EAZ	Search All DSHS manuals ACES EAZ Social Services WCCC Work First   for:
Acronyms  Revisions  WAC Number Index  Site Map  WCCC  DSHS Home

Medical Assistance Programs - Hospice

Revised September 9, 2008

Purpose: To provide an overview of the Hospice program and explain how to correctly determine eligibility for Hospice.

CLARIFYING INFORMATION Overview: Hospice is a 24-hour intermittent program coordinated by a hospice interdisciplinary team for persons with a terminal illness and a prognosis of six months or less to live. The hospice program allows the terminally ill client to choose physical, pastoral/spiritual and psychosocial comfort, and palliative care rather than cure. Hospitalization is used only for acute symptom management. Hospice care is initiated by the choice of the client, family or physician. The client's physician must certify a client as appropriate for hospice care. Hospice can be ended at any time by the client or family (revocation) by the hospice agency (discharge) or by the death of the client. Hospice care may be in a client's home, in a medical institution  including a hospice care center, nursing facility or in an alternate living facility. For certain clients who are found eligible for Categorically Needy (CN) medical coverage or who already receive CN coverage, hospice care is a service which is covered by their medical ID card. When it is to the client's advantage, Institutional Hospice rules are used to determine eligibility. The program used for this is a C01. See section (4) below. The C01/Hospice Program is not a waiver program; however the eligibility follows the same rules as the waiver program under WAC 388-515-1505 when countable income is under the Special Income Level (SIL). The special income level is 300% of the Federal Benefit Rate, (FBR). Waiver rules are used to determine Hospice when a client is not otherwise eligible for a Non Institutional CNP program. Federal rules indicate if a State has a Home and Community Waiver program, clients should be given the same opportunity to these rules, if it is to their benefit, since Hospice clients meet institutional criteria. General Eligibility - Who is eligible for hospice? (WAC 388-503-0505): Definitions relating to Hospice are in WAC 388-551-1010. A person who meets these general eligibility requirements: Verification of age and identity Citizenship or immigration status Non citizen children are eligible to receive hospice services if receiving a children's medical program. Residency Social Security Number Assignment of Medical Support rights Attains Institutional Status (WAC 388-513-1320 1(a)) Institutional status is met when the 13-746 DSHS/Medicaid Hospice notification is received with an election date indicated. Is not subject to a penalty period of ineligibility. Note: Refer to Alien Emergent Medical (AEM) WAC 388-438-0110; 388-513-1350 for clients not meeting citizenship requirements and needing Hospice services. Hospice Providers must get pre-approval from H.R.S.A in order to bill services under the AEM program. If the individual is in a nursing facility under hospice, an additional prior authorization is needed from HRSA for the nursing facility coverage under AEM. Requests to H.R.S.A to authorize hospice coverage for AEM clients should be addressed to: H.R.S.A Notification Unit P.O. Box 45506 Olympia WA 98504-5506 FAX: 360-586-1471 If this is for nursing facility coverage under hospice, make sure this is indicated on the referral with the name and address of the nursing facility. When am I Eligible for Hospice as a service? A person must be eligible for a categorically needy (CN) or medically needy (MN) program* to receive hospice care. Examples include but are not limited to the following: CNP non institutional Medicaid in an alternative living facility (G03) General assistance for Aged, Blind or Disabled who have a NGMA determination from DDDS (GA-A, GA-D, GA-B) General assistance - disability determination pending (GA-X) Temporary Assistance for needy families Healthcare for Workers with Disabilities (HWD) Children's Health (including non-citizen children's programs). SCHIP Foster Care/Adoption Support Refugee Assistance * For clients determined eligible under the MN program, see additional instructions in section 4 below. Clients must meet the Hospice diagnostic criteria plus Medicaid eligibility criteria in order to receive Hospice. Clients who already receive medical under any of these programs do not have to submit a new application to be considered for hospice, this is considered a change of circumstances. This includes clients who have not met spend-down. If a client is eligible for a non institutional CNP Program, the Hospice provider bills Health and Recovery Services Administration (H.R.S.A) the same as any other service. If the client is residing in a medical facility such as a nursing home or hospice care center, the case must be changed to a C01 institutional hospice case. When am I eligible for C01 Hospice program following institutional Medicaid rules? Use the C01 hospice program for a client who receives hospice services and who resides in a medical institution (nursing home, hospice care center). (ACES will trickle to a C95, C99 depending on income when the client is in a medical institution). For some clients who do not reside in medical institutions, it could be to their benefit to follow institutional rules when determining eligibility for Hospice services. Institutional rules allow the spend-down of excess resources towards the cost of care, a higher resource limit for married couples, a higher income allocation amount for a spouse and a higher income standard for a single person. Clients need to meet aged, blind or disabled criteria to be eligible for the C01 hospice program. SSI related medically needy. A client should always be considered for a C01 program before authorizing benefits or services under MN for the following reasons: CN scope of care Clients will not have to meet the spend-down amount prior to becoming eligible. (They may have to pay toward the cost of care each month. This is paid directly to the Hospice provider). Once eligible, Medicaid is backdated to the first of the month The CN income limit is the Special Income Limit (SIL) which is higher than the CN income limit for non-Institutional medical. The personal needs allowance standard is higher for a single person (100% FPL) as opposed to the MNIL used for non-institutional medical. A community spouse's income is not counted when determining hospice participation. The personal needs allowance (PNA) is the MNIL when there is a community spouse. A dependent's income is not counted when determining hospice participation. Higher income allocation to a community spouse and dependents when living with a community spouse. Single Healthcare for Workers with Disability (HWD) clients with income below 100% of the FPL. They would not have to pay a premium for medical coverage and would have no participation. For clients receiving waiver services through Aging and Disability Services Administration (ADSA) ,see additional instructions under Worker Responsibilities section 4) ADSA Waiver Programs. For clients with income under the Medicaid Special Income Level  (SIL) see 388-515-1505 waiver programs for complete eligibility criteria if residing outside a medical institution. How will my DSHS agency know I have elected hospice services? When a client elects hospice services, the hospice agency provides notification to DSHS within five days of the election date using the 13-746 DSHS/ Medicaid hospice notification form.  This includes the client's name, the effective date the client elected hospice services, the type of hospice (Medicare or Medicaid), the name of the hospice provider and the name of the facility if the client lives in a facility. This also includes the daily rate. The hospice agency will provide a signed release of information for the client in order to facilitate the coordination of services between the agency and the community services office (CSO) or home and community services (HCS). This will be faxed to the HRSA notification unit and is imaged into the DMS system. (FAX number is 360-725-1965). The hospice agency checks for eligibility using MedWeb (a Medicaid electronic verification system) If the client is not on assistance, the provider will assist the client in submitting an application for assistance with the DSHS/Medicaid Hospice notification and release of information. A hospice agency is responsible to verify a client's eligibility with the client or with the appropriate HCS office or CSO. When a client's hospice status changes, the hospice agency faxes a hospice another notice to the HRSA notification unit to be imaged.  Examples include: the client revokes hospice services, the client discharges from a hospice facility or the clients dies. If a client transfers to a different hospice agency, both the old and the new providers fax a notification form with the necessary information. Once clients do elect Hospice, covered drugs and items are limited under the Hospice program. Certain items are covered in the Hospice daily rate. (WAC 388-551-1210 ). Revocation of services. (WAC 388-551-1360 ) The Hospice provider is responsible to notify HRSA of the revocation by completing and forwarding a copy of the 13-746 DSHS/Medicaid hospice notification form. The Hospice provider is responsible to give the client a copy of the revocation statement and inform the client that the revocation statement must be presented with the client's current medical identification care when obtaining Medicaid covered services, supplies or both. Client's need to use this procedure until the department can remove Hospice coding out of the H.R.S.A payment system/Medicaid Management Information System (MMIS) and a new Medical ID card is issued. How do I know which office to contact? HCS determines eligibility for hospice when clients are receiving services authorized by Home and Community Services except when there is a TANF/family related medical program attached. HCS determines eligibility for Hospice when one spouse is receiving services from Home and Community Services and the other spouse is in need of hospice. The CSO determines eligibility for all other clients requesting hospice services. Clients residing in Hospice Care Facilities and Nursing Homes are not receiving HCS services. NGMA requests for these clients need to go through the CSO. Hospice services are authorized through H.R.S.A not through ADSA. CENTRALIZED PROCESSING FOR CSD Centralized Medical Unit (CMU) staff determine eligibility for non-HCS Hospice cases. Medical only applications received may be routed via DMS to CSO 132 @HSP for processing. Applications received in the CSO that include requests for other programs are processed by the local office for other programs and by the CMU for Hospice. Set a same date tickler to CSO 132 @HSP for application processing CMU Contact Information: Address: DSHS - CMU PO Box 34350 Seattle, WA 98124-9511 Phone: (206) 341-7433, or Toll Free (800) 337-1835

EXAMPLE Client is active on MN/S95 and enters a nursing facility under hospice. CSO central unit #132 does a program change to C01/Hospice.

Client's receiving services through HCS who elect Hospice service and close HCS services. The HCS office will make the appropriate redetermination to the Hospice program and transfer the case to specialty unit #132. The Hospice agency needs to be notified when a case is transferred to a different DSHS office.

EXAMPLE Client in a Nursing Home receiving services through ADSA. Client elects Hospice. Once a client has elected Hospice, the Nursing Home service with ADSA ends. The case is changed from a L02 Nursing Home to a C01 Hospice case by HCS staff, the case is then transferred to CSO 132 specialty medical unit. The client is still residing in the Nursing Facility, but the funding is through the Hospice program. (See 4.c for coding instructions).

WORKER RESPONSIBILITIES Hospice eligibility cases are high priority cases. Clients who elect hospice services have a terminal illness with a prognosis of six months or less. If the CSO receives a DSHS/Medicaid hospice notice from the hospice agency on a Medicaid recipient we process this as a change. The client does not need to submit a new application or eligibility review. APPLICATIONS Client is determined eligible for non-institutional CNP coverage: Process application following regular Medicaid processing guidelines. The C01 program is not used if client is eligible for another CNP program. Code the hospice provider as authorized representative type 'NO' on the AREP screen to receive copies of letters (including pending letters). On the INST screen code Hospice on the HCB Service section with the Hospice service start date. Indicate "MA" as approval source. Using the13-746 DSHS/Medicaid hospice notification, FAX a response to the Hospice Agency indicating the client is receiving CNP Medicaid and has no participation requirement (the only time a client may have to pay toward the cost of their care is when using the C01 institutional hospice rules). The DSHS 13-746 has instructions describing how to complete the form. http://www1.dshs.wa.gov/pdf/ms/forms/13_746.pdf Document in the narrative that the CSO response portion of the DSHS 13-746 has been faxed back to the hospice agency. Follow equal access (necessary supplemental accommodation)  procedures described in WAC 388-200-1300 when appropriate. Client has income over the MNIL, resources exceed SSI related standards, client has a community spouse, client resides in a medical facility (nursing home/hospice care center), or is not otherwise eligible for non-institutional CNP coverage. In ACES, screen in a C01 medical coverage group. Code the hospice provider as authorized representative type 'NO' on the AREP screen to receive copies of letters (including pending letters). If the hospice election date is within 90 days of the application date, consider retro coverage under the C01 program back to the election date as long as the client is income and resource eligible in each of the prior months. How is a client related to the C01 program? Refer to 388-515-1505 Financial Eligibility Requirements for long- term care services under HCS CN Waiver when C01/Hospice rules are used to determine eligibility when not residing in a medical institution.  A client must be Aged, Blind or Disabled to be eligible for this program. Follow regular office procedures to request a Non-Grant Medical Assistance (NGMA) determination from DDDS if no disability has been established. Refer to 388-513-1315 for eligibility and 388-513-1380 for participation rules for Hospice residing in a medical institution such as a nursing facility or hospice care centers.  Household Composition - who do I include in the AU? Indicate the spouse and dependents as non-members on the STAT screen. Income allocation requirements are processed using the LTCD, SHEL and INST screens for this program, not the STAT screen. See ACES PROCEDURES: Resources - What should I know? Resource standards for the C01/Hospice program follow institutional SSI related rules. Do not deny applications when resource limits exceed $2000 for a single client or $3000 for a married client. Refer to WAC 388-513-1350 for more information.

EXAMPLE A married couple, one applying for hospice. Their combined available resources total $35,000. In this example, the community spouse* is allowed the Spousal Resource Transfer Max under institutional Medicaid rules. (Effective July 1st 2005, this limit is $41,943 plus $2000 for the institutionalized client). *A community spouse is a person who does not receive institutional, waiver or hospice services and who is legally married to an institutionalized client.

List all assets owned by the client including their primary residence. Remember, this client may be subject to estate recovery. A client may reduce their excess resources in the month of application by any unpaid medical expenses for which they are liable. This can include health insurance, Medicare premiums, deductions and co-insurance charges and any necessary medical care recognized under state law, but not covered under the state's Medicaid plan (see WAC 388-513-1380 section 4). For CN, the excess resources plus the non excluded income cannot be greater than the SIL. For MN, the excess resources plus the non excluded income is less than the private hospice rate plus the amount of recurring medical expenses, for hospice services received at home. (see WAC 388-513-1395 (2)(b).

EXAMPLE Single client applies for medical and has elected hospice services. Gross income is $1800. (Under the SIL). He has $4000 in his savings account but you verified he has an unpaid hospital bill of $2000. If the client is liable for the bill in the month of application, he will be resource eligible. A client who is receiving hospice services in a nursing facility may also apply excess resources towards the cost of their care.

EXAMPLE Single client applies for medical and has elected hospice services in a nursing facility. He has income of $500 per month but has $5000 in available resources. Client would be resource ineligible for most Medicaid programs. If the hospice cost of care* exceeds the excess resources plus the monthly income, the client would be eligible under the C01 program. (This will trickle to a C95 because the excess resource plus the income is over the SIL). The excess resources are applied towards the client's share of the cost of care (participation). See (v) below for more information on participation. *Cost of care is determined by taking the daily rate and multiplying by the number of days in the month. For Hospice in an alternative living facility multiply the daily rate by 30.42.

EXAMPLE Single client applies for medical and has elected hospice services at home. He has $2000 income (over the SIL) and $4000 in resources. The cost of care is $2100 per month. We would deny the Hospice Medicaid as his available income plus excess resources exceed the cost of care.

Married clients do have a higher resource standard when using institutional hospice rules. The hospice applicant is allowed $2,000 in resources in addition; their community spouse is allowed $41,943. Once a client has been determined resource eligible for hospice and has a community spouse the client has until the end of the month of the first regular eligibility review to transfer any excess resources owned in their name into the name of their community spouse. Set alert 1 month prior to Review to check the status. Income: The CN income limit for the (C01) Hospice program is higher than the MNIL and uses the SIL (Special Income Level). This makes this program more beneficial for clients whose income is higher and who would only qualify for MN coverage or MN with a spend-down under the SSI related medical (S) programs. The SIL is 300% of the Federal Benefit Rate (one person SSI payment standard). The financial eligibility rules for long term care services are detailed in WAC 388-515-1505. Follow the rules in this WAC when Hospice clients have income under the Special Income Level (SIL). For clients whose income exceeds the SIL, refer to section 5) Special Instructions below. Client retains 100% of the Federal Poverty Level as a Personal Needs Allowance (PNA) when single and living at home. Client retains the MNIL as a Personal Needs Allowance (PNA) when married with a community spouse and living at home. See current Personal Needs Allowance Standards for clients residing in an alternate living or nursing facility. Spouse's income is not counted when determining how much the client must pay each month toward Hospice care (also called participation). (The institutional spouse's income may be allocated to the community spouse). Dependent children can be allowed allocations from the Hospice applicant's income. This is coded on the INST screen in ACES (under family member exemptions). Participation: Long term care has two parts - initial eligibility (is the person financially eligible?) and post eligibility commonly known as participation (how much does the client have to contribute towards the cost of their care?). When there is participation involved, hospice agencies must be given an award letter showing the amount they need to collect. We must also return the DSHS/ Medicaid Hospice Notification form to the Hospice Agency indicating the participation and an award letter will follow. Coding: These instructions are for guidance only - refer to ACES instructions on coding C01/COPES for more detailed instruction. It is essential the following information is indicated accurately for correct program eligibility. Some of the screens in Long Term Care eligibility, such as the DEM1/Living Arrangement, INST screen, SHEL screen and LTCD screen, work together in determining correct client cost of care (participation). Medical Coverage Group is C01. Client living arrangement and marital status on DEM 1 screen will determine the correct personal needs allowance. INST screen will need to show the 'H' Hospice service on the HCB/Service field and 'MA' for the approving source. There are two start dates listed on the DSHS/Medicaid hospice notification form (election date and Medicaid hospice start date) - it is the election date that needs to be listed in the start date field in ACES. If there are dependent children, each dependent child is indicated separately as type 'C' under Family Member Exemptions on the INST screen. If the dependent child has income, the gross, non-excluded amount is coded under amount. Each dependent is listed separately on this screen. Deductions such as non covered medical or health insurance are coded on the INST screen. Information regarding the Medical Institution or Alternative Living Facility is coded in line one of the INST screen for clients living in those types of facilities. Examples of a medical institution can be a Nursing Facility or Hospice Care Center. Examples of Alternate Living Facilities can be an Adult Family Home, Assisted Living Facility or Enhanced Adult Residential Center. LTCD screen is used to code community spouse income and resources. This screen works in conjunction with the INST screen and the SHEL screen to do the correct deeming of income to the community spouse and dependents. Indicate correct deemor type and living arrangement. HH size includes the spouse and dependent; do not include the applicant/recipient in this total count. Only indicate the community spouse's gross non-excluded earned and unearned income on the LTCD screens. The dependent's income is indicated on the INST screen under family member exemptions. LTCD/Resources. ACES combines total countable client resources listed on their resource screens and the community spouse resources listed on the LTCD screen and compares the total to the standard. In the first year of eligibility the total must be at or below the spousal resource transfer maximum plus $2,000 allowed under SSI related Medicaid. Be aware that the LTCD screen is Assistance Unit (AU) specific and information on resources will be lost if changing to another LTC program such as L02. A client has until the first scheduled review to transfer resources in excess of the $2,000 limit to the community spouse. (It may be preferable to indicate all the couple's resources initially on the client's resource screens until the first review. At first review indicate the resources transferred to the community spouse on the community spouse's resource screens). SHEL screen. It is important to indicate the community spouse's shelter costs on the LTC client's SHEL screen. The system will do a second calculation to see if the community spouse is eligible for additional deeming for excess shelter. Community Spouse Resource Evaluation (CRSA) screen will come up on all cases with a community spouse. The date the client entered the nursing home or started hospice service is indicated. CHANGE OF CIRCUMSTANCES Active TANF, GAX or other CNP medical programs: Hospice is a covered service for these programs so no program change is required. Code the hospice provider as authorized representative type 'NO' on the AREP screen to receive copies of letters. Hospice agencies need to get a termination notice if the Medicaid is closed. On the INST screen code 'H' Hospice on the HCB Service section with the Hospice service start date. Indicate 'MA' as approval source. Using the DSHS/Medicaid hospice notification form, FAX a response to the Hospice Agency indicating the client has CNP Medical and has no participation requirement (the only time a client will have to pay toward the cost of care is when using the C01 institutional hospice rules). Client is active on S95 and S99 (including spend-down in M status): Add a C01 program to the existing active medical assistance unit to look at a program change - be sure to code the hospice provider as authorized representative type 'NO' on the AREP screen to receive copies of letters (including pending letters). Determine eligibility for the C01 hospice program following instructions under previous APPLICATIONS section. Shorten the certification end date to match the original certification end date of the original medical assistance unit. If approved, generate a hospice award letter (02-18) and ensure a copy is sent to the hospice provider. See the special circumstances section for instruction on active MN Medicaid client entering a nursing facility. Follow necessary supplemental accommodation (NSA) procedures described in WAC 388-200-1300 when appropriate. WHAT IF THE 5-DAY NOTICE INDICATES THE CLIENT IS DECEASED? If the client was a recipient of CN medical or was receiving MN coverage because their spenddown had already been met, the FSS does not need to do a program change. Follow instructions in the APPLICATIONS Section (1) (a) to respond back to the hospice agency using the DSHS/Medicaid Hospice notification. Indicate that the client was eligible for hospice as a service and to bill according to their billing instructions with zero participation. If the client is deceased and we have a pending application, follow the application instructions listed above for either the C01 hospice program or non-institutional Medicaid CNP. It is essential that an eligibility determination is made for these clients. The hospice agencies must still be notified timely of the approval or denial decision. If the client is deceased and there is no application prior to the date of death, a representative may apply on the client's behalf. ADSA PROGRAMS (Additional Instructions) Waiver programs such as HCS COPES, PACE, MMIP, MNRW, MNIW and DDD Waiver programs take precedence over Hospice. ACES is coded under the primary Waiver service and participation is applied toward the Waiver program first. Indicate the Hospice agency on the AREP for the C01 program (such as COPES that is already active). Additional coding is not needed in ACES other than narration. Report to the case manager of the Waiver service the client has elected Hospice. Send a copy of the DSHS/Hospice Notification form to the Social Worker/case manager of record so they have information on the Hospice Provider to coordinate services. It is important that services are coordinated between the Hospice provider and the DSHS agency providing a waiver or medicaid personal care (MPC) service so there is no duplication of services. For clients who elect Hospice while in a Nursing Facility, ACES is coded as Hospice in a Nursing Facility under the C01 program. The case must be changed from the L series (L02, L95 and L99) to a C01. If the client is on SSI, keep the client on the L01 program in order for the correct Personal Needs Allowance (PNA) to be issued. A Hospice award letter will need to be hand generated for SSI and GA-X in a Nursing Home (02-18). If the client does not receive SSI, screen in a C01. The system will trickle to the correct program depending on the income. ACES supports Hospice in a Nursing Facility when income is over the Special Income Level (SIL). Code the INST screen the same as a Nursing Facility case, add Hospice as level of care. On the HCB service field code 'H' under type. Indicate service start/election date. 'MA' (for MAA now H.R.S.A) is approving authority. Code the Hospice agency on the AREP to receive notices. SPECIAL INSTRUCTIONS Some cases require processing alternatives or fall outside of these instructions. Listed below are a few circumstances to be aware of. See WAC 388-515-1550 for eligibility for Hospice with income over the SIL at home. Eligibility is the same as the Medically Needy In-Home Waiver (MNIW) except the PNA for MN Hospice at home is the MNIL. Use the S02/S95/S99 series as a processing alternative and follow ACES processing instructions for the MNIW program. In cases which involve an SSI/S01 client with earnings who maintains CNP eligibility under 1619B criteria, do not change to the C01 program. Retain the S01 program. In cases which involve a single client receiving Non-Institutional Medicaid in an Alternative Living Facility, maintain eligibility under the G03/G95 series as these clients are paying their income toward the cost of care on this program (see WAC 388-513-1305, Non Institutional Medical in an Alternate Living Facility). When both Hospice and COPES, or another Waiver Program have been approved in the same month, and no award letter has gone out showing participation for either program, always assign the participation to the COPES/other Waiver program first as it is the priority program. Example: Hospice election on 4/3, COPES service approval on 4/10, financial worker processing application on 4/15. Indicate COPES as the service under HCB on INST screen and assign any participation to the COPES provider. If Hospice/C01 has been opened with an award letter issued showing participation assigned to a Hospice provider and COPES, or another Waiver Program is opened in the same month but at a later date, participation will start with the COPES/Waiver program on the first of the following month. Active MN Medicaid clients who have met spenddown and are placed in a nursing home would be allowed the following deductions to determine the amount of the client's participation in the cost of care: Allow the MNIL if the client is at home the first day of the month he or she is admitted to the facility, or the appropriate personal needs allowance (PNA) based on the client's living arrangements if not at home on the first day of the month. Client's monthly spenddown liability that has been met for each month through the certification period. Note: The spenddown liability deduction is coded on the INST screen in ACES with notation in remarks. The determination of the MNIL/PNA is based on the information coded on the INST screen and DEM1 screen in ACES. All allowable deductions found in WAC 388-515-1505(4)(b) for COPES and WAC 388-513-1380 for nursing home. The $20.00 disregard used as a deduction for MN non-institutional spenddown is counted towards the client's monthly nursing home participation in the post eligibility process.

EXAMPLE Single client on Medicaid MN program with base period 1/06-3/06. Spenddown was met in February and case was certified effective 2/1/06. Client has monthly income of $825 per month. He enters the nursing home from home on 3/5/06. His MN spenddown was computed as follows: $825.00 monthly income -$20.00   -603.00 MNIL $202.00 per month available for spenddown use as a deduction. Nursing Home Participation for 3/06 is computed as follows: $825.00 monthly income -603.00 MNIL (at home 3/1/2006) -$202.00 spenddown liability $20.00 participation to the nursing facility. The spenddown base period ended in March. This deduction can only be used through the last month of the original MN base period.

For further assistance, contact your regional representative: Region 1 Mary Beth Ingram 360-725-1327 ingramb@dshs.wa.gov Region 2 Kathy Johansen 360-725-1321 johankj@dshs.wa.gov Region 3 Kevin Cornell 360-725-1423 corneke@dshs.wa.gov Region 4 Colleen Clifford 360-725-2075 cliffcj@dshs.wa.gov Region 5 Cindy Palko 360-725-1324 palkocm@dshs.wa.gov Region 6 Cathy Fisher 360-725-1357 fishecl@dshs.wa.gov

---

Modification Date: September 9, 2008

Have comments on the manual? Please e-mail us. You can also use this link to report broken links or content problems.