Incapacity Determination - Incapacity Requirements for HEN Referral
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Incapacity Determination - Incapacity Requirements for HEN Referral


Revised December 30, 2013


Incapacity Requirements for referral to the Housing and Essential Needs (HEN) program


WAC 388-447-0001What are the incapacity requirements for referral to the Housing and Essential Needs (HEN) program?

<p>WAC 388-447-0001

WAC 388-447-0001

Effective January 1, 2014

WAC 388-447-0001 What are the incapacity requirements for referral to the Housing and Essential Needs (HEN) program?

(1) For the purposes of this chapter, the following definitions apply:

(a) "We" and "us" mean the department of social and health ser-vices.

(b) "You" means the applicant or recipient.

(c) "Incapacitated" means you cannot be gainfully employed due to a physical or mental impairment that is expected to continue for at least ninety days from the date you apply.

(d) "Mental impairment" means a diagnosable mental disorder.

(e) "Physical impairment" means a diagnosable physical illness.

(2) You must be incapacitated in order to receive a HEN referral.

(3) We determine if you are incapacitated when:

(a) You apply for a referral to the HEN program;

(b) You become gainfully employed;

(c) You obtain work skills by completing a training program;

(d) We receive new information that indicates you may be able to work; or

(e) Your incapacity authorization period ends.

(4) We deny your HEN referral if you are gainfully employed at the time of application for referral to the HEN program. "Gainfully employed" means you are performing, in a regular predictable manner, an activity usually done for pay or profit and earning more than the substantial gainful activity standard defined by the social security administration (SSA).

(5) We do not consider you to be gainfully employed if you are working:

(a) Under special conditions that go beyond providing reasonable accommodation; or

(b) Occasionally or part-time because your impairment limits the hours you are able to work compared to unimpaired workers in the same job.

(6) We determine you are incapacitated if you are:

(a) Approved through the progressive evaluation process (PEP). The PEP is a sequence of eight steps described in WAC 388-447-0030 through 388-447-0100;

(b) Eligible for services from the developmental disabilities administration (DDA);

(c) Diagnosed as having an intellectual disability based on a full scale score of seventy or lower on the Wechsler adult intelli-gence scale (WAIS);

(d) Eligible for long-term care services from aging and long-term support administration (ALTSA);

(e) Released from a medical institution where you received ser-vices from ALTSA within the past 90 days; or

(f) Released from inpatient treatment for a mental impairment within the past 90 days if:

(i) The release from inpatient treatment was not against medical advice; and

(ii) You were discharged into outpatient mental health treatment.

(7) If you have a physical or mental impairment, are impaired by alcohol or drug addiction, and do not meet the other incapacity criteria in section 6 (b) through (f), we decide if you are incapacitated by applying the PEP. We do not consider symptoms related to substance use or a diagnosis of chemical dependency when determining incapacity when we have evidence substance use is material to your impairment(s).

(8) We consider substance use material to your impairment(s) if you are disabled primarily because of drug or alcohol addiction.

(9) If your impairment will persist at least sixty days after you stop using drugs or alcohol, we do not consider substance use to be material to your impairment(s).

(10) In determining incapacity, we consider only your ability to perform basic work-related activities. "Basic work-related activities" are activities that anyone would be required to perform in a work setting. They consist of: Sitting, standing, walking, lifting, carrying, handling; and other physical functions (including manipulative or postural functions such as pushing, pulling, reaching, handling, stooping, or crouching), seeing, hearing, communicating, remembering, understanding and following instructions, responding appropriately to supervisors and co-workers, tolerating the pressures of a work setting, maintaining appropriate behavior, using judgment, and adapting to changes in a routine work setting.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Worker Responsibilities

1. Determine eligibility for ABD cash assistance and HEN Referral by applying the Concurrent Disability/Incapacity Determination process.

2. Approve incapacity if the individual is ineligible for ABD and meets the non-Progressive Evaluation Process (PEP) criteria outlined in WAC 388-447-0001 (6) (b) through (i).

3. If the individual is ineligible for ABD and does not meet the non-PEP criteria outline above, determine incapacity by applying the eight step HEN Referral PEP outlined in WAC 388-447-0030 through 388-447-0100.

4. If the individual meets any of the incapacity requirements outlined in WAC 388-447-0001 (6) (a) through (i), approve HEN Referral for 12 months.

 

Modification Date: December 30, 2013