Incapacity Determination - Acceptable Medical Evidence

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Revised December 13, 2011

Purpose: This section describes acceptable sources of medical evidence for determining incapacity for the Medical Care Services (MCS) program.

WAC 182-508-0020

Acceptable medical evidence. (Emergency rule effective 11/1/11.)

WAC 182-508-0020

Effective October 14, 2012

WAC 182-508-0020 Acceptable medical evidence.

The agency or the agency's designee accepts medical evidence from these sources:

(1) For a physical impairment, a health professional licensed in Washington state or where the examination was performed:

(a) A physician, which for medical care services (MCS) program purposes, includes:

(i) Medical doctor (M.D.);

(ii) Doctor of osteopathy (D.O.);

(iii) Doctor of optometry (O.D.) to evaluate visual acuity impairments;

(iv) Doctor of podiatry (D.P.) for foot disorders; and

(v) Doctor of dental surgery (D.D.S.) or doctor of medical dentistry (D.M.D.) for tooth abscesses or temporomandibular joint (TMJ) disorders.

(b) An advanced registered nurse practitioner (ARNP) for physical impairments that are within the ARNP's area of certification to treat;

(c) The chief of medical administration of the Veterans' Administration, or their designee, as authorized in federal law; or

(d) A physician assistant when the report is cosigned by the supervising physician.

(2) For a mental impairment, professionals licensed in Washington state or where the examination was performed:

(a) A psychiatrist;

(b) A psychologist;

(c) An advanced registered nurse practitioner certified in psychiatric nursing; or

(d) At the agency's or the agency's designee's discretion:

(i) A person identified as a mental health professional within the regional support network mental health treatment system provided the person's training and qualifications at a minimum include having a master's degree and two years of mental health treatment experience; or

(ii) The physician who is currently treating the individual for a mental impairment.

(3) "Supplemental medical evidence" means information from a health professional not listed in subsection (1) or (2) of this section and who can provide supporting medical evidence for impairments identified by any of the professionals listed in subsection (1) or (2) of this section. The agency includes as supplemental medical evidence sources:

(a) A health professional who has conducted tests on or provides ongoing treatment to the individual, such as a physical therapist, chiropractor, nurse, physician assistant;

(b) Workers at state institutions and agencies who are not health professionals and are providing or have provided medical or health-related services to the individual; or

(c) Chemical dependency professionals (CDPs) when requesting information on the effects of alcohol or drug abuse.

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.

Clarifying Information

Supplemental Medical Evidence may be used to help better understand the client'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.
During an ADATSA assessment, the Chemical Dependency Professional (CDP) may suspect that the client has mental health or physical issues that could get in the way of participating in ADATSA treatment or that are not related to their addiction. Follow these procedures for handling requests for evaluations from assessment entities:
1. The CDP should refer the client back to the CSO to apply for MCS.
2. 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: December 13, 2011