the check reveals the subject has been convicted of any the offenses listed in chapter 388-06 WAC, or their equivalents in other jurisdictions, MAA informs the MSS or MSM agency or CSO that the individual is not approved to provide First Steps childcare;

     (iii) If the check reveals the subject has been convicted of an offense not listed in a category in chapter 388-06 WAC, MAA considers such information in determining the character, suitability, and competence of the prospective caretaker as required by chapter 74.15 RCW. MAA will not use the conviction as the sole basis for not approving the person to provide First Steps childcare unless the conviction is directly related to the authorization being sought. MAA does consider the following factors:

     (A) The seriousness and circumstances of the illegal act;

     (B) The number of crimes for which the person was convicted;

     (C) The amount of time passed since the illegal act was committed;

     (D) The age of the person at the time of conviction;

     (E) The behavior of the person since the illegal act was committed;

     (F) Recommendations of persons closely associated with the person; and

     (G) The vulnerability of the persons under care.

     (g) MAA keeps confidential any nonconviction background information provided by BCCU. (Conviction history is not confidential.)

     (h) The department may provide disqualified individuals with background check findings about themselves at the individual's written request.

     (10) A client who does not agree with a department decision regarding First Steps childcare program services has a right to a fair hearing under chapter 388-02 WAC. After receiving a request for a fair hearing, MAA may request additional information from the client or the department. After MAA reviews the available information, the result may be:

     (a) A reversal of the initial department decision;

     (b) Resolution of the client's issue(s); or

     (c) A fair hearing conducted per chapter 388-02 WAC.

     (11) To be reimbursed, authorized First Steps childcare providers must submit claims for payment to MAA within ninety calendar days of the first date the childcare is provided. The childcare provider also must provide a W-9 form. The client receives the billing form and W-9 form from the authorizer listed in subsection (3) of this section, and gives the forms to the designated childcare provider.

     (a) First Steps childcare billing form DSHS 14-316(X):

     (i) Sections IV and V must be completed by the childcare provider and signed and dated (sections I, II, and if applicable, III, are completed by the authorizer).

     (ii) The childcare provider mails the original completed form to MAA, or gives it to the client and the client gives the form to the authorizer, who submits it to MAA.

     (b) W-9: The childcare provider completes and mails the original W-9 form to MAA, or gives the completed original to the client and the client gives it to the authorizer, who submits it to MAA. (An original W-9 is completed only once for MAA files unless the information changes.)

     (12) MAA sets reimbursement for First Steps childcare services at a maximum dollar amount per hour from legislatively appropriated funds. Reimbursement is subject to any exceptions, restrictions, or other limitations listed in this section and other published WAC. MAA pays the childcare provider directly for First Steps childcare services when the client and the client's designated First Steps childcare provider meet all the criteria in this section.

     (13) MAA reimburses MSS agencies for the time spent authorizing childcare through the First Steps childcare program if the client is not receiving MCM services. MAA reimburses once per client, per pregnancy/postpregnancy period, when childcare is authorized.

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