Home and Community Based Waivers (HCBS)

Waiver Overview

The Developmental Disabilities Administration (DDA) offers five Home and Community Based Services (HCBS) Waivers:

  • Basic Plus
  • Children's Intensive In-home Behavioral Supports (CIIBS)
  • Community Protection         
  • Core
  • Individual and Family Services (IFS). 

Each of the five waivers provides an array of services tailored to the specific populations they serve. Waiver services provide additional support when Medicaid state plan services and other supports are not sufficient.  For more information about the waiver program, go to the Services and Information Request form, contact your Case Resource Manager, Social Worker, or regional DDA office.

For detailed information about all DDA services, please visit the Informing Families Website.

DDA received approval from the Centers for Medicare and Medicaid Services (CMS) for the 5 year renewals of the following 4 waivers:  Basic Plus, Core, Community Protection (CP) and Children’s Intensive In-home Behavioral Support (CIIBS).  DDA also received approval of the Individual and Family Services (IFS) waiver amendment. 

Current Approved Waivers

The Centers for Medicare and Medicaid Services have approved DDA’s five HCBS Waiver Appendix K applications.  Appendix K provide the state flexibility in existing waiver programs.

Waiver Renewal

The waiver renewal application for the Individual and Family Services (IFS) Waiver was approved by The Centers for Medicare and Medicaid Services (CMS) on July 30, 2019.

Approved changes to the five-year IFS waiver renewal, effective September 1, 2019:

  • Removed the client age limit of three years of age or more in order to be eligible for this waiver
  • Expanded provider types for the waiver service Peer Mentoring        
  • Changed the waiver calendar year from June 1 through May 31 to September 1 through August 31 to match the calendars of DDA’s other four waivers         
  • Added Behavioral Health Stabilization Services – Crisis Diversion Bed Services      
  • Removed Therapeutic Equipment and Supplies and add these benefits to a renamed Specialized Equipment and Supplies
  • Technical changes to performance measures, rate methodologies, and service definitions

Waiver Amendments/

Two sets of draft waiver amendments for the Individual and Family Service, Basic Plus, Core, Community Protection and Children’s Intensive In-Home Behavioral Support (CIIBS) Waivers are available for public comment February 5, 2020, through March 5​, 2020.  Draft amendments can be viewed using the waiver amendment links below:

Draft Amendment 1

Proposed Changes to the IFS, Basic Plus, Core, Community Protection and Children’s Intensive In-Home Behavioral Support waivers effective January 1, 2020:

Add the following new Medicaid eligibility group to all waivers:

  • Working individuals with disabilities who buy into Medicaid (BBA working disabled group as provided in §1902(a)(10)9A)(XIII)) of the Act). The Centers for Medicare and Medicaid Services (CMS) allow this type of change to be made retroactively.

Draft Amendment 2

Proposed Changes to the IFS, Basic Plus, Core, Community Protection and Children’s Intensive In-Home Behavioral Support waivers effective July 1, 2020:

In the second set of five waiver amendments, DSHS and Health Care Authority intend to amend the waivers with an effective date of July 1, 2020. The amendments propose to:

  • Add the following new services:
    • Specialized Habilitation, which are habilitative supports for clients to learn or maintain skills in self-empowerment, safety awareness and self advocacy, interpersonal skills and effective communication, coping strategies for typical life challenges, and managing daily tasks and acquiring adaptive skills, to the IFS, Basic Plus, Core and CIIBS waivers;
    • Complementary Therapies: Music Therapy and Equine Therapy, to the CIIBS waiver;
    • Emergency Services to the CIIBS waiver;
    • Community Engagement will replace Community Guide in the Basic Plus and Core waivers;
    • Therapeutic Adaptations to the IFS, Basic Plus and CIIBS waivers;
    • Specialized Evaluation and Treatment – Sex Offender Treatment Provider Therapy to IFS, Basic Plus, Core and CIIBS waivers;
  • Rename and redefine Behavioral Health Stabilization Services in all waivers to include:
    • Stabilization Services – Staff/Family Consultation Services Stabilization Services – Specialized Habilitation
    • Stabilization Services – Crisis Diversion Bed
  • Reorganize the following supports to be included in a new service called Specialized Evaluation and Treatment Services:
    • Risk Assessment, including polygraph and plethysmograph
    • Sex Offender Treatment Provider Therapy
  • Revise the following service in the Basic Plus, Core and Community Protection waivers:
    • Chemical Extermination of Bed Bugs to become Extermination of Bed Bugs
  • Phase out Positive Behavior Support and Consultation (PBSC) from all waivers for adult clients age 21 and older (Specialized Habilitation is a new service to address habilitative supports that may have been addressed through PBSC in the past. Behavioral health benefits are also available to waiver participants through the Medicaid State Plan through Managed Care Organizations (MCOs) or Medicaid fee-for-service)
  • Revise the service provider requirements for:
    • Group Training Homes
  • Restructure CIIBS waiver fund categories for improved budget tracking
  • Remove the following habilitative services:
    • Community Guide will be replaced by Community Engagement in the Basic Plus and Core waivers
    • Prevocational Services from the Basic Plus, Core and Community Protection waivers (all clients previously receiving Prevocational Services have already transitioned to other services)
    • Remove the following state plan related waiver services.  Supports historically received in these services are now available to waiver participants through the managed care organization or Medicaid Fee-for-Service plan:
    • Specialized Psychiatric Services from all waivers
    • Skilled Nursing (except nurse delegation) for youth age 20 and younger from all waivers
    • Behavioral Health Stabilization Services – Specialized Psychiatric Services
    • Personal Care from Basic Plus waiver (service is available on the Community First Choice program)
  • Adjust technical language
  • Revise estimates for state plan utilization and expenditures
  • Revise estimates for waiver service utilization and expenditures
  • Revise post-eligibility treatment of income language for CIIBS waiver.

All participants who are currently receiving services proposed to be removed or phased out will be transitioned to appropriate Medicaid state plan or other waiver services during a transition process. The transition process will occur at the client’s next scheduled annual assessment following the July 1, 2020, effective date of the waiver amendments. Youth age 20 and younger currently receiving positive behavior support will continue to have access to that service.

Official notices are also located in the Washington State Register and in our field services offices.  Send your comments to DDAWaiverAmendments@dshs.wa.gov during the comment period.

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