WAC 388-448-0130 Treatment and referral requirements
We refer you to medical providers for available medical treatment or other agencies for treatment, rehabilitation or work activities when we decide it will improve your ability to be gainfully employed or reduce your need for GAU. "Available medical treatment" means medical, surgical, chemical dependency, or mental health services, or a combination of them.
When you are first approved and at each review determination, we give you written information regarding your treatment requirements.
You must accept and follow through on required medical treatment and referrals to other agencies and services, including applying for SSI, unless you have good cause for not doing so. Examples of good cause are found in WAC 388-448-0140.
We may require you to undergo alcohol or drug treatment before reviewing your eligibility for GAU.
You may request a fair hearing if you disagree with the treatment or referral requirements we set for you
Give the person an orientation or have a follow-up interview following incapacity approval as a best practice. Improve treatment results by hearing a person's concerns, identifying goals, and explaining program rules.
Create a GA Case Plan for each person receiving GA. Send a copy to the person.
Help the person understand the participation and verification requirements.
List all the information the person needs to participate.
Give details in the plan. Include the "what, where, and when."
Describe the steps that are necessary to achieve self-sufficiency.
Verification strategies may vary, depending on the assessment.
Monitor regularly, but not necessarily every month.
Ensure progress is being made.
Engage the person in active participation.
Update the GA Case Plan when requirements change.
Non-U.S. Citizens / Naturalization Referral
Refer all non-U.S. citizens who appear to meet SSA disability criteria directly to the local SSA District Office before providing facilitation services.
When SSA accepts an application from a GAU or TANF non-U.S. citizen:
Verify with the local SSA office that an application has been filed,
For GA recipients, submit a request for GAX certification and verify SSA shows there is a DSHS 18-235, Interim Assistance Reimbursement Authorization is on file, and
Provide the necessary accommodations and facilitation services to assist the recipient with the application process.
When SSA rejects an application or does not allow a qualified alien (as defined in WAC 388-424-0005) to apply because of citizenship status AND the qualified alien has lived in the United States for at least four years:
Advise the person that if they become a U.S. citizen (naturalize), they will then be eligible to apply for federal benefits. The list of naturalization services contractors is in Section M, NATURALIZATION REFERRAL LIST,
Revise the GA Case Plan. Refer the non-U.S. citizen for screening by a contractor to determine if it is in their interest to naturalize - do not require the person to become a citizen. Provide information about the naturalization screening referral in the GA Case Plan.
NOTE:
It is best to discuss a specific agency referral with the person.
Close the SSI Facilitation Screen in ICMS, using "SSI/SSA Denied-Non Citizen (SN)" as the reason code. A date field will open. Enter the date that you made the naturalization referral. Document and track the referral in ICMS, and
Continue tracking the case and contact the contracted naturalization services provider to determine if the person followed through with the referral. Obtain the results of the provider's assessment and document in case notes.
NOTE:
Please remember to enter the coding on the SSI Facilitation Screen in ICMS. (See 2.c., above.)
When a non-citizen reports SSI approval, inform the person that unless they naturalize they will only receive SSI for seven years from the date they entered the U.S. if:
They entered as a refugee, asylee, Cuban/Haitian entrant, Amerasian, victim of trafficking, or
Letters are not the only one way the person can verify cooperation or participation. See the Verification chapter in the EA-Z manual. For example, a phone call by the Social Worker to the provider or treatment agency is a quick and paperless way to verify participation. Document your phone call in ICMS as verification.
Send a warning letter when verification is not received.
If there is no response to the letter, assume refusal to cooperate without good cause.
Refer to Good Cause and Penalties for determining good cause and sanctions for non-compliance.
Take action on a person's non-compliance right away. Do not wait until the case is up for review.
WAC 388-448-0140
WAC 388-448-0140
Effective August 1, 2001
WAC 388-448-0140 Good cause for refusing medical treatment or other agency referrals
We may determine that you have good cause for refusing required treatment or referrals to other agencies. We may require you to provide proof to support your good cause claim. Valid reasons for refusing treatment and other agency referrals include, but are not limited to, the following:
Valid reasons for refusing treatment referrals:
You are so fearful of the treatment that your fear could interfere with the treatment or reduce its benefits;
Treatment could cause further limitations or loss of a function or an organ and you are not willing to take that risk;
You practice an organized religion that prohibits treatment; or
Treatment is not available without cost to you.
Valid reasons for refusing treatment or other agency referrals:
We did not give you enough information about the requirement;
You did not receive written notice of the requirement;
The requirement was made in error;
You are temporarily unable to participate because of documented interference, or
Your medical condition or limitations are consistent with the definition of necessary supplemental accommodation (NSA), WAC 388-472-0020, and your condition or limitations contributed to your refusal per WAC 388-472-0050.
The person must provide supporting verification when claiming a reason listed under WAC 388-448-0140. See the Verification chapter in the EA-Z manual.
When a person gives a reason that is not listed in WAC, assess whether the reason for not participating is valid. Other circumstances other than those specified in WAC may prevent the person from participating.
If necessary, update the GA Case Plan to include only items that the person is capable of participating in.
Apply the appropriate penalty using a 14-118 when there is not good cause for non-participation.
WAC 388-448-0150
WAC 388-448-0150
Effective September 1, 2000
WAC 388-448-0150 Penalty for refusing medical treatment or other agency referrals
If you refuse required treatment or agency referral without having good cause, we will stop your GAU benefits.
We stop your GAU benefits until you agree to accept and pursue the required treatment service or referral.
If you reapply, you must wait for a penalty period to pass before you begin getting benefits. The penalty is based on how often you have refused:
Use a 14-118, Incapacity Decision to notify financial services to stop GA benefits when you decide that the person does not have good cause.
When the period of ineligibility penalty coincides with the last month of incapacity, send a14-217, Notice of Information Required for Incapacity Review, to the person.
When the person reapplies:
Deny GA benefits when the person continues to refuse requirements.
When the person agrees to cooperate, use DSHS 14-118, Incapacity Decision to notify financial services to reopen GA benefits. The person must demonstrate willingness to pursue the program requirements.
NOTE:
The period of ineligibility penalty begins the date of re-application or the first of the following month, whichever is later. Impose a subsequent period of ineligibility (second, third, and subsequent failures) only when there is an additional refusal to cooperate with the same treatment or referral requirement as the previous penalty. Failure to cooperate with a different treatment or referral requirement counts as a new first failure.
Resources
The following agencies can provide services to assist people to become employable.
Chemical dependency treatment agencies serve people who have a problem with alcoholism or drug addiction:
A DASA-contracted chemical dependency treatment agency determines if a person has a chemical dependency.
When chemical dependency is established, the treatment agency will recommend and provide services as appropriate.
Use the treatment agency recommendations to revise the GA Case Plan.
Persons who are eligible for GA but are chemically dependent receive residential treatment in a DASA-contracted residential treatment agency. Persons may remain on GA while receiving treatment.
DASA contracts with counties to provide outpatient chemical dependency treatment services free of charge to low income clients, including GAU clients.
DASA requires contracted treatment agencies to include planning for vocational goals or finding a job in the agency's treatment plan.
Medicaid eligible persons (GAX, SSI) use their medical identification card to get outpatient chemical dependency treatment services.
If the person is eligible for both GA and ADATSA Shelter, inform the person of their right to choose the desired program.
Refer to the Division of Developmental Disabilities when medical evidence documents one of the following diagnoses began prior to age 18:
Mental retardation or severe cognitive impairment,
Cerebral palsy,
Epilepsy, or
Autism.
The Division of Vocational Rehabilitation (DVR) serves people who:
Have a physical, mental, or sensory limitation,
DVR assigns higher priority to people whose limitations are severe and permanent.
The limitation must hinder the person's ability to prepare for, get, or keep a job that matches their capabilities and potential.
Intend to and can work after receiving vocational rehabilitation services, and
Require vocational rehabilitation services to prepare for, get or keep a job.
Tribal programs are available in some areas and may include:
Medical services,
Chemical dependency treatment, and
Vocational training and employment services.
The Veterans Administration (VA) serves persons who were active in military service and honorably discharged. Services may include:
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Modification Date: March 19, 2008
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