Deciding how long a client is incapacitated
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Deciding how long a client is incapacitated

Revised December 13, 2011

Purpose: This section gives guidance on how to decide how long a client is incapacitated when applying for the Medical Care Services (MCS) program.
WAC 182-508-0120Deciding how long a client is incapacitated. (Emergency rule effective 11/1/11.)

WAC 182-508-0120

WAC 182-508-0120

Effective November 1, 2011

WAC 182-508-0120 Deciding how long a client is incapacitated. (Emergency rule effective 2/29/12.)

The agency or the agency's designee decides how long an individual is incapacitated, up to the maximum period set by WAC 182-508-0160, using medical evidence on the expected length of time needed to heal or recover from the incapacitating disorder(s).

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

  1. If the provider gives a time range for the length of incapacity, for example, 3 to 6 months, do not automatically approve for the minimum or maximum length of time.  Each case should be assessed individually, taking into consideration the person's incapacitating condition, treatment plan, likelihood of improvement within a specific timeframe, etc.  You should decide how much time is needed within the range given by the provider.

NOTE: Don't choose the minimum length of time for incapacity in order to use it as a case management or treatment monitoring tool.

EXAMPLE

Joan has recently been diagnosed as having depression.  She was prescribed her third medication trial two days ago.  The provider indicates that the previous two trials on different medications have been unsuccessful, and it may take some time to find a successful medication or combination of medications.  Given the information regarding the medication issues, your assessment may be to approve her incapacity for 6 months.


EXAMPLE

Paul has a tibia fracture.  The medical provider stated that Paul's degree of limitation is expected to continue for 6 to 9 months.  Paul is 20 years old, and is otherwise in excellent physical condition.  Based on these factors, you assess that he may be employable within 6  months, and approve incapacity for 6 months.


  1. When completing the DSHS 14-118 Incapacity Decision, keep in mind:
    1. The date of eligibility is the date complete medical documentation is received or the 45th day of application, whichever is earlier.
    2. For denials and termination, you must include the specific reason on the 14-118 so that the client receives adequate notice.
Modification Date: December 13, 2011