cakÏAEnk Developmental

Disabilities Administration

o˚gkan Children's Intensive In-Home

Behavioral Support Waiver

EvÆeKXay™WmfvkehqatagwwnlaYn˙Rd™tIÆ: dshs.wa.gov/dda/service-and-information-request

swkHaH™wgkanRd™tIÆ: dshs.wa.gov/DDA/dda/find-an-office

otHafvkehqa:

buk˚qnÏU™tIƆ™wgkankanwU™msUnµkanFzgSWg HlJ kan†id†BSJÆSanSamadotHaÏAEnk Washington Telecommunication Relay Service odYkanbIbHaelk 7-1-1 HlJ 1-800-833-6388 (TTY)..

egJÆwnRKhzbewqakanSAlASid

DSHS 22-1755 LA (3/18) Laotian

Chelan, Douglas, Ferry, Grant, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens

Adams, Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Klickitat, Walla Walla,

Whitman, Yakima

Island, San Juan, Skagit, Snohomish, Whatcom

King

Kitsap, Pierce

Clallam, Clark, Cowlitz, Grays Harbor, Jefferson, Lewis,

Mason, Pacific, Skamania, Thurston, Wahkiakum

(800) 319-7116 R1ServiceRequestA@dshs.wa.gov

(866) 715-3646 R1ServiceRequestB@dshs.wa.gov

(800) 567-5582 R2ServiceRequestA@dshs.wa.gov

(800) 974-4428 R2ServiceRequestB@dshs.wa.gov

(800) 735-6740 R3ServiceRequestA@dshs.wa.gov

(888) 707-1202 R3ServiceRequestB@dshs.wa.gov

˚av†I otrASzb ElA wIEml˙

kaneKXaeTig Waiver˚µh™wgKMewqakancqdsJÆeKXanµ, HlJ efJÆwcApÆWnRpepznkanSAlA SidyÆag wJÆnSamadTJkehzdRd™Vntuk@evla.SwbTamnµÏU™czdkansÆvYeHlJwkM rAnI (CRM). T™aHakvÆa CRM bBmIevlavÆag, VH™SzÆg ˚vamRv™nµSaYotrASzbbBcÆaYegint™wgTiÆntIÆTJkkÆavyUÆfaYR†™H™wgkant™wgTiÆn HlJ YJÆn˚µh™wgKMtagwwnlaYn˙Rd™tIÆ www.dshs.wa.gov/dda/service-and-information-request. kanSwd˚ÆwgnµkqdeknkanbMri kanSµlzbkanSA lASidbBRd™hzb pAkznkaneKXaeTigkanbMrikan. kanSAlASid E†ÆlAyÆagmIKwbeKdVncµnvn Kwg˚qnÏU™tIÆSamadTJkhzbVs™. DDA mISidwµnadtIÆcA†xgKwbeKdkancqdsJÆeKXaVSÆ wIg†amkanmIRv™VH™Vs™VnegintjnSµlzbÏU™eKXahÆvmnµkanSAlASid˚qnVHmÆ.

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• egJÆwnRKhzbewqaKwgÏAEnk DDA Rd™TJkpA†ieSd, †zd HlJ ÏAEnk DDA Rd™TÆvgdjgyÆagbBmIeHdÏqnVnkanpA†ibzdkanVSÆ˚µh™wgKM; HlJ

• sAnid HlJ cµnvnKwgkanbMrikantIÆTJkwAnuYadVH™Rd™hzb; HlJ

• kanpA†ieSd, kanludlqg, HlJ kan†zdkanbMrikan; HlJ

• kanpA†ieSdkanelJwkewqatÆanHmMVH™kanbMrikan; HlJ

• T™aHakvÆaRd™Y™aYRpyUÆSATantIÆwaSzYyUÆbÆwnwJÆn, tIÆbBEmÆnbÆwnelJwk ewqaKwg˚qnVd˚qnnjÆg; HlJ

• kanpA†ieSdKwgÏAEnk DDA tIÆcAehzd†am˚µh™wgKMbBVH™SqÆgVb Ec™gkanRpHa˚qnwJÆn˚qnVd˚qnnjÆg; HlJ

• kanesqacqdsJÆcako˚gkanSAlASid; HlJ

• kanpA†ieSdVn˚µh™wgKMtIÆcAhzbewqakanbMrikan ICF/IID EtntIÆvÆa cAEmÆnkanbMrikanSAlASid; HlJ

• ÏAEnk DDA fqbeHznvÆakanbMrikantIÆmIRv™VH™VnkanSAlASidpzd cubznSamad†wbSAnwg˚vam†™wgkand™anSuKAfab ElA˚vamyUÆdImI Ehg ElA buk˚qnbBeHznf™wmnµ; HlJ

• ˚qnVd˚qnnjÆgRd™TJk†Ira˚apAemInÏqnvÆabB†™wgkanlAdzbkanpiÆnpqv ICF/IID; HlJ

• buk˚qnRd™TJk†Ira˚apAemInÏqnvÆabBSwd˚ÆwgnµegJÆwnRKhzbewqa Kwg CIIBS.

ÏU™hzbkansÆvYeHlJw†™wgRd™Swd˚Æwgnµkqdekn†BlqgRpn[tuk@yÆag:

• epznlUk˚™aÏU™tIÆmIegJÆwnRKRd™hzbKwgÏAEnk DDA odYwIg†am RCW 71A.10.020(5).

• mI˚vameSzWwqg˚AodYwIg†amkqdekntIÆTJkkB†xgRv™El™vyUÆVnkqdHmaY Social Security Act.

• h™wgKMewqakanbMrikanpiÆnpqvrAYAYav/Medicaid ElA mIraYRd™tIÆfiSUdRd™sjÆgbBkaYekIn 300% Kwgmad†ATankan sÆvYeHlJwegin SSI KwgrzdTAbankag.

– T™aHakvÆaepznedzkn™wY, raYRd™ ElA szbSinKwgfBEmÆcAbBTJk ficarAna˚idRlÆVSÆ

– T™aHakvÆaepznÏU™VHYÆwaSzYyUÆnµ˚UÆÏqvemzW, raYRd™ ElA szbSinKwg ˚UÆÏqvemzWcAbBTJk ficarAna˚idRlÆVSÆ.

• mIszbSin†CkvÆa $2,000 HlJ yUÆVno˚gkan Apple Health for Workers with Disabilities (HWD).

• Swd˚ÆwgnµrAdzbKwgkanpiÆnpqvtIÆTJkewqaVH™yUÆVnSATabznkan piÆnpqvpankagSµlzbbuk˚qntIÆmI˚vameSzWwqg˚Ad™anpznYaEnv˚id (ICF/IID) †amtIÆTJkTJkficarAnaeHznodYkanpAemInÏqnKwg ÏAEnk DDA.

• EÏnkanbMrikanlvmSUnVSÆbuk˚qn (PCSP) SAEdgVH™eHznvÆa ˚vam†™wgtagd™anwAnamzY, ˚vampwdfzY, ElA kanƒjkƒqnVH™ dI˚JnSamadTJk†wbSAnwgRd™EnvVdyUƆamsumnumsqntIÆmIkan bMrikanSAlASid ElA/HlJ kan˚vb˚umebiÆgnµpAcµedJwn.

• †qklqgeHznf™wmtIÆcAhzbewqakanbMrikanwIgVSÆehJwn ElA sumnumsqnEtn tIÆvÆacAEmÆn ICF/IID.

• Sµlzb CIIBS etqÆanxn, buk˚qnnxnYzgcA†™wg:

– mIwaYu 18 pI RpeTig 17 pI SµlzbkancqdsJÆeb{wg†Xn(hzbVs™RpeTigwaYu 20 pI);

– TJkpAemInÏqnVneb{wg†XnvÆayUÆVnkanSÆWg†BkanczdHaVH™yUÆ nwkehJwnSUg ElA h™aYEhgY™wnkanpAfjdtIÆmIbznHa;ElA;

– waSzYyUÆnµ˚wb˚qvÏU™tIÆeHzn†qklqgtIÆcAeKXahÆvmVno˚gkan CIIBS.

WAHKIAKUMcounty

Region 2

Region 3

Region 1

P ACIFI Ccounty

GRAYS HARBORcounty

JEFFERSO Ncounty

CLALLA Mcounty

MASO Ncounty

T HURSTO Ncounty

LEWIScounty

S KAMANI Acounty

COWLITZcount

CLARKcounty

KLICKITA Tcounty

YAKIMAcounty

KITTITA Scounty

PIERCEcounty

KINGcounty

CHELA Ncounty

S NOHOMIS Hcounty

S KAGI Tcounty

W HATCOMcounty

OKANOGANcounty

FERRYcounty

STEVEN Scounty

PEN DOREILLE

county

SPOKANEcounty

LINCOL Ncounty

WHITMA Ncounty

ADAM Scounty

GRANTcounty

DOUGLAScounty

F RANKLINcounty

WALLA WALLAcounty

COLUMBI Acounty

GARFIELDcounty

ASOTINcounty

BENTONcounty

S AN JUANcounty

KITSAPcounty

Region 1 Region 2 Region 3

ISLANDcounty

I SLANDcounty

kanpÆWnEpgsIvid

kanpÆWnEpgsIvid

kanbznrAYaYodYSAlUbkÆWvkzb Waiverkqm Department of Social and Health Service’s Developmental Disabilities Administration (DDA) mIo˚gkan Home and Community-Based Service (HCBS) Medicaid Waiver H™ao˚gkan. kanSAlASid E†ÆlAo˚gkanSAenI VH™mIkanbMrikanwznecaAcqgefJÆwcA†wbSAnwg˚vam†™wgkantagd™anwAnamzY ElA ˚vampwdfzYyUÆVnsumnumsqn. o˚gkan Children’s Intensive In-Home Behavioral Support (CIIBS) waiver SAenIVH™mIkanbMrikanHlaY@yÆagemJÆwevlabBmIRv™VH™ÏÆanEHlÆgsÆvYeHlJw wJÆn@(pAkznfzYewksqn, Medicaid, ohghWn,wJÆn@.)

o˚gkan Children’s Intensive In-Home Behavioral Support (CIIBS) waiver wU™msUsavHnuÆmÏU™tIÆSÆWg†BkanczdVH™ yUÆnwkehJwnY™wnkanpAfjdtIÆepznbznHa.o˚ghÆag CIIBS kÆWvfznnµkan vagEÏnhwbd™anElAkanwU™msUkanpAfjddImuÆgVSÆ˚wb˚qv.o˚gkan CIIBS waiver hzbVs™edzkn™wYwaYu 8 pI Ha 20 pI.

T™aHakvÆa˚vam†™wgkanSµlzbkanbMrikantIÆTJk†Ira˚apAemInÏqnebiÆg El™vkaYekInKwbeKdKwgkanbMrikantIÆTJkewqaVH™faYR†™o˚gkan CIIBS waiver, ÏAEnk DDA cAtµ˚vamfAYaYam†BlqgRpn[wIk etJÆwnjÆg HlJ HlaYetJÆwefJÆwcA†wbSAnwg˚vam†™wgkantagd™an SuKAfab ElA ˚vamyUÆdImIEhg.

• s[bwkkanwU™msU†amtzmmAsadtIÆmIRv™VH™†JÆmwIk;

• el[m†XnehzdkanYqkevxn†BkqdrAbWbefJÆwcASzÆgwwkmaerJÆwgkaneKXaeTigkanbMrikantIÆbBEmÆnSAlASidtIÆmIyUÆbBVH™lvmyUÆVno˚gkanSAlASid CIIBS waiver nwkcakkanwU™msU†amtzmmAsad;

• VH™owkadtIÆcAh™wgKMewqakanSAlASidtagwJÆntIÆmIkanbMrikantIƆ™wgkan;

• SAenIkanczdVH™yUÆVnSATabznkanpiÆnpqvpankagSµlzbbuk˚qnÏU™tIÆmI˚vam eSzWwqg˚Ad™anSA†ipznYa (ICF/IID).

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kanbMrikanKwg WaiverVs™bwk˙HmaYVSÆefJÆwcASAEdgVH™ CRM eHznvÆakan bMrikanEnvVdEdÆtIÆSqnVc:

kanbMrikan†amsumnumsqn

kanKqnSqÆgRpma – kanVs™egin˚JnVH™ÏU™VH™kanbMrikanSµlzb kanKqnSqÆgRpmatIÆbBEmÆnkanfAYabantIƆ™wgkanefJÆwcAeKXa Ha kanbMrikanSAlASidtIÆTJkkÆavecaAcqgyUÆVn PCSP.

kanbMrikanKwgnzkvisakan

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kanbMrikanpiÆnpqvSuKAfaborkcidVH™tuÆntÆWg – kanpiÆnpqvnwnohgHmMVnfavAedJwdh™wn – kanbMrikanpiÆnpqvyUƆamehJwn ElA kanpAfjdsqÆv ˚avSµlzbÏU™tIƆqkyUÆVnkanSÆWgwzn†AraYh™aYEhglqgRpVnkantµgan tagcidVc ElA yUÆVnkanSÆWgwzn†AraYKwgkannwnohgHmMorkcid.

kanwU™msUkanpAfjdVH™RpVntagdI ElA kanpjkSa – kanwU™msUtIÆ Ek™RK ˚vam†™wgkantagSuKAfabkanpAfjd. SiÆgeHlqÆan[lvmewqakaneKXa EskEsgodYkqgefJÆwcASqÆgeSImkanpAfjdsjÆgcAehzdVH™˚unnAfabKwg sIvidVH™dIK{n ElA kaneKXaVnsumnumsqn.

kan†Ira˚apAemInÏqnebiÆgkanSÆWgwzn†AraY – kan†Ira˚apAemIn ÏqnebiÆgkanpAfjdhunEhg, eƒXarqbkvn, warqmtagefd, HlJ nµlÆaefJÆw cAficarAnaebiÆg˚vam†™wgkanVnkanbMrikantagorkcid, fAYa ban HlJ kanbµbzd.

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kanbMrikanVH™kanebiÆgEYgdUEl

kanyudfzksqÆv˚av – kanÏÆwn˚aYrAYASxnVH™EkÆbuk˚qnÏU™tIÆwaSzYyUÆnµ ElA ebiÆgEYgdUEllUk˚™a.

ÏAlidtAfzn ElA kanbMrikan

etzkonolcIsÆvYeHlJw - ÏAlidtAfzn ElA kanƒjkƒqntIÆTJkVs™ efJÆwcASqÆgeSIm HlJ hzkSa˚vamSamadVnkantµgan.

kanpzb†qvVH™eKXakzbSAfabEvdl™wm – kandzdEpgtaghUbhÆagVS ÆehJwntIÆcµepznSµlzbbuk˚qntIÆcAdµenInkandµrqgsIvidyUÆVnsumnumsqn.

e˚JÆwgnuÆgfieSd - e˚JÆwgnuÆgbBcµkzdtIÆTJkdzdEpgVSÆ˚vam†™wgkan tIÆkÆWvfznnµ˚vameSzWwqg˚A.

wubpAkwnfAYabanfieSd ElA e˚JÆwgVs™SwY – wubpAkwn ElAe˚JÆwgVs™SwYtIÆcµepzntagd™ankanfAYabantIÆbBmIRv™VH™faYR†™o˚gkan Medicaid (Apple Care).

wubpAkwn ElA e˚JÆwgVs™SwYbµbzdhzkSa - e˚JÆwgVs™SwYtIƆ™wg kanefJÆw cAvagVs™EÏnkanwU™msUkanbµbzdhzkSa HlJ kan pAfjddI.

kandzdEpgYanfaHanA-kandzdEpgVH™eHmaASqmVSÆYan faHanAsjÆgwµnvY˚vamSAdvk˚vam†™wgkanKwgtÆan ElA wU™msUkanlvmeKXanµsumnumsqn.

cqÆgVs™p{m˚UÆmJHqvn[efJÆwcAvagEÏnSµlzbkan†Ira˚apAemInÏqnpAcµpI. Case resource manager (CRM) cAwAtibaYeTigkanbMrikan ElA kqdkµnqd, ElA bzntjkkanbMrikantIÆTJkelJwkewqayUÆVnEÏnkan Person-centered service plan (PCSP). kanbMrikanbag yÆag†™wgmIkankvdebiÆg˚Jn ElA kanwAnumzdkÆwntIÆmzncATJkewqaVH™. SwbTamnµ CRM kÆWvkzbvÆaraYrAwWdEnvVdEdÆtIƆ™wgkanSµlzb kanwAnumzdlÆvgHn™a. kanbMrikanyUÆVnSIÆKAEnglvmewqa:

• kanbMrikan†amsumnumsqn – SqÆgeSImkaneKXahÆvmKwglUk˚™aElA kanpzb†qveKXanµsumnumsqn

• kanbMrikanKwgnzkvisakan – kanbMrikanwU™msUtIÆTJkewqaVH™odYnzk visakantIÆmISznYa

• kanbMrikanVH™kanebiÆgEYgdUEl – kanwU™msUSµlzbÏU™eKXahÆvm ElA ÏU™VH™kanebiÆgEYgdUElKwgeKqaecXa

• ÏAlidtAfzn ElA kanbMrikan – wubpAkwn, e˚JÆwgVs™SwY ElA kan bMrikanfieSdSµlzbÏU™eKXahÆvmnµ