part 6

[Virtual Presenter] We are discussing the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington state. Certain rules and regulations must be followed when an individual reenters waiver services. If an individual terminates waiver services within 30 calendar days of the end of the waiver year with the intention of returning to waiver services early in the next waiver year, they must return to the waiver within 60 calendar days of the next waiver year or they may lose their waiver slot and be required to reapply for services. There are also restrictions on payment for waiver services provided by parents, guardians, and relatives of waiver individuals. For the F-S-W and C-I-H Waiver, parents, stepparents, and legal guardians of waiver individuals who are minors (under the age of 18) may not receive payment for the delivery of any waiver-funded service to the minor waiver individuals. Other relatives (defined as follows and excluding spouses) may provide waiver services to waiver individuals when that relative is employed by or a contractor of a DDRS-approved provider. There are also limits on the number of reimbursable waiver-funded residential habilitation services that can be provided to an adult waiver individual by a paid relative and/or legal guardian. These services may not exceed a total of 40 hours a week per paid relative and/or legal guardian caregiver. It is important to note that related/relative for all purposes pertaining to waiver-funded programs operated by the D-D-R-S includes certain natural, adoptive, and step relationships. These include: Aunt (natural, step, adopted), Brother (natural, step, half, adopted, in-law), Child (natural, step, adopted), First cousin (natural, step, adopted), Grandchild (natural, step, adopted), Grandparent (natural, step, adopted), Nephew (natural, step, adopted), Niece (natural, step, adopted), Parent (natural, step, adopted, in-law), Sister (natural, step, half, adopted, in-law), Spouse (husband or wife), and Uncle (natural, step, adopted)..

[Audio] Welcome to our presentation on the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington state. Today, we will be discussing the process for individuals who have previously terminated waiver services to reenter waiver services, and outlining the rules and regulations for parents, guardians, and relatives who provide F-S-W and C-I-H Waiver Services. We will also be providing details about the reimbursable waiver-funded residential habilitation services that can be provided to adult waiver individuals by paid relatives and legal guardians, and the natural, adoptive, and step relationships that are considered related/relative for all purposes pertaining to waiver-funded programs operated by the D-D-R-S-. However, before a relative may be considered to be a provider, they must meet the following criteria: The relative must be at least 18 years of age. The relative is employed by or a contractor of an agency that is approved by the D-D-R-S to provide care under the waiver. The relative meets the appropriate provider standards (per Indiana Administrative Code 460 I-A-C 6) for the services being provided. The decision for the relative to provide services to a waiver individual is part of the P-C-I-S-P planning process, which indicates that the relative (defined previously) is the best choice of persons to provide services from the DDRS-approved provider agency, and this decision is recorded and explained in the PCISP. There is detailed justification as to why the relative is providing service. The decision for a relative to provide services is evaluated periodically (for example, at least annually) to determine whether it continues to be in the best interest of the waiver individual. Payment is made only to the DDRS-approved Medicaid enrolled waiver provider agency in return for specific services rendered. The services must be rendered one-on-one with the individual or in shared settings with group sizes allowable per specified waiver service definitions and documented as acceptable by all relevant I-S-T-s-. Authorization for shared or group services must be documented in the approved service authorization for each group individual. With the exception of groups of waiver individuals as noted previously, the relative (defined above) may not be responsible for others (including their other children or family members) nor engaged in other activities while providing services. Note: Regarding Participant Assistance and Care (P-A-C--) under the F-S-W--, and Residential Habilitation and Support (R-H-S--) under the C-I-H Waiver, reimbursable waiver-funded residential habilitation services furnished to an adult waiver individual by a paid relative and/or legal guardian may not exceed a total of 40 hours a week per paid relative and/or legal guardian caregiver..

[Audio] We will now discuss the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington state. In this section, we will focus on the appeal process for individuals and families who have previously terminated waiver services and wish to reenter the program. It's important to note that there have been some changes to the appeals process. The administrative law judge (A-L-J--) offices have moved from the Family and Social Services Administration (F-S-S-A-) to a new Office of Administrative Law Proceedings (O-A-L-P-). The A-L-Js are no longer employees of the F-S-S-A-. Appeals are now submitted and processed as outlined in Sections 8.1 through 8.18 in this section. You can review the O-A-L-P website at in.gov/oalp for more information. An appeal request is a request for a hearing before an A-L-J with the O-A-L-P-. The purpose of an appeal is to determine whether a decision made by a service coordinator, waiver specialist, the Division of Disability and Rehabilitative Services (D-D-R-S-) Central Office, or other entities affecting the waiver applicant, waiver participant, or provider was correct. An appeal request must be in writing and forwarded to the hearing authority. Service authorization is used to notify each Medicaid Home and Community-Based Services (H-C-B-S-) applicant, waiver participant, or prospective waiver participant of any action that affects their services..

[Audio] Good afternoon, everyone. This presentation will provide an overview of the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington state. First, let's discuss the rules and regulations for individuals who have previously terminated waiver services to reenter waiver services. In order to do this, they must go through an appeal process. This process allows them to challenge any adverse determination made by the case manager or bureau of disabilities services. Appeals must be received by the F-S-S-A within 33 calendar days of the decision date noted on the service authorization. Lastly, let's talk about the reimbursable waiver-funded residential habilitation services that can be provided to adult waiver individuals by paid relatives and legal guardians. These services can include a variety of different types of support, such as transportation, housing, and employment assistance. In terms of natural, adoptive, and step relationships, all relationships pertaining to waiver-funded programs operated by the D-D-R-S are considered related/relative..

[Audio] We are delighted to host this presentation on policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington state. Today, we will delve into the appeal process for individuals who have previously terminated waiver services to reenter waiver services, and we will outline the rules and regulations for parents, guardians, and relatives who provide F-S-W and C-I-H Waiver Services. We will first discuss the appeal process for individuals who have terminated waiver services. According to the DDRS HCBS Waivers policy, the applicant for H-C-B-S waiver supports, waiver individual or their legal guardian/authorized representative has the right to appeal any waiver-related decision of the state. A service authorization is issued with the release of each state decision pertaining to a service authorization. Each service authorization contains the appeal rights of the applicant/individual, as well as instructions for filing an appeal. The appeal must be received by the O-A-L-P within 33 calendar days of the service authorization. Next, we will discuss the appeal process for individuals with intellectual disabilities (I-I-D--). Under Section 8.3 of the DDRS HCBS Waivers policy, the individual, or their legal guardian/authorized representative, has the right to appeal the O-B-A within 30 calendar days of the service authorization. Each service authorization contains the appeal rights of the individual, as well as instructions for filing an appeal. To quality for H-C-B-S waiver services under the C-I-H Waiver or F-S-W administered by D-D-R-S-, an individual must be found to require the same state-defined level of care specified for admission/entrance to an intermediate care facility for individuals with intellectual disabilities (ICF/IID). Finally, we will discuss the appeal process for reserved waiver capacity (priority criteria). Under Section 8.4 of the DDRS HCBS Waivers policy, the applicant, individual or their legal guardian/authorized representative has the right to appeal a denial for entrance to the waiver via priority criteria within 18 calendar days of the decision. The decision letter will contain the appeal rights of the applicant/individual, as well as instructions for filing an appeal. In conclusion, the appeal process for individuals who have terminated waiver services is an important aspect of the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the D-D-R-S in Washington state. By understanding the appeal process and the time limits for requesting appeals, individuals can ensure that their rights are protected and that their needs are met. Thank you for your attention..

[Audio] If an individual wishes to reenter waiver services, they must go through the appeal process outlined in Section 8 of the DDRS HCBS Waivers. This section outlines the rights, information, and procedures for the appellant or their authorized representative to understand the hearing process. The appellant may examine the case record prior to the hearing, and the notice of scheduled hearing is sent to both parties at least 10 calendar days before the hearing. If the appellant wishes to request a continuance from the hearing, they must submit a written request to the O-A-L-P-. Good cause must exist for a continuance to be granted, and reasons for continuance may include serious physical or mental conditions, incapacitating injury, desire to obtain legal counsel, submission of additional exhibits, a death in the family, severe weather conditions impacting hearing participation, schedule conflicts impacting availability of witnesses, or other similar circumstances. The A-L-J will consider each case according to legal and case standards and may reschedule the hearing at an agreed upon date between all involved parties. Only in rare cases will additional continuances be granted. If an individual wishes to review the proposed action, they may request an informal pre-hearing conference with the designated state staff within the appropriate units. This conference may lead to an informal resolution of the issue, but it is optional and in no way delays or replaces the administrative hearing..

[Audio] We are pleased to present this slide deck on the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington state. Our focus today will be on the appeal process for DDRS HCBS Waivers. If an individual (or their authorized representative) withdraws the request for a hearing, an administrative hearing must still be held. Otherwise, an appeal request may be disposed of without holding a fair hearing in the following situations: If the appellant's situation has changed and the B-D-S service coordinator, D-D-R-S Central Office, the appellant, or another designee determines that the proposed action or action taken is incorrect, the service coordinator may adjust the action. If the appellant wishes to withdraw the appeal, they will be assisted by the B-D-S service coordinator and/or case manager or D-D-R-S Central Office in promptly notifying the OALP ALJ in writing of the decision. An administrative hearing is a review of actions of a service coordinator, case manager, D-D-R-S Central Office, or B-D-S waiver unit regarding issues relating to the H-C-B-S waivers. An A-L-J--, who is not an employee of the O-A-L-P-, will hold the hearing and issue findings of fact, conclusions of law, and a decision related to the appeal request. A hearing allows the dissatisfied appellant an opportunity to present their issue and describe the circumstances and needs in their own words. An attorney or another individual of their choice may represent the individual. A designated state staff within the appropriate units will attend the hearing and present evidence supporting the action under appeal. Before the hearing, the appellant (or their authorized representative) will be given an opportunity to: Have an informal pre-hearing conference to discuss the issue being appealed with the B-D-S District representative, B-D-S waiver unit representative, D-D-R-S Central Office representative, or other designee. Examine the entire case file and all documents and records that will be used by the B-D-S District representative, B-D-S waiver unit representative, D-D-R-S Central Office representative, or other designee at the hearing, noting that the state's appeal-related evidence will be sent by the state to the appellant and their authorized representative, if applicable, prior to the hearing. Be represented by legal counsel at the appeal hearing. Thank you for joining us today. We hope this information will be helpful..

[Audio] We are pleased to provide information on the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington state. This slide will detail the process for individuals who have previously terminated waiver services to reenter waiver services, as well as the rules and regulations for parents, guardians, and relatives who provide F-S-W and C-I-H Waiver Services. It will also outline the reimbursable waiver-funded residential habilitation services that can be provided to adult waiver individuals by paid relatives and legal guardians, as well as the natural, adoptive, and step relationships that are considered related/relative for all purposes pertaining to waiver-funded programs operated by the D-D-R-S-. It is important to note that if you are appealing a decision made by the D-D-R-S-, there are specific rules and regulations that must be followed in order to have a successful appeal. These rules include submitting exhibits to the state and the A-L-J prior to the hearing, and providing thorough support of the action proposed or taken at the hearing. Thank you for your attention, and please feel free to ask any questions you may have..

[Audio] Our organization provides services to individuals with developmental disabilities, which include F-S-W and C-I-H Waiver Services. If an individual wants to rejoin the program after terminating waiver services, they must follow a specific process. There are rules and regulations for people providing F-S-W and C-I-H Waiver Services. We offer reimbursable waiver-funded residential habilitation services that can be provided by paid relatives and legal guardians. These services are considered related/relative for all purposes related to waiver-funded programs operated by us. If someone wants to appeal a decision related to F-S-W and C-I-H Waiver Services, they must follow a specific process. This includes identifying and labeling all relevant documents, preparing a written outline for the testimony at the hearing, and presenting the case or having it presented by legal counsel or another person. The A-L-J conducts the hearing, and both parties have the opportunity to present testimony, introduce relevant evidence, and question or refute any testimony or evidence presented by the other party. It's important to note that our policies and procedures for F-S-W and C-I-H Waiver Services are subject to change, and individuals should stay informed of any updates or changes. We operate under state and federal policies and procedures, and all decisions related to F-S-W and C-I-H Waiver Services are subject to review and appeal. Our ultimate goal is to provide high-quality services and support to individuals with developmental disabilities, and individuals who want to appeal a decision related to F-S-W and C-I-H Waiver Services should follow the specific process outlined in this presentation..

[Audio] We are here to provide information on the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington state. In this presentation, we will be discussing the process for individuals who have previously terminated waiver services to reenter waiver services, as well as the rules and regulations for parents, guardians, and relatives who provide F-S-W and C-I-H Waiver Services. Additionally, we will be providing details about the reimbursable waiver-funded residential habilitation services that can be provided to adult waiver individuals by paid relatives and legal guardians, as well as the natural, adoptive, and step relationships that are considered related/relative for all purposes pertaining to waiver-funded programs operated by the D-D-R-S-. In this slide, we will be discussing the appeal process for individuals who wish to challenge the decision made by the Administrative Law Judge (A-L-J--) regarding their waiver services. The state shall ensure that the appellant receives the state’s exhibits and the appellant shall ensure that the state receives any exhibits submitted by the appellant prior to the day of the hearing. As directed in the hearing notice and in most cases, exhibits should be submitted at least 10 calendar days prior to the scheduled hearing. Section 8.12: Continuance of Hearing If the A-L-J determines that further evidence is needed to reach a decision, the decision is delayed until such further evidence is obtained. The hearing may also be reconvened, if necessary, to obtain additional testimony. The parties will be notified of this and of the time frame allowed and method for obtaining this evidence. Any evidence submitted must be copied and given to the opposite party, who then has the opportunity for rebuttal. Section 8.13: The Hearing Record The hearing record is an official report containing the transcript or recording of the testimony of the hearing, together with all papers and requests filed in the proceeding, and the decision of the A-L-J--. Section 8.14: The Fair Hearing Decision A written copy of the ALJ’s hearing decision is sent to all parties. The decision includes: The findings of fact and conclusions of law regarding the issue under appeal Supporting laws and regulations In all cases, the decision of the A-L-J is based solely on the evidence introduced at the hearing and the appropriate federal and state laws and regulations. The A-L-J signs the decision, which also contains the findings of fact and the conclusion of the law. The decision is to be explained to the appellant upon request. Section 8.15: Actions of the Administrative Law Judge’s Decision Unless an Agency Review is requested, the decision of the A-L-J shall be binding upon the D-D-R-S or the Office of Medicaid Policy and Planning (O-M-P-P-) and is to be enacted. Section 8.16: Agency Review Any party may request an Agency Review if dissatisfied with the decision made by the A-L-J--. The Agency Review request must be made in writing to the FSSA’s O-A-L-P or the ultimate agency authority, within 10 calendar days following receipt of the hearing decision. After an Agency Review is requested, the O-A-L-P or the ultimate agency authority will write to all parties to acknowledge receipt of the request and to provide information concerning the review. No new evidence will be considered during the Agency Review; however, any party may submit a written Memorandum of Law, citing evidence in the record, for consideration. The state of Washington is committed to ensuring that individuals who wish to challenge the decision made by the A-L-J have access to a fair and impartial appeal process. This presentation provides information on the.

[Audio] Individuals with developmental disabilities in Washington state can receive F-S-W and C-I-H Waiver Services from D-D-R-S-. These services are designed to help individuals live independently and achieve their goals. It is important for parents, guardians, and relatives who provide these services to understand the rules and regulations. D-D-R-S also offers reimbursable waiver-funded residential habilitation services to adult waiver individuals. These services can be provided by paid relatives and legal guardians. Relationships for all purposes pertaining to waiver-funded programs operated by D-D-R-S include natural, adoptive, and step relationships. If an individual is not satisfied with the final action taken by the D-D-R-S-, they may file a petition for judicial review. If a lawsuit is filed, all inquiries should be directed to the FSSA OGC or the Attorney General’s Office. The policies and procedures for F-S-W and C-I-H Waiver Services may change, so individuals should refer to the most current version as of July 1, 2024, which is version 11.1. The library reference number for this information is PRPR10014, and it was published on September 9, 2024..

[Audio] I will be discussing the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington State. The text will provide information on the process for individuals who have previously terminated waiver services to reenter these services, as well as the rules and regulations for parents, guardians, and relatives who provide these services. Additionally, I will be providing details on the reimbursable waiver-funded residential habilitation services that can be provided by paid relatives and legal guardians to adult individuals, as well as the relationships that are considered related for all purposes related to waiver-funded programs operated by the D-D-R-S. However, my main focus today is on the B-D-S Quality Assurance Services, which are responsible for developing and implementing quality improvement and quality assurance systems to ensure the health and welfare of individuals receiving Medicaid Home and Community-Based Services (H-C-B-S-) waiver services. The activities of the B-D-S include developing policies, conducting provider compliance reviews, investigating complaints, reviewing mortality, and managing the state's automated system for reporting incidents of abuse, neglect, and exploitation. In the Family and Social Services Administration (F-S-S-A-) Division of Disability and Rehabilitative Services (D-D-R-S-), the B-D-S Quality Assurance Services team and authorized vendors are responsible for developing and implementing quality improvement and quality assurance systems to assure the health and welfare of individuals receiving Medicaid Home and Community-Based Services (H-C-B-S-) waiver services. This includes developing policies, conducting provider compliance reviews, investigating complaints, reviewing mortality, and managing the state's automated system for reporting incidents of abuse, neglect, and exploitation. The B-D-S and its authorized vendors are also responsible for managing the D-D-R-S Incident Reporting System, and providers are required to report any incidents..

[Audio] We are pleased to invite everyone to a presentation on the policies and procedures for the provision of F-S-W and C-I-H Waiver Services by the Developmental Disabilities Residential Services (D-D-R-S-) in Washington state. The presentation will provide details on the process for individuals who have previously terminated waiver services to re-enter waiver services, as well as the rules and regulations for parents, guardians, and relatives who provide F-S-W and C-I-H Waiver Services. Additionally, the presentation will cover the reimbursable waiver-funded residential habilitation services that can be provided to adult waiver individuals by paid relatives and legal guardians, as well as the natural, adoptive, and step relationships that are considered related/relative for all purposes pertaining to waiver-funded programs operated by the D-D-R-S-. Quality assurance is an essential aspect of providing waiver services. To ensure individuals receive high-quality care, the D-D-R-S has established policies and procedures that cover various issues, such as injuries, medication errors, and the use of physical restraints. It is vital that individuals, guardians, families, and service providers understand these policies and procedures to provide the best possible care for individuals. The D-D-R-S also has a complaint system in place for individuals to file complaints on behalf of individuals receiving supports or services through the H-C-B-S waivers. The complaint system is designed to provide individuals, their families/guardians, providers, and community members with an additional venue for identifying and addressing issues when day-to-day monitoring activities have been, or appear to be, ineffective in assuring an individual’s health and safety. The D-D-R-S encourages complainants with individual-specific issues to first approach their case managers to try and resolve the issue first. If this has not produced the desired outcome, the complainant can contact the D-D-R-S again to file a complaint. When requested, complainants can choose to be anonymous. We hope this presentation has been informative, and we understand the importance of quality assurance in providing waiver services. Thank you for your attention, and we welcome any questions you may have..