Chemical Dependency Treatment - ADATSA Eligibility Information
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Chemical Dependency Treatment - ADATSA Eligibility Information


Revised December 7, 2011



Purpose: To describe who is eligible for ADATSA treatment services, treatment limitations, and what services the department provides to clients in treatment.

WAC 182-508-0320ADATSA--Eligible individuals. (Emergency rule effective 11/1/11.)
WAC 182-508-0325When am I eligible for ADATSA treatment services?
WAC 182-508-0330What clinical incapacity must I meet to be eligible for ADATSA treatment services?
WAC 182-508-0335Will I still be eligible for ADATSA outpatient services if I abstain from using alcohol or drugs, become employed, or have a relapse?
WAC 182-508-0340What is the role of the certified chemical dependency service provider in determining ADATSA eligibility?
WAC 182-508-0345What are the responsibilities of the certified chemical dependency service provider in determining eligibility?
WAC 182-508-0350What happens after I am found eligible for ADATSA services?
WAC 182-508-0355What criteria does the certified chemical dependency service provider use to plan my treatment?
WAC 182-508-0365What happens when I withdraw or am discharged from treatment?

WAC 182-508-0320

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WAC 182-508-0325

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WAC 182-508-0330

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WAC 182-508-0335

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WAC 182-508-0340

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WAC 182-508-0345

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WAC 182-508-0350

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WAC 182-508-0355

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WAC 182-508-0365

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CLARIFYING INFORMATION

  1. To qualify for the ADATSA program of assistance the person must:
    1. Meet financial eligibility criteria for Medical Care Services (MCS) described in WAC 182-508-0005; and
    2. Be incapacitated by alcoholism or drug addiction as determined by a DBHR designated "assessment agency" as defined in WAC 182-508-0330 and WAC 182-508-0335; and
    3. Want and be able to benefit from treatment.

NOTE:

An ADATSA applicant who is receiving Unemployment Compensation may be eligible for ADATSA services if the person meets clinical eligibility criteria. An ADATSA recipient must notify Employment Security before entering residential treatment.


  1. The department relies on the ADATSA assessment agency for a diagnosis for all referred clients and a treatment plan for all ADATSA eligible clients. The assessment agency determines a course of treatment based on an individual assessment. Treatment may consist of residential or outpatient services or combination of the two.
  2. An eligible ADATSA client may be placed directly into an outpatient program without having to go through any residential treatment.
  3. While in ADATSA treatment the person is eligible for:
    1. Medical Care Services coverage from the assessment date to the end of the continuum of treatment.
    2. A possible living stipend while participating in ADATSA outpatient treatment which is administered by the county.
    3. Food assistance if financially and categorically eligible.
  4. If a person is requesting residential treatment, the person's financial eligibility for ADATSA is based on the monthly facility rate. Clients with income over the MCS eligibility standard described in WAC 182-508-0230 may qualify for residential placement only. This occurs when the cost of a month's residential care exceeds the calculated monthly income (with work incentives if appropriate). The cost of residential care is based on the level of care needed. The levels of residential care and the cost of care is:
  • Intensive Inpatient - $90.18 per day
  • Long Term Care - $53.52 per day
  •  Recovery House - $41.14 per day

EXAMPLE

A person's monthly SSA income is greater than the MNIL but the ADATSA assessment agency determines the person needs inpatient residential treatment. The cost of one month's care for the person is $1605.60. The person's income is $1500.00 per month, which is less than the monthly cost of residential care. The person would be eligible for ADATSA, but only while actually participating in residential treatment.


  1. Continue to consider ADATSA recipients who are successfully participating in outpatient treatment to be incapacitated, even if they become gainfully employed. They remain eligible for assistance through completion of treatment as long as they are participating in treatment and their income does not exceed the financial eligibility payment standard after allowing the work disregards and incentives.
  2. As with any assistance recipient, when the person appears to be disabled, refer for SSI facilitation.
  3. DO NOT TRANSFER an ADATSA treatment client in any phase of treatment.

 


NOTE:

The exception to this rule is:

For client transfers from the Mt. Vernon CSO and the Spokane CSO for individuals who have been at Pioneer Center North or Pioneer Center East.   See Pioneer Center North and East Treatment.


  1. If a TANF, SSI, ABD cash assistance, MCS medical, Categorically Needy Medical Assistance, or Medically Needy Medical Assistance client is in need of chemical dependency treatment services, refer to Section L. Do not change the program of assistance to ADATSA.

WORKER RESPONSIBILITIES

  1. All persons seeking ADATSA benefits must file an application for assistance with the CSO.
  2. The financial worker follows the same income and resource guides for ADATSA as for medical care services.
  3. Compute countable income according to income polices for MCS clients. (See INCOME.) If the person's net income is greater than the eligibility standard, the person is not eligible when in outpatient treatment or when waiting to enter residential treatment.
  4. If the person needs residential care and the person's income is greater than the payment standard but less than the cost of residential care, the person may be eligible only while participating in residential treatment. When referring the person to the ADATSA Assessment agency, be sure to inform the agency exactly the amount of the person's net income. Advise them the person is not eligible for outpatient treatment but may be eligible for residential treatment, depending on the cost of residential care.
  5. If the person's countable income is greater than $2705.00 per month, the person would not be eligible for ADATSA for any level of care as the person's income exceeds the cost of any level of residential care.
  6. Refer a person who claims a medical problem in addition to chemical dependency to an incapacity specialist to determine the appropriate program for the client: ADATSA, ABD cash or MCS medical.
  7. Once financial eligibility has been determined the ADATSA assessment agency determines if the chemical dependency issue meets the criteria for the ADATSA program.
  8. If the person does not claim an incapacity or if the incapacity specialist determines ADATSA is the appropriate program, follow these steps to refer to the ADATSA assessment agency:
    1. Have the person sign a release of information form, Initiates the 065-02 in ACES (DSHS 14-299(X) - ADATSA Referral Form) if the applicant is financially eligible, and
    2. Give the 065-02 and copy of the release form to the applicant to take to the ADATSA assessment agency. The FSS may send a copy of the letter and release form to the ADATSA assessment agency, based on local procedures.
    3. Advise the ADATSA Assessment agency if the applicant may be eligible for only residential treatment if the applicant's net income is greater than the payment standard.

NOTE:

The assessment agencies must make sure the CSO has determined financial eligibility before an ADATSA assessment is made.


  1. If the person is determined eligible for ADATSA, the FSS opens Medical back to the date of assessment.

  2. Do not change the public assistance program to ADATSA for persons receiving TANF, SSI, ABD cash assistance, MCS medical, Categorically Needy Medical Assistance, or Medically Needy Medical Assistance if the person remains eligible for these programs.

  3. If a person receiving TANF, SSI, ABD cash, MCS medical, Categorically Needy Medical Assistance, or Medically Needy Medical Assistance is in need of chemical dependency treatment services, refer to Section L. Access to Treatment Services for TANF, SSI, ABD cash assistance, Medical Care Services and Medicaid Clients.

  4. If the person is not eligible for ADATSA or any other program of public assistance, inform the applicant of other resources for treatment as described in Section M. Chemical Dependency Treatment - Not Eligible.


ACES PROCEDURES

See Alcoholism and Drug Addiction Treatment and Support Act (ADATSA)
Modification Date: December 7, 2011