Washington State Register, Issue 16-12
| Jurisdiction | Washington |
| Library | Washington Register |
| Year | 2016 |
Washington State Register, Issue 16-12 WSR 16-12-022
[ 1 ] Permanent
WSR 16-12-010
PERMANENT RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Developmental Disabilities Administration)
[Filed May 19, 2016, 2:38 p.m., effective June 19, 2016]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The department is amending WAC 388-832-
0015 and repealing WAC 388-832-0085 due to the 2014
operating supplemental budget directing the developmental
disabilities administration to move the state funded individ-
ual and family services (IFS) program into a 1915(C) home
and community based services waiver. These changes will
reflect that the IFS program is closed to new entrants.
Citation of Existing Rules Affected by this Order:
Repealing WAC 388-832-0085; and amending WAC 388-
832-0015.
Statutory Authority for Adoption: RCW 71A.12.030,
71A.12.120.
Other Authority: ESSB 6002 2014 operating supplemen-
tal budget, SSB 6387 of the 63rd legislature, 2014 regular
session.
Adopted under notice filed as WSR 16-06-048 on Febru-
ary 24, 2016.
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Federal Statute: New 0, Amended 0, Repealed 0; Federal
Rules or Standards: New 0, Amended 0, Repealed 0; or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 1,
Repealed 1.
Number of Sections Adopted at Request of a Nongov-
ernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Ini-
tiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify,
Streamline, or Reform Agency Procedures: New 0, 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0, Repealed 0.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Making: New 0, Amended 0, Repealed 0; Pilot Rule Making:
New 0, Amended 0, Repealed 0; or Other Alternative Rule
Making: New 0, Amended 1, Repealed 1.
Date Adopted: May 18, 2016.
Katherine I. Vasquez
Rules Coordinator
AMENDATORY SECTION (Amending WSR 09-11-054,
filed 5/13/09, effective 6/13/09)
WAC 388-832-0015 Am I eligible for the IFS pro-
gram? (1) The IFS program and SSP in lieu of IFS is not
open to new enrollment.
(2) If you were enrolled in the IFS program before June
1, 2015 you are eligible to ((be considered for)) remain on the
IFS program if you meet the following criteria:
(a) You are currently an eligible client of ((DDD)) DDA;
(b) You live in your family home;
(c) You are not eligible to enroll((ed)) in a ((DDD))
DDA home and community based services waiver defined in
chapter 388-845 WAC;
(d) You are currently enrolled in ((traditional family sup-
port, family support opportunity or the family support pilot or
funding has been approved for you to receive IFS program
services)) the IFS program;
(e) You are age three or older;
(f) You have been assessed as having a need for IFS pro-
gram services as listed in WAC 388-832-0140; and
(g) You are not receiving a ((DDD)) DDA adult or child
residential service or licensed foster care.
(((2))) (3) If you are a parent who is a client of ((DDD))
DDA, you are eligible to ((receive)) remain on the IFS pro-
gram ((services)) in order to promote the integrity of the fam-
ily unit until your next assessment, provided:
(a) You meet the criteria in subsections (((1))) (2)(a)
through (f) ((above)) of this section; and
(b) Your minor child who lives in your home is at risk of
being placed up for adoption or into foster care.
REPEALER
The following section of the Washington Administrative
Code is repealed:
WAC 388-832-0085 When there is state funding available
to enroll additional clients on the IFS
program, how will DDD select from
the clients on the IFS program request
list?
WSR 16-12-022
PERMANENT RULES
HEALTH CARE AUTHORITY
(Washington Apple Health)
[Filed May 20, 2016, 12:54 p.m., effective June 20, 2016]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The agency is amending these rules to include
changes to broker requirements for transportation requests
made by tribes, changes to client responsibility in regards to
urgent care requests, changes to limitations on trips when a
client is discharged from an emergency department; and to
clarify the limitation in providing trips for additional off-site
mental health activities.
Citation of Existing Rules Affected by this Order:
Amending WAC 182-546-5000, 182-546-5100, 182-546-
5200, 182-546-5300, 182-546-5400, 182-546-5550, 182-
546-5700, and 182-546-6000.
Statutory Authority for Adoption: RCW 41.05.021,
41.05.160.
Adopted under notice filed as WSR 16-08-104 on April
5, 2016.
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 Nongov-
ernmental Entity: New 0, Amended 0, Repealed 0.
WSR 16-12-022 Washington State Register, Issue 16-12
Permanent [ 2 ]
Number of Sections Adopted on the Agency's Own Ini-
tiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify,
Streamline, or Reform Agency Procedures: New 0, Amended
8, 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 0, Amended 8, Repealed 0.
Date Adopted: May 20, 2016.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 15-03-050,
filed 1/14/15, effective 2/14/15)
WAC 182-546-5000 Nonemergency transportation—
General. (1) The medicaid agency covers nonemergency
nonambulance transportation to and from covered health care
services, as provided by the Code of Federal Regulations (42
C.F.R. 431.53 and 42 C.F.R. 440.170) subject to the limita-
tions and requirements under WAC 182-546-5000 through
182-546-6200. See WAC 182-546-1000 for nonemergency
ground ambulance transportation.
(2) The agency pays for nonemergency transportation
for clients covered under state-funded medical programs sub-
ject to funding appropriated by the legislature.
(3) Clients may not select the transportation provider or
the mode of transportation.
(4) A client's right to freedom of ((access to health care))
choice does not require the agency to cover transportation at
unusual or exceptional cost in order to meet a client's per-
sonal choice of provider.
AMENDATORY SECTION (Amending WSR 15-03-050,
filed 1/14/15, effective 2/14/15)
WAC 182-546-5100 Nonemergency transportation—
Definitions. The following definitions and those found in
chapter 182-500 WAC apply to nonemergency medical bro-
kered transportation. Unless otherwise defined in WAC 182-
546-5200 through 182-546-6000, medical terms are used as
commonly defined within the scope of professional medical
practice in the state of Washington.
"Ambulance" - See WAC 182-546-0001.
"Broker" - An organization or entity contracted with
the medicaid agency to arrange nonemergency transportation
services for clients.
"Drop off point" - The location authorized by the trans-
portation broker for the client's trip to end.
"Escort" - A person authorized by the transportation
broker to accompany and be transported with a client to a
health care service. An escort's transportation may be autho-
rized depending on the client's age, mental state or capacity,
safety requirements, mobility skills, communication skills, or
cultural issues.
"Extended stay" - A period of time spanning seven
consecutive days or longer for which a client receives health
care services outside of his or her local community and for
which he or she may request assistance with meals ((and/or))
and lodging.
"Guardian" - A person who is legally responsible for a
client and who may be required to be present when a client is
receiving health care services.
"Local community" - The client's city or town of resi-
dence or nearest location to residence.
"Local provider" - A provider, as defined in WAC 182-
500-0085, who delivers covered health care service within
the client's local community, and the treatment facility where
the services are delivered ((are also)) within the client's local
community.
"Lodging and meals" - Temporary housing and meals
((in support of)) provided during a client's out-of-area medi-
cal stay.
"Mode" - A method of transportation assistance used by
the general public that an individual client can use in a spe-
cific situation. Methods that may be considered include, but
are not limited to:
• Air transport;
• Bus fares;
• Ferries/water taxis;
• Gas vouchers/gas cards;
• Grouped or shared-ride vehicles;
• Mileage reimbursement;
• Parking;
• Stretcher vans or cars;
• Taxi;
• Tickets;
• Tolls;
• Train;
• Volunteer drivers;
• Walking or other personal conveyance; and
• Wheelchair vans.
"Noncompliance or noncompliant" - When a client:
• Fails to appear at the pickup point of the trip at the
scheduled pickup time;
• Misuses or abuses agency-paid medical, transportation,
or other services;
• Fails to comply with the rules, procedures, or policies
of the agency or those of the agency's transportation brokers,
the brokers' subcontracted transportation providers, or health
care service providers;
• Poses a direct threat to the health or safety of self or
others; or
• Engages in violent, seriously disruptive, or illegal con-
duct.
"Pickup point" - The location authorized by the
agency's transportation broker for the client's trip to begin.
"Return trip" - The return of the client to the client's
residence, or another authorized drop-off point, from the
location where a covered health care service has occurred.
"Short stay" - A period of time spanning one to six days
for which a client receives health care services outside of his
or her local community and for which he or she may request
assistance with meals ((and/or)) and lodging.
"Stretcher car or van" - A vehicle that can legally
transport a client in a prone or supine position when the client
does not require medical attention en route.
Washington State Register, Issue 16-12 WSR 16-12-022
[ 3 ] Permanent
"Stretcher trip" - A transportation service that requires
a client to be transported in a prone or supine position without
medical attention during the trip. This may be by stretcher,
board, gurney, or other appropriate device. Medical or safety
requirements must be the basis for transporting a client in the
prone or supine position.
"Transportation provider" - ((An individual)) A per-
son or company under contract with a broker((, for the provi-
sion of trips)) to provide trips to eligible clients.
"Trip" - Transportation one-way from the pickup point
to the drop off point by an authorized transportation provider.
"Urgent care" - An unplanned appointment for a cov-
ered medical service with verification from an attending phy-
sician or facility that the client must be seen that day or the
following day.
AMENDATORY SECTION (Amending WSR 15-03-050,
filed 1/14/15, effective 2/14/15)
WAC 182-546-5200 Nonemergency transportation
broker and provider requirements. (1) The medicaid
agency requires:
(a) Brokers and subcontracted transportation providers
to be licensed, equipped, and operated in accordance with
applicable federal, state, and local laws, and the terms speci-
fied in their contracts;
(b) Brokers to:
(i) Screen their employees and subcontracted transporta-
tion providers and employees prior to hiring or contracting,
and on an ongoing basis thereafter, to assure that employees
and contractors are not excluded from receiving federal funds
as required by 42 U.S.C. 1320a-7 and 42 U.S.C. 1320c-5; and
(ii) Report immediately to the agency any information
discovered regarding an employee's or contractor's exclusion
from receiving federal funds in accordance with 42 U.S.C.
1320a-7 and 42 U.S.C. 1320c-5.
(c) Drivers and passengers to comply with all applicable
federal, state, and local laws and regulations during transport.
(2) Brokers:
(a) Must determine the level of assistance needed by the
client (e.g., curb-to-curb, door-to-door, door-through-door,
hand-to-hand) and the mode of transportation to be used for
each authorized trip;
(b) Must select the lowest cost available mode or alterna-
tive that is both accessible to the client and appropriate to the
client's medical condition and personal capabilities;
(c) Must have subcontracts with transportation providers
in order for the providers to be paid by the broker;
(d) Must provide transportation services comparable to
those available to the general public in the local community;
(e) May subcontract with licensed ambulance providers
for nonemergency trips in licensed ground ambulance vehi-
cles; and
(f) ((May)) Must negotiate in good faith a contract with a
federally recognized tribe that has all or part of its contract
health service delivery area, as established by 42 C.F.R. Sec.
136.22, within the broker's service region, to provide trans-
portation services when requested by that tribe. The contract
must comply with federal and state requirements for con-
tracts with tribes. When the agency approves the request of a
tribe or a tribal agency to administer or provide transportation
services under WAC 182-546-5100 through 182-546-6200,
tribal members may obtain their transportation services from
the tribe or tribal agency with coordination from and payment
through the transportation broker.
(3) If the broker is not open for business and is unavail-
able to give advance approval for transportation to an urgent
care appointment or after a hospital discharge, the subcon-
tracted transportation provider must either:
(a) Provide the transportation in accordance with the bro-
ker's after-hours instructions and request a retroactive autho-
rization from the broker within two business days of the
transport; or
(b) Deny the transportation, if the requirements of this
section cannot be met.
(4) If the subcontracted transportation provider provides
transportation as described in subsection (3)(a) of this sec-
tion, the broker may grant retroactive authorization and must
document the reason in the client's trip record.
AMENDATORY SECTION (Amending WSR 14-07-042,
filed 3/12/14, effective 4/12/14)
WAC 182-546-5300 Nonemergency transportation—
Client eligibility. (1) The agency pays for nonemergency
transportation for Washington apple health (WAH) clients,
including persons enrolled in an agency-contracted managed
care organization (MCO), to and from health care services
when the health care service(s) meets the requirements in
WAC 182-546-5500.
(2) Persons assigned to the patient review and coordina-
tion (PRC) program according to WAC 182-501-0135 may
be restricted to certain providers.
(a) Brokers may authorize transportation of a PRC client
to only those providers to whom the person is assigned or
referred by their primary care provider (PCP), or for covered
services which do not require referrals.
(b) If a person assigned to PRC chooses to receive ser-
vice from a provider, pharmacy, ((and/or)) or hospital that is
not in the person's local community, the person's transporta-
tion is limited per WAC 182-546-5700.
AMENDATORY SECTION (Amending WSR 15-03-050,
filed 1/14/15, effective 2/14/15)
WAC 182-546-5400 Nonemergency transportation—
Client responsibility. (1) Clients must comply with applica-
ble state, local, and federal laws during transport.
(2) Clients must comply with the rules, procedures and
policies of the medicaid agency, brokers, the brokers' subcon-
tracted transportation providers, and health care service pro-
viders.
(3) A client who is noncompliant may have limited trans-
portation mode options available.
(4) Clients must request, arrange, and obtain authoriza-
tion for transportation at least two business days before a
health care appointment, except when the request is for an
urgent care appointment or a hospital discharge. Requests for
trips to urgent care appointments must not be to an emer-
gency department (also known as an emergency room).
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