DIVISION OF DEVELOPMENTAL
DISABILITIES
Olympia, Washington
TITLE: PLANNED AND EMERGENCY SHORT TERM STAYS POLICY 4.01
Authority: 42 CFR 483.440 (b)
RCW 71A.12; 71A.16.010; 71A.20.090 WAC 388-97
WAC 388-825
PURPOSE
This policy establishes procedures for authorizing and
providing both planned and emergency short term stays at the Residential Habilitation Centers
(RHC) operated by the Division of Developmental Disabilities (DDD).
SCOPE
This policy applies to RHC and Field Services staff.
DEFINITIONS
Adolescent means a DDD eligible youth age 13 through 17 years.
Child means a DDD eligible youth age 8 through 12.
Emergency means a sudden, unexpected occurrence demanding
immediate action.
Long term admission of a person to an RHC means the request has gone
through the DDD Admissions
Review Team (ART) and admission has been approved by the Division Director.
Planned means a specific timeframe for a Short Term Stay (STS),
including admission and discharge dates.
Short
term stay (STS) means
temporary residential services provided to a person on an emergency or planned basis. A
STS can be any number of days up to a year, but the DDD regional office must submit an
ETR for any stay greater than 30 days in a calendar year and every
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30 days thereafter. Nursing
Facility (NF) rules limit short term stays to 31 days without an exception. A
STS does not require review by ART and is not an approved long term placement.
POLICY
A.
RHC capacity that is not being used for long term residents may be
available for short term
stays.
B.
Children under age 8 may not be admitted for planned or emergency short
term stays.
C.
When a client is at an RHC for a STS beyond 180 days, Field Services
staff must pursue a request
for ICF/MR (Intermediate Care Facility for the Mentally Retarded) admission, following the procedures set
forth in DDD Policy 3.04, ICF/MR Admissions Protocol, unless the
following conditions are met:
1.
The Region has identified a service provider and has a prospective
discharge plan;
2.
This additional STS cannot exceed 180 days; and
3.
Total time in STS status can be no more than one year. PROCEDURE
A. Short Term Stay Admissions
1.
Application, ICF/MR eligibility determination, and referral to the RHC
for a STS are
handled through the DDD regional office where the RHC is located.
2.
Prior Approval by the Regional Administrator (RA) is required for a STS
of 30 calendar days
or less.
3.
Division Director or designee ETR approval is required for:
a.
Any STS for more than 30 days in a calendar year; and
b.
Any STS of a child or emergency STS of an adolescent when a residence is not identified for their
return.
The Region must submit an ETR to the Division Director
for any stay exceeding 30 days and for every 30 days thereafter during the
stay.
B. Planned Short Term Stay
1. A Planned Short Term Stay is
limited to 30 days in a calendar year unless
approved
by the Division Director via the ETR process.
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2. The DDD regional office will
provide all required referral information to the RHC
at least 5 working days prior to
placement. Part of the required information is part of the DDD Assessment and is
acceptable in that form. At the time of referral, the following information must be current
within the last 90 calendar days:
a. Legal information, including:
i.
Criminal justice system actions;
ii.
Local law enforcement involvement;
iii.
Contractual obligations or court ordered decrees; and
iv.
Pending criminal charges and any related information.
b. Medical information, including:
i.
Name, address, and telephone number of physician and back-up physician;
ii.
Updated immunization record;
iii.
Current medical evaluation, including physical examination and current diagnoses;
iv.
Report of current Hepatitis B screening;
v.
Report of current tuberculosis (TB) screening if the STS is at an N F;
vi.
All current prescription medications and purpose;
vii.
Known allergies; and
viii.
Prescribed diet and reason.
c. Functional and/or developmental
assessments, including a review of any
significant challenging behaviors (e.g., danger to self
or others) and any planned interventions previously used or in effect. Include
copies of the client’s
current Positive Behavior Support Plan (PBSP) and completed DSHS 10-272,
Cross System Crisis Prevention and Intervention Plan, if applicable.
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d.
The Individual Support Plan
(ISP) that includes an objective for the STS or emergency care.
e.
For children, the current Individual Education Plan (IEP) and plan for school attendance during the
STS.
f.
Updated social service information, including:
i.
Family profile, including name and address of primary contact and legal representative/guardian
status;
ii.
Social development;
iii.
Placement history;
iv.
Employment history and interests; and
v.
Reason for referral, including reasons that preclude community placement.
C. Emergency STS Admissions
1.
Emergency STS
admission of an adult to an RHC is temporary, pending resolution of the crisis and the development of
appropriate community resources.
2.
Emergency STS admission of an adolescent (age 13 through 17) to
an RHC is temporary
and may be authorized by the RA or designee when a residence is identified for the youth’s
return.
3.
ETR approval by
the Division Director is necessary when an adolescent is admitted for an emergency STS and does not have a
residence to which he/she can return.
The Region submits the ETR to the Division Director for approval containing the following:
a.
A plan for services and supports, if appropriate, to be provided within
the family home
upon the youth’s return from emergency STS.
b.
A plan for voluntary placement services (when in-home supports have been exhausted and are
determined ineffective in meeting the needs of the youth) with the goal of
community placement or family reunification; and
c.
Progress towards placement planning is reported to the Division
Director at least
every 30 days via the ETR process.
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4. Emergency admission of a
child (age 8 through 12) requires prior approval from
the Division Director and the same planning as described
in section 3 above.
5. When an emergency exists and STS
admission is for 72 hours or less, referral
information may be abbreviated if normal procedures
cannot be followed. The information must still contain, at a minimum, the following:
a.
The reason for referral, including situations that are precluding the
use of community
resources;
b.
Medical information, updated by the DDD regional office as necessary, including current medications,
allergies, and any existing and available immunization and health records;
c.
Existing behavioral information and current PBSP, updated by the DDD regional office as needed; and
d.
Description of requested services during the STS.
6. The Case Resource Manager (CRM)
along with the RHC Interdisciplinary Team
(IDT) will plan STS services based upon the person’s
individual needs.
7. When an emergency STS admission
exceeds 72 hours, the DDD regional office
will supply all referral information normally required
for a planned STS to the RHC within 5 working days.
8. An IHP will be developed if STS
is expected to extend beyond 30 days.
Assessments will begin upon admission.
D. Discharge Procedures
1.
A discharge plan will be in place upon admission for a planned STS,
including the residence
to which the client will return.
2.
If extenuating circumstances prevent the discharge as planned, the DDD
regional office
responsible for the client will make alternative plans or request an extension of the STS, not to exceed a
total 30 days in the calendar year.
3.
If a discharge does not/cannot occur within the 30 days allowed for STS
in a calendar
year, written approval via ETR by the Division Director is required for any extension. The request to
the Director must include information describing what the region will do to remain actively
involved with the client, how they will participate in the client’s treatment, and what resources
they have identified to use when discharge planning begins.
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4. An Emergency STS discharge plan
must be developed as soon as appropriate after
admission and when the client begins to stabilize. The
CRM and the RHC IDT will
develop the plan, which must include a residential placement with a
ti meframe for discharge.
EXCEPTIONS
The RA must initiate an Exception to Rule (ETR) request
to the Division Director using the Comprehensive Assessment and Reporting Evaluation (CARE)
system. The Division Director will make the final decision on ETR requests. The initial decision may
be verbal, followed by an electronic confirmation of the ETR request approval or denial on the RA’s
worklist in CARE.
No other exceptions to this policy may be authorized
without the prior written approval of the Division Director.
SUPERSESSION
DDD
Policy 4.01 Issued April 1, 2008
DDD Policy 4.01 Issued February 1, 2008
DDD
Policy 4.01 Issued April 24, 2006
DDD
Policy 4.01 Issued June 25, 2004
DDD
Policy 4.01 Issued April 13, 2000
DDD
Policy 4.01 Issued June 30, 1999
DDD Policy 4.01
Issued
February 14, 1994
Approved: /s/ Linda Rolfe Date: February 1, 2009
Director,
Division of Developmental Disabilities
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