Purpose: To describe who is eligible for ADATSA treatment services, treatment limitations, and what services the department provides to clients in treatment.
(1) To be eligible for the Alcohol and Drug Addiction Treatment and Support Act (ADATSA) services, an individual must:
(a) Be eighteen years of age or older;
(b) Be a resident of Washington as defined in WAC 182-503-0520;
(c) Meet citizenship requirements as described in WAC 182-503-0532;
(d) Provide their Social Security number; and
(e) Meet the same income and resource criteria for the medical care services (MCS) program (unless subsection (2) of this section applies), or receive federal assistance under Supplemental Security Income (SSI) or temporary assistance for needy families (TANF).
(2) An individual with nonexcluded countable income higher than the MCS eligibility standard described in WAC 183-508-0230 may qualify for inpatient only residential treatment if total countable income is below the projected monthly cost of care in the treatment center based on the state daily reimbursement rate.
WAC 182-508-0325 When am I eligible for ADATSA treatment services?
You are eligible for ADATSA treatment services when you meet the:
Financial eligibility criteria in WAC 388-800-0048 (Ed. Note: Correct WAC reference is now WAC 182-508-0320); and
Incapacity eligibility criteria in WAC 388-800-0055 (Ed. Note: Correct WAC reference is now WAC 182-508-0330).
If you are able to access, at no cost, state-approved chemical dependency treatment comparable to ADATSA treatment services, you may choose it rather than ADATSA.
WAC 182-508-0330 What clinical incapacity must I meet to be eligible for ADATSA treatment services?
You are clinically eligible for ADATSA treatment services when you:
Are diagnosed as having a mild, moderate, or severe dependency on a psychoactive substance class other than nicotine or caffeine, using the current criteria for Psychoactive Substance Dependence in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (DSM IV or its successor);
Have not abstained from alcohol and drug use for the last ninety days, excluding days spent while incarcerated;
Have not been gainfully employed in a job in the competitive labor market at any time during the last thirty days. For the purposes of this chapter, "gainfully employed" means performing in a regular and predictable manner an activity for pay or profit. Gainful employment does not include noncompetitive jobs such as work in a department-approved sheltered workshop or sporadic or part-time work, if the person, due to functional limitation, is unable to compete with unimpaired workers in the same job; and
Are incapacitated, i.e., unable to work. Incapacity exists if you are one or more of the following:
a. Currently pregnant or up to two months postpartum;
b. Diagnosed as at least moderately psychoactive substance dependent and referred for treatment by child protective services;
c. Diagnosed as severely psychoactive substance dependent and currently an intravenous drug user;
d. Diagnosed as severely psychoactive substance dependent and has at least one prior admission to a department-approved alcohol/drug treatment or detoxification program;
e. Diagnosed as severely psychoactive substance dependent and have had two or more arrests for offenses directly related to the chemical dependency; or
f. Lost two or more jobs during the last six months as a direct result of chemical dependency.
WAC 182-508-0335 Will I still be eligible for ADATSA outpatient services if I abstain from using alcohol or drugs, become employed, or have a relapse?
When you are successfully participating in ADATSA outpatient treatment services you are still considered incapacitated and eligible for ADATSA treatment through completion of the planned treatment, even if you:
Become employed;
Abstain from alcohol or drug use; or
Relapse (resumption of your psychoactive substance abuse dependence).
WAC 182-508-0340 What is the role of the certified chemical dependency service provider in determining ADATSA eligibility?
A department-certified chemical dependency service provider determines your clinical incapacity based on alcoholism and/or drug addiction.
The certified chemical dependency service provider provides a written current assessment needed to determine your eligibility.
This assessment is the department's sole source of medical evidence required for the diagnosis and evaluation of your chemical dependency and its effects on employability.
WAC 182-508-0345 What are the responsibilities of the certified chemical dependency service provider in determining eligibility?
The role of the certified chemical dependency service provider is to:
a. Provide your diagnostic evaluation and decide your initial treatment placement;
b. Conduct a face-to-face diagnostic assessment, according to WAC 388-805-310, to determine if you:
i. Are chemically dependent;
ii. Meet incapacity standards for treatment under WAC 388-800-0055 (Ed. note: Correct WAC reference is WAC 182-508-0330); and
iii. Are willing, able, and eligible to undergo a course of ADATSA chemical dependency treatment, once determined incapacitated.
c. Determines a course of treatment based on your individual assessment of alcohol/drug involvement and treatment needs in accordance with RCW 70.96A.100.
WAC 182-508-0350 What happens after I am found eligible for ADATSA services?
Once your financial and clinical eligibility is established, the certified chemical dependency service provider:
Develops your ADATSA treatment plan;
Arranges your initial chemical dependency treatment placements taking into account the treatment priorities described under WAC 388-800-0100 (Ed. note: Correct WAC reference is WAC 182-508-0370);
Provides you with written notification of your right to return to the community service office (CSO) at any time while receiving ADATSA treatment;
Provides you with written notification of your right to request a fair hearing to challenge any action affecting eligibility for ADATSA treatment; and
Notifies the CSO promptly of your placement or eligibility status changes.
WAC 182-508-0355 What criteria does the certified chemical dependency service provider use to plan my treatment?
When evaluating a treatment plan which will benefit you the most, the certified chemical dependency service provider considers clinical or medical factors utilizing the American Society of Addiction Medicine (ASAM) Patient Placement Criteria (PPC).
WAC 182-508-0365 What happens when I withdraw or am discharged from treatment?
You will be terminated from ADATSA treatment services if you leave treatment.
If you are discharged from treatment for any other reason, you will be referred to the next appropriate level of treatment.
If you are absent from any residential treatment services for less than seventy-two hours you may reenter that program without being considered as having dropped out. This is done at the discretion of the treatment service administrator and without requiring you to apply for readmittance through the certified chemical dependency service provider.
Once you voluntarily leave treatment you must reapply and be referred again to the certified chemical dependency service provider to receive further ADATSA treatment services.
If you are terminated from treatment you are not eligible for benefits beyond the month in which treatment services end. Rules regarding advance and adequate notice still apply, but you are not eligible for continued assistance pending a fair hearing.
To qualify for the ADATSA program of assistance the person must:
Meet financial eligibility criteria for Medical Care Services (MCS) described in WAC 182-508-0005; and
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
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.
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.
An eligible ADATSA client may be placed directly into an outpatient program without having to go through any residential treatment.
While in ADATSA treatment the person is eligible for:
Medical Care Services coverage from the assessment date to the end of the continuum of treatment.
A possible living stipend while participating in ADATSA outpatient treatment which is administered by the county.
Food assistance if financially and categorically eligible.
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.
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.
As with any assistance recipient, when the person appears to be disabled, refer for SSI facilitation.
DO NOT TRANSFERan 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.
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
All persons seeking ADATSA benefits must file an application for assistance with the CSO.
The financial worker follows the same income and resource guides for ADATSA as for medical care services.
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.
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.
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.
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.
Once financial eligibility has been determined the ADATSA assessment agency determines if the chemical dependency issue meets the criteria for the ADATSA program.
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:
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
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.
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.
If the person is determined eligible for ADATSA, the FSS opens Medical back to the date of assessment.
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.
