Social Services Manual

The Social Services website is designed for and used by Economic Services, and Health and Recovery Services Administration staff. The main component of this web site is the Social Services Manual. It provides administrative rules and procedures for staff who provide social services to people applying for and receiving cash, food and medical assistance in Washington State.

Social Services Manual Revisions

Rev # Chapter / Section Issue Date
139 Program Standards DCS Good Cause June 29, 2017
138 Division of Vocational Rehabilitation (DVR) June 5, 2017
136 Medical Evidence Reimbursements- Medical Evidence to Support SSI Applications September 16, 2016
135 SSI Facilitation- Special Circumstances- Children's Applications August 31, 2016
134 Good Cause August 10, 2016
133 SSI Facilitation- Forms September 16, 2016
132 Medical Evidence Reimbursements October 31, 2016
131 SSI Facilitation- Application: Medical Evidence to Support SSI Applications September 16, 2016
130 SSI Facilitation- SSA Determinations and Appeals August 31, 2016
129 SSI Facilitation- Application: SSA Teleservice June 24, 2016
128 SSI Facilitation- Application: Application June 24, 2016
127 SSI Facilitation- Application: Medical Records June 22, 2016
126 Naturalization December 8, 2015
125 Disability Determination - Concurrent Disability/ Incapacity Determination Process December 1, 2015
124 Incapacity Determination - When HEN Referral Eligibility Ends December 1, 2015
123 Incapacity Determination - Review of Incapacity December 1, 2015
122 Medical Evidence Reimbursements August 5, 2015
121 SSI Facilitation - Application October 10, 2014
120 SSI Facilitation - Introduction October 10, 2014
119 Medicaid Treatment Child Care May 16, 2013
118 Disability Determination - Step 5 March 19, 2013
117 Disability Determination - Review of Disability March 19, 2013
116 Disability Determination - Step 2 March 19, 2013
115 Disability Determination - Step 4 March 19, 2013
114 Disability Determination - Concurrent Disability / Incapacity Determination Process January 15, 2013
113 Statewide SSI Facilitator Contact List December 26, 2012
112 Disability Determination - Review of Disability August 31, 2012
111 Disability Determination - Step 2 August 30, 2012
110 Disability Determination - Step 5 August 27, 2012
109 ABD/HEN REFERRAL - APPLICATION AND INTAKE PROCESS August 17, 2012
108 Medical Evidence Reimbursements July 20, 2012
107 Statewide SSI Facilitator Contact List June 29, 2012
106 Disability Determination - Concurrent Disability / Incapacity Determination Process June 29, 2012
105 First Steps June 25, 2012
104 Good Cause June 7, 2012
103 Family Planning Services June 5, 2012
102 SSI Facilitation - SSA Determinations and Appeals April 5, 2012
101 Medical Evidence Reimbursements March 14, 2012
100 SSI Facilitation - SSA Determinations and Appeals March 12, 2012
99 Medicaid Treatment Child Care November 1, 2011
98 Good Cause November 1, 2011
97 SSI Facilitation - SSA Determinations and Appeals August 30, 2011
96   June 1, 2011
95 Incapacity Determination - When HEN Referral eligibility ends May 23, 2011
94   March 22, 2011
93 First Steps March 1, 2011
92 Medical Evidence Reimbursements January 21, 2011
91 Division of Vocational Rehabilitation (DVR) January 10, 2010
90 Naturalization December 1, 2010
89 Naturalization December 1, 2010
88 Naturalization December 1, 2010
87   December 1, 2010
86 Medical Evidence Reimbursements December 1, 2010
85 Incapacity Determination - PEP Step I November 1, 2010
84 Medicaid Treatment Child Care September 1, 2010
83 Family Planning Services June 30, 2010
82 First Steps June 21, 2010
81 Incapacity Determination - When HEN Referral eligibility ends July 1, 2010
80 Incapacity Determination - How to determine incapacity July 1, 2010
79   July 1, 2010
78 SSI Facilitation - Introduction May 20, 2010
77 Incapacity Determination - PEP Step I May 1, 2010
76 Incapacity Determination - How to determine incapacity May 1, 2010
75 SSI Facilitation - Application February 17, 2010
74   February 4, 2010
73 SSI Facilitation - Supporting Home and Community Services (HCS) January 12, 2010
72 SSI Facilitation - Application January 4, 2010
71 Incapacity Determination - PEP Step I January 7, 2010
70 Mental Health Services January 7, 2010
69 Medical Evidence Reimbursements January 7, 2010
68   January 7, 2010
67 Incapacity Determination - How to determine incapacity January 7, 2010
66 SSI Facilitation - Introduction January 7, 2010
65   January 7, 2010
64 Incapacity Determination - How to determine incapacity January 7, 2010
62 Managed Care October 9, 2009
60 Medical Evidence Reimbursements September 1, 2009
59 Medical Evidence Reimbursements July 1, 2009
58 Incapacity Determination - Housing and Essential Needs (HEN) Referral- Table of Contents July 1, 2009
57 Division of Vocational Rehabilitation (DVR) June 9, 2009
56 Medical Evidence Reimbursements May 1, 2009
54 Incapacity Determination - Housing and Essential Needs (HEN) Referral- Table of Contents March 1, 2009
53 Ongoing Additional Requirements (OAR) November 6, 2008
52 SSI Facilitation - Introduction October 29, 2008
51   October 1, 2008
50 Ongoing Additional Requirements (OAR) July 1, 2007
49 SSI Facilitation - SSA Determinations and Appeals April 1, 2007
48 SSI Facilitation - Supporting Home and Community Services (HCS) March 1, 2007
47 Statewide SSI Facilitator Contact List March 1, 2007
46 Incapacity Determination - When HEN Referral eligibility ends March 1, 2007
45   February 1, 2007
44 SSI Facilitation - Tracking December 1, 2006
43 SSI Facilitation - Special Situations - Children's Applications December 1, 2006
42   November 1, 2006
41 Managed Care November 1, 2006
39 Medical Evidence Reimbursements November 1, 2006
37 SSI Facilitation - SSA Interim Assistance Reimbursement Agreement (IARA) September 1, 2006
36 Incapacity Determination - How to determine incapacity September 1, 2006
35 SSI Facilitation - Application September 1, 2006
34 Naturalization Agencies September 1, 2006
33 SSI Facilitation - Introduction September 1, 2006
32 Incapacity Determination - PEP Step I July 1, 2006
31 Incapacity Determination - How to determine incapacity July 1, 2006
30 SSI Facilitation - Application June 1, 2006

ABD/HEN Referral - Application and Intake Process

Created on: 
Oct 21 2014

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

WAC 388-449-0001 - What are the disability requirements for the Aged, Blind or Disabled (ABD) program?


Worker Responsibilities

Intake Interview

  1. Review the referral (14-084) from financial services and any existing medical documentation.
  2. Consider if the individual is age 65 or older or meets any of the approval criteria in WAC 388-449-0001 (3) (a) through (d). If documentation is available confirming the individual meets age or non-SEP approval criteria for ABD, a social service intake is not required. Complete the SEP tool in ICMS and send a 14-118 to financial approving ABD.
  3. If the individual does not meet the age or non-SEP ABD approval criteria detailed above, complete the social service intake assessment.
  4. Explain the purpose, eligibility requirements, and benefits of the ABD cash and HEN Referral programs.
  5. Complete the Social Services Intake in ICMS. Document:
    1. Claimed impairments in the client’s own words;
    2. Treatment history;
    3. Education and training history;
    4. Work history (15 years); and
    5. Your professional observations.
  6. Obtain a signed IARA when the individual has a current pending SSI application.

NOTE: - While it is a best practice to complete a social service intake assessment on all ABD/HEN Referral applicants, a social service intake assessment is not required for applicants 65 or older or individuals who meet the approval criteria detailed in WAC 388- 449-0001 (3) (a) through (d).

Do not automatically deny ABD/HEN Referral when an applicant fails to complete a social service intake assessment. Review available documentation and approve ABD if the individual is age 65 or older or meets any of the non-SEP approval criteria detailed in WAC 388-449-0001 (3) (a) through (d).

For applicants who do not meet any of the non-SEP approval criteria, continue to track the case and deny ABD/HEN Referral by the 45th day of application, using the appropriate denial reason found on the 14-118 Incapacity Decision form.

Requesting Medical Evidence

  1. Request medical records from acceptable medical sources per WAC 388-449-0010 (doctors) who provided treatment in the last five years.
  2. Request medical records from all treating medical professionals seen in the last 90 days.
  3. Request a mental or physical evaluation only when no current medical records exist or there is no diagnosis from a doctor within the last five years.

Alcohol and Substance Abuse

Created on: 
Oct 21 2014

Revised December 30, 2013

Purpose:

Provide a basic overview of alcohol/substance abuse system and guidelines to assist in determining if a client is in need of alcohol or substance abuse treatment.

Guidelines

The department recognizes that identification and treatment of alcohol and substance abuse issues are of paramount importance in assisting clients to attain self-sufficiency. The Division of Behavioral Health and Recover (DBHR) contracts with local treatment centers which provide alcohol and substance abuse evaluations and treatment.

Evaluation and treatment services are provided for clients receiving services under the following programs:     

  • WorkFirst;
  • ABD cash assistance;
  • HEN Referral; and 
  • Medicaid.

Under certain circumstances, other persons in low-income status may also receive evaluation and treatment services.

Alcohol dependency and chemical dependency are addictive diseases that include the following four symptoms:

  • Craving: A strong need or urge to use alcohol or other substances
  • Loss of Control: Not being able to stop drinking or using once the drinking or use has begun
  • Physical Dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, or anxiety
  • Tolerance: The need to drink or use greater amounts of alcohol or other substances to achieve the effects.

Alcohol and Substance Abuse

Alcohol or substance abuse can be just as harmful as an addiction or dependency. Some of the problems associate with alcohol and substance abuse include:

  • The inability to fulfill work, school, or family obligations;
  • Involvement in legal issues such as drunk driving arrests or violence;
  • Increased social and inter-personal problems, including family violence, child neglect and abuse;
  • Increased occurrence of accidents; and,
  • Health concerns, such as harm caused by the use of alcohol or substances during pregnancy, and increases in the risk of other medical disorders.

Worker Responsibilities

WorkFirst Clients

All WorkFirst applicants are screened using the Alcohol / Substance Abuse Screening Tool in e-JAS. If the alcohol / substance abuse screening indicates the likelihood of abuse use the e-JAS alcohol / substance abuse evaluation to determine if you should refer the client to the local Certified Chemical Dependency Counselor for a full assessment.

More information is in the WorkFirst Handbook - 6.7 Resolving Issues - Substance Abuse.

ABD/HEN Referral/PWA

Recipients are required to complete an assessment if there is an indication of substance abuse or chemical dependency. If assessed as in need of treatment, the recipient must follow through with all recommended treatment activities as a condition of eligibility.

Links

Assessment

Purpose:

This category describes the information collected by a case worker in an assessment, the skills the case worker needs to conduct an effective assessment and where to find information about assessments designed for specific programs.

Clarifying Information

  1. An assessment is a brief or extended compilation of client information including:
    1. Risk factors,       
    2. Mental / physical conditions,
    3. Family interaction,
    4. Employment support network,
    5. Needs,
    6. Strengths,
    7. Barriers, and
    8. Other significant information as presented by the client or observed by the case worker.
  2. During the assessment the case worker and the client work together to identify the resources available to the client through the CSO, other agencies or community-based organizations.
  3. To conduct an effective assessment the case worker needs the skill and ability to:
    1. Create an environment in which the client feels safe to discuss sensitive and personal issues.
    2. Establish rapport with the client.
    3. Apply active listening skills.
    4. Identify the client's interests, skills, abilities, obstacles, strengths, needs for services, and personal resources.
    5. Help the client develop and set realistic goals and action plans.
    6. Use professional expertise to observe and note the client's physical appearance, body language, eye contact, affect, dress, personal hygiene, speech patterns and cognitive abilities.
    7. Gather and incorporate other medical / psychological reports, tests and information, as needed to complete the assessment.
  4. The case worker and other program staff use the information collected through the assessment to develop an action plan, or other plans for service delivery.
  5. There are several assessment / evaluation tools available to case workers, they include:
  6. e-JAS automated assessment
  7. Intensive Services Assessment
  8. Teen Living Assessment
  9. ABD cash - Sequential Evaluation Process
  10. MCS/ HEN- Progressive Evaluation Process
  11. SSI Facilitation
  12. Good Cause Determination
  13. Necessary Supplemental Accommodations
  14. Learning Needs Screening Tool

This chart shows the assessment types, what form or system is used to collect the information required for the assessment and purpose of the assessment in relation to the specific program in which it is used.

Reasons for Assessment

Assessment Form or System

Purpose of Assessment

Pregnancy to Employment

e-JAS assessment or Intensive Services Assessment

Determines the type of participation activities that best meets the needs of parent and child based on the results of the assessment.

Whole Family Services

e-JAS assessment

Determines the participant's strengths, needs and the barriers to participation / employment.

Intensive Services

e-JAS assessment or Intensive Services Assessment

Determines the participant's strengths, needs and the barriers to participation / employment.

Minor Teen Living

Teen Living Assessment 14-427 (X)

Assess the minor's living arrangement and the social services needs of the minor and her child.

ABD cash assessment

ICMS Intake and Evaluation

Assess work history, skills and abilities. Determines the severity level, duration of impairments and eligibility for ABD cash program.

MCS/HEN  assessment

ICMS Intake and Evaluation

Assess work history, skills and abilities. Determines the severity level, duration of impairments and eligibility for MCS/HEN.

Refugee Personal Employment Plan

RCA Personal Employment Plan (DSHS 14-191(X))

Primary data input document, all services are initiated from this document. Case plan and all referral services are recorded on this document.

SSI Facilitation

ICMS SSI

Assists clients with SSI application process.

Good Cause

e-JAS Family Violence assessment category and the Good Cause Decision form 18-444 (X)

Determines if there are family violence issues that would put the client at risk if DCS collects support.

Necessary Supplemental Accommodation (NSA)

NSA Accommodation Plan 14-415(X)

Determines need for accommodation to access DSHS services.

Learning Needs Screening tool

e-JAS screening / evaluation and e-JAS assessment

Screens for presence of learning needs and possible learning disabilities.

Issue Specific (family violence, substance abuse, mental health, general health, child welfare, etc.)

e-JAS assessment or Intensive Services Assessment 14-433 (X)

Examines a specific issue and how it affects a participant's ability to participate and the services needed to address the barrier.

 

Worker Responsibilities

  1. Receive referral for assessment from the WorkFirst case manager, Financial Eligibility Worker or through local office procedure via the e-JAS system or hard copy paper referral.
  2.  Determine the type of assessment required.
  3. Conduct the assessment in a safe and confidential environment.
  4. Document the results of the assessment in the appropriate automated system.
  5. Provide feedback to the referring worker regarding the results of the assessment and the recommendations for further services and participation.
  6. Make appropriate referrals to community service providers when necessary.
  7. Develop an IRP that addresses the needs discovered in the assessment.
  8. Provide assistance and support services to the client to help them meet the goals established on their IRP.

Audits

Purpose:

This category describes the case review process used by the Disability Specialist Supervisor.

Worker Responsibilities

The supervisor:

  1. Informs workers when cases are due for review.
  2. Once the review is complete, provides the program specialist with a copy of the completed audit for the case.
  3. Follows regional or CSO procedures for documenting the review conclusions, and
  4. Monitors cases identified for corrective action.

Chemical Dependency Treatment Requirements For ABD, PWA, And HEN Referral

Created on: 
Oct 21 2014

WAC 388-447-0120 -How does alcohol or drug dependence affect my eligibility for referral to the housing and essential needs (HEN) program?

AC 388-449-0220 -How does alcohol or drug dependence affect my eligibility for the ABD cash and Pregnant Women Assistance programs?


Clarifying Information 

  1. If there is an indication of a potential substance use disorder, ABD/HEN Referral/PWA recipients must complete a chemical dependency assessment as a condition of eligibility. Indications of a potential substance use disorder include:
    • A note regarding alcohol on the breath (AOB) or signs of intoxication by a medical provider or DSHS staff.
    • A diagnosis of a substance –related disorder.
    • Medical or mental health chart notes indicating overuse or misuse of prescribed medication.
    • Recent legal problems associated with substance use (e.g. DUI, Possession of Controlled Substance).
    • Concern regarding the person’s substance use expressed by family members, friends, or past employers.
  2. If the chemical dependency assessment indicates a need for treatment, ABD/HEN Referral/PWA recipients must participate in recommended treatment as a condition of eligibility.
  3. Chemical dependency assessments are valid for 6 months. If a person is assessed as dependent, no additional assessments are needed for 6 months.

Worker Responsibilities 

  1. If there is an indication of a substance use disorder or chemical dependency, notify the ABD/PWA/HEN Referral recipient that they must complete a chemical dependency assessment using the 14-529 (ABD) or 14-527 (HEN Referral).
  2. If the chemical dependency assessment indicates a need for treatment, notify the ABD/PWA/HEN Referral recipient that they must participate in treatment using the 14-529 (ABD) or 14-527 (HEN Referral).
  3. Track participation in the chemical dependency assessment and treatment using the CD Treatment tab of the ICMS Case Plan screen. Treatment monitoring is required for all recipients assessed as in need of substance use disorder or chemical dependency treatment.
  4. If the recipients fails to follow through with an assessment or treatment, send the 14-522 (ABD) or 14-528 (HEN Referral). If the recipient does not respond to the 14-522 (ABD) or 14-528 (HEN Referral), assume non-cooperation without good cause.
  5. Good cause for failure to complete a chemical dependency assessment or treatment is limited to the following:
    • The recipient’s physical or mental impairment prevents them from participating based on a review of available objective medical evidence;
    • The outpatient substance use disorder or chemical dependency treatment the recipient needs is not available in the county where they reside; or
    • The inpatient substance use disorder or chemical dependency treatment the recipient needs is not available in an area they can reasonably access.
  6. If the recipient fails to follow through with a chemical dependency assessment or treatment without good cause, terminate ABD/PWA/HEN Referral using ACES Reason Code 578.
  7. The individual remains ineligible for the ABD/PWA/HEN Referral programs until they reapply and provide proof they have resolved their non-cooperation status.

Crisis Intervention

Purpose:

This category provides general information regarding crisis intervention including but not limited to, planning, implementation and available resources that may be able to assist a client in a crisis situation.

Clarifying Information

Definition of a Crisis: A disruption or breakdown in a person’s or family’s normal or usual pattern of functioning. A crisis cannot be resolved by a person’s customary problem-solving resources/skills.

A crisis may be different from a problem or an emergency

  • While a problem may create stress and be difficult to solve, the family or individual is capable of finding a solution. Consequently, a problem that can be resolved by an individual or a family without outside intervention is not a crisis. Oftentimes, a problem may seem like a crisis to a family or individual under stress and not thinking clearly. Interventions that establish trust and provide reassurance, advice or a referral by the case worker may resolve such a problem.
  • An emergency is a sudden, pressing necessity, such as when a life is in danger because of an accident, a suicide attempt, or family violence. It requires immediate attention by law enforcement, CPS, or other professionals trained to respond to life-threatening events. If a situation can wait 24 to 72 hours for a response, without placing an individual or a family in jeopardy, it is a crisis and not an emergency.
  • Three basic elements of a crisis are: A stressful situation, difficulty in coping, and the timing of intervention. Each crisis situation is unique and will require a flexible approach to the client and situation.

Situations Which Can Lead to a Crisis

Everyone has experiences that make them feel upset, disappointed, or fatigued. When these types of feelings are combined with certain life events or situations, they often lead to mounting tension and stress. Five types of situations have been identified that may produce stress and, in turn, contribute to a state of crisis. Types of client crisis situations presented in the CSO are typically related to the following:

  • Family Situations - a child abuse investigation, spouse abuse, an unplanned pregnancy, a parent’s desertion, a chronically ill family member, and lack of social supports are examples of family situations that can create stress and crises.
  • Economic Situations - sudden or chronic financial strain is responsible for many family crises, such as loss of employment, eviction, no food, a theft of household cash or belongings, high medical expenses, missed child support payments, repossession of a car, utilities cut off from service, money “lost” to gambling or drug addiction, and poverty.
  • Community Situations - neighborhood violence, inadequate housing, a lack of community resources, and inadequate educational programs illustrate some ways the community may contribute to family crises.
  • Significant Life Events - events that most view as happy, such as a marriage, the birth of a child, a job promotion, or retirement, can trigger a crisis in a family; a child enrolling in school, the behaviors of an adolescent, a grown child leaving the home, the onset of menopause, or the death of a loved one can also be very stressful life events.
  • Natural Elements -crises are created by disasters such as floods, hurricanes, fires, and earth quakes, or even extended periods of high heat and humidity, or gloomy or excessively cold weather.

Worker Responsibilities

  1. CSO case workers and disability program specialists can have a major lasting impact on their clients' lives and assist other CSO staff by responding appropriately and promptly to client crises. CSO Financial Workers and WorkFirst Case Managers are to attempt to resolve crisis issues that relate to the assigned caseloads and programs. If necessary, CSO staff my consult with case workers and disability program specialists to resolve client-related crisis situations.
  2. The successful resolution of an emergent situation can do much to strengthen the case worker's bond of trust with their client, and set the stage for a cooperative and productive future relationship. When confronted with a client emergency, case workers and disability program specialists respond by doing the following:
    1. Take a quick inventory of the situation;
    2. Identify the type of crisis;
    3. Take action;
    4. Attempt to defuse situation and/or reassure the client;
  3. Once the situation is calm:
    1. Identify and contact available community resources in your area that can assist the client through the crisis
    2. Document events to the extent possible, maintaining confidentiality when required.
  4. Maintain your professional skills and resources:
    1. Identify and post information about available community resources. Keep that information available to all clients and staff.
    2. Seek additional training opportunities when available. Additional resources for Crisis Intervention Training include:

DSHS

DOP - www.hr.wa.gov,

UW School of Social Work - http://socialwork.uw.edu/

Crisis Clinic of Thurston and Mason Counties - www.crisis-clinic.org.

Disability Determination - Concurrent Disability / Incapacity Determination Process

Created on: 
Dec 01 2015

Summary

  1. Under the concurrent process, the Department first attempts to obtain medical evidence necessary to determine eligibility for ABD cash assistance identified in WAC 388-449-0015.                                                                                                                                                   
  2. If the applicant does not meet ABD disability criteria outlined in WAC 388-449-0001 or fails to provide the medical evidence necessary for the Department to determine ABD eligibility within the 45 day standard of promptness, the Department will consider eligibility for the HEN Referral program.
  3. Medical evidence necessary to determine HEN Referral eligibility is outlined in WAC 388-447-0005 and WAC 388-447-0010.

Worker Responsibilities

  1. Review available records and approve ABD when the applicant meets any of the non-SEP criteria outlined in WAC 388-449-0001.
  2. If available records are not sufficient to approve ABD, complete a social service intake assessment and review available records to determine what additional evidence is necessary to determine ABD disability.
  3. Request medical records from within the past 5 years associated with any potentially disabling impairment(s).
  4. Request a mental health or physical evaluation from an ABD acceptable medical source identified in WAC 388-449-0010 only when current medical records are insufficient to determine ABD eligibility or when the impairment has not been established by an ABD acceptable medical source within the past 5 years.
  5. If sufficient medical evidence necessary to determine ABD eligibility is not received within the 45 day standard of promptness or the applicant does not meet ABD disability criteria, consider eligibility for the HEN Referral program.
NOTE: See #3 of the When HEN Referral Eligibility Ends section for information regarding when a new SEP is conducted for an active HEN Referral recipient.
NOTE: A social service intake assessment is not required to determine ABD disability. If the applicant fails to complete a social service intake assessment, review available evidence to determine if the applicant meets the approval criteria detailed in WAC 388-449-0001. If the applicant meets the approval criteria detailed in WAC 388-449-0001, approve ABD. If the applicant does not meet the approval criteria detailed in WAC 388-449-0001, deny ABD for no medical evidence.

Disability Determination - Step 1

Created on: 
Oct 21 2014

WAC 388-449-0005 Sequential Evaluation Process Step 1 -- How does the department determine if you are performing substantial gainful employment?

The SGA is an earnings standard that is adjusted periodically by SSA. An individual may be financial eligible for ABD cash but fail the disability requirement if they are working and earning above the SGA limit. Examples of jobs that a person may that aren’t counted toward ABD when determining financial eligibility, but are considered when determining SGA are earnings from:

  •  Work study
  •  AmeriCorps
  •  University Year for Action
  •  Urban Crime Prevention Program
  •  Retired Senior Volunteer Program

Disability Determination - Step 2

Created on: 
Oct 21 2014

WAC 388-449-0035 How does the department assign severity ratings to my impairment?

WAC 388-449-0040 How does the department determine the severity of mental impairments?

WAC 388-449-0045 How does the department determine the severity of physical impairments?

WAC 388-449-0050 How does the department determine the severity of multiple impairments?

WAC 388-449-0060 Sequential Evaluation Process step II - How does the department review medical evidence to determine if I am eligible for benefits?


  1. The severity of an impairment is the extent to which it affects the individual's ability to perform basic work activities.
  2. The Disability Specialist determines severity based on medical and other evidence received by the Department. When the individual needs help obtaining necessary evidence (e.g. meets Equal Access criteria or requests assistance), the Disability Specialist assists the individual in obtaining necessary evidence.
  3. Severity ratings are assigned to all medically determinable impairments, meaning all impairments that could reasonably result from a condition diagnosed by an acceptable medical source identified in WAC 388-449-0010.
  4. Severity ratings are assigned by the Disability Specialist based on the overall medical evidence and input received from the contracted Review of Medical Evidence (RME).
EXAMPLE - Betty provides a physical evaluation that indicates she has severe hyperlipidemia. Betty has no symptoms that currently impair her ability to perform basic work activities resulting from the condition. The Disability Specialist assigns a severity of "none" to Betty's hyperlipidemia.
EXAMPLE - Tim has been diagnosed with multi-level degenerative disc disease involving his lumbar spine. An L-spine MRI indicates a broad based disc protrusion mildly indents the thecal sac at the L4-5 level. Available medical evidence indicates Tim experiences intermittent numbness and weakness in his left leg and has significantly limited range of motion in his back secondary to pain. The Disability Specialist assigns a "marked" severity to Tim’s degenerative disc disease.
EXAMPLE - Phil has been diagnosed with Generalized Anxiety Disorder by a contracted psychologist. The Psychological Evaluation indicates Phil has suffered from frequent anxiety and excessive worry, which he is unable to control, for at least the past 12 months. The psychologist notes Phil has difficulty concentrating, becomes irritable, and has difficulty sleeping. The BAI completed as part of the Psychological Evaluation is consistent with marked-to-severe anxiety. The contracted psychologist notes significant limits on Phil's ADLs and assigned a GAF of 45. Based on the overall clinical findings and objective evidence, the Disability Specialist assigns a "marked" severity.
  1. When an individual has multiple impairments, we consider whether the impairments have a cumulative effect on their ability to perform basic work activities.
  2. The Disability Specialist assigns a higher overall severity if the cumulative effect of multiple impairments results in a greater impact on the individual's ability to perform one or more basic work activity.
EXAMPLE - Jerry has been diagnosed with moderate C-spine degenerative disc disease. He also has moderate arthritis involving his dominant hand. Based on medical and other evidence received, the two conditions result in a very significant limitation in Jerry's ability to handle and manipulate objects. Based on the cumulative effect on Jerry's ability to perform a basic work activity, the Disability Specialist assigns a "marked" overall severity.

Clarifying Information

  1. ABD Disability Determinations are made by a team consisting of a Disability Specialist and a contracted doctor.
  2. The contracted doctor reviews the diagnosis, severity, functional limitations, duration and onset date recorded by the Disability Specialist if the individual has at least a moderate overall severity that has lasted or is expected to last 12 months or more or result in death.
  3. The Disability Specialist makes necessary adjustments to the diagnosis, severity, functional impairments, and onset date based on the contracted doctor's professional medical opinion when supported by objective medical evidence. All adjustments are made prior to determining whether the individual meets the disability criteria in Step 2 of the ABD Sequential Evaluation Process (SEP).
  4. If the severity ratings or functional limitations provided by the evaluating medical provider are adjusted, the Disability Specialist must clearly describe the reason why we rejected the medical evidence provider's opinion and identify the medical evidence used to make the determination.
  5. If the overall impairment is of at least a moderate severity and the impairment has lasted or is expected to last 12 months or more or result in death, the Disability Specialist proceeds with the ABD Sequential Evaluation process.
  6. The Disability Specialist denies ABD at Step II if:
    1. The overall impairment is mild, meaning there is not a significant impact on the ability to perform at least one basic work activity.
    2. The impairment has not lasted or is not expected to last 12 months or more or result in death; or
    3. Medical evidence indicates substance use is material to the impairment as defined in WAC 388-449-0015.
NOTE: In general, the opinion of a treating provider is given more weight than that of the contracted RME doctor who has not examined or treated the individual. In addition, the opinion of a specialist involving an area of his or her expertise is given more weight than that of a non-specialist.

Disability Determination - Step 3

Created on: 
Oct 21 2014

Purpose:

Process to determine if a person's impairments meet the SSA listings of impairments criteria.

WAC 388-449-0070 Sequential Evaluation Process step III — How does the department determine if you meet SSA listing of impairments criteria?


Clarifying Information 

  1. Individuals whose impairments meet the SSA listing of impairments criteria are determined to be disabled regardless of their ability to do past work or other work.
  2. The listing of impairments have very specific criteria defined by SSA that must be met in order to determine a person is disabled at this step.
  3. The overall mental or physical impairment severity must be at least marked to consider an for meeting listing criteria.
  4. If the specific diagnostic and other medical criteria for a specific listing is met, the functional impairments that meet the remainder of the listing criteria do not need to be the direct result of the disabling impairments. Other impairments or the treatment of the primary or secondary impairments may contribute to the person's  functional limitations.
    EXAMPLE- Terry has been diagnosed with systemic sclerosis and major depression. The Disability Program Specialist takes all the medical and other evidence into consideration when determining if Terry meets the functional impairment criteria for listing 14.04 (Systemic sclerosis). The Disability Program Specialist does not need determine whether Terry's documented fatigue, weight loss, and social impairments are the result of the systemic sclerosis or the major depression.
  5. A person whose impairments do not meet listing criteria may found to be disabled at Step 4 or Step 5 of the Sequential Evaluation process.

​Worker Responsibilities

Select the body system for the most disabling impairment (SSA Blue Book):

1.00 Musculoskeletal System

2.00 Special Senses and Speech

3.00
Respiratory System

4.00 Cardiovascular System

5.00 Digestive System

6.00 Genitourinary Impairments

7.00
Hematological Disorders

8.00
Skin Disorders

9.00 Endocrine Disorders

10.00
Impairments that Affect
Multiple Body Systems

11.00 Neurological

12.00 Mental Disorders

13.00 Malignant Neoplastic Diseases

14.00 Immune System Disorders

  1. Review the overview for the listings in the appropriate body system.
  2. Determine the specific listing subcategory that describes the person’s impairment. Some listings are specific to only one diagnosis, others describe a chronic condition within a body system that may have multiple diagnosis or underlying causes for the listed impairments.
  3. Compare the description of listing subcategory with the medical evidence.
    • Does the person’s impairment, based on available medical evidence, match the description?
    • If the person’s impairment doesn’t match the description, the person cannot be approved at this step. Continue with the evaluation process (STEP 4).
    • For some listing categories, a documented diagnosis is all that is necessary to establish that an impairment meets a listing subcategory
  4. Compare the medical evidence testing and documentation requirements to the medical evidence in the ECR.
    • Does the available medical evidence meet the specific requirements given for listing category and sub category?
    • If the testing or medical documentation doesn’t match the specific criteria, the person cannot be approved at this step. Continue with the evaluation process (STEP 4).
  5. Compare the description of functional impairments with the medical evidence, other evidence and functional assessment. Typically the person must meet one the functional limitation descriptions associated with a listing. For mental illness and some physical disorders, the person’s functional limitations must meet all of the criteria listed or specific set as described for the specific listing subcategory.
    • Does the person’s functional limitations, based on available medical and other evidence, match all of the necessary criteria for the listing subcategory?
    • If the person’s impairment doesn’t meet the functional criteria, the person cannot be approved at this step. Continue with the evaluation process (Step 4).
  6. If the person’s impairments meet all the required diagnostic, testing, documentation, and functional impairment criteria for a specific listing subcategory:
    1. Approve disability for ABD.
    2. Document the testing (if applicable) and functional limitations that allowed for an approval at this step of the process.

Disability Determination - Step 4

Created on: 
Oct 21 2014

WAC 388-449-0080Sequential Evaluation Process step IV — How does the department evaluate if I am able to perform relevant past work?


Clarifying Information

An individual who is 55 years of age or older meets ABD disability criteria if their impairment prevents them from performing all relevant past work from within the past 15 years.

​WorkerResponsibilities

Social Service Intake Interview

  1. In order to be considered relevant past work:
  2. The work must have been performed within the past 15 years;
    1. The past work must be considered a “substantial gainful activity" as defined in WAC 388-449-0005; and
    2. The individual must have performed the work long enough to meet the Specific Vocational Preparation(SVP) level identified in the Dictionary of
    3. Occupational Titles (DOT) for the corresponding job listing.
  3. Assign an exertional level (e.g. sedentary, light, medium, heavy) to the each specific relevant past work experience that is consistent with the Strength Rating identified in the DOT for the specific job title. Specific DOT job titles can be located using the DOT Search function.
  4. Document any transferable skills the individual gained during each relevant past work episode based on the individual’s specific job duties. Transferable skills are considered at Step 5 of the Sequential Evaluation Process (SEP).
EXAMPLE Henry worked as a roofer for 2 years ending in 2008. As a regular part of his weekly job duties, Henry visited potential job sites and provided labor and material estimates as part of the bidding process. While Henry’s work as a roofer required the ability to perform medium work, he developed transferable skills as a bidder (Estimator/DOT Code 169.267-038) and therefore has sedentary transferable skills.

Sequential Evaluation Process

  1. If the individual is neither denied ABD at Step 1 or Step 2, nor approved for ABD at Step 3, the Disability Specialist determines whether the individual is capable of performing relevant past work.
  2. For each relevant past work episode, the Disability Specialist compares the skill and physical demands identified for the specific corresponding DOT job title to the individual’s residual functional capacity to determine whether the individual is capable of returning to past work.
  3. When determining residual functional capacity, the Disability Specialist gives full consideration to all limitations supported by available medical and other evidence. Limitations include:
    1. mental (e.g. social and cognitive factors);
    2. exertional (e.g. work level);
    3. non-exertional (e.g.visual/auditory limitations, inability to work at heights,chemical sensitivities); and
    4. functional limitations (e.g. restrictions related to unrelieved pain or the effects of prescribed medication)resulting from a medically determinable impairment that are supported by available medical and other evidence.
  4. ABD is denied if the individual is capable of returning to relevant past work.
  5. If the individual is not capable of returning to relevant past work, the Disability Specialist proceeds to Step 5 of the Sequential Evaluation Process (SEP) and considers whether the individual is capable of performing other work available in the national economy.
NOTE: "Residual Functional Capacity" is an assessment of an individual's ability to do sustained work-related physical and mental activities in a work setting on a regular and continuing basis. A "Regular and continuing basis" means 8 hours a day, for 5 days a week, or an equivalent work schedule. See SSR 96-8p for additional details.

Disability Determination - Step 5

Created on: 
Oct 21 2014

WAC 388-449-0100 Sequential Evaluation Process step V — How does the department evaluate if I can perform other work when determining disability?


​Worker Responsibilities

  1. If an individual is not approved at Step 3 and not denied at Steps 1, 2, or 4 of the Sequential Evaluation Process (SEP), the Disability Specialist determines if the individual can perform other work.
  2. When determining if the individual is capable of performing other work, the Disability Specialist gives full consideration to the individual's residual functional capacity, age, education, and work experience.
    NOTE: The Social Security Administration (SSA) defines residual functional capacity (RFC)as the most the individual can do despite their impairment based on an assessment of an individual's ability to do sustained work-related physical and mental activities in a work setting on a regular and continuing basis. A "Regular and continuing basis" means 8 hours a day, for 5 days a week, or an equivalent work schedule. See SSR 96-8p for additional details.
  3. If the individual meets the approval criteria detailed in the Physical, Mental, or Combination tables in WAC 388-449-0100, they are considered unable to perform other work and ABD is approved.
  4.  If the individual does not meet the ABD approval criteria detailed in the Physical, Mental, or Combination tables, the Disability Specialist determines whether the individual is capable of performing at least two jobs available in the national economy.
  5. If the Disability Specialist determines the individual is capable of performing other work available in the national economy, the Disability Specialist must list at least two specific jobs from the Dictionary of Occupational Titles (DOT) that the individual is able to perform given their residual functional capacity, age, education, and work experience.
  6. If the Disability Specialist cannot identify at least two examples of jobs the individual can perform despite their impairment, ABD is approved.

Disability Determination - Review of Disability

Created on: 
Oct 21 2014

WAC 388-449-0150 When does my eligibility for the Aged, Blind, or Disabled (ABD) cash benefits end?


Review and Termination of ABD Cash

  1. The Disability Specialist must review current medical evidence and determine whether the individual meets the ABD disability criteria detailed in WAC 388-449-0001 (3) at least every 24 months.
  2. The Disability Specialist must initiate the disability review far enough in advance to request and consider available medical evidence from the individual's treating medical providers and request clarification and/or additional medical records when necessary to determine ongoing ABD eligibility.
  3. If the individual meets Equal Access (EA) criteria, the Disability Specialist must follow all requirements of the EA plan when reviewing disability.
  4. The Disability Specialist may initiate an early Disability Review at any time, if the Department receives information indicating that the individual is no longer likely to meet SSI disability criteria.
  5. Eligibility for ABD cash ends when a final disability determination is made by SSA or when the individual no longer meets the ABD disability criteria detailed in WAC 388-449-0001 (3).
  6. A final SSA disability determination includes an SSI or SSDI denial at the SSA Post-Appeal stage or an unfavorable determination at the initial, reconsideration, or hearing state for which the individual fails to file a timely appeal.
  7. When SSI or SSDI is denied for any reason, the SSI Facilitator reviews the case record and SSI notice to determine if the individual continues to meet ABD financial criteria detailed in WAC 388-400-0060 and the ABD disability criteria outlined in WAC 388-449-0001 (3).
    1. If it appears the individual no longer meets ABD financial criteria, the SSI Facilitator notifies the Financial Service Specialist that a review of eligibility is needed.
    2. If it appears the individual no longer meets ABD disability criteria, the SSI Facilitator notifies the Disability Specialist that an early Disability Review is needed.
NOTE: An ABD Disability Review is not required for recipients age 65 or older.
NOTE: Screen for EA and implement any necessary accommodations when an individual frequently fails to follow through and/or expresses difficulty understanding program requirements.

Disability Determinations - Medical and Other Evidence

Created on: 
Oct 21 2014

WAC 388-449-0010 What evidence do we consider to determine disability?

WAC 388-449-0015 What medical evidence do I need to provide?


Clarifying Information - WAC 388-449-0010

  1. A diagnosis of a disabling impairment must be established by an acceptable medical source. This means report or chart notes from a physician, psychiatrist, or psychologist within the last 5 years.
  2. After a diagnosis of a potentially disabling impairment has been established, we can use medical evidence from treating providers (PAC’s and ARNP) for current medical evidence.
  3. Once we have an impairment established by a doctor, and current medical evidence, then we may, at our discretion, use documentation of how an impairment limits functioning from other sources. Other sources include, but are not limited to:
    1. Chiropractors
    2. Physical therapists
    3. Naturopaths
    4. Therapists
    5. Social workers
    6. Care givers
    7. Employers
    8. Family member

Clarifying Information-  WAC 388-449-0015

  1. Statements regarding how impairments limit a person’s functioning must be consistent with objective medical evidence.
  2. When determining if a medically determinable condition exists, we only use diagnosis of conditions that will produce potentially disabling symptoms or impairments. These symptoms can either be the direct result of the disease or injury, or as a result of treatment for the condition.
  3. Examples of diagnosis that don’t qualify as a diagnosis of a potentially disabling condition:
    1. ADHD, and other learning disorders, are not considered disabling conditions for adults by SSA and cannot be used as a disabling condition for ABD.
    2. Hypertension is typically asymptomatic and therefore is expected produce potentially disabling symptoms.
    3. Hepatitis is also typically asymptomatic or produces mild symptoms. if the disease has progressed, interferon treatment could result in significant fatigue, but way not meet the duration requirement for disability.
    4. Bereavement or grief is not acceptable diagnosis. While the severity may be temporarily disabling, it is not reasonable to expect the condition for 12 months or more.
  4. Pain cannot be used as a diagnosis. There must be a medically determinable condition (diagnosis of an injury or disease). Once the diagnosis has been established by an acceptable medical source, then written evidence from other treating professionals or non-medical sources can be used to determine how the impairment affects the person’s ability to function.
EXAMPLE Milly has a diagnosis of degenerative disc disease from a physician. Her MRI indicates moderate stenosis. Milly provides a letter from her daughter describing how her mother complains of tingling sensation in her hands and that she has recently seen her mother drop objects that weigh more than 10 lbs. Since Milly has a medically determinable condition that could result in the symptoms described, her daughters statement can be used to help determine the severity of her impairments and her exertional level.
EXAMPLE Bart states that pain in his knee keeps him from working. The physician who examined him found mild edema, but no crepitus, or other abnormal findings, and Bart’s gait and station were noted as WNL. Bart also provided a statement from a physician’s assistant (PAC) that he had seen previously that stated Bart was limited to sedentary work due to knee pain. Since Bart does not have a medically determinable condition, the statement from the PAC can’t be used to when making a determination of disability.

Disability Determination - Chart Note Examples

Revised December 12, 2011

Example Scenarios

The following tables contain examples of phrases found in chart notes and the corresponding rating:

Bob applies for ABD cash and states knee pain is keeping him from working. Note that radiological findings are not requested or necessary in the scenarios describe below.

Examination findings (chart notes) Effect on work activities Rating

Patient complains of transient knee pain, negative for impact on ADLs, negative for redness, swelling, or signs of deformity. ROM WNL [Range of Motion Within Normal Limits].

No effect on basic work-related activities.

none

Patient complains of recurrent knee pain aggravated by running, persistent kneeling, or other prolonged physical activity. Normal gait, ROM WNL. No crepitus or swelling. Recommend PT [Physical Therapy] if symptoms persist.

No significant effect on basic work-related activities.

mild

Patient complains of chronic knee pain aggravated by climbing stairs, kneeling, walking. Has decreased physical activity over the last few months with no relief. Limp observed, knee appears swollen, ROM achieved with audible clicking noise from joint. Recommend follow up treatment with Ortho.

Limits on basic work-related activities.

moderate

Patient ambulates with cane prescribed by PCP prior to losing medical insurance. Unable to get off exam table without assistance. Knee exam significant for swelling, visible scars from prior surgery, lateral laxity, and significantly reduced ROM. States Orthopedist recommended another surgery. Referring to Ortho today.

Significant limits on basic work-related activities.

marked

Patient brought to exam in a wheelchair by daughter. Both knees crushed in a car accident in 2009. Surgery improved functioning initially but trauma induced arthritis has progressed to the point patient can no longer walk more than a few feet with assistive devices. Exam positive for redness, swelling, extensive scar tissue and the appearance of bony deformities.

Unable to perform at basic work-related activities.

severe

Tyler applies for ABD cash and states back pain is keeping him from working.

Examination findings (chart notes) Effect on work activities Rating

Patient complains of intermittent back pain after heavy exertion or “sleeping on it wrong.” pain resolves on its own within a day. ROM WNL. Advised patient to begin a moderate exercise program.

No effect on basic work-related activities.

 

Patient complains of frequent back pain aggravated by lifting and standing for extended periods of time. Relieved by NSAIDs ([Non-Steroidal Anti-Inflammatory Drugs]and rest. Reduced ROM. Reflexes intact. Negative straight leg raise. No signs of radiculopathy. Mild degenerative changes and disc desiccation at L4 and L5. Referred for physical therapy.

No significant effect on basic work-related activities.

 

Patient reports chronic pain aggravated by lifting, standing, and sitting for prolonged periods. Review of X-ray indicate moderate degenerative disc disease. Negative for weakness, numbness or tingling. Referring to ORTHO and cautioned patient not to do any heavy lifting.

Limits on basic work-related activities.

 

Patient reports weakness and concerned that he keeps dropping things. Positive for reduced sensation in extremities. Review of MRI positive for significant degenerate changes and moderate stenosis. Referring to ORTHO.

Significant limits on basic work-related activities.

 

Patient arrives in wheelchair provided by VA. Has been unable to walk or stand since MVA [motor vehicle accident] last July. Condition is stable. Patient is wanting to find a PCP since he no longer lives near a VA clinic.

Unable to perform at least one basic work-related activity.

 

Amy applies for ABD cash and states she can’t work because she has diabetes.

Examination findings (chart notes) Effect on work activities Rating

Well maintained on oral medication. Negative for vision changes, numbness, tingling, dizziness. All other systems WNL.

No effect on basic work-related activities.

 

Uncontrolled. Non compliant with diet and medication. Negative for retinopathy, numbness, tingling. Counseled patient on importance of diet and medication compliance to avoid significant complications.

No significant effect on basic work-related activities.

 

Insulin dependent. Currently well controlled, Persistent peripheral neuropathy limits the time patient can walk and stand.

Limits on basic work-related activities.

 

Insulin dependent. Well controlled presently. Long term history of non compliance. Advanced retinopathy. May be a candidate for laser surgery. Positive for reduced sensation in extremities.

Significant limits on basic work-related activities.

 

Uncontrolled despite compliance with medication. Hospitalized with ketoacidosis twice this month. Positive for neuropathy in feet and retinopathy.

Unable to perform at least one basic work-related activity.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: Diagnostic uncertainty in the form of a provisional diagnosis is NOT acceptable for disability determinations. The person must provide evidence of a medically determinable condition.

Disability Determination WAC Index

Created on: 
Oct 21 2014

Disability Determination Process

WAC 388-449-0001 What are the disability requirements for the Aged, Blind, or Disabled (ABD) program?

WAC 388-449-0005 Sequential Evaluation Process Step 1. How does the department decide if you are performing substantial gainful employment?

WAC 388-449-0010 What medical evidence do we consider to determine disability?

WAC 388-449-0015 What medical evidence do I need to provide?

WAC 388-449-0020 How does the department evaluate functional capacity for mental health impairments?

WAC 388-449-0030 How does the department evaluate functional capacity for physical impairments?

WAC 388-449-0035 How does the department assign severity ratings to my impairment?

WAC 388-449-0040 How does the department determine the severity of mental impairments?

WAC 388-449-0045 How does the department determine the severity of physical impairments?

WAC 388-449-0050 How does the department determine the severity of multiple impairments?

WAC 388-449-0060 Sequential Evaluation Process step II - How does the department review medical evidence to determine if I am eligible for benefits?

WAC 388-449-0070 Sequential Evaluation Process step III - How does the department determine if you meet SSA listing of impairments criteria?

WAC 388-449-0080 Sequential Evaluation Process step IV - How does the department evaluate if I am able to perform relevant past work.

WAC 388-449-0100 Sequential Evaluation Process step V - How does the department evaluate if I can perform other work when determining disability?

SSI Application Requirements

WAC 388-449-0150 When does my eligibility for Aged, Blind, or Disabled (ABD) cash benefits end?

WAC 388-449-0200 Am I eligible for cash assistance for the Aged, Blind, or Disabled (ABD) while waiting for Supplemental Security Income (SSI)?

WAC 388-449-0210 What is interim assistance and how do I assign it to the department?

Treatment and Referral Requirements

WAC 388-449-0220 How does alcohol or drug dependence affect my eligibility for the ABD cash and Pregnant Women Assistance programs?

WAC 388-449-0225 Am I required to participate in vocational rehabilitation services if I receive an ABD cash grant?

Division of Vocational Rehabilitation (DVR)

Revised on June 1, 2017

Purpose

The Community Services Division (CSD) and DVR collaborate to improve employment outcomes for mutual clients and reduce poverty statewide. We work toward these goals by striving to provide seamless and consistent service delivery statewide to mutual clients.

The Warm Handoff

CSD social services and WorkFirst staff use the processes and procedures outlined in the CSD Procedures Handbook when referring CSD cash assistance clients to DVR.

DVR Referral Guidelines

To refer to DVR, the client must:

  1. Want to work;
  2. Have a permanent physical, sensory, or mental disability that constitutes a significant barrier to their employment;
  3. Require vocational rehabilitation services to eliminate or reduce their disability-related barrier(s) to employment; and
  4. Agree to the referral and, if determined eligible by DVR, be available and willing to participate fully in DVR’s Individualized Plan for Employment (IPE).

Before making a referral to DVR, CSD social services or WorkFirst staff provides the client with information and a brief orientation regarding DVR services. CSD staff can access client orientation materials on the CSD DVR Partnership SharePoint site and DVR’s website.

Aged, Blind, or Disabled (ABD) and Housing and Essential Needs (HEN) Referral Clients

  1. The Disability Specialist discusses the benefits of DVR services with all ABD/HEN Referral clients.
  2. When an ABD/HEN Referral recipient chooses to apply and is determined eligible for DVR services, the Disability Specialist incorporates IPE requirements into the client’s ABD/HEN Referral Case Plan. The client is required to report their DVR participation to their ABD/HEN Referral Disability Specialist.
  3. The Disability Specialist terminates ABD or HEN Referral benefits for clients who fail to participate in the DVR portion of their ABD/HEN Referral Case Plan without good cause (RCW 74.04.655). When determining good cause, the Disability Specialist consults with DVR staff and the client (when available) to determine why the client is not participating in DVR services. The Disability Specialist and DVR staff discuss what steps can be taken to support the client’s participation.
  4. The Disability Specialist reviews an ABD/HEN Referral recipient’s progress, at a minimum, when the client:
    1. Becomes employed;
    2.  Is not making satisfactory progress;
    3. Experiences significant improvement or deterioration of their disability;
    4. Is unable or refuses to participate; or
    5. Completes their IPE

WorkFirst Clients

  1. When a client chooses a referral to DVR, WorkFirst staff updates their IRP to include DVR participation.
  2. WorkFirst staff provides support services, as available, to support DVR participation.
  3. While DVR is determining eligibility for vocational rehabilitation services, WorkFirst staff engages the client in other appropriate WorkFirst components.
  4. WorkFirst staff includes DVR in employment case planning for mutual clients.
  5. A DVR IPE is the DVR participation requirement documented in a client’s IRP.
  6. WorkFirst staff reviews a client’s progress with DVR on a monthly basis, and when the client:
    1. Becomes employed;
    2. Is not making satisfactory progress;
    3. Experiences significant improvement or deterioration of their disability;
    4. Is unable or refuses to participate; or
    5. Completes their IPE.
  7. When a client fails or refuses to participate with DVR, WorkFirst staff determines whether the client has good cause. When determining good cause, WorkFirst staff consults with DVR staff and the client (when available) to determine why the client is not participating in DVR services. WorkFirst and DVR staff discuss what steps can be taken to support the client’s participation.
    1. When WorkFirst staff determines that the client did not have good cause, they follow the WorkFirst sanction process for failure to participate in required activities.
  8. When verifying and reporting hours of participation in a client’s IRP, WorkFirst staff:
    1. Enters the start and end date of each IRP activity into eJAS, not to exceed 12 months;
    2. Uses the XD component for activities verified by DVR;
      1. The DVR Vocational Rehabilitation Counselor (VRC) may excuse absences if the client has a good reason for missing scheduled activities
    3. For activities not under the XD component, uses the eJAS code that best describes the activity; and
    4. Uses the DVR Actual Hours Reporting Table available on the CSD DVR Partnership SharePoint site as needed to accurately record participation hours.
  9. When an individual who is an existing DVR client becomes eligible for TANF/WorkFirst, DVR and WorkFirst staff conduct a joint case staffing with the client to determine the appropriate activities as follows:
    1. If the client is able to work, the IRP and IPE assists the client with obtaining employment while continuing DVR training or education services.
    2. If the client is unable to work, the IRP reflects work preparation activities outlined in the IPE.
    3. WorkFirst staff informs the client of TANF program time limits, and the goal of obtaining employment while on TANF.

Refugee Cash Assistance (RCA) Clients

  1. CSD social services staff discusses the benefits of DVR services with any RCA client who has a significant disability-related barrier to employment, and refers interested clients through the Warm Handoff process.

Guidelines for Collaboration and Coordination

  1. CSD identifies and maintains a liaison(s) for every local CSD Community Service Office (CSO).
    1. The current CSD liaison list is on the CSD DVR Partnership SharePoint site.
    2. Liaison Roles and Responsibilities are detailed on the CSD DVR Partnership SharePoint site.
  2. DVR identifies and maintains a liaison(s) for every local DVR office.
    1. The current DVR liaison list is on the DVR Intranet Rehab Resources web page.
    2. Liaison Roles and Responsibilities are detailed on the DVR Intranet Rehab Resources web page.
  3. CSD and DVR fund services based on the following:
    1. DVR funds:
      1. Diagnostic and vocational assessment services required for DVR eligibility determination or IPE development; and
      2. Foreign language or sign language interpreters needed by an individual to participate in DVR services.
    2. (For WorkFirst clients) WorkFirst funds available support services to complete the DVR eligibility determination and support the client’s IPE.
  4. DVR may include any WorkFirst employment activities in an IPE.

Equal Access

Created on: 
Oct 21 2014

NECESSARY SUPPLEMENTAL ACCOMMODATION SERVICES

Purpose:

To provide staff with basic information to Social Service Specialists about Community Service Office responsibilities in the identification of individuals needing extra help (an accommodation) to access or maintain services resulting from a disability or learning or literacy issue.

WAC 388-472-0010 What are necessary supplemental accommodation services (NSA)?

WAC 388-472-0020 How does the department decide if I am eligible for NSA services?

WAC 388-472-0030 How can I get NSA services?

WAC 388-472-0040 What are the department's responsibilities in giving NSA services to me?

The department is required by the Americans with Disabilities Act (ADA) to provide full access to services. These accommodations must be provided on an on-going basis to ensure that the client is able to maintain eligibility and fully access program services.

Worker Responsibilities

  1. When department staff work with clients identified as needing NSA, it is critical that the plan be readily available and used to ensure the client is able to fully access services and maintain eligibility.
    NOTE: Most accommodations are easily provided when the need for accommodation is understood. Other service providers, such as DVR may be able to assist in providing accommodations when the client is eligible for DVR services. In some cases, DVR may have adaptive devices that can be shared, such as access to a TTY for communication with persons with hearing impairments.
  2. Continually be alert to cues that might indicate a client is in need of Equal Access (EA) services.
  3. Conduct an EA and develop an EA Plan if one has not been done.
  4. Provide accommodations whenever appropriate.
    EXAMPLE If you know that a particular client needs assistance, it is your ethical and legal responsibility to inform reception staff that the client is identified as EA and what accommodations are necessary, as stipulated in the EA Plan.

Screening

  • Upon application, all DSHS applicants and recipients are assessed for their need for accommodations.
  • Clients are screened using the ACES On-Line EA Screens to determine the need for accommodations and the plan for delivery of services.
  • Most EA screenings and plan development will be done by reception, financial or WorkFirst Program Specialists.
  • Social Service Specialists will be called upon for their expertise in screening and plan development when necessary.

Equal Access Accommodation Plan

Some EA Plans such as interpreter services or assistance with applications can be easily met. However, if the Financial Services Specialists or other staff need assistance in developing the EA Plan, it is important that the CSO Social Service Specialist is consulted. The CSO Social Service Specialist has primary responsibility for developing EA Plans when other staff are unable to accomplish this task due to the special needs of the client.

ACES Procedures

Equal Access and Accommodation Resources:

Search IESA Clarification Database

Family Planning Services

Purpose:

To provide Family Planning guidelines to Community Services Office (CSO) staff for providing educational, medical and social services to all Washington Apple Health eligible men and women, helping them become self-sufficient and avoid unintended pregnancy by planning and spacing the birth of their children.

WAC 182-532-100 - FAMILY PLANNING SERVICES


Guidelines

CSO workers are not expected to be Family Planning medical experts. CSO staff provide individuals with needs assessment and information about family planning services.

Individuals can access the WithinReach website for additional information about family planning services, such as pregnancy testing and birth control.

Family Planning Program Objectives

  1. Reduce unintended pregnancies using state and local partnerships.
  2. Provide all eligible and potentially eligible men and women with information about, and linkage to, available family planning services per WAC 182-532-100.
  3. Reduce publicly funded maternity costs from unintended pregnancies.
  4. Educate men and women about:
    • Available family planning health services,
    • The variety of birth control methods to help plan, if or when, to have another child,
    • The cost of raising children,
    • Barriers that unintended pregnancies create in becoming self-sufficient, and
    • The best use of TANF and Washington Apple Health resources.

Family Planning Services

  1. Services are provided at local Family Planning clinics or other medical provider agencies.
  2. Services may be covered under
    1. Washington Apple Health, or
    2. The Take Charge Family Planning program.
    3. Information about services is offered by any CSO or Customer Service Center staff, with social service case workers as the lead experts in motivating and educating men and women to access services. The social service case worker may help ensure the individual is linked to a Family Planning Provider via WithinReach.

Upfront Screening

  1. The CSO case managers and Customer Service Center staff play a critical role in providing individuals with information and links to Family Planning services.
  2. All men and women are to be provided information about available services, where to access services or a referral to the social service case worker upon request to discuss the benefits of Family Planning Services.
  3. All TANF clients must receive a minimum set of information about Family Planning services as listed at https://www.dshs.wa.gov/esa/chapter-1-engaging-parents-workfirst/13-front-screening-and-referrals

Worker Responsibilities 

What Happens After the Client is Referred to a Social Worker to discuss Family Planning?

  1. Inform all referred men and women of available benefits and services under the Family Planning program.
  2. Inform them they have family planning resources available under Washington Apple Health coverage.
  3. Ensure that Family Planning information, pamphlets, brochures, and local provider lists are provided to the individual.
  4. Refer the individuals to the WithinReach website for information on birth control and family planning services.

Best Practices 

  1. Conduct an assessment of the client’s needs and barriers to self-sufficiency with regard to family planning. Arrange for other services as needed (such as shelter, clothing, food, mental health, etc.).
  2. Collaborate with local Family Planning agencies to provide educational sessions on Family Planning Program services.
  3. Engage in outreach activities in the community to reach eligible or potentially eligible clients and provide program awareness.
  4. Establish relationships with other community agencies to create effective cross agency referrals to Family Planning services. Some examples include Division of Children and Family Services, Chemical Dependency Treatment Centers, Schools, Colleges, and Job Training Programs.
  5. Conduct client follow-up to discuss:
    1. If the client is using method of choice, and
    2. How family planning methods are working.

The social service case worker and case manager need to complete documentation of referrals, actions, and results in eJAS.

Family Violence

Revised January 3, 2012

Purpose:

To provide information and guidelines to social service case workers regarding victims of Family Violence.

  1. Family Violence crosses all socio-economic boundaries. DSHS adopted the Family Violence Option to PROWRA in 1996 and is, therefore, required to screen and identify all TANF clients for Family Violence. (See WAC 388-61-001.) However any client who utilizes any service provided by the Community Services Office may be affected by Family Violence.
  2. The case worker may find out about a client who is dealing with Family Violence in several different ways including:
    • A referral from the WorkFirst Case Manager, or
    • Self-disclosure by the client while being assessed for other issues.

GUIDELINES

  1. The case worker must interview and assess for safety and other needs.
  2. The case worker must determine if the client:
    1. Needs immediate help to ensure safety for themselves or their children;
    2. Has been mentally, physically or emotionally hurt;
    3. Needs assistance with shelter / housing;
    4. Has a current protection order or wishes to obtain one. If the client wishes to pursue a protection order, offer a referral to a family violence advocate for help in considering all risk factors involved;
    5. Has a safety plan;
    6. Is a battered immigrant (see EA-Z Manual - Citizenship and Alien Status - B. - Eligibility Restrictions for TANF), determine if client needs assistance with obtaining employment authorization; or
    7. Needs help to establish good cause for not cooperating with the Division of Child Support. See Good Cause.
  3. The case worker must refer the client for appropriate services such as shelter, legal, health, transportation, etc., taking into account linguistic and cultural needs in making referrals.

Best Practices

Victims of Family Violence may be reluctant or unwilling to talk to you about what is going on. Some common situations and possible actions may include:

What do I do if the client does not recognize control issues as “family violence” (especially if there are no physical signs present)?
It may be beneficial to talk with the client and walk through the dynamics of power and control.
What do I do if the client is too afraid to talk to me? 
Be sure you know what safety measures are immediately available. Reassure the client and seek help from your local crisis agencies.
What do I do when the client tells me that family violence is affecting them and there is nothing I can do? 
Reassure the client there is help available and utilize available support services.

There are on-site domestic violence advocates stationed in several CSOs. If your office has an advocate on site, coordinate services with them. If you don’t have an advocate, establish working relationships with your local community resources. See the Department’s website for Domestic Violence and Victim Services Programs for ways to create a process to coordinate with your local resources.

WFHB Chapter 6.5 - Family Violence

EA-Z Manual - Confidentiality B. - Address Confidentiality Program.

First Steps

Purpose:

This category describes the First Steps Program which is designed to promote healthy birth outcomes, increase access to early prenatal care, and reduce infant morbidity and mortality.

Guidelines

The 1989 Maternity Care Access Act, implemented as First Steps, seeks to reduce poor birth outcomes, maternal and infant illness and death as well as increase access to maternity and infant care for low-income families. The First Steps program is administered by the Health Care Authority (HCA).

Medical Services

  • Prenatal care

  • Delivery

  • Post pregnancy follow-up, including family planning

  • Dental Care

  • One year of family planning services post pregnancy

  • One year of full medical for newborns

 

Enhanced Services

  • Maternity Support Services (MSS)
  • Infant Case Management (ICM)
  • Childbirth Education (CBE)

 

Expedited Alcohol and Drug Assessment and Treatment Services

  • Alcohol and drug assessment

  • Alcohol and drug treatment

 

Other Services

  • Expedited eligibility determination

  • Outreach

  • Transportation

  • Interpreter services

 

Worker Responsibilities

Provide all pregnant women with information regarding the services available through the First Steps program.

If a woman reports she is pregnant and is not active on Washington Apple Health (WAH) Medicaid, refer them to www.wahealthplanfinder.org to apply for pregnancy medical.  

If a woman already has health insurance and reports she is pregnant, let her know she can access First Steps by contacting the Within Reach Family Hotline at 1-800-322-2588 or by contacting a Local First Steps provider. Additional information regarding the First Steps program can be found at https://www.hca.wa.gov/free-or-low-cost-health-care/apple-health-medicaid-coverage/first-steps-maternity-and-infant-care.

 

Good Cause

Created on: 
Apr 13 2017

Updated on:

April 13, 2017

Purpose:

This chapter provides the department’s policy and procedures for determining if a custodial parent has “Good Cause” (GC) for non-cooperation with department program requirements.

Clarifying Information

Good Cause (GC) means that an individual is relieved of certain program requirements when the individual is unable to participate for various reasons as outlined by each program. The individual must claim and the department must determine good cause.

Department programs that have requirements that can be waived as a result of an individual having good cause are:

  • Division of Child Support (DCS)
  • Aged, Blind or Disabled (ABD) cash
  • Housing and Essential Needs (HEN) Referral
  • Pregnant Women Assistance (PWA)
  • WorkFirst
  • Basic Food Employment and Training (BFE&T)

Worker Responsibilities

Equal Access: Ensure that the individual was screened for Equal Access and that the information is current. If the person’s limitation or impairment prevents her/him from following through on all program requirements, determine if she/he has Good Cause per WAC 388-472-0050. If she/he has Good Cause, the Department will not take adverse action.

Program Requirements 

  1. Division of Child Support (DCS) - Cooperation with Child Support Collection:

    TANF/SFA - The Division of Child Support (DCS) helps families with a variety of services including the collection and disbursement of child support. Parent/caretakers receiving TANF/SFA for themselves and/or their child(ren) are required to cooperate with DCS to help establish paternity, set a child support order, and enforce child support. "Child Support" includes health insurance coverage, medical expenses, birth costs, and child care or special child rearing expenses. Either or both parents are required to provide health insurance for the children, and both parents are required to contribute to uninsured medical expenses, regardless of whether the children received medical assistance. This cooperation requirement is waived if you determine that establishing and/or enforcing child support may result in serious physical or emotional harm to the child or parent/caretaker. This requirement may also be waived in instances of rape (including rape of a child), incest, or when an adoption discussion is taking place. See WAC 388-422-0020 and the EA-Z Manual - Child Support for more information.

  2. ABD Cash: To continue receiving ABD cash, the individual must:

    • Apply for and follow through with the SSI application process.

    • Follow through with a chemical dependency assessment, and participate in treatment, if there is an indication of a substance use disorder.  Good Cause for not doing so is defined in WAC 388-449-0220.
  3. HEN Referral: To continue receiving HEN Referral, the individual must:

    • Be incapacitated as defined in WAC 388-447-0001 through 388-447-0100.

    • Follow through with a chemical dependency assessment, and participate in treatment, if there is an indication of a substance use disorder.  Good Cause for not doing so is defined in WAC 388-447-0120.
  4. PWA: To continue receiving PWA cash, the individual must:

    • Follow through with a chemical dependency assessment, and participate in treatment, if there is an indication of a substance use disorder. Good Cause for not doing so is defined in WAC 388-449-0220.
  5. WorkFirst: WorkFirst policy requires parents to participate up to 40 hours a week in approved activities unless the parent is determined to be exempt per WAC 388-310-0350, WAC 388-310-0300 and WAC 388-310-145 or have a valid Good Cause reason for not participating per WAC 388-310-1600. See: WorkFirst Handbook 1.2- Required Participation.

  6. Basic Food Employment & Training (BFE&T):Persons receiving Basic Food are required to register for work and must participate in BFE&T unless exempt per WAC 388-444-0015 and WAC 388-444-0020 or have a valid Good Cause reason for not participating per WAC 388-444-0050.

    See: EA-Z Manual - Basic Food Employment and Training - F. - Good Cause

Non-Cooperation with Division of Child Support

All requests for Good Cause for non-cooperation with DCS due to serious physical or emotional harm to the child or parent/caretaker are referred to the WorkFirst Social Service Specialist (SSS). The SSS will review any documents associated with the referral including but not limited to:

  • DSHS 18-334(X), Your Options for Child Support Collection, for the parent's/caretaker's statement of claim outlining their fears and concerns; and
  • Additional documents, statements or other types of verification that has been gathered that support the parent's/caretaker's Good Cause request. Even without other documentation, you must accept a sworn statement in support of the good cause claim.

Note: Even without other documentation, you must accept a sworn statement in support of the good cause claim.

Parent Interview

Whenever possible, interview the parent/caretaker on the same day you receive the Good Cause referral. If the interview is not done the same day the referral is received, schedule the interview within 30 days.

During the interview the WorkFirst Social Service Specialist will:

  1. Find out why the parent/caretaker does not want to pursue Child Support. Ask if there are current issues around Family Violence, rape, incest or pending adoption. Review eJAS for possible Family Violence. If you feel that the parent, caretaker, or child(ren) is endangered, or at risk of serious harm, seek assistance from an on-site or community-based domestic violence advocate.
  2. Talk with the parent/caretaker about what she/he views as the pros and cons of establishing paternity and/or collecting Child Support. If you feel the parent/caretaker is misinformed about a child's rights to resources, benefits, or entitlements, help the parent to seek advice from appropriate resources. Resources may include legal advocacy, DCS staff located in the CSD, the local DCS office, a family violence advocate, etc.
  3. Inform the parent/caretaker:
    1. About the advantages and disadvantages of pursuing Child Support.
    2. About their choice between Good Cause Level A and Level B options. (See Section 7 for more information about Level A and B)
    3. If there is more than one noncustodial parent (NCP) for the children in the assistance unit, the parent/caretaker must be given the option of claiming Good Cause for each NCP.
    4. Once a support order has been established, the NCP has an obligation to pay child support for the child. Granting either level of Good Cause does not cancel the support obligation or any existing child support order. However when Good Cause Level A is approved, DCS closes the case and does not take any action to establish paternity or to establish/ enforce a child support order against that NCP until the Good Cause claim is withdrawn or the parent/caretaker applies for non-assistance support enforcement services. This makes it important to obtain and maintain accurate information about the basis for the Good Cause exemption.
    5. If Good Cause is approved now, but later withdrawn, DCS will begin necessary actions to establish paternity and/or to establish/enforce both past and current child support from the NCP. It is important that a victim of family violence understand this if there are any continuing safety risks at the time DCS action begins.
    6. If Good Cause Level A is approved and has not been denied or withdrawn at the time the parent/caretakers cash assistance is terminated, DCS will not reopen the case at that time. DCS will reopen the case only if the parent/caretaker applies for TANF again without claiming Good Cause, or submits a non-assistance support enforcement application to DCS.
    7. If cash assistance closes after Good Cause Level A approval, the Good Cause claim will not close. It will remain open through the next review period.
    8. If the NCP is in another state, DCS may need to ask the other state to help. DCS may be required to provide the parent/caretaker address to the other state and rely on that state to keep it confidential.
  4. Ask the parent/caretaker for verification. Discuss with the parent/caretaker the types of verification that can be used to substantiate the Good Cause claim. Verification may include one the following:
    • Completed 18-334(X) or other signed statement from the survivor herself or himself, outlining his/her fears and concerns;
    • Civil or criminal court orders (domestic violence protection orders, restraining orders, no-contact orders);
    • Medical, police, or court reports; or
    • Written statement from clergy, friends, relatives, neighbors or co-workers.
      NOTE: DSHS cannot require a parent to provide documents such as court orders or police records in order to support a claim of Good Cause. There are many reasons why a victim of family violence would not be in possession of these. For example, if s/he has fled and left these papers behind, or if seeking copies of these documents would alert a perpetrator to her/his whereabouts. In addition, many victims, for a variety of good reasons, have never sought help from systems like the police, courts or medical facilities.
  5. Offer a referral to the on-site or community based domestic violence advocate.
  6. If the parent/caretaker does not want to proceed with the Good Cause claim they can withdraw their request at anytime. Remind the parent that she/he may request Good Cause at anytime if her/his circumstances change. Document the parent's request to withdraw the claim. Send a DSHS 18-444 (X), Good Cause Decision, to the parent/caretaker, DCS, and FSS marked withdrawn. If the parent/caretaker has questions or fears about issues related to custody, visitation or paternity, refer the parent/caretaker to the legal services CLEAR line (1-888-201-1014).
  7. If it is necessary for you to conduct a review of the parent/caretaker's statement or other verification provided, consult with the on-site or community-based family violence advocate to ensure the parent's/caretaker's safety as needed.  Only make third party contacts with the knowledge and consent of the parent/caretaker. Inform the parent/caretaker of each specific contact.
    1. When the decision is based upon phone verification, document the date, phone number, and the person you talked with, along with the information you received.

    2. If the parent/caretaker needs help getting verification and consents to your helping her/him, have the parent/caretaker complete and sign the DSHS 14-012 - Authorization to Release Information.

      1. If the parent/caretaker does not consent to department assistance, talk with the parent/caretaker in order to identify other ways to get the verification.

    3. Offer the parent/caretaker the opportunity to obtain the information on his/her own.

  8. Explain to the parent/caretaker that the parent/caretaker has the opportunity to decide what level of Good Cause protection is necessary. There are two levels:
    • Level A: DCS will not pursue the establishment of paternity, establishment of a support order, or enforcement/collection of child support or from the NCP because any contact with the NCP poses a risk of serious harm to the child or parent/caretaker. DCS closes the child support case, takes no actions on the child support case and the parent/caretaker will not receive child support. Even though DCS closes the child support case, any child support owed under an existing child support order continues to accumulate each month that it is not paid. In the future, if the good cause claim is withdrawn or if the parent/caretaker files an application for DCS nonassistance services, DCS will reopen the case and collect both current and past due child support.
    • Level B: DCS will pursue the establishment of a support order and collect child support without the parent/caretakers cooperation. DCS keeps the parent/caretaker advised of case actions, but the parent/caretaker is not required to cooperate with DCS; she/he may elect to cooperate or not. Generally, paternity establishment is not pursued in Level B cases because these proceedings require the cooperation and involvement of the child and custodial parent.)
      Note: If either Level A or Level B good cause is granted after a case has been filed in court by the prosecutor's office, the prosecutor must request the permission of the court to withdraw from or dismiss the action.

      See Appendix II for information about DCS that provides additional information to the parent about DCS functions and the DCS Handbook for Child Support policies.

Claim Determination and Processing

  1. If possible, make a determination within 30 days. Social Service Specialists (SSS) are required to use the Barcode Good Cause program for claim determination and processing. Good Cause is found if the parent or caretakers written statement outlining their fears and concerns, or other verification, indicates that the likelihood of harm to the parent/caregiver or child(ren) is too great to safely seek collection of child support.When verification has been received and/or the review of the verification is completed, you are ready to make a decision.
  2. If you approve Good Cause, set the review date for twelve months or shorter if circumstances warrant.
  3. If TANF/SFA benefits are provided to the parent who requested Good Cause due to serious physical or emotional harm to the child or parent/caretaker but assistance is terminated while the claim is still pending, the SSS must complete the Good Cause determination. DCS must be informed to know if further action concerning the child support case is necessary.
  4. If a determination cannot be made, because of loss of contact or some other reason, the default decision is approval of the good cause claim.
  5. If the parent reapplies for cash assistance after a default approval decision, Good Cause must be re-determined according to the standard process.
  6. If the parents/caretakers cash is terminated before the Good Cause decision is made, a determination must be completed.
  7. Supervisory approval is required on all Good Cause claims before the decision letter can be generated. The supervisor approves the DSHS 18-444(X) - Good Cause Decision by checking the 'reviewed by Supervisor' box in the Barcode Good Cause system.
  8. Notify the parent/caretaker of the final decision on the DSHS 18-444(X) - Good Cause Decision. Copies of the decision must also be provided to the FSS and DCS.
  9. If Good Cause is denied, advise the parent/caretaker that:
    1. She/he has a right to an Administrative Hearing. See- (EA-Z Manual - Administrative Hearings).
    2. If circumstances change, the parent/caretaker may, at any time, request another good cause determination due to serious physical or emotional harm to the child or parent/caretaker by completing and signing another Your Options for Child Support Collection (DSHS 18-334(X)).
    3. On-site or community based domestic violence advocates are available.
  10. Document essential case information in the appropriate confidential notes section (Barcode Good Cause Program and eJAS). The notes may be needed in the future to:
    1. Support the decision;
    2. Aid at review; and
    3. Inform the Administrative Hearing process.

Reviewing Good Cause Determinations

Review Good Cause determinations at intervals consistent with the family circumstances. Social Service Specislists are required to use the Barcode Good Cause program for reviewing good cause determinations.

  1. If Good Cause is approved because the child was conceived as a result of rape or incest, it is not necessary to review the Good Cause decision. The review date can be set for the child's eighteenth birthday.  However, advise the parent/caretaker that they can withdraw their claim of Good Cause at any time if she/he wishes to do so.
  2. If Good Cause is approved based on any other circumstance (e.g.. physical or emotional harm to the child or parent/caretaker or adoption discussions or proceedings), Good Cause will be reviewed periodically, usually every twelve months.
  3. At the time of review:
    1. Review the documented facts in the case record. Determine if contact with the parent/caretaker is necessary to make the determination to continue Good Cause.
    2. If there is sufficient verification in the record to continue the Good Cause determination without contacting the parent/caregiver, authorize continued Good Cause and establish a new review date at an appropriate time in the future.
    3. If contact is necessary:
      1. Interview the parent/caretaker to determine if the circumstances have changed since the last Good Cause determination. If additional verification is available and necessary to make a re-determination, inform the parent about what she/he will be expected to provide. Ask the parent/caretaker if she/he expects to have any problems in providing the information and offer to assist the parent/caregiver if she/he needs special accommodations or is unable to obtain the verification.
      2. Evaluate the new verification and circumstances against the previous Good Cause determination.
    4. Complete a DSHS 18-444(X), Good Cause Decision:
      1. Mark the box to indicate it is a re-determination; and
      2. Send copies to the parent, DCS, and FSS.
  4. If the cash assistance is closed, deny Good Cause to close out the good cause claim.  DCS will not pursue the establishment of a support order unless the parent/caretaker files an application for non-assistance child support services through DCS. 
    1. In the Barcode Good Cause program, take the following steps:
      1. Check "Review Claim"
      2. "Good Cause Established?" - check "No"
      3. "Reason for Good Cause Decision" - Select "No Proof of Good Cause"
      4. Enter Close Date - End date of current review
      5. "Reason" - Select "Financial Assistance Closed"

Referrals and Resources

  1. Offer the parent/caretaker a referral to the on-site or community-based domestic violence advocates who may be able to help them address the circumstances creating the need for the Good Cause claim. Document family violence related referrals in the Barcode Good Cause program. For TANF parents/caretakers also document the referral in eJAS in the Family Violence Special Records note type.
  2. Explain the use of the Washington Apple Health to obtain health care coverage for the family. Ask the parent/caretaker if she/he needs any special accommodations to seek or access health care coverage services. Tell the parent/caretaker that receiving Medicaid or other state-funded health care coverage will not automatically result in a DCS case, but that they can apply for DCS services if they wish to do so.
  3. Give the parent/caretaker available informational brochures related to DCS or Good Cause due to serious physical or emotional harm to the child or parent/caretaker and discuss any other pertinent issues related to the parents/caretakers situation.
  4. Encourage the parent/caretaker at risk of family violence to determine if enrolling in a community support group, counseling activities or contacting legal services (CLEAR 1-888-201-1014) is in their best interest.
  5. If the parent would like more information about DCS support enforcement services, have the client call 1-800-442-KIDS.
  6. Some parents may be participating in the Address Confidentiality Program (ACP) through the Office of the Secretary of State. The ACP protects the address of persons attempting to escape from family violence or sexual assault situations. Participants use a substitute address in place of their actual physical or mailing address. See the EA-Z Manual if the parent is participating in, or you would like more information about the Address Confidentiality Program.

Form Number

Title

Use

Distribution

DSHS 14-012(X)

Authorization to Release Information

To obtain evidence when the parent/caretaker is unable to provide it directly

Original to verification source, copy to  parent/caretaker and case record

DSHS 18-334(X)

Your Options for Child Support Collection

Parent/Caretaker's statement outlining their fears and concerns why a Good Cause claim is needed

Social Services receives a copy with the referral to determine Good Cause

DSHS 18-444(X)

DCS Good Cause Decision

Notify parent/caretaker, DCS and financial services of Good Cause  determination

Original to parent/caretaker, copies to case record, financial services and DCS

DSHS 22-583(X)

Facts about the DCS Child Support Enforcement Program

Give to parent/taker

To parent/caretaker

DSHS 22-688(X)

Support their future

Give to parent/caretaker with Toll-free DCS number

To parent/caretaker

DSHS 14-475

Appointment Letter for Division of Child Support (DCS) Good Cause Determination

Send to the parent/caretaker for a Good Cause appointment.

To parent/caretaker

DSHS 18-011

DCS Information Request

DCS sends to CSD requesting good cause information within 30 days.

CSD staff send back to DCS

DSHS 18-011(A)

DCS Information Update

DCS sends to CSD to begin the good cause process when a parent/caretaker has informed DCS about family violence in the home.

Copy to case record

Search IESA Clarification Database

Good Cause -Appendix II

Division of Child Support Information

  1. Address information contained in DCS child support records is confidential. DCS releases confidential address information only upon completion of the address disclosure process. See WAC 388-14A-2105 through 388-14A-2140.
  2. This is the Address Disclosure Process when the custodial parent (CP) does not have an approved Good Cause claim:
    1. The request for an address must be in writing, state the purpose of the request and include a copy of the custody or visitation order that is the basis for the request. The requester’s signature must be notarized unless presented in person.
    2. When DCS receives a written request for a CP’s address, DCS notifies the CP that DCS received a request for his or her address. DCS mails the notification to the CP’s last known address.
    3. When the CP receives notification of the request for his or her address within 30 days the CP may:
      • Provide a copy of a court order which limits the requestor’s right to contact the CP and/or children
      • Get a court or tribal order to prevent release of the address
      • Request an administrative hearing to prevent release of the address
      • Contact the CSO caseworker to make a Good Cause claim if the children receive public assistance.
  3. If the CP requests a hearing there is a 21-day appeal period plus a 30-day late appeal period after the hearing decision. This is effectively a 51-day appeal period.
  4. When the CP does have an approved Good Cause claim, DCS denies the address disclosure request. When DCS denies an address disclosure request, DCS notifies the CP that their address was requested but DCS denied the request.
  5. New federal legislation requires DCS to give the children’s and custodian’s address to the NCP’s employer when DCS enforces the medical insurance provision of a child support order. The CP may elect to use the DCS Medical Support Program address for this purpose instead of the CP’s and children’s address.
  6. If the CP has questions about requesting an address for the NCP, the CP should call DCS at 1-800-442-KIDS.

Incapacity Determination - Incapacity Requirements for HEN Referral

Created on: 
Oct 06 2015

INCAPACITY REQUIREMENTS FOR REFERRAL TO THE HOUSING AND ESSENTIAL NEEDS (HEN) PROGRAM

WAC 388-447-0001 What are the incapacity requirements for referral to the housing and essential needs (HEN) program?


 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.

Incapacity Determination - PEP Step I

Created on: 
Oct 21 2014

Review of Medical Evidence 

WAC 388-447-0030 Progressive evaluation process step I - How does the department review the medical evidence required for an incapacity determination?


Worker Responsibilities

  1. Determine if there is sufficient medical evidence:
    1. Review available medical evidence to determine if it is sufficient to determine incapacity. Sufficient medical evidence must meet all requirements outlined in WAC 388-447-0010.
    2. If the medical evidence is not sufficient to determine incapacity, pend the incapacity determination and request additional medical evidence.
  2. Determine Duration:
    1. If the provider's assigned duration is consistent with the medical evidence provided, accept it.
    2. If the provider fails to assign duration or the provider's assigned duration is not consistent with available objective medical evidence, use reference sources and your professional judgment to assign duration. Clearly document what evidence was used to adjust the duration.
    3. When the provider identifies a condition aschronic, you may consider the condition to meet the 90-day duration requirement even when qualified as episodic or in remission if this determination is consistent with the objective medical evidence.
    EXAMPLE

    Dale is diagnosed with chronic rapid-cycling bipolar disorder. The most significant impairment on work activities is due to psychotic symptoms which, according to his psychiatrist, are episodic in nature. Although not currently psychotic, he has had 3 major psychotic episodes within the last 2 months. He has not yet been stabilized on medication. Accept this as meeting the 90-day duration requirement.

  3. PEP Step 1 Determination:
    1. If available medical evidence meets the requirements outlined in WAC 388-447-0010 and the duration supported by objective medical evidence is at least 90 days, proceed to PEP Step 2.
    2. If it is clear the impairment will not last at least 90 days or available medical evidence does not meet the requirements outlined in WAC 388-447-0010, deny incapacity.

Incapacity Determination - PEP Step II

Created on: 
Oct 21 2014

PEP Step II - Determining the Severity of mental Impairments 

NOTE: The DSHS 13-865 Psychological/Psychiatric Evaluation form, DOC 13-450 Behavioral Health Discharge Summary, or typed narrative evaluation may be used to assess mental health impairments.

WAC 388-447-0040 Progressive evaluation process step II - How does the department determine the severity of mental impairments?


Clarifying Information

  1. The Short Clinical Scale is no longer used in the mental health community and has been removed from the psychological evaluation form. Any symptom that affects work function and is listed in the DSM IV or DSM V may be listed by the mental health provider.
  2. Only consider symptoms that have an impact on work function when determining incapacity.
  3. See the learning disabilities and deficits chapter when a learning disorder is diagnosed. Most learning disorders aren't incapacitating.
  4. Don’t consider diagnosis and symptoms of alcohol or substance abuse, or dependence, when determining incapacity through the PEP.
  5. Alcohol and substance use information is requested in order to differentiate between substance use and mental health symptoms, and to provide information for the development of a case plan.
  6. A symptom that was not observed by the evaluator may be considered when determining incapacity accepted if consistent with others symptoms of a diagnosis the evaluator observed.

Incapacity Determination - PEP Step III

Created on: 
Oct 21 2014

PEP Step III--Determining the Severity of Physical Impairments 

WAC 388-447-0050 Progressive evaluation process step III - How does the department determine the severity of physical impairments?


Clarifying Information

Compare the severity rating given by the medical evidence provider with the objective evidence.

  1. When it is consistent, accept it.
  2. When it is not consistent,  raise or lower the rating after consulting medical sources and references. You must have clear and convincing reasons for adjusting a provider's severity rating. Always fully explain your clear and convincing reasons for not accepting the provider's rating in your notes.

Incapacity Determination - PEP Step IV

Created on: 
Oct 21 2014

PEP Step IV--Determining the Severity of Multiple Impairments

WAC 388-447-0060  Progressive evaluation process step IV - How does the department determine the severity of multiple impairments?


Worker Responsibilities

Document the cumulative effect (or lack of effect) that multiple impairments have on the basic work activities.

Incapacity Determination - PEP Step V

Created on: 
Oct 21 2014

PEP Step V--Determining Level of Function of Mentally Impaired Individuals in a Work Environment

WAC 388-447-0070 Progressive evaluation process step V - How does the department determine the impact of a mental impairment on my ability to function in a work environment?


Clarifying Information

  1. Cognitive and Social Factors:

    Approvals at PEP step V based on cognitive and social factors are intended for individuals who are unable to perform the basic work functions necessary to learn the basic skills of a job, perform to an employer’s expectations, or behave in a manner acceptable in a work place.

  2. Mental Status Examinations (MSE):

    The purpose of a Mental Status Examination (MSE) is to assess the presence and extent of a person's mental impairment. The MSE may suggest specific areas for further testing or specific types of required tests. There are standardized and non-standardized Mental Status Examinations.

    1. A standardized MSE includes a series of specific questions designed to assess memory, thought process and content, perception, attention and concentration, judgment, intelligence, insight, and orientation. A standardized MSE should usually be given where psychotic or cognitive problems are indicated in the psychological/psychiatric evaluation. While the Folstein is the most common, many standardized MSE's are available.
    2. A non standardized MSE is not numerically rated and may be documented by indicating the degree to which a person is oriented (e.g.. "O x 3" means a person is normal in the "three spheres" of time, place, and person - or fully oriented) along with more comprehensive observations including assessment of appearance, movement and behavior, affect, mood, speech, thought content and process, cognition, judgment, and insight.
    3. The MSE must be conducted by an authorized provider and included within the psychological/psychiatric evaluation or attached as an addendum.
    4. When used in conjunction with the evaluation, the MSE provides objective information, which should be consistent with the diagnoses and ratings contained in the psychological/psychiatric evaluation.
      1. If the ratings on the psychological/psychiatric evaluation are inconsistent with the MSE, contact the provider for clarification before proceeding.
      2. Some mental status exams use a numeric rating system. For example, a score of 24 or more on the Folstein Mini Mental Status Examination is considered normal.
    EXAMPLE:

    The cognitive ratings on the DSHS13-865 are marked to indicate the client cannot follow simple one and two-step instructions. However, the client had no difficulty following instructions specifically developed to test this function - folding a piece of paper and placing it on the floor. Contact the provider and request clarification. The two pieces of information must be consistent to accurately reflect the status of the person being evaluated.

Worker Responsibilities

  1. Ensure an objective MSE accompanies or is included with the psychological/psychiatric evaluation.
  2. If the MSE is not consistent with the evaluation, obtain clarification from the provider.

Incapacity Determination - PEP Step VI

Created on: 
Oct 21 2014

Determining Level of Function of Physically Impaired Individuals in a Work Environment 

WAC 388-447-0080 Progressive evaluation process step VI - How does the department determine the impact of a physical impairment on my ability to function in a work setting?


Clarifying Information

Consideration of exertionally-related or non-exertional limitations may be crucial either in eliminating specific types of past work or in accurately assigning the level of work the person can currently perform. Non-exertion limitations may include:

  • Restrictions in seeing or hearing,
  • Allergies,
  • Restrictions in operating dangerous machinery or driving, and
  • Restrictions in working at heights due to dizziness.

Incapacity Determination - PEP Step VII

Created on: 
Oct 21 2014

Evaluating a Client's Capacity to Perform Relevant Past Work

WAC 388-447-0090 Progressive evaluation process step VII - How does the department determine ability to perform past work?


Worker Responsibilities

  1. Enter the age rounded to the nearest full year.
  2. Enter each job from the Social Service Intake, or other available source, considered to be relevant past work.
  3. Use O*NET to get exertion and skill levels for the jobs the client has held.  According to the Department of Labor, O*Net has replaced the Dictionary of Occupational Titles.
  4. Compare the physical and mental requirements for each job with the person's current functional abilities, as identified in Steps V and VI.  If mental or non-exertional physical limitations prevent an individual from performing a job they were formerly capable of doing, indicate that the person cannot do this job and document the specific reason.
    EXAMPLE: A client is advised not to work in high places because of a seizure disorder.  This would prevent the client from returning to past work as a roofer, but the client could perform past work as a retail clerk.
  5. Deny incapacity when a person has recently completed a vocational training or gained work skills that they can currently use to perform a job.
  6. Deny incapacity when a person is able to do relevant past work performed within the past 5 years.
  7. Approve incapacity when a person is 55 years old or older and is unable to perform relevant past work, or has no relevant past work.

Incapacity Determination - PEP Step VIII

Created on: 
Oct 21 2014

Evaluating a Client's Capacity to Perform Other Work.

WAC 388-447-0100 Progressive evaluation process step VIII - How does the department determine ability to perform other work?


Clarifying Information

  1. Completion of high school by attendance in a special education curriculum in the basic academic classes of math, English and writing is considered limited education.  Classes for non-academic reasons such as speech therapy and interpersonal relationships are not to be considered special education or limited schooling.
  2. High school education and above includes a non-English education if it otherwise meets the standards of a U.S.high school education.
  3. Approve incapacity if the individual meets the criteria in the tables in WAC 388-447-0100.

Incapacity Determination - When HEN Referral Eligibility Ends

Created on: 
Dec 01 2015

 

1. HEN Referral eligibility ends at the end of the incapacity authorization period if current objective medical evidence shows there has been material improvement to the individual's impairment, or if there is no current medical evidence:

a. "Material improvement" means the impairment no longer meets the incapacity requirements outlined in WAC 388-447-0001 (6) (a) through (f).

EXAMPLE: Willie was previously determined incapacitated based on a physical impairment with a "moderate" severity rating. The new medical evaluation indicates that condition has healed so impairment no longer exists. However, Willie has another, previously unclaimed physical problem. The second impairment has a "moderate" severity rating but does not qualify Willie according to the PEP. There is material improvement because there is no impairment that meets incapacity requirements outlined in WAC 388-447-0001 (6) (a) through (f) at review.

 

b. "No current medical evidence" means the individual failed to provide the medical evidence necessary to determine incapacity outlined in WAC 388-447-0010.

i. When the disability specialist receives medical evidence, they complete the incapacity review before the 15th whenever possible, to ensure the client receives advance notice in the event of a denial.

ii. If no current medical evidence is received by the first business day following the due date for medical evidence (usually the 11th or the first business day following), the disability specialist issues a 14-118 to deny incapacity.

NOTE: If HEN Referral is denied at incapacity review, the disability specialist approves HEN Referral back to the first of the month (not the date medical evidence was received) when: Medical evidence is received within thirty (30) days of the end of the HEN Referral authorization period (in ACES); the delay was not due to the individual’s failure to cooperate; and the medical evidence meets incapacity requirements defined in WAC 388-447-0001.

2. HEN Referral eligibility ends if there was a previous error.

a. "Previous error" means that the previous incapacity determination was incorrect because:

i. The information the department had was incorrect or not sufficient to determine incapacity; or

ii. Program rules were not applied correctly based on the information available at the time.

NOTE: When the disability specialist discovers that an error was made in a prior incapacity decision and the client should not have been previously approved, AND the current available evidence indicates that the person does not qualify, deny incapacity. Document how the error makes the person ineligible.

3. HEN Referral eligibility ends when the client is found eligible for ABD through the SEP process.

NOTE: While an individual is active on the HEN Referral Program, the disability specialist may conduct a new SEP in the following situations:

a. At the end of the 12 month HEN Referral authorization (incapacity review)

b. When the client has reapplied for the ABD cash program, and has been referred by financial to the disability specialist for a new disability determination

c. When additional medical evidence is received within 30 days from an initial ABD denial/ HEN Referral approval.

EXAMPLE: Doug applied for ABD cash benefits on 8/1 and completed an intake with a disability specialist that same day. The medical evidence received and reviewed by the disability specialist was not signed by an acceptable medical source per WAC 388-449-0010. Due to Standard of Promptness the disability specialist processed the case on 9/15 which denied ABD (due to lack of acceptable medical source) and approved the client for a HEN Referral .

On 10/10 the disability specialist received additional medical evidence that was signed by an acceptable medical source. Because the new medical information was received within the 30 day reconsideration period from the initial ABD denial (WAC 388-406-0065), the disability specialist completed a new SEP which subsequently found the client eligible for ABD.

EXAMPLE: At her incapacity review, Jenny was denied ABD and again found eligible for a HEN Referral, for a period of 12 months, based on a completed SEP. Two weeks later, the disability specialist received additional medical evidence indicating potential eligibility for ABD. Because the evidence was received within 30 days of the ABD denial, the disability specialist completed a new SEP to determine ABD eligibility in line with Concurrent Disability/ Incapacity Determination Process.

4. HEN Referral eligibility ends in the event that the client turns age 65, as they are now eligible for ABD per WAC 388-400-0060 (1)(a)(i).

Incapacity Determination - Required Medical Evidence

Created on: 
Oct 21 2014

Purpose: 

This chapter describes medical evidence required for HEN Referral incapacity determinations.

WAC 388-447-0010 What medical evidence do I need to provide?


Clarifying Information 

1. Per WAC 388-447-0010 (5), the Department will cover the cost of obtaining medical evidence necessary to determine incapacity following our published fee schedule if the applicant/recipient is unable to obtain necessary evidence without incurring a cost.

Incapacity Determination - Acceptable Medical Evidence

Purpose:

This section describes acceptable sources of medical evidence for HEN Referral incapacity determinations.

WAC 388-447-0005 What evidence does the department consider to determine incapacity?


 Clarifying Information

  1. 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.

Incapacity Determination - Assignment of Severity Ratings

How Severity Ratings are Assigned for HEN Referral Incapacity 

Clarifying Information

  1. When the provider does not give a severity rating:
    1. Review the medical evidence. Use reference sources, facts present in the medical evidence, and your professional judgment to assign a severity rating that is consistent with the objective medical evidence and severity definitions in WAC 388-447-0020 and 388-447-0040; or
    2. Refer the case to a Medical Consultant for assistance with interpreting the medical information.
  2. When the severity rating given by the provider is supported by the objective findings, accept the rating.
  3. You may adjust the provider's ratings if you have clear and convincing reasons why the rating should be adjusted (e.g. rating is not consistent with the objective medical evidence). If the adjusted rating results in the person having only one impairment with a severity rating less than three, deny incapacity at Step 1 (see WAC388-447-0030).

Incapacity Determination - Chemical Dependency

How alcohol or drug dependence affects an individual's eligibility for medical care services

Clarifying Information

House bill 2082 passed into law and mandates:

  1. Persons who are primarily incapacitated due to alcohol or drug addiction are ineligible for ABD cash and MCS benefits.
  2. Persons who meet incapacity requirements, and who are assessed as in need of drug or alcohol treatment (CD), must participate in treatment as a condition of eligibility for ABD cash, PWA cash, and MCS medical.
  3. The CD treatment requirements and good cause reasons listed in WAC 182-508-0220 are defined in state law (RCW 74.04.005).
  4. An “indication” of chemical dependency includes:
    • A notation of alcohol on breath (AOB) by a medical provider, DSHS staff, or in ACES case notes.
    • Medical or mental health chart notes counseling a client on substance use.
    • Recent legal problems associated with substance use (DUI, etc.)
    • The person states verbally or in writing that they use an illegal substance in any quantity.
    • Concern of the person’s substance use is expressed by family members, friends, etc.
  5. See the Alcohol and Substance Abuse chapter for more information on signs of chemical dependency or abuse.
  6. Chemical dependency assessments are valid for 6 months. If a person is assessed as dependent, no additional assessments are needed for 6 months.

Worker Responsibilities

  1. Determine if a person has an incapacitating impairment that is separate from chemical dependency or abuse per WAC 182-508-0030.
  2. If the person is primarily incapacitated by chemical dependency:
    1. Deny incapacity for applicants and recipients of MCS. 
    2. Encourage the person to engage in CD treatment and provide chemical dependency resource information.
    NOTE: Don’t request a chemical dependency assessment to support an incapacity decision of no clear differentiation. Only refer persons primarily incapacitated by alcohol or drugs for an assessment if they indicate they want to pursue treatment.
  3. If it can be established that a person has a separate incapacitating impairment, and there is an indication of substance abuse or addiction, approve incapacity, and open the ICMS screen “chemical dependency”. Send a form 14-527 MCS Plan letter requiring the client: 1. Sign a DBHR release of information form 14-314. 2. Complete a chemical dependency assessment.
  4. If the person is assessed as dependent and in need of chemical dependency treatment, update the 14-527 MCS plan to require the person to participate and complete treatment as recommended by the certified chemical dependency professional (CDP).
  5. If assessed as dependent, but treatment isn’t recommended because the person isn’t amenable to treatment – this means the person has refused treatment. Send a 14-528 good cause letter and terminate benefits if the person does provide proof a good cause reason listed in WAC 182-508-0220.
  6. Communicate with the CDP if questions arise regarding the level of treatment the person is capable of participating in or if the person has special needs such as a dual diagnosis placement.
  7. If the person is assessed as needing inpatient treatment, but medical treatment prevents the person from entering into inpatient treatment, contact the chemical dependency counselor to request the assessment be updated to recommend outpatient treatment.
EXAMPLE Mike was assessed as dependent with a recommendation for 90 days of inpatient treatment. He was scheduled to enter treatment on September 5th. He calls his social worker and requests he be sent to outpatient treatment because he has visitation with his children on the weekends. The social worker explains Mike must comply with the inpatient treatment requirement. The treatment requirement won’t be changed and Mike will not have good cause if he fails to participate.

Tracking Assessment and CD Treatment

  1. Tracking and verification of compliance with CD assessment through completion of treatment is mandatory for every MCS client with an indication of chemical dependency. You must have a signed form 14-314
  2. Document all tracking and verification actions in the ICMS chemical dependency screen and case notes.
  3. Treatment monitoring and protective payees are mandatory for clients assessed as dependent.

Non compliance and good cause

  1. Send form 14-528 MCS Good Cause letter when verification of CD treatment compliance isn’t received, or if we receive information that the person didn’t complete treatment as recommended.
  2. If there is no response to the good cause letter, assume refusal to cooperate without good cause.
  3. Good cause for non compliance is defined in WAC 182-508-0220. All good cause reasons for failing to participate in CD treatment are temporary. Engage the person in treatment as soon as possible. These are the only acceptable reasons for refusing or failing to complete a chemical dependency assessment or treatment.
    1. We determine physical or mental health impairment, or treatment, prevents participation in treatment:
      1. Based on a review of objective medical information and treatment recommendations.
      2. Impairments must be severe or acute - person can’t ambulate, they are hospitalized or mental health is so unstable as to preclude any participation at this time.
      3. Communicate with the medical or mental health provider regarding status of the person’s condition and engage the person in treatment as soon as possible.
      4. Communicate with the chemical dependency provider about the special physical or mental health needs of the person to see if the person can be accommodated or treated effectively.
    2. Outpatient treatment isn’t available in the county you live in. Cooperating with waiting list procedures is cooperating with treatment. (Must make an assessment appointment and agree to be placed on a waiting list if necessary).
    3. Inpatient chemical dependency treatment. Cooperating with waiting list procedures is cooperating with treatment. (Must make an assessment appointment and agree to be placed on a waiting list if necessary).
  4. Take action on a person’s non-compliance immediately. Don’t wait until the incapacity review.
  5. Terminate assistance using a 14-118 when there isn’t good cause for non compliance.
EXAMPLE Shannon was assessed as dependent with a recommendation for 90 days of inpatient treatment. She was assigned a bed date of August 10th. The social worker did not receive notice that Shannon entered treatment on the 10th and sent a 14-528 good cause letter. Shannon called her social worker and explained that she had been scheduled for knee surgery on September 9th. Shannon provides verification of her surgery date, and the ISW contacts the CD counselor to request the treatment recommendation be changed to outpatient treatment. Her case is changed to require compliance with outpatient treatment. Shannon demonstrated good cause for failing to participate in in-patient treatment, but she must now participate in outpatient treatment.
EXAMPLE Roger was assessed as dependent with a recommendation for 90 days of inpatient treatment. He was scheduled to enter treatment on October 8th. The social worker did not receive notice that Roger entered treatment on the 10th and sent a 14-528 good cause letter. Roger calls his social worker and states he did not enter inpatient treatment because he could not find anyone to take care of his house. Roger doesn’t have good cause for failing to participate or a valid reason for changing the assessment recommendation.
EXAMPLE Sandy was assessed as dependent with a recommendation of outpatient treatment. She was scheduled to start treatment on September 10th. The social worker did not receive notice that Shannon started treatment and sent a 14-528 good cause letter. Sandy called her social worker and explained that she had physical therapy appointments she needed to attend. Sandy provides verification of her physical therapy appointments. They don’t conflict with the CD treatment sessions and that the PT appointments can be rescheduled if a conflict arises. Sandy has not demonstrated good cause for failing to participate in CD treatment and her benefits end September 30th.

Incapacity Determination - Housing and Essential Needs (HEN) Referral- WAC Index

Created on: 
Oct 21 2014

Information and Referral (I&R)

Purpose:

How to provide individuals contacting the department for services with information and referrals to community resources.


Guidelines

1. Information and Referral (I & R) is a service available to all persons who request it from the department regardless of how they make such a request.

2. Resources available to assist the client will vary depending on whether the client is currently receiving services from DSHS.

3. Any staff person can refer the client to a Social Worker for I & R assistance if the staff person cannot directly assist the client by providing either the requested information or referral.

4. Staff should make referrals in an efficient manner that connects the person directly with the resource and eliminates any unnecessary steps or time.

NOTE: Information about local community resources can be found on the web at the Access Washington Resource Directory.

Worker Responsibilities

  1. Discuss the person’s needs with them.
  2. Determine if there are resources within the department or community to meet the client’s needs and make an appropriate referral.
  3. If the person appears to be able to make their own appointment with the resource, give them the information they need to do so. If it appears the person needs help to connect with the resource, provide them with appropriate assistance.
  4. Document the information that you gave to the person (if appropriate) or referrals that were made on the person’s behalf. Make the documentation in the system associated with the program from which the person is receiving services. For example:
Program System
TANF / SFA, RCA, food assistance only ACES, eJAS
ABD cash, MCS ICMS
Non-Recipients Barcode
EXAMPLE

Mary reports family violence issues and requests information and services from the receptionist. The receptionist immediately refers the client to a Social Service Specialist who:

  1. Determines if Mary or her children are in immediate danger.
  2. Conducts an assessment and makes appropriate referrals including to the Family Violence Advocate in the local office.
  3. Based upon the outcome of the assessment either:
    1. Give Mary the information n to assist her with her needs (if it appears she can follow through with needed resources); or
    2. Complete a referral form including the name, address, phone number, directions etc. so that the client can get to the resources on her own.
EXAMPLE

Henry reports his family has no food. His family has applied for food assistance and has an expedited appointment in 3 days. staff may:

  1. Providing Henry with information about local food banks.
  2. Check the Access Washington Resource Directory for information about local food banks and give Henry the address and days and times the food bank is open.
  3. Provide local contacts (such as churches) to assist Henry with obtaining food.

Incapacity Determination - Review of Incapacity

Created on: 
Dec 01 2015

Worker Responsibilities

1. Review incapacity at the end of the 12 month incapacity authorization period. 

  1.  Send the Notice of Information Required for Incapacity Review, DSHS 14-525.
  2. Provide Adequate Notice: Send the 14-525 between six and eight weeks prior to the incapacity review date (around the 10th of the month prior to the incapacity review month).
  3. Ensure the Incapacity Review Notice complies fully with the person’s current Equal Access Plan.
  4. Specify the information needed for the review.
  5. Establish the deadline for the person to provide current medical evidence as the 10th of the month of incapacity review, or the first business day following the 10th if the 10th falls on a holiday or weekend.

Learning Disabilities and Deficits

Purpose: 

Provide information for the identification of learning disabilities and deficits and use of the Washington State Learning Needs Screening tool.

Definitions

NOTE: Although the affects on the individual may be similar, do not confuse learning deficits or needs and acquired impairments with each other or with learning disabilities.
  1. Learning disability:

    1. Is a neurological condition that impedes the individual's ability to store and/or process information.

    2. Can affect the individual's social skills and ability to read, write, speak, and compute math. Individuals with learning disabilities are generally (but not necessarily) of above average intelligence.

    3. Always creates a disparity between the individual's measured IQ and performance IQ. For example, the individual may have a measured IQ of 125 but as a result of dyslexia, has reading skills that are below average.

  2. Learning deficits and learning needs:

Individuals lacking educational opportunities or who have had other issues that have interfered with learning are often mislabeled as having learning disabilities because the effects on the individual's performance may be similar. However, an individual who has very little education or has never learned to read has a learning deficit, not a learning disability.

  1. Acquired impairments:

Acquired impairments, resulting from head injury trauma or other types of injury may also affect the individual's ability to process information. As a result, an acquired impairment may be mislabeled as a learning disability. For example, following a motorcycle accident that resulted in a head injury, the person has poor memory. The poor memory is a result of the accident (an acquired impairment) not a learning disability in and of itself.

Distinguishing Characteristics

  • People can overcome a learning deficit through remediation, such as additional schooling.

  • Learning disabilities are not reversible and are a life-long issue but individuals with learning disabilities may develop accommodation skills and strategies that aid in lessening the effects of the learning disability.

  • A true learning disability rarely prevents an individual from becoming employed or self-sufficient.

  • Specific strategies or accommodations may be needed in order for the individual to be successfully employed. For example;

    • A strategy may involve encouraging the individual to choose a career that takes advantage of the individual's strengths and minimizes the areas of difficulty.

    • An accommodation might involve having the individual's work hours listed in a column rather than in a matrix or using a small tape recorder instead of making a "To-Do" list.

Guidelines 

  1. The Learning Needs Screening Tool does not distinguish learning disabilities from learning deficits.

  2. A high score obtained on this instrument is only an indicator of the possible existence of learning deficits and disabilities. For example, the client may obtain a high score as a result of having either poor reading skills due to a lack of education, or dyslexia.

  3. Determination of a true learning disability is accomplished only through the administration of intelligence tests and other psychological measurements.

  4. It is usually much more effective to determine what the client needs in order to succeed rather than focusing on the disability or deficit. For example, if it is known that the client has poor reading skills, the client may need to choose a career that does not require extensive reading or obtain additional schooling to improve his/her reading skills.

Worker Responsibilities

  1. Screen clients for learning deficits and disabilities using either the e-JAS or hard copy of the Washington State Learning Needs Screening Tool (DSHS 15-250(x). 

  2. If learning needs or deficits are suspected then consider referring the client to local resources such as the Learning Disabilities Association of Washington or your local community college.

  3. Document action and outcomes as appropriate in e-JAS and in the client's Service Plan or IRP.

    1. WF Handbook  - Learning Disabilities 6.6

    2. Learning Needs Screening Tool

Limited English Proficiency (LEP)

Medicaid Treatment Child Care

Purpose: 

A budget proviso was included in the 2006 Supplemental budget that allows the Department of Social and Health Services (DSHS), Economic Services Administration to refer children and families receiving Washington Apple Health to the Medicaid Treatment Child Care (MTCC) program beginning July 1, 2006.   As of November 1, 2011 administration of the MTCC program will be transferred from Children’s Administration to the Department of Early Learning (DEL), there will be no changes to the program and services for the children will remain the same.

Guidelines

Medicaid Treatment Child Care (MTCC) is an early intervention/prevention program authorized by the Department of Early Learning (DEL) and implemented through contracted community based providers to deliver quality early development child care to children ages birth to 5 years old.  MTCC programs provide medically necessary; age appropriate, psycho-social services to young children who are exposed to substantial environmental, familial, and biological risk factors that can impact their social development, behavior, and overall mental health.

MTCC providers conduct a process to admit, assess and diagnose each child authorized by DEL.  A Multi-Disciplinary Team meets after the child has an assigned diagnosis to generate the child's Individual Treatment Plan (ITP).  An ITP is developed to address the needs identified in this process.  The services provided under the ITP include, but are not limited to, the following:

  • Therapeutic play;
  • Individual counseling for behavior modification;
  • Family counseling;
  • Group interventions with both child and parent;
  • Monthly home visits; and
  • Facilitated groups for caregivers.

Economic Services Administration, Children's Administration and Public Health Nurses can make referrals to MTCC for identified children that are at risk of abuse or neglect.

Eligibility

Any identified child on Washington Apple Health at risk of abuse or neglect can be referred to MTCC.
The following characteristics may be used to identify families that are at risk of abuse or neglect. One or more of these characteristics in and of themselves do not constitute abuse and/or neglect, although the more factors that are apparent strengthen the potential that the family may be at risk.

  • Perceived and/or actual sources of financial and emotional support (socially and financially isolated), especially with any or all of the following:
    • Age of children (0-5)
    • Several children close in age
    • Young parent(s): teens and early twenties (and therefore, young children)
  • Mental health/Substance abuse
    • Drug or alcohol abuse by the parent(s) and not in treatment
    • Mental illness diagnosed and not controlled
    • Depression
  • Domestic violence with violent partner still in family
  • Chronically Impoverished (i.e. consistently during one or more years)
  • Severe emotional problems of a child or a mentally ill child
  • Poor education and work experience
  • History of abuse/neglect for the child
  • Parental history of abuse/neglect as a child

Once DEL authorizes the referral, the MTCC Provider must conduct a comprehensive assessment, diagnosis, and complete the Statement of Medical Necessity form and submit to DEL who completes the secondary review process to determine medical necessity.

If the form meets medical necessity DEL will inform the MTCC provider and authorize payment for MTCC services for 6 months. If the child does not meet medical necessity criteria they will be transitioned out of the program within 30 days after being denied. If denied the WFSW and/or biological parent can ask DEL for a ‘Request for Review’.

Worker Responsibility

The Community Services Office (CSO) Social Worker must:

  • Identify and assess families that are at risk of abuse or neglect.
  • Work with the MTCC provider to determine if a referral is appropriate and space is available.
  • If appropriate, complete the Referral/Authorization Form 13-001 and send to DSHS ESA CSD HQ MTCC Referrals.  The referral  will be reviewed and sent to the DEL MTCC Administrator for authorization.
  • Act as the case manager while the child remains in the program.
  • Document in eJAS and update IRP as appropriate when the parent is involved in program activities.
  • If available, attend the MTCC Provider Multi-Disciplinary case staffing(s) for referred families.

 DEL must:

  • Process the referral/authorization.
  • Forward the completed authorization form to the MTCC provider.
  • Review the Statement of Medical Necessity to determine medical necessity.
    • If the Statement of Medical Necessity is denied the social worker or biological parent can Request for Review.
  • Authorize payment for services not to go over 6 months if Statement of Medical Necessity approved.
  • Track referrals and authorizations.

 MTCC provider must:

  • Conduct a comprehensive assessment, diagnosis, and complete Statement of Medical Necessity form within 30 calendar days from the first day in which the child attends the program.
  • Send completed Statement of Medical Necessity forms to DEL.
  • Complete the ITP within 50 calendar days of the first day the child attends the facility. 
  • Review and update the treatment plan at intervals no greater than 90 days.
  • Send monthly progress reports.
NOTE: There are on-going reauthorizations required at regular 6 month intervals.  This will require the social worker to track and re-authorize services at the appropriate time. The referent and the MTCC provider are jointly responsible for timely reauthorizations

Medical Evidence Requirements and Reimbursements

Revised on: September 30th, 2016

Purpose

This section details ABD program medical evidence requirements and reimbursement rates.

Clarifying Information

Reimbursements described in this section are solely to pay the fees necessary to obtain objective medical evidence of an impairment that limits work activity. We do not pay for medical evidence to evaluate medical conditions that are not claimed or unlikely to impair work functions.

If a person meets all of the non-disability eligibility requirements listed in WAC 388-400-0060, we reimburse for the costs of obtaining the objective evidence necessary to determine disability based on our published fee schedules.

  1. Clients must appear to be financially eligible for ABD cash before we authorize an evaluation or payment.
  2. Request medical records if available before authorizing new evaluations or services.
  3. Payments do not apply to services authorized by the Division of Disability Determination Services (DDDS) or medical examinations or reports required by court order or treatment placement.
  4. Payments for medical evidence related to TANF cases are authorized in eJAS as Support Services (WorkFirst Handbook 2.2).
  5. See WorkFirst Handbook 3.7.1.6 for information regarding reimbursement for medical evidence associated with TANF/SFA ineligible parent time limit extensions.

What is "Current" Medical Evidence?

  1. Initial decision: Current medical evidence for an initial decision must be based on an examination or findings from within 90 days of the date of application. Only request new medical evidence when available evidence is either older than 90 days or insufficient to determine disability.
    1. Document your reason for obtaining new medical evidence.
    2. For the purposes of establishing a diagnosis, medical evidence greater than 90 days old from the date of application is acceptable when it is:
      • A report within the past 5 years that includes a diagnosis of a potentially disabling condition based on an examination by an acceptable medical source, defined in WAC 388-449-0010;
      • Intelligence testing scores from a Wechsler Adult Intelligence Scale (WAIS - III or IV editions) administered after age 18; or
      • A diagnostic imaging report such as an X-ray or MRI when referenced in an examination performed within 90 days of application.
  2. Review decision: Current medical evidence for a review decision must be based on an examination or findings from within the past 45 days.
    1. If the client has seen a medical provider within the past 45 days, request a report from records rather than authorizing a new evaluation whenever possible.
    2. If existing available medical records are not sufficient to determine disability, clearly document the reason for obtaining any new testing or evaluations at review.

Medical Evaluations and Testing

  1. General physical evaluation: A general physical evaluation should contain all of the following information:
    1. The Chief complaint and symptoms reported by the client;
    2. Medical history including onset date and treatment history;
    3. Physical examination findings including but not limited to: vital signs, observations, a description of any abnormal findings, and range of motion (when appropriate);
    4. Results of diagnostic testing and imaging (e.g. labs, X-rays, pulmonary function tests, etc.);
    5. A diagnosis and International Classification of Diseases (ICD) code for any impairment that affects work activity and is supported by objective findings;
    6. A description of how the medical condition impacts the client's overall ability to perform basic work-related activities;
    7. A description of any non-exertional limitations which may include workplace restrictions;
    8. A prognosis including an estimate of how long the functional impairment will persist at the current level of severity;
    9. Current or past drug or alcohol use or abuse;
    10. An opinion whether current impairments which limit work activity are primarily the result of alcohol or drug use within the past 60 days;
    11. Recommendations for additional testing or consultation;
    12. Treatment recommendations;
    13. The name, title and signature of the person performing the evaluation;
    14. The date of service; and
    15. Copies of all available chart notes, hospital discharge summaries, diagnostic reports, and other medical records from the past six months.
  2. Comprehensive physical evaluation (e.g. orthopedic, neurological): A comprehensive physical evaluation contains all of the information listed under the general physical evaluation section above, in addition to:
    1. Progression of symptoms such as motor loss, sensory loss, or mental restrictions;
    2. Description of any restrictions on personal care or daily activities caused by the condition; and
    3. Copies of clinic records.
  3. Psychological and psychiatric evaluation:
    1. Psychological evaluation is a diagnostic interview, including an MSE (mental status exam) and an assessment of daily living skills conducted by a licensed psychologist.
    2. Psychiatric evaluation is a diagnostic interview, including an MSE (mental status exam) and an assessment of daily living skills conducted by a licensed psychiatrist.
    3. Both evaluation types result in a written report that must include:
      1. The chief complaint or the impairment/symptoms claimed by the client;
      2. Psychosocial history including onset date and treatment history;
      3. Educational and work history;
      4. Any past or present drug or alcohol use or abuse, including treatment history;
      5. A description of the client's activities of daily living;
      6. A list of all mental health symptoms that impact the client's ability to work, including a description of the severity and frequency of those symptoms;
      7. A diagnosis; from the current Diagnostic and Statistical Manual of Mental Disorders (DSM), or lack thereof, of any impairment that impacts work activity and is supported by objective findings;
      8. A description of how the medical condition impacts the client's overall ability to perform basic work-related activities;
      9. An opinion whether any current impairments which limit work activity are primarily the result of alcohol or drug use within the past 60 days;
      10. A prognosis including an estimate of how long any functional impairment will persist at the current level of severity;
      11. An opinion of the client's capacity to manage funds;
      12. Treatment recommendations;
      13. The name, title, and signature of the person performing the evaluation; and
      14. The date of service.
  4. Psychological diagnostic testing is only reimbursed when necessary to establish a diagnosis or the severity of a mental health impairment. Psychological diagnostic testing is limited to the following:
    1. Evaluation of personality disorders:
      1. MMPI-II: Minnesota Multiphasic Personality Inventory
      2. PAI-II: Personality Assessment Inventory
    2. Evaluation of depression:
      1. BDI-II: Beck Depression Inventory
      2. HAM-D: Hamilton Rating Scale for Depression
    3. Evaluation of anxiety:
      1. BAI: Beck Anxiety Inventory
      2. HAM-A: Hamilton Rating Scale for Anxiety
    4. Evaluation of a potential cognitive disorder:
      1. WAIS-III or WAIS IV: Wechsler Adult Intelligence Scale
      2. WMS-III: Wechsler Memory Scale
      3. TONI-4: Test of Nonverbal Intelligence, Fourth Edition
      4. Trails: Trail Making Test Parts A and B
    5. Evaluation of potential memory malingering:
      1. REY 15-Item Memory Test
      2. TOMM: Test of Memory Malingering
    6. Evaluation of potential psychiatric illness malingering
      1. M-FAST: Miller Forensic Assessment of Symptoms Test
      2. SIRS: Structured Interview of Reported Symptoms

Sub-test scores, statistical scores, and a narrative summary of all tests must be included. Please see Mental Incapacity Evaluation Services: Fee Schedule, for limitations on testing reimbursements and additional details.

NOTE:  The examining psychologist or psychiatrist determines which of the listed tests are clinically appropriate and must clearly document in the evaluation report why each test is performed.

Mental Health Professional (MHP)

  1. MHP reports may only be used as medical evidence for the purposes of determining incapacity for the HEN Referral program.
  2. MHP reports may be used as other evidence to help determine severity and functional capacity for the purposes of an ABD disability determination, only after a diagnosis has been established by an acceptable medical source and we have obtained a current assessment of functioning from a doctor or other treating medical source listed in WAC 388-449-0010.
  3. No reimbursement, other than copy fees, shall be authorized for MHP reports.

ProviderOne and the Social Service Payment System (SSPS)

NOTE:  Providers must be enrolled with ProviderOne to claim and receive payment for Incapacity Evaluation services.  Refer all medical providers to the ProviderOne billing system for claims with dates of service after 11/01/2015. Use SSPS to reimburse for medical evidence with dates of service before 11/01/2015. 
NOTE: Continue to use SSPS to reimburse for Medical Records (copies), SSI Medical Evidence Transportation costs, and Medical Evidence to Support SSI Applications (approved through the Barcode ETR process).

Most services provided before 11/01/2015 are paid using SSPS Service Code 6220. Refer to SSPS Manual Appendix H for details regarding available Service Codes and how to use them.

Pay either the provider's usual and customary fee or the maximum payment, whichever is less. Refer to the Medical Evidence Fee Schedules section for maximum payment amounts.

ABD/HEN Referral Payment Review Request

The Payment Review Request (PRR) tool in ICMS can be used to identify and report psychological and physical functional evaluations that lack elements required by ABD/HEN Referral program rules, and are in need of further review. Please visit the ABD/HEN Referral Payment Review Request section of the CSD Procedure Handbook for additional information.  

NOTE: Social Service staff must first attempt to obtain missing information by contacting the medical provider by phone, FAX, or by mail before initiating the PRR tool.  Be sure to document the attempt in ICMS case notes.

 

Medical Evaluations and Diagnostic Procedures

Created on: 
Aug 05 2015

Medical Evidence Fee Schedule

Medical Evaluations and Diagnostic Procedures

You must be enrolled in ProviderOne to claim reimbursement for these services.  Please visit the Health Care Authority’s New Providers page for information about ProviderOne enrollment.

 

NOTE: We only pay for non-invasive diagnostic services and exams necessary to establish a diagnosis or the severity of an impairment that limits work activity.  We reimburse for the costs of obtaining the objective evidence necessary to determine disability based on our published fee schedule and established Medicaid rates.
For services not included on this fee schedule, you may need to submit a separate claim to ProviderOne using established CPT codes.
The maximum payment for all evaluation and report services includes the cost of providing chart notes and medical records.
Reimbursement Fee Table

Service Type

Reimbursement Fee

ProviderOne Service Code

General physical evaluation

$150.00

99455

Comprehensive physical evaluation

$170.00

99456

Report from records

$31.00

99080

Missed appointment

$30.00

99199

Non-Invasive Diagnostic Testing

Established Medicaid Rates

Established CPT Codes

⃰  This section details Aged, Blind, or Disabled (ABD) program medical evidence reimbursement rates.  For a detailed service descriptions visit the Medical Evidence Reimbursements section of the ESA Social Services Manual.

Mental Incapacity Evaluation Services

Medical Evidence Fee Schedule

Mental Incapacity Evaluation Services

Reimbursement for psychological evaluations and testing is limited to the terms and conditions outlined in the Community Services Division (CSD) Mental Incapacity Evaluation contract. 

For information about contracting with DSHS please visit the CSD Mental Incapacity Evaluations contracts page.

CSD Contractors must be enrolled in ProviderOne to claim reimbursement for these services.  Please visit the Health Care Authority’s New Providers page for information about ProviderOne enrollment.

 

NOTE:  The maximum payment for all evaluation and report services includes the cost of providing chart notes and medical records.  Providers may choose to use DSHS form 13-865 or provide a narrative report.  The psychological evaluation form 13-865 must be typed in order to be eligible for payment.

Service Type

Service Description

Reimbursement Fee

ProviderOne Service Code

Additional Conditions

Clinical Evaluation

When performed by a licensed/contracted psychologist (Taxonomy:  103T00000X)

$150.00

96150

Modifier 25

Must be an acceptable written report as described in Exhibit B, Statement of Work.

Clinical Evaluation

When performed by a licensed/contracted psychiatrist (Taxonomy:  2084P0800X)

$170.00

90791

Must be an acceptable written report as described in Exhibit B, Statement of Work.

Evaluation of general mental disorders

  • MMPI-2:  Minnesota Multiphasic Personality Inventory*

 

  • PAI-II:  Personality Assessment Inventory

 

 

 

$50.00

 

 

 

$50.00

 

 

 

96101

Modifier U6

 

 

96101

Modifier U1

No more than one (1) test from this category per evaluation

 

*May substitute the MMPI-2: Restructured Form provided the report documents why the substitution is necessary.

Evaluation of depression

 

  • BDI-II:  Beck Depression Inventory

 

  • HAM-D:  Hamilton Rating Scale for Depression

 

$10.00

 

 

$10.00

 

96101

Modifier U7

 

96101

Modifier U8

No more than one (1) test from this category per evaluation.

Evaluation of anxiety

  • BAI:  Beck Anxiety Inventory

 

  • HAM-A:  Hamilton Rating Scale for Anxiety

 

$10.00

 

 

$10.00

 

96101

Modifier UB

 

96101

Modifier UC

No more than one (1) test from this category per evaluation.

Evaluation of cognitive disorders

  • WAIS-III or WAIS-IV:  Wechsler Adult Intelligence Scale

 

  • WMS-III:  Wechsler Memory Scale

 

  • Test of Nonverbal Intelligence, Fourth Edition (TONI-4)

 

  • Trails:  Trail Making Test Parts A & B

$120.00

 

 

 

$120.00

 

 

$30.00

 

 

$10.00

96101

Modifier U3

 

 

96118

Modifier U4

 

96101

Modifier U4

 

96118

Modifier U5

The TONI is used to evaluate individuals with limited language ability.  It is reimbursed instead of and not in addition to the WAIS and WMS.

Evaluation of potential memory malingering

  • Rey Fifteen-Item Memory Test

 

  • TOMM:  Test of Memory Malingering

$10.00

 

 

$30.00

96101

Modifier U9

 

96101

Modifier U2

No more than one (1) test from this category per evaluation.

Evaluation of potential psychiatric illness malingering

  • M-Fast:  Miller Forensic Assessment of Symptoms Test

 

  • SIRS:  Structured Interview of Reported Symptoms

$20.00

 

 

$10.00

96101

Modifier UA

 

96101

Modifier U5

No more than one (1) test from this category per evaluation.

Missed appointment

  • DSHS Client fails to appear at scheduled date and time and the DSHS Client or referring CSO did not request cancellation within twenty-four (24) hours prior to the appointment, unless the conditions in the Additional Limitations column apply.

 

  • The DSHS Client arrives more than ten (10) minutes after the scheduled start time unless the conditions in the Additional Limitations column apply.

 

  • The Contractor observes the DSHS Client to be intoxicated.

$30.00

99199

This is not paid when the Contractor is providing services at a CSO and another DSHS Client is available.

 

This fee is only paid once per referral.

This section details Aged, Blind, or Disabled (ABD) program medical evidence reimbursement rates.  For a detailed service descriptions visit the Medical Evidence Reimbursements section of the ESA Social Services Manual.

 

Medical Records-Medical Evidence Fee Schedule

Created on: 
Aug 05 2015

Medical Evidence Fee Schedule

Medical Records

We use the Social Service Payment System (SSPS) to reimburse for medical records.  Please submit claims to the requesting DSHS Community Services Office for processing.

 

Service Type

Reimbursement Fee

SSPS Reason Code

Medical Records (copies)

$0.30 per page – maximum of 150 pages

Additional charges allowed:

$20 for handling or clerical fee**

Actual cost of sales tax**

Actual cost of postage***

 

A

⃰  This section details Aged, Blind, or Disabled (ABD) program medical evidence reimbursement rates.  For a detailed service descriptions visit the Medical Evidence Reimbursements section of the ESA Social Services Manual.

** Additional charges must be itemized on the bill to be eligible for reimbursement.

*** The cost of postage is eligible for reimbursement only if the Department was unable to provide the vendor with a postage-paid business reply envelope.

Mental Health Services

Purpose: 

Provide a basic overview of services available to assist clients in accessing mental health services.


Clarifying Information

The following resources are available to assist  adults, youth and families with children in accessing mental health services. Depending on the situation access to mental health treatment and services may require facilitating the referral  through the person’s primary care provider, Regional Support Network (RSN) or local mental health provider. It is highly recommended that each office know and collaborate with  all local mental health providers and RSN.

If it appears the individual is in crisis due to a mental illness referral should be immediately made to the RSN for emergency crisis intervention services. A Designated Mental Health Professional (DMHP) will determine if an involuntary mental health evaluation and treatment is warranted. Crisis services are available to any person regardless of income or citizenship status. If the crisis requires the involvement of law enforcement ask the 911 operator to involve Crisis Intervention Team [CIT] officers if they are available in your community. They are trained to de-escalate violent situations in which a mental illness may be a contributing factor.

Regional Support Network (RSN) Mental Health Prepaid Health Plans

RSNs, through licensed mental health agencies, provide medically necessary services to clients eligible for the Title XIX Medicaid program as well as some other persons with a diagnosed mental illness An in-person appointment with the mental health provider will be necessary to make that determination. Services include emergency crisis intervention, case management, counseling and psychotherapy, and psychiatric treatment, including medication management. A directory of RSNs and licensed community mental health agencies is available at the link listed below.

Medicaid Healthy Options Program

Title XIX Medicaid clients who are enrolled in Healthy Options are eligible for limited mental health services through the Healthy Options health plans. The benefits include psychiatric and psychological testing, evaluation and treatment and unlimited medication management when provided in conjunction with mental health treatment covered by the Contractor. Mental health benefits offered through the Healthy Options plans are limited to those Title XIX who do not meet the RSN’s Access to Care Standards.  Detailed information is provided at the Healthy Options website listed below.

Primary Care Provider (Family Physician)

Clients with depression or anxiety disorders may be served by accessing the person’s Primary Care Provider to assist in determining if the mental disorder is treatable by medication or other services covered by health insurance or medical coupons. The primary care provider’s medical assessment may also be helpful in documenting the need for treatment when referring the client to a psychiatrist or other mental health services provider.

WorkFirst/ TANF

TANF/WorkFirst clients may be screened using the Depression and Anxiety Disorder screens in the e-JAS Mental Health Category in the Social Services Assessment. If, as a result of the e-JAS Depression and Anxiety Disorder screenings, it appears the client needs further evaluation, refer the client to his or her primary care provider or local mental health service provider.

RESOURCES

Washington Apple Health 

http://www.samhsa.gov (Substance Abuse and Mental Health Services Administration)

www.psychtest.com

www.med.nyu.edu.com

www.selfgrowth.com

Search IESA Clarification Database (internal use only)

Mental Status Exam Guidelines

Revised December 12, 2011

A mental status exam (MSE) must accompany all mental health reports for determination of Disability based benefits. A MSE must be included with the submission of DSHS form 13-865.

A mini mental status exam (MMSE) cannot be substituted for a MSE.

MSE GUIDELINES

Every MSE must include observation detail for each of the categories listed below. Individual questions may be altered and additional questions may be added:

 

Examples of observation detail:

General Appearance

  • Well groomed or unkempt?
  • What is the person wearing? 
  • Are clothes appropriate for weather and situation?
  • Evidence of psychomotor agitation or retardation?  Give examples.

Attitude and Behavior

  • Is the person cooperative, irritable, belligerent etc.?
  • Is there any indication of malingering or factitious behavior?  Explain.

Mood and Affect

  • How does the person describe his or her mood?
  • Is the person’s affect congruent with the stated mood? Explain.

Content of Thought

  • Are there any delusions?
  • Is the person suicidal?  Homicidal?  What leads you do this conclusion?

Stream of Mental Activity

  • Is speech normal or tangential or circumstantial?  Give Examples.

Orientation

  • Is the person oriented times three?

Memory

  • Remote—can person remember past events?
  • Recent—can person remember 3/3 objects after 5 min?
  • Immediate—how well can the person do digit span back and forward?

Fund of Knowledge

  • Is the person aware of current events?  Give examples.
  • Does the person know the names of the president and governor?
  • Can the person answer simple geography questions, such as naming bordering states?

Concentration

  • Serial 7’s or 3’s?  Give person’s response.
  • Spell WORLD forward and backward?
  • Follow a three step command?
  • Difficulty following conversation.  Give examples.

Abstract Thinking

  • Interpret proverbs?  Give examples.

Insight and Judgment

  • Does the person have insight into his/her condition?
  • Does the person show good judgment when asked what he/she would do if smelling smoke in crowded theater?

Naturalization

Created on: 
Nov 09 2015

SSI facilitation of a non-U.S. citizen and naturalization referral. 


Worker Responsibilities 

Search IESA Clarification Database

  1. Because the rules under which non-United States (non-U.S.) citizens are eligible for Social Security benefits are very complex, refer all persons, including ABD cash and TANF recipients, who are non-U.S. citizens and appear to meet SSA disability or aged criteria directly to the local Social Security Administration (SSA) office before providing SSI facilitation services.
    NOTE: Open the SSI Facilitation screen in ICMS for ABD cash recipients
  2. When SSA accepts an application from the ABD recipient:
    1. Verify with the local SSA office that an SSI application was filed.
    2. Request ABD certification
    3. Verify that a valid DSHS 18-235, Interim Assistance Reimbursement Authorization (IARA) has been filed with SSA.  If not, take the necessary steps to provide an IARA to SSA.
    4. Document and update the SSI Facilitation screens in ICMS.
    5. Provide Equal Access and SSI Facilitation services to assist the recipient throughout the application process.
  3. When SSA rejects an SSI application because of citizenship status, of a person defined as qualified alien per WAC 388-424-0001), and the person has lived in the United States for at least four years:
    1. Schedule a face-to-face interview whenever possible. Explain the advantages of becoming a U.S. citizen such as: citizenship gives them the right to apply for federal benefits, vote and makes traveling abroad easier.
      NOTE: Never tell the person that they must become a U.S. Citizen.
    2. Suggest that the person contacts agencies in their local area that can help them become US citizen. You may give them a NATURALIZATION REFERRAL LIST which provides a list of agencies that have historically provided naturalization services.
    3.  If the person needs help contacting the naturalization agency:
      1. Call one of the local naturalization agencies to make an appointment for the person. 
      2. Help the person make transportation arrangements, such as contacting a friend or relative of the person.
      3. Give the person the NATURALIZATION REFERRAL LIST.
    4. Enter “SSI/SSA denied-Non Citizen (SN)” as the closing reason code on the SSI Facilitation screen in ICMS. Enter the date that you made the naturalization referral in the date field. 
    5. When a person who is a non-U.S. citizen reports SSI approval, explain that unless they naturalize they will only receive SSI for seven years from the date they entered the U.S:
      1. As a refugee, asylee, Cuban/Haitian entrant, Amerasian, victim of trafficking, Special Immigrant from Iraq or Afghanistan, or
      2. They have had deportation or removal withheld.
    6. Review the benefits of citizenship and the list of naturalization services providers.

Naturalization Agencies

Revised July 25, 2012

The following is a list of naturalization services agencies. See the Naturalization chapter for the referral information.

All agencies are authorized to provide immigration services and can help connect you to someone who speaks your language.

Naturalization Services Referral List  

Asian Counseling & Referral Service
3639 Martin Luther King 
Way South
Seattle, WA 98144
(206) 695-7600
Hmong, Mien, Chinese, Vietnamese, Laotian

Catholic Community Services of King County
4250 Mead Street
Seattle, WA 98118
(206) 725-2090
Russian, Ukrainian, Somali, Arabic, Kurdish

Center for Multi Cultural Health
105 14th Ave #2C
Seattle, WA 98122
(206)461-6910
Russian, Ukrainian, Khmer, Amharic, Tigrinya

Chinese Information Service Center
611 S. Lane St.
Seattle, WA 98104
(206) 624-5633
Cantonese, Mandarin, Vietnamese

Filipino Community of Seattle*
5740 ML King Jr. Way S
Seattle, WA 98118
(206) 722-9372
Filipino dialects

Lutheran Community 
Services NW
115 NE 100th St., Suite200
Seattle, WA 98125
(206) 694-5742
French, Arabic

Korean Women’s Assn.
123 East 96th Street
Tacoma, WA 98445
(253) 535-4202
Korean, Ukrainian, Russian Vietnamese, Cambodian

Multi Cultural Self Sufficiency Movement
11016 Bridgeport Way SW
Tacoma, WA 98499
(253) 584-5615
Korean, Russian, Ukrainian, Romanian, Moldavian,Spanish

Tacoma Community House
1314 South L St.
Tacoma, WA 98415
(253) 383-3951
Russian, Ukrainian, Vietnamese, Spanish, Cambodian, Lao

East African Community Development Council
7101 Martin Luther King
Way South, Suite 203
Seattle, WA 98146
(206) 7355-6343
Somali, Oromo, Amharic, Tigrinya 
Ready by Five
414 North Third Street
Yakima, WA 98901
(509) 454-2493
Portuguese, Spanish, Russian

Khmer Community of Seattle-King County
10025 16th Ave SW
Seattle, WA 98146
(206) 762-3922
Bosnian, Khmer, Vietnamese, Somali, Amharic, Tigrinya

International Rescue
Committee
100 S. King St. ,Suite 570
Seattle, WA 98104
(206) 623-2105
Spanish, German, French

International Rescue
Committee
16256 Military Road S. #206
SeaTac, WA 98188
(206) 623-2105
Bosnian, Somali, Arabic, Vietnamese, Amharic, Russian, Tigrinya, Nepali, Burmese, Chin

Jewish Family Services
1601 16th Avenue 
Seattle, WA 98122
(425) 643-2221
Russian, Farsi,

Neighborhood House
905 Spruce St., Suite 200
Seattle, WA 98104
(206) 461-8430
Vietnamese, Other

NW Immigrant Rights Project
615 2nd Ave. Suite 400
Seattle, WA 98104
(206) 957-8604
Any Language

NW Immigrant Rights Project
121 Sunnyside Ave.
PO Box 270
Granger, WA 98932
(509) 854-2100
Spanish

Refugee & Immigrant 
Services NW

2000 Tower Street
Everett, WA 98201-1352
(425) 388-9307
Russian, Ukrainian

East African Community Services
7054 32nd Ave. South,
Suite 207
Seattle, WA 98118
(206) 721-1119
Somali, Eritrean, Oromo, Tigrinya, Iraqi, Sudanese

Lao Community  Services
7101 Martin Luther King
Way South, Suite 214
Seattle. WA 98118
(206)  501-4115
Laotian

Refugee Federation Service Center Coalition 
7101 Martin Luther King
Way South, Suite 214
Seattle. WA 98118
(206) 725-9181
Russian, Ukrainian, Somali
Cambodian, Vietnamese, Bhutanese, Burmese

Eritrean Community of Seattle and Vicinity
2404 East Spruce
Seattle, WA 98122
Tigrinya, Amharic

Korean Women’s  Assn.
5305 East 18th St., Ste 117
Vancouver, WA 98661
(360) 906-0577
Russian, Ukrainian

Refugee Women’s Alliance
4008 M.L.King Way S.
Seattle, WA 98108
(206) 721-0243
Somali, Vietnamese, Amharic,

Sea Mar Community Health Centers
8915 14th Ave S
Seattle, WA 98108
(206) 764-4700
Spanish

St. James ESL Program
804 9th Avenue
Seattle, WA 98104
(206) 382-4511
Russian, Vietnamese

Ukrainian Community Center of Washington
221 Hardie Avenue NW
Renton, WA 98057
(425) 430-8229
Ukrainian, Russian, Polish

Literacy Source
720 N. 35th, Suite 103
Seattle, WA 98103
(206) 782-2050
Spanish, Hindi, Tamil, Malayalam, French, German

World Relief-Kent
841 N. Central Ave. N.
SuiteC-106
Kent, WA 98032
(253) 277-1121
Ukrainian, Russian, Belarusian, Moldavian, Polish

World Relief
(Spokane)
1522 N. Washington, 
Suite 204
Spokane, WA 99201
(509) 484-9829 
Russian, Swahili, Arabic, Spanish, French,  Karen, Burmese, Nepali, Hindi, Kirundi/Kinyarwanda

Multi Cultural Self Sufficiency Movement
30819 14th Ave. S. #F
Federal Way, WA 9800
(253) 945-6010
Korean, Russian, Ukrainian, Romanian, Moldavian,Spanish

Lutheran Community 
Services NW
3600 Main St. Suite 200
Vancouver, WA 98663
(360) 694-5624
Russian, Ukrainian, Bosnian, Spanish, Burmese

World Relief
(TriCities)
2600 N. Columbia Center
Blvd., Suite 206
Richland, WA  99352
(509) 734-5477
Arabic, Burmese, Russian, Serbo-Croation, Somali, Spanish, Ukrainian

Somali Community Services Coalition
15027 Military Road South
Suite 4 and 5
Seattle, WA 98188
(206) 431-7967
Somali
Korean Women’s Assn.
4629 168th St. SW #G
Lynnwood, WA 98037
(425) 742-3696
Korean, Russian, Ukrainian

Non-Suitability Determination of In-Home Relative WCCC Provider

Purpose: 

To provide social service specialists with guidelines and the process for using information we have, when the provider has been in our system through ABD cash or the HEN Referral program and they are applying to be paid through the Working Connection Childcare.

WAC 170-290-0135- In-home/relative providers 

 


Clarifying Information -WAC 170-290-0135

When a person is receiving ABD cash or HEN Referral services and medical, social or criminal information is available, use the following process to determine if that information indicates the person is unable to meet the needs of caring for a child/children and therefore not suitable to receive WCCC payment as an in-home/relative provider.

See WAC 170-290-0135 and WAC 170-290-0140 (4).

Worker Responsibilities - WAC 170-290-0135

  1. Review the “letter of recommendation” from 3rd party who knows the provider.  This letter must be included in the WCCC referral.
  2. Review medical, social or criminal evidence in the person’s case record including incapacity evaluations, supporting evidence from assessments, and Social Security disability status.
  3. Review the person’s statement about their ability to perform the care functions and meet the responsibilities listed in WAC 170-290-0135.
  4. If the medical evidence conflicts with the statement from either the third party or the person, we deny the payment for childcare.
  5. Notify WCCC worker of the decision to deny.
  6. Document your findings in eJAS or ICMS notes.
NOTE:  You cannot disclose details about our findings to the consumer due to confidentiality.   All you can disclose is that the provider did not pass the character and suitability review.  You may discuss your findings with the provider.
EXAMPLE - Applicant provider eligible for a HEN referral.  Medical report shows provider is unable to work due to a broken leg.  Provider is performing childcare for two children, ages 9 and 12.  Provider uses crutches to walk, is able to fix the children breakfast, and help them with their homework after school.  Childcare subsidy payments could be authorized for this provider.
EXAMPLE - Applicant provider is receiving ABD cash due to mental impairment.  Provider is applying for childcare for one grandchild age 3.  Psychological report states provider has a chronic mental illness and is likely to qualify for SSI.  The report rates the provider's the ability to interact appropriately in public and maintain hygiene as severely impaired. Third party statement includes comments that the grandparent relates well with the child and takes child to the park daily.  The third party statement is not consistent with the medical report.  This provider is not suitable for childcare subsidy payments.

Ongoing Additional Requirements

Created on: 
Oct 22 2014

WAC 388-473-0010 What are ongoing additional requirements and how do I qualify?

WAC 388-473-0020 When do we authorize meals as an ongoing additional requirement?

WAC 388-473-0040 Food for service animals as an ongoing additional requirement.

WAC 388-473-0050 Telephone services as an ongoing additional requirement.

WAC 388-473-0060 Laundry as an ongoing additional requirement.

WAC 388-478-0050 Payment standards for ongoing additional requirements.

See Ongoing Additional Requirements in the Eligibility A-Z Manual for more information about role of the Financial Worker in setting up service for the client.


Definition

An "Ongoing Additional Requirement" is a benefit that is needed by a person that maintains their independent living situation or allows them to live in an environment that is as independent as possible.

Eligibility Determination 

  1. A person may request Ongoing Additional Requirements benefits from either their Financial or Social Worker. If the request is made to the Financial Worker, the Financial Worker must give a referral to the Social Worker. 

  2. The Social Worker verifies the need and determines eligibility for these benefits through an assessment.  This may include an interview, collateral contacts, or a home visit.

  3. Notify the Financial Worker via inter-office memo of your decision.

  4. We do not approve Ongoing Additional Requirement benefits if:

    1. The assistance they are requesting is available to them through another program, or
    2. The person lives in a licensed adult family home or boarding home.

Worker Responsibilities

  1. Document the reason for the request for benefits as well as the facts supporting the approval or denial of benefits in the case progress notes.
  2. Provide the Financial Worker with the eligibility decision and a summary of this information by inter-office communication memo (available in ICMS).
  3. If Ongoing Additional Requirements benefits are approved, the Financial Worker will notify the person and generate payment.
  4. Review eligibility for Ongoing Additional Requirements as requested by a Financial Worker.

Clarifying Information - WAC 388-473-0040

What is a service animal?

The ADA defines a service animal as any guide dog, signal dog, or other animal individually trained to provide assistance to an individual with a disability. If they meet this definition, animals are considered service animals under the ADA regardless of whether they have been licensed or certified by a state or local government.

Service animals perform some of the functions and tasks that the individual with a disability cannot perform for him or herself.  Guide dogs are one type of service animal, used by some individuals who are blind. This is the type of service animal with which most people are familiar. But there are service animals that assist persons with other kinds of disabilities in their day-to-day activities.

Some examples include:

  • Alerting persons with hearing impairments to sounds.
  • Pulling wheelchairs or carrying and picking up things for persons with mobility impairments.
  • Assisting persons with mobility impairments with balance.

A service animal is not a pet.

Social Worker Responsibilities

1.   Use the following criteria to determine if the person's need for a service animal qualifies as an On-going Additional Requirement.

The animal:

a.  Must help the person with a sensory, mental, or physical disability.

b. The training does not need to be formal, but the animal should be trained to help the person with tasks related to the disability. Do not ask for proof of training.

EXAMPLE The client indicates the dog is to help with the blindness to get around. If the use of the animal in assisting the client seems questionable, you can request verification from the client's medical professional that the animal provides assistance with the disability.
EXAMPLE The dog is used to calm down the patient.  It seems questionable.  You can ask the client to provide a statement from the treating doctor, psychiatrist, or other medical professional on how the animal helps the clients with the disability.

3.  Approve Ongoing Additional Requirements when the above conditions are met.

4. Notify the Financial Worker of your decision using the inter-office communication memo available in ICMS.

5. For HCS cases, the HCS SW or Area Agency on Aging (AAA) case manager makes the determination of the need of OAR. Notify the financial worker of your decision using the DSHS 14-443 financial social service communication form. (This form is located in the barcode ECR under the forms tab.)


Worker Responsibilities - WAC 388-473-0050

Before authorizing benefits for telephone services, verify the person is receiving local telephone service under the Washington Telephone Assistance Program (WTAP). You can verify this by contacting the local telephone company.

NOTE: - if the amount the person needs is higher than the standards in WAC 388-478-0050, the worker should request an exception to rule to allow a higher payment standard.

LINKS

Pregnancy and Women's Health

Created on: 
Oct 22 2014

Purpose: 

This category contains these sections:

  1. PREGNANCY CRITERIA FOR CASH ASSISTANCE

    1. WAC 388-462-0010 - Temporary Assistance for Needy Families (TANF) or State Family Assistance (SFA) eligibility for pregnant women.

  2. PREGNANT WOMEN ASSISTANCE

    1. WAC 388-400-0055 - Pregnant Women Assistance.

Pregnant and Parenting Minors

Created on: 
Oct 22 2014

Purpose:

This category provides rules, policy and information to determine a pregnant and/or parenting minor's eligibility for TANF or SFA cash assistance and WorkFirst Support Services based upon the required Teen Living Assessment and school requirements.

WAC 388-486-0005 - Unmarried pregnant or parenting minors - Required living arrangement

WAC 388-486-0010 - Unmarried pregnant or parenting minors - Required school attendance

Living Arrangements

Purpose:

The objective is to assist the minor in finding a home environment that will provide constant appropriate adult supervision, guidance and support to both the parent and the child

Clarifying Information

  • If the Department determines that an unmarried minor parent is residing in an inappropriate living arrangement with the adult parent of the minor parent's child, neither the minor parent nor the adult parent is eligible for TANF benefits. Only the minor parent's child is eligible in such cases (see ASSISTANCE UNITS in the EA-Z manual).
EXAMPLE - A 17-year-old unmarried minor mom and her baby are living with the 25-year-old father of the baby. The Social Worker determines that the living arrangement is not appropriate because there is no appropriate adult supervision. The minor and the adult father of the baby are ineligible for TANF but they are authorized for a child-only grant with a protective payee.
  • The policies in this category apply to both male and female minor parents.
EXAMPLE -The 16-year-old unmarried minor father and his child are living with the 21-year-old mother of the child. He applies for assistance. The Social worker conducts the assessment in the home where the father of the child proposes to live and determines that the living arrangement is not appropriate because there is no appropriate adult supervision. Both the minor father and the 21-year old mother are ineligible for a TANF grant but they are authorized for a child-only grant with a protective payee.

Worker Responsibilities

  1. Complete a Teen Living Assessment (TLA) (DSHS 14-427) at the home where the minor proposes to live.
  2. If a TLA cannot be completed due to a minor's homelessness or an in-home visit would be unsafe, the TLA should be completed in the office. An in-office assessment is completed to ensure the minor is connected to available help and resources and school.
  3. Do not approve the minor's living arrangement if the minor is homeless or if the living arrangement is unsafe.
EXAMPLE - The minor parent is living with her boyfriend who has threatened DSHS Social Workers in the past. The Social Worker feels she would be at risk if she were to conduct a home visit. The Social Worker makes a referral to CPS indicating the minor and her child may not be in a safe environment and works with the minor whenever possible to obtain help and appropriate housing. The minor's living arrangement would not be approved because the living arrangement is unsafe and there is not appropriate adult supervision. A child-only grant should be authorized with a protective payee.

A Teen Living Assessment is completed to:

  1. Determine if the minor's living arrangement is safe and appropriate.
  2. Uncover any issues or needs the minor or the minor's child may have and connect to appropriate resources.
  3. Ensure the minor is enrolled in and attending school. When the minor is not in school, assist them to enroll in school and ensure childcare and transportation needs are met, when necessary.

Follow these guidelines to ensure the minor is in the most appropriate living arrangement:

  1. Determine where the minor's parents are residing and if they are willing to have the minor live with them. This information regarding the whereabouts of the minor's parents may be obtained from the minors themselves, or from the information DSHS already has in the system.
  2. Make every effort to contact the parents (both the mother and the father if they are not living together) to get the parents' perspective as to the reason the minor does not live in the parent's home. If the parental home is safe and appropriate and a parent is willing to have the minor live with them, deny the minor's proposed living arrangement.
  3. When living with a parent or legal guardian is not an option because of abuse, neglect, or because of the parent's unwillingness to allow the minor to live with them, investigate other options. Other options may include a responsible adult relative or supervised minor housing. If there are appropriate and safe adult supervised living arrangements available to the minor, encourage the minor to consider that option.
  4. Contact Children's Services to determine if there is an open case, or a history of child abuse and neglect involving the minor parent or the minor parent's child. If there is an open case of child abuse involving the minor or minor's child, it is important to work with Children's Services while managing the case. Equally important is getting the minor in a living situation that will support the case plan and encourage positive parenting.
  5. Checking with Children's Administration may also provide important background information regarding the environment the minor may have grown up in and whether a Child Protective Service history exists involving the minor and the minor's parents.
  6. Provide information regarding the First Steps program to pregnant clients, including information regarding how to access the program. Some minors are receiving Washington Apple Health for Pregnant Women prior to applying for TANF and may have a maternity case manager who can help coordinate services to the minor
  7. Request that household members be available during the scheduled home visit. This provides an opportunity to meet the household members and gather information and insight about how the household functions.
  8. Observe the surroundings to ensure there are basic necessities (i.e. heat, light, water, food, etc.) and no safety hazards.
EXAMPLE - A Social Worker conducts a home visit with a minor parent who is living in a trailer next to an old house of an adult friend. The minor is not able to live in the house because it is already overcrowded. The trailer the minor is living in does not have electricity except for an extension cord that runs from the house to the trailer that plugs into a space heater, a lamp, a TV and a stereo. The bathroom floor in the trailer is moldy and rotted out and the roof is leaking in the main living area. The Social Worker denies the living arrangement as unsafe for the minor and her baby and assists the minor in finding a more appropriate housing situation. A child-only grant is authorized and a protective payee assigned.

The three most important questions to consider when determining the appropriateness of a minor's living arrangement are:

  1. Is there appropriate adult supervision? Parents should always be the first option explored). When looking at whether there is appropriate adult supervision, consider the role of the adult in the minor's life. Is the adult acting in place of a parent or guardian and providing adult supervision, guidance, support, house rules and responsibilities, etc, to the minor and her child? If the adult of the proposed living arrangement is the boyfriend, girlfriend or friend/buddy of the minor then the role is not that of an adult acting in place of a parent or guardian.
  2. Is the environment safe for the minor and the minor's child?When determining the safety of the proposed living environment be sure to observe the environment for safety and health issues, such as signs of: Abuse and neglect (any type of family violence) involving the minor or the minor's child Alcohol or Drug abuse or selling of drugs Home environmental safety hazards Anything that may put the minor and/or the child at risk
  3. Is the proposed arrangement the best available option? When determining the best available living arrangement, always consider the minor's parents as the first option. If the parents are not available or suitable, consider an adult relative who will provide appropriate adult supervision or a home for pregnant and parenting minors that provides a supportive and supervised living arrangement. When a minor parent’s living arrangement is denied, the minor parent is not eligible for a grant. However, the minor is still eligible to receive a child-only grant for their child, and the grant is assigned to a protective payee.

School Requirements

Clarifying Information 

  1. Educational activities include standard or alternative public school programs, state-accredited private schools, home schooling (approved and monitored by the school district), high school equivalency programs, or any training program that contains an educational component that would lead to a high school diploma or high school equivalency certificate.
  2. There is no requirement as to the number of hours a client must participate, but a minor must maintain satisfactory attendance as determined by the school or program in order to be considered "participating" for the purpose of this policy.)

Worker Responsibilities

  1. Verify school enrollment and attendance (or completions of high school or high school equivalency) at the time of the teen living assessment.
    1. If the minor has graduated high school or obtained a high school equivalency certificate, they are required to participate in regular WorkFirst activities, i.e. job search.
    2. If the minor is not enrolled and/or attending school, assist the minor in enrolling in school and explain support services available (i.e. transportation, childcare, etc). (See Support Services in the WorkFirst Handbook 2.2)
NOTE: If a pregnant or parenting minor refuses to enroll in or attend school, the minor is not eligible for TANF. However, the minor is still eligible for a child only grant for her child, which is assigned to a protective payee.
  1. Monitor monthly school attendance and progress. Request from the minor a monthly attendance record to verify school attendance and quarterly progress reports or grades.

Protective Payees

All pregnant and parenting minors receiving a grant for themselves or their child are required to have a contracted Protective Payee to manage their money and teach money management skills. (See Protective Payees)

Support Services for Minor Parents Not Receiving TANF

Worker Responsibilities 

  1. Authorize support services when the pregnant or parenting minor is not eligible for TANF but is actively working with a social worker to remove the barriers that prevent them from being eligible. See WorkFirst Support Services WAC 388-310-0800.
  2. Use the "TP" code in the e-JAS component screen to authorize support services. This allows support services to be issued for minors who otherwise would not have an active component in e-JAS allowing a payment.
EXAMPLE - A minor applies for TANF and is not living in an appropriate living arrangement but is enrolled in high school equivalency classes and doing well. The minor is denied TANF because of the living arrangement and opened up on a child only grant for her baby. The Social Worker who completed the TLA actively works with the minor to find supervised minor housing that is approved by the department and agrees to authorize support services to pay for the two high school equivalency tests the minor is ready to take.

Tribal Minors

  1. Collaboration is critical between DSHS and the Tribes regarding pregnant and parenting minors who are tribal members. While the Office of the Attorney General has determined that the Department makes the ultimate decision in determining the appropriateness of a tribal minor’s living arrangement, the Department will include the Tribe in the decision-making process.
  2. Work with the local Tribes to develop an acceptable process for conducting teen living assessments, including how changes in circumstances and case updates will be communicated.
  3. It is very important that Tribes are contacted immediately and included when dealing with minor tribal members. The process should meet the following requirements:
    1. The CSO administrator and/or Social Service supervisor will meet with local Tribal government to ensure the opportunity for involvement and consultation is followed in accordance with the Administrative Policy 7.01 American Indian Policy.
    2. Develop specific protocols to establish how the CSO and Tribe will work cooperatively in providing services to Indian minor parents.

Health Care Coverage and First Steps Services

  1. Pregnant and parenting minor's may be eligible for Washington Apple Health coverage even if they are not eligible for TANF because they do not meet the school or living requirements. (See WAC 388-505-0220 (2)).
  2. Refer pregnant minors for First Steps services. Pregnant minors are eligible to receive the following services through First Steps:
    1. Home visits by a public health nurse
    2. Dietician services
    3. Counseling
    4. Maternity case management
  3. Coordinate services when a pregnant or parenting minor is working with Maternity Case Management to avoid duplication of services.

Program Standards

Purpose:

Program Standards are consistent with Policy and WAC rules already in place. They are driven by State, Federal and acceptable Standard Practices. They are key points that make the outcome of a program successful.

To read what the Program Standards are for any of the services provided by social service case workers, click on a program category below.

ABD Cash

 

Case Review

Limited English Proficiency (LEP) Pathway

Case Staffing

Necessary Supplemental Accommodation (NSA)

Chemical Dependency

Pregnancy to Employment Pathway

Children with Special Needs

SSI Facilitation

Confidentiality

Teen Living Assessment

Family Planning

 

Family Violence

 

First Steps

 

Good Cause

 


Social Services Manual - SSM
Eligibility A-Z Manual - EA-Z
Working Connections Child Care Manual - WCCC
WorkFirst Handbook - WF


ABD CASH

Required Actions

  • Explain program and determine incapacity for financially eligible applicants
  • Document all case decisions, actions and treatment, work or agency requirements
  • Develop and provide written notice of treatment or agency referral requirements
  • Complete Disability Assessment, DSHS 11-053 form.

Time Frames

  • 45 calendar days of date of application
  • 5 working days of receipt of medical evidence or change in circumstances affecting work
  • After every incapacity decision
  • Develop / update case plan after every incapacity decision.

Required Verification

Objective medical evidence ICMS screens and Case Notes

WAC/Policy

  • Social Services Manual - Incapacity and SSI Facilitation
  • WAC 388-449-0001 

CASE REVIEW

Required Actions

  • CSO Social Services Supervisors are responsible for monitoring the work of their staff by reviewing 5% of an experienced worker's caseload. 
  • In addition, for new workers, a 100% review is recommended for the first 6 months.

Time Frames

Monthly

Required Verification

ACES, eJAS Case Notes, Case Reading Guide, ABD Audit Program

WAC/Policy

N / A

CASE STAFFING

Required Actions

  • Case Staffings must be completed prior to NCS status.
  • SW participates in case staffing held at any point it appears the client is not progressing or there are significant changes in the client's situation

Time Frames

Prior NCS status.

Required Verification

eJAS NCS tool.

WAC/Policy

  • Social Services Manual
  • WorkFirst Handbook - chapters 3.5 and 3.6.1.

CHILDREN WITH SPECIAL NEEDS

Required Actions

Referral to Public Health Nurse made by WorkFirst Program Specialist or Social Worker

Time Frames

Public Health Nurse initiates home visit within 5 working days of referral

Required Verification

Reports to WorkFirst Program Specialist or SW within 1 working day of scheduled home visit if the client is absent from home at the time of the appointment.

WAC/Policy

N / A

CHEMICAL DEPENDENCY TREATMENT 

Required Actions

  • All ABD or TANF applicants are screened for substance abuse and referred to Social Worker assessment when appropriate
  • Refer to a chemical dependency professional for treatment assessment
  • Refer other financially eligible applicants who request chemical dependency treatment

Time Frames

At application or when developing the case plan.

Required Verification

eJAS, or ICMS Treatment Monitoring screen and Case Notes

WAC/Policy

  • WorkFirst Handbook Chapter 6.7 - Substance Abuse
  • Eligibility A-Z - Chemical Dependency - WAC 388-800, 388-488-0010 and -0130

CONFIDENTIALITY

Required Actions

  • All clients enrolled in the Address Confidentiality Program (ACP) must have an ACP address in all systems. 
  • Enter the ACP P.O. Box number in the eJAS work screen and Confidential Note screen instead of the actual work address.
  • Release information to individuals or agencies with valid consent form.

Time Frames

On-going

Required Verification

ACES, eJAS, ICMS

WAC/Policy

 

FAMILY PLANNING

Required Actions

  • Screen and provide family planning information to all TANF/SFA applicants 
  • Offer client referral to the family planning worker or family planning nurse in the CSO. 
  • The social worker can also make referrals to the family planning worker or family planning nurse, as appropriate. 
  • The family planning worker or nurse will follow up on the referrals and make contact with the participant based on local office procedure.

Time Frames

  • At application, eligibility review, or client contact (until the nurse or social worker make contact with the participant).  
  • Goal is 100% of clients are screened. 
  • Nurse standard: Of those referred, 100% are seen by the FP nurse within 30 days of referral or there is documentation supporting the reason for not being seen.

Required Verification

ACES, eJAS

WAC/Policy

  • WorkFirst - Chapter 1
  • Social Services Manual - Family Planning

FAMILY VIOLENCE

Required Actions

  • All applicants must be screened for family violence and refer to Social Worker for Assessment according to local office policy.
  • If family violence counselor is not available, social worker may develop a safety plan and assist with referrals (safe shelter, counseling, legal, etc.)

Time Frames

Upon application and any contact with the client

Required Verification

ACES, eJAS

WAC/Policy

  • WAC 388-61-001
  • WorkFirst Handbook  - Chapter 6
  • Social Service Manual - Family Violence
  • EA-Z Manual - Interview Requirements

FIRST STEPS

Required Actions

  • Refer all Washington Apple Health-eligible pregnant women to local Maternity Support Services (MSS) provider

Time Frames

Pregnant women must be offered a referral to First Steps services as soon as she is found eligible for Washington Apple Health coverage.

Required Verification

eJAS, ACES

WAC/Policy

  • WorkFirst Handbook Chapter 5.1
  • Social Services Manual

GOOD CAUSE

Required Actions

  • Social Workers must determine whether clients have "Good Cause" to not cooperate within 30 days of referral.
  • For DCS - Review physical or emotional harm to child or caretaker periodically (usually every twelve months)
  • For WorkFirst - prior to sanctioning, the Social Worker may participate in case staffing, or consult with WorkFirst Program Specialist, to review reasons for non-participation. (See standards for Case Staffing)

Time Frames

  • 30 days of request for good cause determination
  • For ABD:
    • Verify as necessary, usually monthly
    • Ten working days from date of non-cooperation warning letter
    • Two working days to send 14-118 to financial

Required Verification

eJAS, ACES

WAC/Policy

  • WF/SFA - WAC 388-422-0020;  HEN Referral - WAC 388-447-0120; ABD - WAC 388-449-0220

LEP PATHWAY

Required Actions

After the initial interview and WorkFirst Orientation:

The Refugee Social Worker:

  • Inputs client data in JAS
  • Completes the screening using eJAS
  • Provides family planning and family violence information in the client's primary language and makes appropriate referrals
  • Refers the client to the LEP Pathway provider for WorkFirst services and activities by completing the Component screen
  • Documents the referral in eJAS
  • Creates the IRP with the participant

Time Frames

Ongoing

Required Verification

ACES, eJAS Case Notes

WAC/Policy

  • WorkFirst Handbook - Chapter 5.2 - WAC 388-310-0900
  • EA-Z Manual - LEP

NSA - Necessary Supplemental Accommodation to ensure Equal Access

Required Actions

  • Screen all heads of households for services to ensure access to programs and services.
  • Develop an accommodation plan for all households confirmed as Equal Access.
  • Review the household's need for Equal Access before any negative case action and during any review of eligibility.

Time Frames

At application and any in-person or phone contact with client. Complete prior to plan activity for which accommodation is required.

Required Verification

ACES Equal Access Assessment and Accommodation Plan Screens

WAC/Policy

  • EA-Z Manual - NSA - WAC 388-472-0010 to 0050
  • WorkFirst - Chapter 1.3

PREGNANCY TO EMPLOYMENT PATHWAY

Required Actions

  • A SW completes the assessment and consults with the case manager to develop an IRP.  The IRP is based upon the results of the assessment
  • The assessment results are documented in e-JAS
  • Review the IRP every three months and update if needed.  Review may be via telephone contact, office or home visit

Time Frames

Ongoing - upon discovering a participant is pregnant or parenting an infant, the WorkFirst Program Specialist will refer the person to the SW for an assessment.  P to E plan is reviewed every three months via telephone contact, office or home visit and documented in e-JAS

Required Verification

  • Pregnancy verification.
  • Verification of child under 12 months

WAC/Policy

WorkFirst Handbook - Chapter 5.1 - WAC 388-310-1450

SSI FACILITATION

Required Actions

  • Obtain Interim Assistance Reimbursement Agreement
  • Send signed IARA to SSA within 30 days
  • File SSI application  and subsequent appeals within 60 days

Time Frames

At application or within 5 working days of ABD approval

Required Verification

ACES and ICMS SSI screens

WAC/Policy

WAC 388-400-0060, 388-449-0200, and 388-449-0210

Social Services Manual -  SSI Facilitation 

TEEN LIVING ASSESSMENT (Pregnant and Parenting Minors)

Required Actions

  • Social Worker completes a Teen Living Assessment (TLA) (DSHS 14-427) to determine the appropriateness of the home the minor proposes to live in
  • Verify enrollment and attendance in based education activities leading to the attainment of a high school diploma or GED
  • Document communication (e-JAS and ACES) between the Social Worker and the WorkFirst Program Specialist indicating the living arrangement has been approved

Time Frames

The assessment should be completed as soon as possible and as dictated by your local office.  Pending applications must be processed within the federal Standard of Processing (30-day time frame)

Required Verification

  • Verification of living arrangement, school enrollment and attendance
  • Documentation in ACES and eJAS

WAC/Policy

EA-Z Manual - Teen Parents WAC 388-486-0005 and -0010

Protective Payees-Guidelines

Created on: 
Jul 21 2017

Revised July 17, 2017

Guidelines

CSD Social Services Staff only assigns a Protective payee to a cash assistance client when the client:

  1. Has a history of mismanagement of funds. See WAC 388-460-0035 When is a protective payee assigned for mismanagement of funds? and Payees on Benefit Issuances - Protective Payees (EA-Z manual). 
  2. Is an unmarried pregnant or parenting minor receiving benefits for themselves and/or their child.  See WAC 388-460-0040 When is a protective payee assigned to TANF/SFA pregnant or parenting minors? and Payees on Benefit Issuances - Protective Payees (EA-Z manual).

Clarifying Information:

  1. Social Services Staff must follow the process for assigning a protective payee to individuals if there is evidence of the following:

    1. Repeated failure to meet obligations for rent, food and other essentials on behalf of themselves or a child in their care;
    2. Repeated requests for additional help because of an eviction or shut-off notice;
    3. A child is not being properly cared for;
    4. Mismanagement of funds due to misuse of alcohol or drugs;
    5. Use of EBT cash benefits at prohibited locations as determined by the Office of Fraud and Accountability two or more times.
  2. Social Services Staff will assign a protective payee only when other approaches to correct or address mismanagement of funds have been unsuccessful.

    1. EXCEPTION: When Social Services Staff receive notice from the Office of Fraud and Accountability (OFA) that a client has used their EBT cash benefits at prohibited locations two or more times, a protective payee must be assigned.
  3. Social Services Staff will not establish a protective payee when the cause of unpaid obligations is simply insufficient funds or a temporary lack of funds due to an emergency.

  4. Social Services Staff must assign a protective payee for minor parent cases unless the client:
    1. Is emancipated;
    2. Is married;
    3. Has turned eighteen years old

Refugee Assistance Program

Purpose:

This category contains rules and procedures for the Refugee Assistance Program and contains the following sections and

WAC 388-466-0005- Immigration status requirement for refugee assistance

WAC 388-466-0140 - Income and resources for refugee assistance eligibility

WAC 388-466-0120 - Refugee cash assistance

WAC 182-507-0130 - Refugee medical assistance (RMA)

WAC 182-507-0135 - Refugee medical assistance (RMA)

WAC 388-466-0150 - Refugee employment and training services 

 

Rights and Responsibilities

Purpose: 

The department and the clients have a shared responsibility to determine and maintain eligibility for cash, medical or food assistance programs.

This category provides information about:

  • The client's rights related to public assistance.
  • The client's responsibilities related to receiving public assistance; and
  • The department's responsibility to the client who applies for or receives public assistance

WAC 388-472-0005 What are my rights and responsibilities? 


Clarifying Information

See EQUAL ACCESS for rules and procedures related to assisting persons with special needs.

See LETTERS and LEP for rules and procedures for translated written material.

See INTERVIEW REQUIREMENTS and LEP for rules and procedures to obtain translators.

Worker Responsibilities 

  1. Review form DSHS 14-113(X), Client Rights and Responsibilities with the household at every:
    1. Application; and
    2. Eligibility review or recertification. 
  2. Face to Face Interviews:
    1. When conducting a face-to-face interview, explain the rights and responsibilities to the client and ask them to sign the form to acknowledge that they understand them. Send the document as file only to be scanned into the client’s Electronic Case Record (ECR).  
  3. Phone Interviews:
    1. When conducting phone interviews, explain the rights and responsibilities to the client, send them a copy of form DSHS 14-113, and request them to sign and return the document. 
NOTE: We are required to provide households a copy of the DSHS 14-113, Client Rights and Responsibilities and request that they sign the document.  Signing the form is not a condition of eligibility.  Do not deny an application for benefits or terminate assistance if the household refuses to sign the form.
  1. When a client applies for or has a review for medical assistance and submits an Application for Benefits, mail a DSHS 14-113(X) and document the action in the ACES narrative.

SSI Facilitation-Introduction

Created on: 
Feb 18 2015

Clarifying Information

Supplemental Security  Income (SSI)

  1. SSI is administered by the Social Security Administration (SSA).
  2. SSI (Title 16) is a Federal assistance program that provides cash and medical benefits to people who:
    1. Do not have qualifying work quarters for Social Security Disability Insurance (SSDI, Title 2),
    2. Meet the same disability criteria as SSDI, and
    3. Meet financial resource and income limits set by SSA.
  3. When SSI is approved, and a valid agreement 18-235 is established, SSA reimburses the state for assistance provided to ABD cash recipients while the SSI application is pending (interim assistance).

Social Security Disability Insurance (SSDI)

  1. SSA determines SSDI eligibility for every person who applies for SSI.
  2. A concurrent claim means that a person has applied for both SSI and SSDI.
  3. To be eligible for SSDI, a person must have worked and contributed to Social Security for a required number of work quarters.
  4. States do not receive interim assistance reimbursement for SSDI payments.

 Benefits of Receiving SSI

  1. ABD cash or TANF recipients who are approved for SSI typically receive:
    1. Increased income,
    2. Access to vocational retraining programs and supported work programs, and
    3. Long term eligibility for cash and medical assistance.
  2. DSHS benefits through recovery of interim assistance and reduced caseloads.
  3. Households receiving TANF receive higher income because SSI payments are not counted as income to the rest of the household.

Presumptive Disability

SSA may find that persons who meet certain severe disability criteria are presumptively disabled.  The list of allegations that meet Social Security Administration (SSA) presumptive disability criteria are maintained on the SSA website.

Worker Responsibilities

When a client appears to meet SSA presumptive disability criteria:

  1. Refer the client directly to SSA and instruct them to claim financial hardship.
  2. When SSA decides the person has a presumptive disability, they authorize SSI benefits for up to six months while the Division of Disability Determination Services (DDDS) reviews the disability.
  3. Presumptive payments may end if DDDS is unable to make a determination within the review period, but DDDS will continue to process the case until a final determination is made.
  4. It is critical that the person's payment status is tracked and cash assistance not provided while a person is receiving presumptive disability payments.  SSA provides these payments as emergency assistance (which is why the person must claim financial hardship to get them), which excludes them from reimbursement as interim assistance.
  5. Notify financial services to terminate an ABD cash recipient’s benefits when the person begins receiving presumptive SSI benefits.

Compassionate Allowances

SSA has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that they clearly meet disability standards.  Compassionate Allowances allow SSA to target the most obviously disabled individuals for allowances based on minimal objective medical evidence that can be obtained quickly.

The List of Compassionate Allowances Conditions can be found on the SSA website.  Be sure to check the list regularly for new conditions.

Worker Responsibilities

When a person appears to meet SSA Compassionate Allowances criteria:

  1. Refer the client directly to SSA for a Compassionate Allowances determination.
  2. Notify financial services to terminate an ABD cash recipient's benefits when the person begins receiving SSI benefits.

Disability Listings

SSA refers to their disability criteria as the “Listings” and publishes them in Disability Evaluation Under Social Security. SSA considers a person disabled when the medical disorder meets or equals the listed disability criteria.

Disability Decision

The Division of Disability Determination Services (DDDS):

  1. Decides if a person applying for SSI, SSDI, or Non-Grant Medical Assistance (NGMA) meets disability criteria;
  2. Uses a sequential evaluation  similar to the ABD cash process  to determine the effect of the physical and/or mental impairment and the combined effect of multiple impairments; and
  3. Considers the effect of the following on the person’s ability to work:
    1. Current and past work activity.
    2. Severity of impairment.
    3. Residual functional capacity.
    4. Age.
    5. Education.

Worker Responsibilities

  1. Assist ALL ABD or TANF recipients who appear to be eligible for SSI. Assistance includes:
    1.  Assessing client needs and appropriateness for SSI facilitation.
    2.  Helping complete SSA application forms.
    3.  Tracking SSA applications.
    4.  Coordinating services.
  2. Provide facilitation services to All:
    1. ABD cash recipients who meet SSI citizenship/immigration requirements.
    2. TANF recipients who appear to meet SSI disability criteria.
    NOTE:  Refer all non-citizen ABD recipients directly to SSA to determine whether they meet SSI citizenship/immigration requirements.  When SSA verifies the non-citizen is eligible to apply for SSI, provide SSI facilitation.
    NOTE:  Clients who are age 65 or older, terminally ill (TERI cases), Compassionate Allowances, and those that meet presumptive listing criteria should be immediately referred to SSA.  Do not submit an SSI application. SSA must process these claims directly.
  3. Develop professional working relationships with:
    1. Social Security District Office (SSADO).
    2. Division of Disability Determination Services (DDDS).
    3. Home and Community Services (HCS).
  4. Provide Equal Access (EA) assessment, planning, and services as appropriate.
  5. Adhere to the following timeframes and procedures:
    1. Assist the person with filing the initial SSI application within 60 calendar days of an ABD cash approval and within 90 days of the date a person receiving TANF is referred for facilitation services.
    2. Meet filing deadlines for reconsideration requests and hearings.
    3. Verify that a current DSHS 18-235, Interim Assistance Reimbursement Authorization (IARA), is on file with Social Security Administration (SSA) within 10 working days after approval for ABD cash, or 30 days after the date the form is signed by the person (whichever date comes first).

Social Security Links:

Social Security Listings

Evidentiary Requirements

Social Security Administration

SSDI

Social Security Employment Programs

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SSI Facilitation - SSA Determinations and Appeals

Revised August 31, 2016

Purpose

This section contains information regarding actions that are necessary when a Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) determination is made by the Social Security Administration (SSA).

WAC 388-449-0150 - When does my eligibility for the Aged, Blind, or Disabled (ABD) cash benefits end?

SSI/SSDI Approvals

  1. When disability is approved at the Initial or Reconsideration level, the Division of Disability Determination Services (DDDS) notifies the Social Security Administration District Office (SSADO).
    1. The Office of Quality Performance (OQP) reviews a percentage of DDDS approvals and denials for quality assurance and has the authority to overturn DDDS decisions.
    2. Approvals by an Administrative Law Judge (ALJ) at the Hearing level or the Appeals Council Review are binding and are not reviewed by the OQP.
  2. The SSADO conducts a financial eligibility review before final approval of SSI benefits.
    1. The financial eligibility review usually involves a mandatory interview with the client.
    2. SSI Facilitators may need to assist with the SSA financial eligibility review process.
    3. The client cannot enter SSI/SSDI pay status until the financial eligibility review is completed.
    4. Terminate ABD cash assistance if the client fails to complete the mandatory SSA financial eligibility review.
    5. SSA sends the client written notice regarding SSI/SSDI once the financial eligibility review is completed.
NOTE: Contact the Office of Financial Recovery (OFR) at 1-800-562-6114 if a client receives the entire retroactive SSI payment. OFR will attempt to obtain any interim assistance reimbursement to which the Department is entitled.

Review of ABD Cash Assistance Following SSI/SSDI Denial

  1. Eligibility for ABD cash assistance ends when:
    1. SSA makes an unfavorable disability determination at the Initial, Reconsideration, or Hearing level and the client fails to file a timely appeal; or
    2. A final unfavorable disability determination is made at the Appeals Council Review or by the ALJ after remand by the Appeals Council.
  2. Eligibility for ABD cash assistance may also end following an SSI/SSDI denial when:
    1. The client no longer meets ABD income and resource requirements; or
    2. The client no longer meets ABD disability criteria.
  3. When SSA denies an application at the Initial, Reconsideration, or Hearing level, the SSI Facilitator reviews the SSA determination and performs a brief review of all available medical evidence to identify if the client's conditions have improved or deteriorated.
    1. If SSA denied the application due to income or resources, the SSI Facilitator notifies financial regarding the denial. Financial reviews the case to determine if the client continues to meet ABD income and resource requirements.
    2. If the client no longer appears to meet ABD disability criteria, the SSI Facilitator notifies the Disability Specialist that an early Disability Review may be needed. The Disability Specialist reviews the medical evidence in detail, and if warranted, requests current medical evidence and initiates an early ABD Disability Review.
    3. If the client appears likely to meet ABD disability criteria, the SSI Facilitator determines an early ABD Disability Review is not necessary and continues with the SSI Facilitation process.
NOTE: The Department may initiate an early Disability Review at any time if new information is received indicating the client may no longer meet ABD Disability Criteria.

Termination of ABD Cash Assistance Following SSI/SSDI Denial

  1. Terminate ABD cash assistance and facilitation services when a client no longer meets program eligibility criteria per WAC 388-400-0060 and WAC 388-449-0001.
  2. Authorize HEN Referral only if the ABD termination is based on a SSA disability denial at the Initial, Reconsideration, Hearing, or Appeals Council Review level and the client meets incapacity criteria defined in WAC 388-447-0001.
  3. Do not authorize HEN Referral if the ABD termination is based on a SSA denial for failing to follow through with the SSI application process (e.g. failing to provide information requested by SSA, failing to attend a required SSA interview, or failing to attend a Consultative Examination (CE) appointment).

Appealing SSI/SSDI Denials

  1. DSHS requires clients to appeal SSI/SSDI denials through the Appeals Council Review stage as a condition of eligibility for ABD cash assistance.
    1. All appeal requests (e.g. Reconsideration, Hearing, and Appeals Council Review) must be filed within 60 calendar days of the SSA denial unless there is good cause for the missed deadline. Only SSA can determine whether there is good cause for a missed appeal deadline.
  2. An ABD recipient cannot choose to withdraw an active appeal without losing cash assistance, including instances when withdrawal is recommended by their legal representative.
NOTE: SSA will not process new SSI or SSDI applications when there is a pending claim under the same title at any stage of the application or appeal process (e.g. Initial, Reconsideration, Hearing, or Appeals Council Review).

Filing a Request for Reconsideration

Reconsideration is the first level of appeal when an SSI/SSDI application is denied.

  1. Always request Reconsideration when an ABD recipient’s SSI/SSDI application is denied, including instances when an early ABD Disability Review is initiated.
  2. A Request for Reconsideration must be filed within 60 calendar days of the SSI/SSDI initial application denial and include:
    1. A completed iAppeal (SSA-561 and SSA-3441);
    2. A signed and dated SSA-827 and SSA-3288;
    3. Any new medical evidence in the Electronic Case Record (list the CSO as a medical source in the iAppeal); and
    4. A new SSA-3373 Function Report and Personal Observation statement when warranted.

Legal Representation

  1. Explain the potential benefits of obtaining legal representation.
  2. A person has the right to select an attorney, friend, or other individual to represent them. They also have the right to decline assistance and represent themselves at a SSI Hearing or Appeals Council Review.
  3. When a client chooses to have a legal representative:
    1. Do not recommend a specific attorney;
    2. Inform the client that legal representatives may also charge for expenses incurred while representing the client; and
    3. Provide the client with a DSHS 09-972 SSI Legal Representation form.
NOTE: It is a conflict of interest for the SSI Facilitator to act as a legal representative for clients.

Filing a Hearing Request

The Hearing is the second level of appeal when an SSI/SSDI application is denied.

  1. If the client obtains legal representation, the attorney will file the Hearing request.
  2. When a client is without legal representation, or the client is in danger of missing the appeal deadline, the SSI Facilitator assists the client with filing the Hearing request.
  3. A Hearing request must be filed within 60 calendar days of the SSI/SSDI Reconsideration denial and include:
    1. A completed iAppeal (HA-501 and SSA-3341);
    2. A signed and dated SSA-827; and
    3. Any new medical evidence (copied from the ECR).

Filing a Request for Appeals Council Review

  1. If the client has a legal representative, the representative may file the request for an Appeals Council Review.
  2. If the client does not have a legal representative or the legal representative chooses not to request an Appeals Council Review, and the client continues to appear to meet ABD disability criteria, the SSI Facilitator will assist the client with filing the written Appeals Council Review request.
  3. The Appeals Council Review request must be filed within 60 calendar days of the SSI/SSDI Hearing denial and include:
    1. A signed and dated HA-520-U5 (Request for Review of Hearing Decision/Order);
    2. A signed and dated SSA-827; and
    3. Any new medical evidence (copied from the ECR).
NOTE: To inquire about the status of an Appeals Council Review that has gone beyond the standard processing timeframes, contact the SSA Office of Disability Adjudication and Review (ODAR), Congressional and Public Affairs Branch at (703) 605-8000 or by fax at (703) 605-8021.

 

SSI Facilitation- SSA Interim Assistance Reimbursement Agreement (IARA)

Revised October 31, 2011

WAC 388-449-0200 - Am I eligible for cash assistance for Aged, Blind, or Disabled (ABD) while waiting for Supplemental Security Income (SSI)?

WAC 388-449-0210 - What is interim assistance and how do I assign it to the department?

Clarifying Information

  1. Persons receiving ABD cash are required to sign a DSHS 18-235, SSI Interim Assistance Reimbursement Authorization (IARA) agreeing to repay interim assistance.
  2. The State of Washington and the Social Security Administration have a written agreement that the IARA is also a notice of intent to file a SSI application.
  3. The IARA signed date is the protective filing date when:
    1. The IARA is filed with the SSA District Office within 30 days of the signed date.
    2. A SSI application is filed with SSA within 60 calendar days of the signed date.

Worker Responsibilities

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  1.  DSHS staff must perform the following actions:
    1. Ensure that a valid IARA has been obtained from persons receiving ABD cash.
    2. Sign and date the IARA representing DSHS.
    3. Ensure the original IARA is received by SSA within 30 calendar days from the date that the SSIF signs it.
  2.  For IARAs signed in the CSO:
    1.  Discuss the IARA with the person so that the person understands how it works.
    2.  Send the original IARA to SSA and makes two copies. Give a copy to the person and send a copy to DMS.
  3. For IARAs received in the mail:
    1. The HUI will sign the IARA and fax the original to the appropriate SSA office with a cover letter.
    2. The IARA received date will be automatically filled in ICMS with the date the HIU prints the IARA cover letter.
    3. HUI staff will image the IARA and assign it to the SSIF or ISW of record.
    4. Unsigned or unusable IARAs will be imaged with a cover letter indicating the IARA was not sent to SSA and that a new IARA will need to be obtained.
  4. Once filed with SSA the IARA is effective for interim assistance repayment for:
    1. 12 months from the signed date.
    2. ;As long as the SSI application is active.

SSI Facilitation-Application

Created on: 
Dec 19 2014

Clarifying Information

Clients who are age 65 or older, terminally ill (TERI cases), compassionate allowances, and those that meet presumptive listing criteria should be immediately referred to SSA. Do not submit an SSI application. SSA must process these claims directly.

Social Security Disability Insurance (SSDI)

  1. SSA determines SSDI eligibility for every person who applies for SSI.
  2. A concurrent claim means that a person has applied for both SSI and SSDI.
  3. To be eligible for SSDI, a person must have worked and contributed to Social Security for a required number of work quarters.
  4. States do not receive interim assistance reimbursement for SSDI payments.

 Benefits of Receiving SSI

  1. ABD cash or TANF recipients who are approved for SSI typically receive:
    1. Increased income,
    2. Access to vocational retraining programs and supported work programs, and
    3. Long term eligibility for cash and medical assistance.
  2. DSHS benefits through recovery of interim assistance and reduced caseloads.
  3. Households receiving TANF receive higher income because SSI payments are not counted as income to the rest of the household.

Presumptive Disability

SSA may find that persons who meet certain severe disability criteria are presumptively disabled.  The list of allegations that meet Social Security Administration (SSA) presumptive disability criteria are maintained on the SSA website.

Worker Responsibilities

When a client appears to meet SSA presumptive disability criteria:

  1. Refer the client directly to SSA and instruct them to claim financial hardship.
  2. When SSA decides the person has a presumptive disability, they authorize SSI benefits for up to six months while the Division of Disability Determination Services (DDDS) reviews the disability.
  3. Presumptive payments may end if DDDS is unable to make a determination within the review period, but DDDS will continue to process the case until a final determination is made.
  4. It is critical that the person's payment status is tracked and cash assistance not provided while a person is receiving presumptive disability payments. SSA provides these payments as emergency assistance (which is why the person must claim financial hardship to get them), which excludes them from reimbursement as interim assistance.
  5. Notify financial services to terminate an ABD cash recipient’s benefits when the person begins receiving presumptive SSI benefits.

Compassionate Allowances

SSA has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that they clearly meet disability standards.  Compassionate Allowances allow SSA to target the most obviously disabled individuals for allowances based on minimal objective medical evidence that can be obtained quickly.

The List of Compassionate Allowances Conditions can be found on the SSA website.  Be sure to check the list regularly for new conditions.

Worker Responsibilities

When a person appears to meet SSA Compassionate Allowances criteria:

  1. Refer the client directly to SSA for a Compassionate Allowances determination.
  2. Notify financial services to terminate an ABD cash recipient's benefits when the person begins receiving SSI benefits.

Disability Listings

SSA refers to their disability criteria as the “Listings” and publishes them in Disability Evaluation Under Social Security. SSA considers a person disabled when the medical disorder meets or equals the listed disability criteria.

Disability Decision

The Division of Disability Determination Services (DDDS):

  1. Decides if a person applying for SSI, SSDI, or Non-Grant Medical Assistance (NGMA) meets disability criteria;
  2. Uses a sequential evaluation similar to the ABD cash process to determine the effect of the physical and/or mental impairment and the combined effect of multiple impairments; and
  3. Considers the effect of the following on the person’s ability to work:
    1. Current and past work activity.
    2. Severity of impairment.
    3. Residual functional capacity.
    4. Age.
    5. Education.

Worker Responsibilities

  1. Assist ALL ABD or TANF recipients who appear to be eligible for SSI.

    Assistance includes:

    1. Assessing client needs and appropriateness for SSI facilitation.
    2. Helping complete SSA application forms.
    3. Tracking SSA applications.
    4. Coordinating services.
  2. Provide facilitation services to All:
    1. ABD cash recipients who meet SSI citizenship/immigration requirements.
    2. TANF recipients who appear to meet SSI disability criteria
    NOTE: Refer all non-citizen ABD recipients directly to SSA to determine whether they meet SSI citizenship/immigration requirements. When SSA verifies the non-citizen is eligible to apply for SSI, provide SSI facilitation.
    NOTE: Clients who are age 65 or older, terminally ill (TERI cases), Compassionate Allowances, and those that meet presumptive listing criteria should be immediately referred to SSA. Do not submit an SSI application. SSA must process these claims directly.
  3. Develop professional working relationships with:
    1. Social Security District Office (SSADO).
    2. Division of Disability Determination Services (DDDS).
    3. Home and Community Services (HCS).
  4. Provide Equal Access (EA) assessment, planning, and services as appropriate.
  5. Adhere to the following timeframes and procedures:
    1. Assist the person with filing the initial SSI application within 60 calendar days of an ABD cash approval and within 90 days of the date a person receiving TANF is referred for facilitation services.
    2. Meet filing deadlines for reconsideration requests and hearings.
    3. Verify that a current DSHS 18-235, Interim Assistance Reimbursement Authorization (IARA), is on file with Social Security Administration (SSA) within 10 working days after approval for ABD cash, or 30 days after the date the form is signed by the person (whichever date comes first).

Social Security Links:

  • Social Security Listings
  • Evidentiary Requirements
  • Social Security Administration
  • SSDI
  • Social Security Employment Programs

Process Overview

The facilitation process includes the following activities:

  1. Preparing for the SSI application interview by reviewing available documents to learn about the person's medical, education, and employment history.
  2. Interviewing the person.
  3. Documenting personal observations of the individual’s appearance, speech, mobility, and activities of daily living.
  4. Preparing and submitting a TANF disability referral packet that:
    1. Contains all relevant medical evidence to support a claim of disability.
    2. Meets SSI evidentiary requirements.
  5. Verifying a signed IARA is on file with SSA for all ABD cash clients.
  6. Obtaining additional medical records when necessary.
  7. Completing SSI application forms and filing the application packet with SSA.

Preparing for the Interview

  1. Research available information to become familiar with the person's situation such as:
    1. Medical records.
    2. Social services assessment of Health, Education, and Employment.
    3. Case notes.
  2. Include information the person should bring to the interview in the appointment letter such as medical sources, completed activity of daily living forms, or a list of medications with:
    1. Name of medication.
    2. Dosage.
    3. Condition.
    4. Who prescribed the medication.

Interview

Revised on June 14, 2016
 
  1. A face to face interview with the person is preferred and can be held:
    1. In the office; or
    2. In a hospital or nursing home.
    3. When a face-to-face interview is not possible, conduct a telephone interview.
  2. During the interview gather information about the person including:
    1. A contact person or advocate, including the address and phone number. This is important for all individuals and essential for people who are homeless;
    2. Onset date of impairment;
    3. The date the individual became unable to work;
    4. Educational history; and
    5. Sources of other information about the person's impairment.
  3. Record all sources of medical information. Use this information to complete the i3368 (Internet Adult Disability Report).
  4. Explore employment history for each type of job the person has held in the last 15 years. Use this information to complete the i3368 (Internet Adult Disability Report) and the SSA-3369 (Work History Report).
  5. Ensure there is a signed DSHS 18-235, Interim Assistance Reimbursement Authorization on file with SSA for each ABD recipient.

Medical Records

Revised on June 22, 2016

  1. The diagnosis of a disabling impairment must be made by an acceptable medical source within 5 years of the SSI application. Once the impairment has been established, SSA considers evidence from other treating providers. Acceptable sources of medical evidence include:
    1. Licensed physicians (medical or osteopathic doctors);
    2. Licensed psychiatrists or psychologists;
    3. Optometrists (for purposes of establishing visual disorders only);
    4. Licensed podiatrists (for purposes of establishing impairments of the foot, or foot and ankle only); and
    5. Qualified speech-language pathologists (for purposes of establishing speech or language impairments only).
  2. DDDS uses the Medical Evidence of Record (MER) as the primary source of medical evidence to determine disability. This includes:
    1. Hospital and clinic records;
    2. Records from the treating physician;
    3. Evaluations by specialists; and
    4. Clinical and laboratory findings (such as: x-rays, lab tests, and psychological testing).
  3. DDDS arranges consultative examinations with contracted physicians and psychologists (including transportation when requested) when medical evidence does not contain sufficient information to make a disability decision.
  4. When completing the Internet Adult Disability Report i3368 for initial applications and the iAppeal for appeals, list the CSO as a source of medical records. All DDDS offices have access to the client's CSD Electronic Case Record.
  5. For TANF clients, use Support Services (see WorkFirst Handbook: Support Services Directory) to obtain additional objective medical evidence when the available evidence does not provide enough information to determine if the client appears to meet SSA disability criteria.

Attorney Requests for Records

When an attorney representing a client that is receiving SSI Facilitation services makes a request for additional medical records to assist with the SSI appeal process:

  1. Ensure that a complete and current DSHS form 17-211 (Authorization for SSI Facilitation Records) is on file.
  2. Determine whether the additional medical evidence is needed to support the SSI application.
  3. If there is not enough information to determine if the medical evidence requested by the attorney is necessary to support the SSI application, the following should be done:
    1. Deny the request; and
    2. Contact the attorney for more information. 
  4. If the records aren’t necessary to support the client’s SSI application:
    1. Send a written notice to the attorney stating the reason that the department has denied their request; and
    2. Document the action taken in ICMS notes.
  5. If the records are necessary to support the client's SSI application, and aren't already in the ECR:
    1. Request the records from the medical provider;
    2. Document the action taken in ICMS notes; and
    3. Provide copies of the medical evidence to the attorney.
NOTE: The medical evidence provider must send records directly to DSHS. Do not authorize or pay for copies of records to be sent directly to an attorney under any circumstances.

Medical Evidence to Support SSI Applications

Revised on August 31, 2016

Special Report for SSI Hearing Purposes

This is medical evidence used at an administrative hearing when an ABD recipient is involved in the Social Security disability determination appeal process. These reports are a supplement to medical evidence already obtained by the Department and any consultative exams obtained by DDDS. A Special Report from a medical provider is defined as:

  1. Verbal information provided to the attorney, followed by a written report; or
  2. In person testimony at an administrative hearing.

Reimbursement for special reports must be pre-approved by the Exception to Rule (ETR) process in Barcode.

Medical Evidence at the SSI Initial, Reconsideration, or Hearing Level

When an additional evaluation or testing is necessary to support a SSI application at any level of the determination process, and DDDS will not pay per their policy, use the following procedures:

  1. If payment is within the medical evidence fee schedule, generate a referral in ICMS using the appropriate DSHS 14-150 to authorize payment, and document the reason for the referral in ICMS case notes.
  2. If payment for medical evidence is outside of the medical evidence fee schedule, submit a request for an expenditure approval through the ETR process in Barcode. Please include the following information in the request:
    1. The specific evaluation or testing being requested, including the credentials of the provider needed to perform or author the evidence (e.g. physician, psychologist, neurologist, etc.);
    2. An explanation of why the evaluation is necessary;
    3. An explanation of why DDDS will not pay for the evaluation or testing; and
    4. If the SSI application was denied, the reason(s) for the denial.
  3. If approval is obtained from CSD Headquarters through the ETR process, clearly document the approval in ICMS case notes.
  4. In order to receive reimbursement for an approved evaluation or additional testing, the provider must send the CSO an invoice for the services being billed.  Upon confirmation that the medical evidence has been received and is complete, social services staff will submit the reimbursement request through SSPS using the appropriate service codes detailed in the CSD Procedures Handbook.

EXAMPLE: An ABD recipient with a mental illness has missed multiple DDDS consultative exams despite coordination with DDDS to arrange transportation. DDDS has refused to schedule another consultative examination. Submit an expenditure request through the Barcode ETR process for an evaluation that meets DDDS consultative examination criteria.

EXAMPLE: The SSIF receives a phone call from an attorney asking DSHS to pay for copies of medical records from the local community hospital. The attorney asks for the complete medical records (e.g. "all records" or "all history") and says that they are being used to "prepare the case for hearing." The SSIF asks what specific records are needed, why those specific records are needed, and if all or part of them are included in the DDDS or CSO records already provided to the attorney. The attorney responds by saying they just want to make sure they have everything. The SSIF denies the request because the need for the records has not been clearly demonstrated.

Personal Observation

  1. A personal observation of the individual is an important piece of the SSI application packet. The SSI Facilitator is the eyes and ears of the DDDS adjudicator.
  2. Focus on writing an objective description of the person's appearance and behavior during a face-to-face interview and avoid value judgments or subjective analysis. Be specific and quantify responses.
  3. Some areas to consider when writing your personal observations:
    1. Deficits in hygiene or grooming.
    2. Difficulty using legs, arms, hands, or shifting position to alleviate pain.
    3. Unusual speech patterns.
    4. Difficulty with long or short term memory.
    5. Unusual surroundings if interviewing the person in their home.
  4. Photographs may be helpful in depicting a person's situation or physical condition. Only take or use photographs with the individual's permission.

Include your personal observation statement within the i3368PRO. (Sign and date the personal observation statement and include it in the application packet if unable to access the i3368 PRO).

Application

Revised on June 24, 2016

  1. The initial SSI application packet includes the following:
    1. SSA Cover Letter;
    2. DSHS form 18-235 Interim Assistance Reimbursement Authorization (signed original);
    3. SSA-8001 (Title 16 application);
    4. Internet iClaim (Title 2 application);
    5. Internet Adult Disability Report i3368;
    6. SSA-3369 Work History Report;
    7. SSA-3373 Function Report;
    8. SSA-827 Authorization to Disclose Information to SSA (signed original, copy, or electronic signature);
    9. Personal Observation Statement;
    10. SSA-3288 Consent for Release of Information (signed original or copy); and
    11. A return envelope.
  2. Refer to SSI Forms for a description of documents used.
  3. Send the completed SSI application packet to the local SSA District Office (SSADO) within 60 calendar days of ABD cash approval.
  4. Send the completed SSI application packet to the local SSADO within 60 calendar days of the referral of a TANF client.
  5. Verify that the SSADO has received the application packet.

 

SSA Teleservice

Revised on June 24, 2016

Teleservice is available for clients when a face to face interview is not possible. Clients may schedule an appointment to apply for SSI by calling SSA Teleservice at 1-800-772-1213, or CSO staff may call and arrange a telephone appointment for the client.

 

NOTE: For all ABD cash recipients, verify a DSHS 18-235 Interim Assistance Reimbursement Authorization is on file with SSA.

 

NOTE: If a non-facilitated client is interested in applying for Social Security Disability or SSI, refer them to SSA Teleservice or the www.ssa.gov website to access the online application for benefits.

Case Transfers

When a person transfers from one CSO to another, the SSI facilitator in the receiving CSO:

  1. Notifies DDDS and SSA of the person's new address and phone number.
  2. Contacts the individual by telephone or schedules an interview to update the person's information.
  3. Inputs new information in the ICMS record.
  4. Notifies DDDS of any updated information.

Death of a Client

Revised August 31, 2016

  1. Pursue the SSI application when an ABD recipient dies and SSA has a signed:
    1. Initial application; and
    2. DSHS 18-235, Interim Assistance Reimbursement Authorization (IARA).
  2. Send written notice of death and intent to pursue the application, along with a copy of the signed IARA, to SSA and DDDS.
  3. When the application is at the Hearing or Appeals Council Review level at the time of the ABD recipient's death:
    1. Send a fax or a letter to the Office of Hearing and Appeals indicating that the State has an interest in the claim; and
    2. Include a copy of the signed IARA.
  4. Leave the SSI Tracking screen open in ICMS until SSA approves of denies the case.

SSI Facilitation-Supporting Home and Community Services (HCS)

Purpose:

This section contains information about: ABD cash eligibility for clients receiving Home and Community Services (HCS) services. SSI Facilitation services for clients receiving HCS services. Coordination between HCS and the CSO.

Worker Responsibilities

Facilitation Services for Clients Receiving HCS Services

  1. When HCS refers an ABD cash client to CSD for facilitation services, SSI Facilitators must provide facilitation services, with the exception of HCS Region 2 which has SSI facilitators.
  2. The referral packet from HCS to CSD should contain:
    1. Copy of the completed HCS CARE Assessment.
    2. Available medical and work history information.
    3. A signed SSA-827, Authorization for Source to Release Information to the Social Security Administration for each identified source of medical evidence and two extras.
    4. A signed DSHS 14-012, Authorization to Release Information.
    5. Copy of any medical documentation.
    6. Information about any need for retroactive Medicaid coverage.
  3. On receipt of a complete packet from HCS, CSD  begins SSI facilitation.

Coordination between HCS and the CSO

HCS and CSD staff work closely together to coordinate the exchange of the following information:

  1. Change of address.
  2. SDX or BENDEX update.
  3. ACES alerts.
  4. SSI/SSDI approval or denial.
  5. Change in eligibility.
  6. New medical information.
  7. Copy of any new CARE assessment.
  8. Change in client advocate information.
  9. Updated personal observations.

CSD Regional Contacts

Region 

Contact

1

Darla Johnson

2

North - Rena Guadagnoli 

South - Sharonda Nash

3

Tiffany Hayden

 

 HCS Regional Contacts

Region

Contact

1

Gary Olson: Financial Program Manager

1

Dan Rees: Subject Matter Expert

2 North

Wendy Wendell: Subject Matter Expert

2 South

Jerald Ulrich: Financial Program Manager

2

Robert Williams: R2 HCS SSI facilitator

3

Tammy Hargrave: Financial Program Manager

3

Ian Horlor: Subject Matter Expert

HCS Headquarters

Cathy Kinnaman: Office Chief, Lori Rolley, Will Reeves, Rob Peters, Graham Zuch

Marcie Birdsall: DDA LTC Specialty Unit Manager

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SSI Facilitation-Tracking

Purpose: 

This section is under revision and will include detailed information on how to read and use SDX information and alerts.

Worker Responsibilities

Tracking the SSI Application

Notify clients that they must inform the department when they receive any information from SSA or DDS.

  1. Monitor and track all pending SSI applications to ensure timely filing of reconsideration requests and appeals.
  2. Use tracking systems to monitor client participation in the application process.

ICMS

Use ICMS to track and record the progress of SSI applications.  The DDDS interface is updated weekly.  SSI facilitation activity reports available in ICMS are:

  • SSI Activity Report.
  • SSI Data Roster including the name and phone number of the DDS adjudicator.
  • DDS status report.
  • SSI Overdue Activity reports.

State Data Exchange (SDX)

The SDX is an exchange of information about a person’s SSI status that is updated weekly.

SDX information is available through ICMS or ACES.  To access SDX data in ACES, see SDX in the ACES User Manual.

State Online Query (SOLQ)

The SOLQ contains real time SSA information. Access the SOLQ through ACES.

See SOLQ in the ACES User Manual for instructions for using SOLQ.

Other Sources

  • Social Security Administration District Office (SSADO).
  • Client advocate.
  • Client contact person.
  • Protective payee.
  • Mental health counselor.
  • Social service agencies working with the client.

SSI Facilitation- Links

SSI Facilitation- Forms

Revised on August 23, 2016

Purpose

This section includes a list of common forms you may use or encounter in SSI Facilitation.

NOTE: Use the Internet version of forms whenever available.

Name

Number

Purpose

Application for Disability Insurance Benefits

Internet iClaim or SSA-16-BK

Apply for Social Security Disability (Title 2 application).

Application for Supplemental Security Income

SSA-8001-F5

Apply for SSI (Title 16 application).

Authorization to Disclose Information to the Social Security Administration

SSA-827

SSA uses this form to obtain medical records. (If disabled child is age 12 or over, child must sign the 827).

Consent for Release of Information

SSA-3288

Receive copies of Consultative Exams, disability determination letters, etc.

Disability Report- Adult

i3368 or

SSA-3368-BK

Report client’s medical conditions, employment history, education, and medical treatment. (The i3368 is connected to the Internet iClaim).
Disability Report- Appeal iAppeal or SSA-3441-BK Report used to update client information (medical conditions and medical treatment) for a disability appeal.
Function Report- Adult SSA-3373-BK Report how client’s condition(s) limit their daily activities.

Interim Assistance Reimbursement Authorization

DSHS 18-235

Repayment agreement when state benefits are duplicated by federal benefits.

Request for Hearing by Administrative Law Judge HA-501-U5 Request an appeal hearing when a reconsideration has been denied. (This form is included in the iAppeal).
Request for Reconsideration SSA-561-U2 Request a reconsideration when denied at the initial determination. (This form is included in the iAppeal).

SSI Cover Letter

DSHS 02-577

Cover letter for initial application, reconsideration, or hearing packet.

SSI Legal Representation

DSHS 09-792

Client notice. Resource list of legal representatives.

 

Links

Electronic DSHS Forms

Social Security Administration Forms

Sanctions-SSI Applications

Purpose: 

Social workers are agents of change who empower our clients to improve their own lives.

WAC 388-449-0200 - Am I eligible for cash assistance for Aged, Blind, or Disabled (ABD) while waiting for Supplemental Security Income (SSI)?

Clarifying Information

  1.  Compliance with DSHS and SSA is a condition of eligibility for ABD cash.
  2. Individuals who the Department has established don’t meet the definition of “qualified alien” for SSI eligibility aren’t required to pursue SSI. For example: PRUCOLs and people terminated from SSI due to the seven year rule aren’t qualified aliens.
  3. PROCOLs may have enough work quarters to qualify for SSDI and must pursue SSDI.
  4. Non-Citizens must cooperate with the SSI/SSDI application process until it is established by SSA that they don’t meet the requirements for either program.
  5. When cash assistance has been terminated because the person failed to comply with pursuing disability benefits even if they claim good cause, only authorize further ABD cash assistance after the person verifies they have taken action to comply.

Medical Treatment

  1.  ABD cash clients must cooperate with SSA requirements. To be eligible for SSI, individuals must provide documentation that their impairments are disabling despite appropriate medical treatment.
  2.  Clients must follow through with recommended treatment for all potential disabling condition.   The only good cause reasons for failing to cooperate with recommended medical and mental health treatment are:
    1. The client provides proof that their treating provider has discussed a treatment risk and the person is pursuing a less dangerous treatment option.
    2. The client provides proof there is a direct out of pocket medical cost for the recommended treatment. Transportation or other incidental costs don’t meet the good cause requirement for failing to cooperate with treatment.

Worker Responsibilities

If a person fails to apply for SSI, or follow through with any SSA requirement:

  1. Send form 14-509  Good Cause letter to schedule an appointment with a SSIF.
  2. If the person had good cause for failing to comply with the SSI application process, explain the requirement and coordinate with DDDS or SSA to help the person fulfill the requirement.
  3. If the person failed to file an SSI application, reconsideration, or hearing request, complete the application or request for appeal at the good cause appointment regardless of whether good cause is established.
  4. Use the 14-118 to notify financial services to terminate ABD cash benefits until the person has signed the IARA, filed the SSI application, completed the consultative examination, or any other SSA requirement regardless of whether good cause is established. 
  5. If the person complies with signing the IARA or the SSA application process requirement before ABD benefits have terminated, use the 14-118 to notify financial services to reinstate ABD benefits because the person has complied.

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Statewide SSI Facilitator Contact List

Revised on April 27, 2016

See the CSO locator for CSO contact information.

Location SSIF Unit Supervisor Phone Number
Region 1 Darla Johnson 509-227-2205
Region 2 North Rena Guadagnoli 206-496-4158
Region 2 South Sharonda Nash 206-716-2312
Region 3 Tiffany Hayden 253-476-7037