Incapacity Determination - How to determine incapacity
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Incapacity Determination - How to determine incapacity


Revised November 2, 2011



WAC 182-508-0015Determining if an individual is incapacitated. (Emergency effective 11/1/11.)

WAC 182-508-0015

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WORKER RESPONSIBILITIES

  1. Review the referral from financial services and any existing medical documentation.
  2. Consider if the person meets any of the non-PEP criteria in WAC 182-508-0010.
  3. Explain the purpose, eligibility requirements, and benefits of Medical Care Services (MCS) and Alcoholism and Drug Addiction Treatment and Support Act (ADATSA) programs.
  4. Per WAC 182-508-0015 (4), we decide if persons who have a physical or mental impairment and are impaired by alcohol or drug addiction are eligible for MCS by following the Progressive Evaluation Process (PEP).  WAC 182-508-0015 (4) does not presume that a person is ineligible for MCS.  The PEP must be followed to make a decision.

NOTE:

Under no circumstances will a case manager order or request a UA be performed.

 


5.  Review DSHS 14-050(X), Statement of Health, Education, and Employment with the person.

a.  Discuss the medical history with the person.

b.  Observations should be documented.

c.  Ask the person what they feel needs to happen for them to return to work.

6.  Explain the purpose, eligibility requirements, and benefits of MCS and Alcoholism and Drug Addiction Treatment and Support Act (ADATSA) programs.

7.  Coordinate with a DBHR Chemical Dependency Professional to schedule an assessment when:

a.  The person wants primary ADATSA.

b.  The person meets incapacity criteria and there is an indication of alcohol or drug abuse or addiction.


CLARIFYING INFORMATION

1.    Supplemental Medical Evidence may be used to help better understand the person's incapacities and make well-informed incapacity decisions. Supplemental Medical Evidence does not replace Objective Medical Evidence (OME). OME must still be obtained for the Progressive Evaluation Process.

2.    During an ADATSA assessment, the Chemical Dependency Professional (CDP) may suspect that the person has mental health or physical issues that could get in the way of the person participating in ADATSA treatment or that are not related to their addiction. Follow these procedures for handling requests for evaluations from assessment entities:

a.    The CDP should refer the client back to the CSO to apply for MCS.

b.    The CSO Case Worker should evaluate the request and consult with the CDP if necessary. The Case Worker should process the MCS application with the appropriate evaluation unless there is a clear and convincing reason otherwise.

Modification Date: November 2, 2011