PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Effective Date of Rule: June 1, 2007.
Purpose: The purpose of these new rules in chapter 388-828 WAC is to govern and support the administration of the division's newly developed, computer-based assessment tool that is designed to measure the support needs of clients for service determination. The DDD assessment will replace existing paper-based methods resulting in a universal assessment and support planning process. The purpose of the DDD assessment is to provide a comprehensive assessment process that: (1) Collects a common set of assessment information for reporting purposes to the legislature and the department; (2) promotes consistency and accuracy in evaluating client support needs for purposes of planning, budgeting, and resource management; (3) identifies a level of service and/or number of care hours that is used to support the assessed needs of clients who have been authorized to receive Medicaid/waiver personal care, waiver respite care, and/or voluntary placement program services; and (4) records clients' service requests.
Statutory Authority for Adoption: RCW 71A.12.030.
Other Authority: Title 71A RCW.
Adopted under notice filed as WSR 07-03-158 on January 23, 2007.
Changes Other than Editing from Proposed to Adopted Version: There have been no changes other than minor editing to improve clarity in the proposed rule.
(Strikeouts indicate words deleted from proposed rules. Underlines indicate words added to proposed rules.)
(1) You have not identified a person willing to receive notice or correspondence on your behalf regarding specific DDD decisions as required per RCW 71A.10.060 and DDD does not believe you are capable of understanding department decisions that may affect your care (see WAC 388-828-1140); or
(2) A respondent cannot be identified to participate in your DDD Assessment (see WAC 388-828-1540(c));
If there is no one available to receive notice or correspondence on your behalf regarding specific DDD decisions, DDD will do all of the following:
(2) You or your legal guardian has have not identified an
ADSA contracted provider.
If you are unable to identify an ADSA contracted provider, DDD will provide you or your legal guardian with contact information for ADSA contracted agency providers.
DDD intends to assess all clients per WAC 388-828-1100 by
June 30, 2008 based on available resources.
(4) You are not receiving a paid service and You are
approved for funding of a DDD paid service and an assessment
must be performed prior to the authorization of services;
(8) Private Duty Nursing services per chapter 388-106551
WAC; or
A final cost-benefit analysis is available by contacting Mark R. Eliason, P.O. Box 45310, Lacey, WA 98504-5310, phone (360) 725-2517, fax (360) 407-0995, e-mail eliasmr@dshs.wa.gov.
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 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 126, 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 126, Amended 0, Repealed 0.
Date Adopted: April 23, 2007.
Blake D. Chard
for Robin Arnold-Williams
Secretary
3788.7The Division of Developmental Disabilities (DDD) Assessment
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Definitions"AAIDD" means the American Association on Intellectual and Developmental Disabilities.
"Acuity Scale" refers to an assessment tool that is intended to provide a framework for documenting important assessment elements and for standardizing the key questions that should be asked as part of a professional assessment. The design helps provide consistency from client to client by minimizing subjective bias and assists in promoting objective assessment of a person's support needs.
"ADSA" means the aging and disability services administration (ADSA), an administration within the department of social and health services, which includes the following divisions: home and community services, residential care services, management services and division of developmental disabilities.
"ADSA contracted provider" means an individual or agency who is licensed, certified, and/or contracted by ADSA to provide services to DDD clients.
"Adult Family Home" or "AFH" means a residential home in which a person or persons provide personal care, special care, room and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the services (see RCW 70.12.010).
"Agency provider" means a licensed and/or ADSA certified business who is contracted with ADSA or a county to provide DDD services (e.g., personal care, respite care, residential services, therapy, nursing, employment, etc.).
"Algorithm" means a numerical formula used by the DDD Assessment for one or more of the following:
(1) Calculation of assessed information to identify a client's relative level of need;
(2) Determination regarding which assessment modules a client receives as part of his/her DDD assessment; and
(3) Assignment of a service level to support a client's assessed need.
"Authorization" means DDD approval of funding for a service as identified in the Individual Support Plan or evidence of payment for a service.
"CARE" refers to the Comprehensive Assessment Reporting Evaluation assessment per chapter 388-106 WAC.
"Client" means a person who has a developmental disability as defined in RCW 71A.10.020(3) who also has been determined eligible to receive services by the division under chapter 71A.16 RCW.
"Collateral contact" means a person or agency that is involved in the client's life (e.g., legal guardian, family member, care provider, friend, etc.).
"Companion home" is a DDD contracted residential service that provides twenty-four hour training, support, and supervision, to one adult living with a paid provider.
"DDD" means the division of developmental disabilities, a division with the aging and disability services administration (ADSA), department of social and health services (DSHS).
"Department" means the department of social and health services (DSHS).
"Group home" or "GH" means a ADSA licensed adult family home or boarding home contracted and certified by ADSA to provide residential services and support to adults with developmental disabilities.
"ICF/MR" means a facility certified as an intermediate care facility for the mentally retarded to provide habilitation services to DDD clients.
"ICF/MR Level of Care" is a standardized assessment of a client's need for ICF/MR Level of Care per 42 CFR 440 and 42 CFR 483. In addition, ICF/MR Level of Care refers to one of the standards used by DDD to determine whether a client meets minimum eligibility criteria for one of the DDD HCBS waivers.
"Individual Support Plan" or "ISP" is a document that authorizes and identifies the DDD paid services to meet a client's assessed needs.
"Legal Guardian" means a person/agency, appointed by a court, who is authorized to make some or all decisions for a person determined by the court to be incapacitated. In the absence of court intervention, parents remain the legal guardians for their child until the child reaches the age of eighteen.
"LOC score" means a score for answers to questions in the Support Needs Assessment for Children that are used in determining if a client meets eligibility requirements for ICF/MR Level of Care.
"Modules" refers to three sections of the DDD Assessment. They are: the Support Assessment, the Service Level Assessment, and the Individual Support Plan (ISP).
"Panel" refers to the visual user-interface in the DDD Assessment computer application where assessment questions are typically organized by topic and you and your respondents' answers are recorded.
"Plan of Care" or "POC" refers to the paper-based assessment and service plan for clients receiving services on one of the DDD HCBS waivers prior to June 1, 2007.
"Raw Score" means the numerical value when adding a person's "Frequency of Support," "Daily Support Time," and "Type of Support" scores for each activity in the support needs and supplemental protection and advocacy scales of the Supports Intensity Scale (SIS) Assessment.
"Residential Habilitation Center" or "RHC" is a state-operated facility certified to provide ICF/MR and/or nursing facility level of care for persons with developmental disabilities per chapter 71A.20 RCW.
"Respondent" means the adult client and/or another person familiar with the client who participates in the client's DDD Assessment by answering questions and providing information. Respondents may include ADSA contracted providers.
"SIS" means the Supports Intensity Scale developed by the American Association of Intellectual and Developmental Disabilities (AAIDD). The SIS is in the Support Assessment module of the DDD Assessment.
"Service Provider" refers to an ADSA contracted agency or person who provides services to DDD clients. Also refers to state operated living alternative programs (SOLA).
"SOLA" means a state operated living alternative program for adults that is operated by DDD.
"State supplementary payment" or "SSP" is the state paid cash assistance program for certain DDD eligible Social Security Income clients per chapter 388-827 WAC.
"Supported living" or "SL" refers to residential services provided by ADSA certified residential agencies to clients living in homes that are owned, rented, or leased by the clients or their legal representatives.
"Waiver personal care" means physical or verbal assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL) due to your functional limitations per chapter 388-106 WAC to individuals who are authorized to receive services available in the Basic, Basic Plus, and Core waivers per chapter 388-845 WAC.
"Waiver respite care" means short-term intermittent relief for persons normally providing care to individuals who are authorized to receive services available in the Basic, Basic Plus, and Core waivers per chapter 388-845 WAC.
"You/Your" means the client.
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Division of Developmental Disabilities Assessment(2) The DDD Assessment has three modules:
(a) The Support Assessment (see WAC 388-828-2000 to WAC 388-828-6020);
(b) The Service Level Assessment (see WAC 388-828-7000 to WAC 388-828-7080); and
(c) The Individual Support Plan (ISP) (see WAC 388-828-8000 to 388-828-8060).
(3) The DDD Assessment is part of the Aging and Disability Services Administration's (ADSA) Comprehensive Assessment Reporting Evaluation system (CARE).
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(1) Collects a common set of assessment information for reporting purposes to the legislature and the department.
(2) Promotes consistency in evaluating client support needs for purposes of planning, budgeting, and resource management.
(3) Identifies a level of service and/or number of hours that is used to support the assessed needs of clients who have been authorized by DDD to receive:
(a) Medicaid personal care services or DDD HCBS Waiver Personal Care per chapter 388-106 WAC;
(b) Waiver respite care services per chapter 388-845 WAC;
(c) Services in the Voluntary Placement Program (VPP) per chapter 388-826 WAC.
(4) Records your service requests.
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(1) You are currently approved by DDD to receive a DDD paid service evidenced by meeting one of the conditions in WAC 388-828-1440;
(2) You request enrollment in one of the DDD HCBS waivers per chapter 388-845 WAC;
(3) You are age three or older and request a DDD Assessment;
(4) You have been determined eligible for categorically needy medical coverage per WAC 388-475-0100 and requested one of the following Medicaid state plan services:
(a) You have requested an assessment for Medicaid personal care services per chapter 388-106 WAC; or
(b) You have been approved to receive Private Duty Nursing services for clients seventeen years of age and younger per WAC 388-551-3000.
(5) You are receiving SSP in lieu of a DDD paid service per chapter 388-827 WAC;
(6) You request admission to a RHC per title 42 CFR 440, title 42 CFR 483, and title 71A RCW;
(7) You reside in a RHC or community ICF/MR and you are involved in discharge planning for community placement;
(8) You do not meet any of the conditions listed in WAC 388-828-1120.
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(1) You have not identified a person willing to receive notice or correspondence on your behalf regarding specific DDD decisions as required per RCW 71A.10.060 and DDD does not believe you are capable of understanding department decisions that may affect your care (See WAC 388-828-1140); or
(2) A respondent cannot be identified to participate in your DDD Assessment (See WAC 388-828-1540(c));
(3) You reside in a RHC and are not currently involved in discharge planning for community placement;
(4) You reside in a community ICF/MR and are not authorized by DDD to receive employment/community services paid through the counties; or
(5) You are under the age of three and do not meet any of the conditions in WAC 388-828-1100.
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(1) Consult with the Assistant Attorney General to determine if:
(a) You are able to represent yourself; or
(b) You require a legal representative/guardian.
(2) Continue current services until the issue is resolved per section (1) above.
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(2) Only clients receiving a DDD paid service, SSP in lieu of a DDD paid service, or who are approved for a DDD paid service will receive the Service Level Assessment and Individual Support Plan modules since these modules are required:
(a) Prior to the authorization/reauthorization of a DDD paid service or SSP; and
(b) To determine a service level and/or number of hours for a service; and
(c) To authorize the DDD approved paid service(s) per WAC 388-828-8000.
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(1) Provide information and referral for Non-DDD community-based supports; and
(2) Add your name to the waiver data base, if you have requested enrollment in a DDD HCBS waiver per chapter 388-845 WAC; and
(3) Authorize short-term emergency services as an exception-to-rule (ETR) per WAC 388-440-0001.
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(1) You are age seventeen or younger; and
(2) Your family has not made a request for your admission to a Residential Habilitation Center (RHC).
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(1) Ask if you would like referral information for ICF/MR services; and
(2) Continue to administer your DDD Assessment; and
(3) Continue to authorize the DDD paid services or SSP you are receiving at the time of your DDD Assessment if you continue to meet the eligibility requirements for those services.
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(1) Explain what happens if you refuse to allow DDD to administer the DDD Assessment to you, your respondents, and the person you have identified to receive notice on your behalf per RCW 71A.10.060.
(2) Consult with the Assistant Attorney General when you have not identified a person to receive notice on your behalf per RCW 71A.10.060 to determine if:
(a) You are able to represent yourself; or
(b) You require a legal representative/guardian.
(3) Terminate existing DDD paid services when they reach their authorized end date.
(4) Provide you notice and appeal rights for denied and/or terminated service(s) per WAC 388-825-100 and WAC 388-825-120.
(5) Provide you with information on how to contact DDD in case you later decide you want a DDD Assessment administered.
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(2) DDD will complete your DDD Assessment no later than thirty days from the date it was created in CARE.
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(1) You are approved to receive a DDD paid service; and
(2) You or your legal guardian has not identified an ADSA contracted provider.
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(1) An open social service payment system (SSPS) authorization within the past ninety days used for payment of a service or SSP; or
(2) A current county service authorization for one of the following services:
(a) Person to Person; or
(b) Individual Employment; or
(c) Group Supported Employment; or
(d) Pre-vocational/Specialized Industries; or
(e) Community Access; or
(f) Individual and Family Assistance.
(3) A current waiver POC or waiver ISP; or
(4) Residence in a State Operated Living Alternative (SOLA) program; or
(5) Authorization of Family Support services within the last twelve months per chapter 388-825 WAC; or
(6) Documentation of DDD approval of your absence from DDD paid services for more than ninety days with available funding for your planned return to services; or
(7) Evidence of approval for funding of a DDD service or enrollment in a DDD HCBS waiver; or
(8) Payment of services using Form A-19 State of Washington Invoice Voucher for receipt of:
(a) Dangerous Mentally Ill Offender funds
(b) Crisis stabilization services;
(c) Specialized psychiatric services; or
(d) Diversion bed services.
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(1) You are receiving a DDD paid service and your annual reassessment is due for continuation of the DDD paid service; or
(2) You are receiving a DDD paid service and a reassessment is needed due to a significant change that may affect your support needs; or
(3) You are receiving SSP in lieu of a DDD paid service and your eligibility for SSP needs to be re-determined per WAC 388-827-0120;
(4) You are approved for funding of a DDD paid service and an assessment must be performed prior to the authorization of services; or
(5) You make a request to have a DDD Assessment administered and meet the criteria in WAC 388-828-1100; or
(6) You are contacted by DDD and offered an opportunity to have a DDD Assessment.
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(1) Funding from the legislature that provides resources for services to be available by a certain date;
(2) The annual reallocation of dollars for Traditional Family Support in June 2007; or
(3) Emergency services as determined by DDD as critical to the client's health and safety.
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(1) On an annual basis if you are receiving a paid service or SSP; or
(2) When a significant change is reported that may affect your need for support. (e.g. changes in your medical condition, caregiver status, behavior, living situation, employment status).
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(2) DDD requires that at a minimum: you, one of your respondents, and your DDD case resource manager/social worker participate in your DDD Assessment interview. In addition:
(a) If you are under the age of eighteen, your parent(s) or legal guardian(s) must participate in your DDD Assessment interview.
(b) If you are age eighteen or older, your court appointed legal representative/guardian must be consulted if he/she does not attend your DDD Assessment interview.
(c) If you are age eighteen and older and have no legal representative/guardian, DDD will assist you to identify a respondent.
(d) DDD may require additional respondents to participate in your DDD Assessment interview, if needed, to obtain complete and accurate information.
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(1) The legislature has directed DDD to assess all eligible clients with a common, standardized assessment process that measures the support needs of individuals with developmental disabilities.
(2) The DDD Assessment algorithms in the Support Assessment module are designed to:
(a) Determine acuity scores and acuity levels for a variety client needs; and
(b) Provide a valid measure of each client's support needs relative to the support needs of other clients who have received the DDD Assessment.
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(1) Explain what happens if you refuse to answer a question on a mandatory panel to you, your respondents, and the person you have identified to receive notice on your behalf per RCW 71A.10.060.
(2) Consult with the Assistant Attorney General when you have not identified a person to receive notice on your behalf per RCW 71A.10.060 to determine if:
(a) You are able to represent yourself; or
(b) You require a legal representative/guardian.
(3) Terminate existing DDD paid services when they reach their authorized end date;
(4) Provide you notice and appeal rights for denied and/or terminated service(s) per WAC 388-825-100 and WAC 388-825-120; and
(5) Provide you with information on how to contact DDD in case you later decide you want a DDD Assessment administered.
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| If you are approved by DDD to receive: | Your client group is: |
| (1) DDD DCBS Waiver services per chapter 388-845 WAC; or (2) State-only residential services per chapter 388-825 WAC; or (3) ICF/MR services per 42 CFR 440 and 42 CFR 483. |
Waiver and State-Only Residential |
| (4) Medicaid personal care (MPC) per chapter 388-106 WAC; or (5) DDD HCBS Basic, Basic Plus, or Core Waiver services per chapter 388-845 WAC and Personal Care services per chapter 388-106 WAC; or (6) Medically Intensive Health Care Program services per chapter 388-551 WAC; or (7) Adult Day Health services per chapter 388-106 WAC; or (8) Private Duty Nursing services per chapter 388-106 WAC; or (9) Community Options Program Entry System (COPES) services per chapter 388-106 WAC; or (10) Medically Needy Residential waiver services per chapter 388-106 WAC; or (11) Medicaid Nursing Facility Care services per chapter 388-106 WAC. |
Other Medicaid Paid Services |
| (12) County Employment services per chapter 388-850 WAC. (13) Other DDD paid services per chapter 388-825 WAC, such as: (a) Family support services; or (b) Professional services. (14) Non-waiver voluntary placement program services per chapter 388-826 WAC; (15) SSP only per chapter 388-827 WAC; |
State-Only Paid Services |
| (16) You are not approved to receive any DDD paid services. | No Paid Services |
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(1) DDD "Assessment Main" and Client Details Information
| Client Group | ||||
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State Only Paid Services |
| Assessment Main | X | X | X | X |
| Demographics | X | X | X | X |
| Overview | X | X | X | X |
| Addresses | X | X | X | X |
| Collateral Contacts | X | X | X | X |
| Financials | X | X | X | X |
| Client Group | ||||
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State-Only Paid Services |
| Home Living | X | X | X | X |
| Community Living | X | X | X | X |
| Lifelong Learning | X | X | X | X |
| Employment | X | X | X | X |
| Health & Safety | X | X | X | X |
| Social Activities | X | X | X | X |
| Protection & Advocacy | X | X | X | X |
| Client Group | ||||
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State-Only Paid Services |
| Activities of Daily Living | X | X | X | X |
| IADLs (Instrumental Activities of Daily Living) | X | X | X | X |
| Family Supports | X | X | X | X |
| Peer Relationships | X | X | X | X |
| Safety & Interactions | X | X | X | X |
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State-Only Paid Services |
| Medical Supports | X | X | X | X |
| Behavioral Supports | X | X | X | X |
| Protective Supervision | X | X | X | X |
| DDD Caregiver Status* | X | X | X | X |
| Programs and Services | X | X | X | X |
| *Information on the DDD Caregiver Status panel is not mandatory for clients receiving paid services in an AFH, SL, GH, SOLA, or RHC. | ||||
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State-Only Paid Services |
| Environment | X | X | O | |
| Medical Main | O | X | O | |
| Medications | X | X | X | |
| Diagnosis | X | X | X | |
| Seizures | X | X | X | |
| Medication Management | X | X | X | |
| Treatments/programs | X | X | X | |
| ADH (Adult Day Health) | O | O | O | |
| Pain | X | X | X | |
| Indicators-Main | O | X | O | |
| Allergies | X | X | X | |
| Indicators/Hospital | X | X | X | |
| Foot | X | X | O | |
| Skin | X | X | O | |
| Skin Observation | O | O | O | |
| Vitals/Preventative | X | X | O | |
| Comments | O | O | O | |
| Communication-Main | O | X | O | |
| Speech/Hearing | O | X | O | |
| Psych/Social | O | X | O | |
| MMSE (Mini-Mental Status Exam) | O | X | O | |
| Memory | O | X | O | |
| Behavior | O | X | O | |
| Depression | O | X | O | |
| Suicide | O | O | O | |
| Sleep | O | O | O | |
| Relationships & Interests | O | O | O | |
| Decision Making | O | X | O | |
| Goals | X | O | O | |
| Legal Issues | O | O | O | |
| Alcohol | O | O | O | |
| Substance Abuse | O | O | O | |
| Tobacco | O | X | O | |
| Mobility Main | O | X | O | |
| Locomotion In Room | O | X | O | |
| Locomotion Outside Room | O | X | O | |
| Walk in Room | O | X | O | |
| Bed Mobility | O | X | O | |
| Transfers | O | X | O | |
| Falls | O | O | O | |
| Toileting-Main | O | X | O | |
| Bladder/Bowel | O | X | O | |
| Toilet Use | O | X | O | |
| Eating-Main | O | X | O | |
| Nutritional/Oral | O | X | O | |
| Eating | O | X | O | |
| Meal Preparation | O | X | O | |
| Hygiene-Main | O | X | O | |
| Bathing | O | X | O | |
| Dressing | O | X | O | |
| Personal Hygiene | O | X | O | |
| Household Tasks | O | X | O | |
| Transportation | O | X | O | |
| Essential Shopping | O | X | O | |
| Wood Supply | O | X | O | |
| Housework | O | X | O | |
| Finances | O | O | O | |
| Pet Care | O | O | O | |
| Functional Status | O | O | O | |
| Employment Support* | X* | X* | X* | |
| Mental Health | X | X | X | |
| DDD Sleep* | X* | O | O | |
| *Indicates that: (a) The "Employment Support" panel is mandatory only for clients age twenty-one and older who are on or being considered for one of the county services listed in WAC 388-828-1440(2). (b) The "DDD Sleep" panel is mandatory only for clients who are age eighteen or older and who are receiving: (i) DDD HCBS Core or Community Protection waiver services; or (ii) State-Only residential services. |
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Support Assessment Module
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(1) Collect a common set of assessment information that is scored for all persons who are eligible to receive a DDD Assessment per WAC 388-828-1100;
(2) Promote a consistent process to evaluate client support needs;
(3) Determine whether a person meets the ICF/MR level of care standard for potential waiver eligibility; and
(4) Identify the persons receiving, or approved for, DDD paid services or SSP who will need the additional two assessment modules:
(a) The Service Level Assessment module; and
(b) The Individual Support Plan module.
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(1) The Support Assessment for Children;
(2) The Supports Intensity Scale (SIS)Assessment;
(3) DDD Protective Supervision Acuity Scale;
(4) DDD Caregiver Status Acuity Scale;
(5) DDD Activities of Daily Living (ADL) Acuity Scale;
(6) DDD Behavioral Acuity Scale;
(7) DDD Medical Acuity Scale;
(8) DDD Interpersonal Support Acuity Scale;
(9) DDD Mobility Acuity Scale;
(10) DDD Respite Assessment; and
(11) Programs and Services component.
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| Components contained in the Support Assessment module | Age (0-15) |
Age (16+) |
| The Support Assessment for Children | Yes | No |
| SIS Support Needs and Supplemental Protection and Advocacy Scales | No | Yes |
| SIS Exceptional Medical and Behavior Support Needs Scales | Yes | Yes |
| DDD Protective Supervision Acuity Scale | Yes | Yes |
| DDD Caregiver Status Acuity Scale | Yes | Yes |
| DDD Activities of Daily Living Acuity Scale | Yes | Yes |
| DDD Behavioral Acuity Scale | Yes | Yes |
| DDD Medical Acuity Scale | Yes | Yes |
| DDD Interpersonal Support Acuity Scale | Yes | Yes |
| DDD Mobility Scale | Yes | Yes |
| Current Programs and Services component | Yes | Yes |
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The Support Assessment for Children
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(1) Your ICF/MR Level of Care score for DDD HCBS waiver eligibility;
(2) The health and welfare needs that must be addressed in your individual support plan if you are enrolled in a DDD HCBS waiver; and
(3) Your support need levels for:
(a) The DDD Activities of Daily Living Acuity Scale;
(b) The DDD Interpersonal Support Acuity Scale; and
(c) The DDD Mobility Acuity Scale.
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(1) Dress and groom self: What support does the child need to dress and groom self as expected of others of same age?
| Answers | Definitions | LOC Score | Acuity Score |
| Physical Assistance | Needs major support in the form of total physical assistance, intensive training and/or therapy for dressing and grooming. | 1 | 4 |
| Training | Needs moderate support in the form of some physical assistance and/or training and/or therapies to dress and groom self. | 0 | 3 |
| Reminders/Prompts | Needs reminders or prompts to dress and groom self appropriately. | 0 | 2 |
| No support needed or at age level | At age level (may have physical supports) in dressing and grooming. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs major support in the form of total physical support. Intensive training intervention and/or daily therapy to toilet self. | 1 | 4 |
| Partial physical assistance, training | Needs moderate support in the form of some physical assistance, standard training and/or regular therapy. | 0 | 3 |
| Reminders/prompts | Needs reminders or prompts. | 0 | 2 |
| No support needed or at age level | Toilets self or has physical support in place to toilet self. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs major support in the form of total physical assistance, intensive training and/or daily therapy. | 1 | 4 |
| Partial physical assistance, training | Needs moderate support in the form of some physical assistance, standard training, and/or regular therapy. | 1 | 3 |
| Reminders/prompts | Needs help with manners and appearance when eating, in the form of reminders and prompts. | 0 | 2 |
| No support needed or at age level | At age level (may have physical supports) in eating. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs major intervention in the form of total physical support to move around, intensive training and/or daily therapy. | 1 | 4 |
| Partial physical assistance, training | Needs moderate support such as someone's help to move around or may use or learn to use adaptive device or may require standard training. | 1 | 3 |
| Reminders/prompts | Needs mild intervention in the form of training and physical prompting for scooting/crawling/walking behaviors. | 0 | 2 |
| No support needed or at age level | No supports needed - child is scooting/crawling/walking at age level | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Currently someone else must always determine and communicate child's needs. | 1 | 4 |
| Training/therapy | With intensive training or therapy support, child may learn sufficient verbal and/or signing skills to make self easily understandable to others. May include partial physical support. | 1 | 3 |
| Adaptive device/interpreter | With physical support (adaptive device, interpreter), child is always able to communicate. | 0 | 2 |
| No support needed or at age level | No supports needed and/or at age level. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Child is not old enough to know about money. | 0 | 4 |
| Partial physical assistance, training | Family must devise special opportunities for child to earn/or spend money. | 0 | 3 |
| Create opportunities, reminders/prompts | Needs to learn about earning and/or spending money in typical age-level ways. | 0 | 2 |
| No support needed or at age level | Needs no support. Independently uses opportunities typical to his/her age group to earn and/or spend money. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs major support in the form of special and/or technical help to and from family/teachers to create opportunities for making choices and taking responsibility. | 1 | 4 |
| Partial physical assistance, training | Needs moderate support in the form of family/teachers creating and explaining a variety of opportunities for making choices and taking responsibility. | 1 | 3 |
| Create opportunities, reminders/prompts | Needs some support in the form of explanation of available options for making choices and taking responsibility. | 1 | 2 |
| No support needed or at age level | Needs no support. Readily uses a variety of opportunities to indicate choices (activity, food, etc.) and take responsibility for tasks, self, etc. | 0 | 0 |
| Answers | Definitions |