(1)
While DDA may review your eligibility at any time, DDA will review your
eligibility:
(a) At age 19 when the most
recent eligibility determination was completed before age 16.
(b) At age 19 when determined eligible with
another neurological or other condition similar to intellectual disability and
academic delays were used as evidence of substantial functional
limitations.
(c) Before
authorization of any DDA-paid service if one is not currently receiving paid
services and the most recent eligibility determination was before June 1,
2005.
(d) If the evidence used to
make the most recent eligibility determination is insufficient, contains an
error, or appears fraudulent.
(e)
If new information becomes available that does not support the current
eligibility determination.
(f) If
you are determined eligible due solely to enrollment in the fee-for-service
(FFS) medically intensive children's program (MICP) but you are no longer
eligible for FFS MICP services.
(2) DDA will notify you in writing at least
six months before your eligibility review date.
(3) When a review occurs and there is
insufficient information to determine your eligibility, DDA can disenroll you:
(a) On your 20th birthday if it is an age 19
review; or
(b) 90 days after the
information is requested, if the review is because:
(i) A paid service is requested;
(ii) The evidence used to make the most
recent eligibility determination is insufficient, contains an error, or appears
fraudulent;
(iii) New information
is available that does not support the current eligibility determination;
or
(iv) You are no longer eligible
for FFS MICP services under chapter
182-551 WAC.
Notes
Wash. Admin.
Code §
388-823-1010
Amended by
WSR
14-07-028, filed 3/10/14, effective
4/10/2014
Amended by
WSR
14-12-046, Filed 5/29/2014, effective
7/1/2014
Amended by
WSR
18-15-046, Filed 7/13/2018, effective
8/13/2018
Amended
by
WSR
19-14-119, Filed 7/3/2019, effective
8/3/2019
Amended by
WSR
24-01-119, Filed 12/19/2023, effective
1/19/2024
Amended by
WSR
24-18-040, Filed 8/27/2024, effective
10/7/2024
Reviser's note: The bracketed material
preceding the section above was supplied by the code reviser's office.
Reviser's note:RCW
34.05.395 requires the use of underlining and
deletion marks to indicate amendments to existing rules. The rule published
above varies from its predecessor in certain respects not indicated by the use
of these markings.
Statutory Authority:
RCW
71A.10.020,
71A.12.030,
71A.12.050,
71A.12.070,
71A.16.020,
71A.16.030,
71A.16.040,
71A.16.050, and chapters 71A.10,
71A.12, and 71A.16 RCW. WSR 05-12-130, § 388-823-1010, filed 6/1/05,
effective 7/2/05.
