In-Home Providers

The purpose of this chapter is to provide requirements on how to select, contract with,
and/or terminate in-home providers.
Section Summary
How Do I Assist the Client in Selecting a Provider?
What are the Limitations on Clients and Providers?
How Do I Complete the Contracting Process with a Provider?
o Initiating a Contract
o Submitting a Bacground Chec
o !eviewing Bacground Chec !esults
o "btaining, !eviewing, and Taing #ction on "ther Information
o Completing a Contract
o Terminating a Contract
esources
ules and Policy
IP !iles and D"S !A#s
!ingerprint Chec$ !A#s
Dis%uali&ying Crimes !A#s
'ac$ground Chec$ !A#s
(etting a Provider )um*er !A#s
Character+ Competence+ and Suita*ility Assessment !orm
)otice to Clients Who ,mploy an IP !orm
As$ an ,-pert
$ou can contact Sue %c&onough at '()*+ ,-.--.(( or %c&onSC/dshs.wa.gov.
In-0ome 1roviders
WAC 388-71-0505
WAC 388-71-0510
How Do I Assist the Client in Selecting a Provider?
2. 3se the C#!4 assessment to determine the services and number of hours
the client is eligible to receive.
-. #ssist the client in selecting a qualified provider, as defined in the 5#C (66-
,2-*.** through 5#C (66-,2-*.7*7 and !C5 ,8.(7#.*7. ',+ and '6+.
(. &iscuss with the client his/her needs/tass, when the9 need to be provided,
and his/her preferences as the9 are outlined in the Service Summar9 and
#ssessment &etails.
)ote. It is mandator9 that the client is given choices in both the t9pe of qualified
provider that he/she wants to have perform the services he/she is eligible for and
authori:ed to receive, as well as who the specific qualified provider's+ will be.
8. The client ma9 choose to have personal care and other services be provided
b9.
Informal supports, which will remain unpaid;
# qualified and contracted individual provider, who will be emplo9ed b9 the
client as defined in 5#C (66-,2-*.** through 5#C (66-,2-*.7*7;
# home care agenc9 contracted with the &epartment through the #rea
#genc9 on #ging;
# combination of informal supports, I1, and/or home care agenc9, as long
as the total hours authori:ed do not e<ceed those allowed b9 the client=s
C#!4 assessment, and an 4T!, if one was requested and approved.
Considerations when assisting the client in maing a choice of provider>
Is the client independent in decision maing, or usuall9 independent?
Can the client supervise the provider, or is someone available who can assist
the client in supervising the provider?
&oes the client have the abilit9 to mae himself/herself understood b9 others?
If the answers to the questions above are 9es, then the client is a good candidate
to have an individual provider. If the client has someone in mind that is qualified,
that person should be contracted as an I1.
&oes the client mae no/few decisions?
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Is the client unable to supervise a provider, and lives alone, or no one is
available to supervise a provider?
Is the client=s abilit9 to communicate rarel9/never understood b9 others and
lives alone?
If the answers are 9es to these questions, then the client ma9 best be served b9
an agenc9, or a combination of I1 and agenc9.
.. &etermine whether the prospective provider can adequatel9 meet the needs
of the client. In maing this decision, consider>
5hat care/tass the client is eligible to receive. Carefull9 review and
discuss with the client his/her personal care and other needs, when these
services need to be provided, and the client=s preferred schedule.
5hether the client=s care needs conflict with the availabilit9 of the
prospective provider. 'e.g. &oes the provider have other wor or
responsibilities that interfere with the client=s needs and schedule? Is the
provider woring for more than one client?+ Carefull9 review each client=s
preferred schedule and consider travel time.
5hether the I1 has responsibilities or other factors that compromise their
abilit9 to adequatel9 care for the client. @or e<ample, does the provider
have famil9 or personal responsibilities, circumstances or stress that
would compromise the adequate care of the client? '$ou ma9 utili:e the
Aarit Burden Scale incorporated into C#!4 to assist 9ou in 9our
discussion with the client and I1.+
5hether 9ou have a good faith belief that the care is not being provided or
could not be provided adequatel9 as authori:ed in the care plan.
&iscussing concerns 9ou have with the client's+ and e<plain the balance
between consumer choice and the requirements under WAC /00-12-3433
5H67(H WAC /00-12-34838 and CW 19:/8A:384 ;1< A)D ;0<.
1. !efer the client to the H6", CA, #7ALI5= A75H6I5= ,!,AL
,(IS5= when the client=s choice is to have an I1 or a bacup I1, and
he/she doesn=t have someone in mind. $ou ma9 also access the !egistr9 for
9our client. In addition to providing a list of possible I1s for the client, the
!egistr9 also has a number of resources for clients to access which includes
information about how to hire and eep a provider as the emplo9er.
Additional In&ormation a*out HC#A.
o The 0CB# !egistr9 promotes and supports a client=s choice of providers.
o Cegislation passed in -**- created the 0CB# and required them to
develop a !eferral !egistr9 of qualified I1s for clients and case managers
to access.
o The !eferral !egistr9 is a web-based service that matches clients with
pre-screened I1s based on geographic location, needs, availabilit9, and
preferences.
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o The !eferral !egistr9 provides a resource for clients who ma9 not now or
have access to a qualified provider through famil9 or friends, access to a
second or third I1, and bac-up providers.
Can a relative be a provider?
# client ma9 choose a relative>
,-cept a spouse/legall9 separated spouse when the client is in a waiver
program, such as C"14S, %1C, or Dew @reedom programs.
5ho meets the same provider qualifications that an9 other potential provider
must meet in order to be a contracted and paid provider.
# relative provider must be contracted as an Individual 1rovider in order to be
paid. 0e or she cannot be emplo9ed b9 a home care agenc9 and be paid to
provide services for their relative.
5hen the relative provider is>
# spouse 'allowed onl9 under the Chore program+;
# parent's+; or
#n adult child between the age of 26 and -2, then>
a. The C% and the client must complete the &S0S form 2*-8)7, EDotice to
Clients 5ho 4mplo9 an Individual 1roviderF form and submit it to 0I3 for
imaging into the electronic case record. The form is an I!S requirement and
must be filed in the client=s case record.
b. 3se the following SS1S codes. These codes ma9 be found in the SS1S
%anual online and are>
o 82). - "rientation
o 8..7 G 8.)7 %1C
o .-.7 G .-)7 C"14S
o 8-.6 G 8-)2 Chore
!re%uently As$ed #uestions a*out IP !iles and D"S
#: What is the Department policy on storing IP documents in the Aging &ile?
#. The Character, Competence and Suitabilit9 form '&S0S 2*-8)6+ is appropriate but
optional to eep in the aging file as it is client specific. It is required that the C/C/S be
documented but C%/ S5 ma9 or ma9 not use the form. # cop9 should also be placed in
the I1 file.
#: Why am I receiving items in my mystery mail &or IPs?
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#. &%S is a s9stem for Client records. Because I1 documents are not for the client,
the s9stem does not have an9 wa9 to match them to a client.
Do not send IP documents to the HI7: If 9ou do receive an assignment for an I1
document in &%S, do not forward that item. 1rint the item and send to the appropriate
office/staff person.
WAC 388-71-0540
WAC 388-71-0546
What are the Limitations on Clients and Providers?
Limitations on Programs
5hen assessing clients for services, 9ou must>
2. Consider the availabilit9 of all resources that could assist the client in meeting
his/her needs when 9ou are doing a C#!4 assessment and are scoring #&Cs
and I#&Cs under Hstatus.= If the client=s needs are currentl9 being met without
compensation, there is no unmet need. If an unpaid provider now wants to be
paid and the client wants this person to be their provider, this person must meet
all the provider qualifications to receive pa9ment and the client must have
documented unmet needs that qualif9 him/her for an I1 '@or e<ample, if an
unpaid provider is onl9 providing an I#&C such as laundr9, the dept. would not
pa9 the provider to provide laundr9 service. The client must have documented
unmet #&C needs that would not otherwise be met if the provider chose not to
provide it.+ 5hen the client chooses an individual provider, 9ou and the client
must consider the qualifications, availabilit9, and capabilit9 of the potential
provider, regardless of the relationship between the client and the potential
provider.
-. "ffer all resources available to the client, including formal and informal supports
and assistive technolog9.
(. #uthori:e services based on the #CTS# published rates. #CTS# published rates
and program rules establish the total hours and how much the &epartment pa9s
toward the cost of services.
Limitations on Providers
2. #ssign providers and tass, ma<imi:ing both client choice and case
manager/social worer responsibilities in 9our discussion's+ with the client and I1.
-. $ou ma9 den9 a contract, suspend, or terminate a provider when 9ou>
0ave a reasonable, good faith belief that the client=s choice of a provider
will be unable to appropriatel9 meet the care needs of the client;
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)ote. If the client and provider do not live together, the client cannot be taen to
the providerIs home to receive care.
In-0ome 1roviders
@ind that an I1=s inadequate performance or inabilit9 to deliver qualit9 care
is Jeopardi:ing the health, safet9, or well-being of a client. $ou ma9 tae
action to terminate the contract between the &epartment and the I1;
0ave a reasonable, good faith belief that the health, safet9, or well-being
of a client is in imminent Jeopard9. $ou ma9 summaril9 suspend the contract.
,-amples to consider.
Client K2 and Client K- choose to have the same I1. Both clients have some
tass scheduled for the same time and the commuting time between clients is
-* minutes each wa9. "ne provider cannot meet the needs of both clients
whose schedules conflict, so the plan must include more than one provider to
accommodate the schedule, tass and client preferences. #dditionall9, there
needs to be consideration for travel time to and from wor, personal business,
etc. for the provider.
The client has care needs and is authori:ed for services that require a
provider on a dail9 basis, and some tass need to be provided during the
middle of the da9. The provider the client has chosen has a full time Job
%onda9 through @rida9 and therefore cannot be the onl9 provider. The plan
needs to include two qualified providers of choice, one of which is the client=s
original choice and another who can meet the weeda9 needs when the first
provider is woring.
The client is authori:ed to receive in-home services. $ou have a good faith
belief that their choice of an I1 cannot adequatel9 meet the care needs of the
client due to other responsibilities and factors. $ou ma9 den9 the client=s
choice of I1. $ou ma9 also wor with the client and develop a plan that could
include the client=s choice of I1 for tass that this I1 can provide, and add an
additional provider's+, to adequatel9 meet the care needs of the client.
The client is eligible to receive in-home services and has been receiving
services from one I1. $ou have a good faith belief that the I1 has
demonstrated inadequate performance or is unable to deliver qualit9 care and
is Jeopardi:ing the health, safet9, or well-being of the client. In 9our
discussion with the client, 9ou develop a plan that will adequatel9 meet the
care needs as authori:ed and tae action to terminate the current I1.
(. I1s can provide services for one unrelated person that lives with the I1 in the I1=s
own home. In this situation, rent cannot be a condition for providing personal
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care. Cicensing regulations appl9 when I1s provide services to more than one
unrelated person in the I1=s home. In this case, the I1 must become a licensed
adult famil9 home and can no longer be paid under the I1 program.
8. #lso see the ECan a !elative be a 1rovider?F section for additional limitations of
providers.
)ote. The client is the emplo9er of the I1 and can choose who the9 want to provide
their care. 0owever, 9ou have statutor9 authorit9 under !C5 ,8.(7#.*7. '6+ and must
den9 a client=s choice of an9 provider if 9ou have a reasonable, good faith belief that the
provider is unable to appropriatel9 meet the needs of the client.

WAC 388-71-
0515
WAC 388-71-
0513
WAC 388-71-05640
WAC 388-71-
0560
How Do I Complete the Contracting Process with an Individual Provider?
$ou must contract with an individual provider before the provider can be authori:ed/paid
to provide services to 0CS/### clients. 5here are no retroactive contracts.
1roviders cannot be paid for services provided before the date that the contract is
effective.
Initiating a Contract
#ccess the #genc9 Contracts &atabase '#C&+ to ensure that no previous 0CS I1
contract is in effect for the proposed individual provider. To initiate a contract, the
provider must provide a>
a. Social Securit9 card 'an original card from the Social Securit9 #dministration
or other written verification from that office+ or a certificate of birth in the
3nited States; and
b. Lalid driver=s license or other picture identification from the I-7 list; "!
c. #uthori:ation to wor in the 3nited States.
.2 4nsure that the identifications presented are the person who wants to be
contracted. =ou may accept veri&ication o& ID and a *ac$ground chec$ &rom
HC#A. # bacground chec from 0CB# ma9 be accepted for up to one 9ear
from date it was run b9 0CB#.
.- 1hotocop9 the original documents and attach the cop9 to the contracts. 5hen
9ou cannot machine cop9 the original documents, record the document t9pes,
numbers, and a statement that staff reviewed the original documents. Sign and
date the statement and attach the statement to the contract instead of the
document copies.
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)65,. If 9ou have reasonable cause to believe that the provider has been
arrested or convicted of a disqualif9ing crime within the two-9ear c9cle, 9ou
must complete a new bacground chec.
In-0ome 1roviders
)ote. $ou ma9 use this process only when 9ou cannot cop9 the original documents.
(. Complete the 0CS/### Individual 1rovider Intae each time 9ou complete a
contract for an I1, which normall9 will be at the time of initial contracting and then
ever9 four 9ears. If, for some reason, 9ou complete a new contract on a provider
prior to the four 9ear renewal c9cle, 9ou must complete a new 0CS/###
Individual 1rovider Intae. To do this>
#ccess the 0CS/### Individual 1rovider Intae form at
http>//asd.dshs.wa.gov/CCS/CCS-formats.htm, and clic on Forms and
Formats and on HCS-AAA Individual Provider Intake.
0ave the I1 complete the I-7 form, which is 1art B of the 0CS/### Individual
1rovider Intae Instructions and place the I-7 form and all supporting
documentation in the I1=s contract file. $ou do not need to complete 1art B or
the I-7 form again if 9ou have a valid I-7 form and supporting documents are
currentl9 in the file;
4nter receipt of the I-7 form into #C&.
8. Inform the contractor about the criminal histor9 bacground application process
and e<plain that the &epartment/agenc9 is required to submit a Bacground
#uthori:ation ever9 two 9ears from the date of the previous bacground chec to
the 5ashington State 1atrol through>
a. The Bacground Chec Central 3nit 'BCC3+, which provides comprehensive
criminal histor9 information, including aliases, as well as information about
persons who are on a state registr9 for findings of abuse, neglect,
abandonment, or e<ploitation against a minor or vulnerable adult.
b. In addition to the above, if the provider has lived in 5ashington State less
than three 9ears, 9ou must do a fingerprint-based chec. See the @ingerprint
Chec @#Bs for additional information.
.. 4<plain that the law prevents the &epartment from contracting with and maing
pa9ment to a provider who, under 5#C (66-,2-*.8*>
a. 0as been convicted of a disqualif9ing crime. &isqualif9ing crimes are in
statute and are listed in the &isqualif9ing Crimes @#Bs.
b. 0as been found b9 a court, state licensing board, disciplinar9 board, or
dependenc9 board to have neglected, se<uall9 abused or e<ploited a minor or
vulnerable adult.
c. 0as abused, neglected, abandoned, or e<ploited a minor or vulnerable adult.
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d. 0as a court-issued order of protection against him/her for abuse or
e<ploitation of a minor or a vulnerable adult.
e. 0as been determined b9 a state agenc9 or &epartment to have abused,
neglected, abandoned, or e<ploited an9one.
f. 0as had a license to care for minors or vulnerable adults denied, revoed, or
suspended.
g. 5ill be unable to appropriatel9 meet the client=s needs, as determined b9 the
&epartment or ###, who has a reasonable good faith belief '!C5
,8.(7#.*7. '6+ and 5#C (66-,2-*.8) +.
)65,. Send a 1lanned #ction Dotice '28-8*.+ to the client when den9ing the client=s
choice of provider, and include the date, reason, and 5#C. Send a 1rovider
Dotification to the provider.
Submitting a Background Check
$ou must perform a bacground chec before 9ou can complete the contract
process. !efer to Bacground Chec @#Bs for more information.
2. 0ave the I1 complete and sign the criminal histor9 Bacground #uthori:ation
according to instructions. !eview the application.
-. &en9 the contract if the I1 discloses a E9esF in K22 'if disqualif9ing+ through K28
on the authori:ation.
(. Inform the client and provider that the Bacground #uthori:ation must be
completed before the provider can be contracted. The Bacground #uthori:ation
must be sent utili:ing the web-based s9stem to BCC3 no later than 1 week after
the I1 signs the application.
8. Submit the Bacground #uthori:ation to the person's+ designated in 9our office to
process it through the web-based s9stem to BCC3. BCC3 will send the results
bac through the web-based s9stem.
5hen fingerprinting is required, submit the application through the web-based
s9stem, and hold the fingerprint card until 9ou receive the results from BCC3.
Then, mail the Bacground #uthori:ation 'with the I& for the applicant and the
BCC3 I& K 'which is identified in the web-based s9stem under results+ with
the fingerprint card attached to the &S0S Bacground Chec Central 3nit,
1" Bo< 8.*-., "l9mpia 76.*8-.*-..
5hen BCC3 receives the fingerprint-based results, the9 will send 9ou the
results letter.
Reviewing the Background Check Results
2. Dotif9 the client and provider that if the application comes bac from BCC3 with
a conviction for a disqualif9ing crime, a negative action, or a finding spelled out in
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K22 through K28 on the application, the &epartment will no longer provide
pa9ment to the provider.
D"T4>
There are no e<ceptions.
$ou will receive a RECOR letter from !CC" when there is a #ending
charge for a disqualif9ing crime. 0owever, pending crimes are alwa9s
disqualif9ing based on character$ com#etence$ and suita%ilit&, until there is an
outcome in court. The character$ com#etence$ and suita%ilit& determination
must be documented on the #ssessment &ocumentation @orm or other
document that is maintained in the provider=s file. 5hen the court has made
its determination, the person must be disqualified if convicted of a
disqualif9ing crime. Complete a character, competence, and suitabilit9
determination in writing if the I1 has a conviction for a non-disqualif9ing crime
or the person is found not guilt9.
If the provider disputes the outcome of the bacground chec, he/she
must go to the court and as that the9 @#M the court records that provide
proof of the inaccurac9 to BCC3. BCC3 will review the court documents,
include the ##N when necessar9, and re-issue a corrected letter if the court
information provides clarification of the crime.
-. !eview the results of the bacground chec and>
a. 1rovide the results of the bacground chec to the client, per !C5
8(.-*#.,2* '.+.
b. &en9 the provider if BCC3 sends a letter that states EConvictions and'or
Other (e)ative Action A)ainst the A##licant are on the Secretar&*s +ist of
is,ualif&in) Crimes and (e)ative ActionsF.
c. Complete a character, competence, and suitabilit9 determination when 9ou
receive a EA Record of Convictions and'or Other (e)ative Actions A)ainst the
A##licant which re,uires a Character$ Com#etence$ and Suita%ilit& ReviewF
letter. $ou ma9 use the #ssessment &ocumentation @orm or S4!s to
document 9our decision about denial or approval. Include this documentation
in the provider file. If 9ou have previousl9 completed a character,
competence, and suitabilit9 determination, 9ou do not have to complete a new
one on the same provider of the same client if there are no new convictions
or negative actions and the provider meets all other provider qualifications in
meeting the client=s needs. 'If the provider is going to wor for another client,
9ou need to complete another determination in relation to the new client.+ If
you find that you do not need a new determination$ &ou still need to
document that 9ou have>
!eviewed the current bacground chec;
@ound that there is no new information;
!eferred to the previous character, competence, and suitabilit9
determination 9ou made with the date; and
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Stated 9our decision.
d. Send a 1lanned #ction Dotice '28-8*.+ to the client, if 9ou are den9ing the
client=s choice of provider. Include the date, the reason 9ou are den9ing the
provider and the relevant 5#C.
e. Send a 1rovider Dotification '2)-276+letter to the provider when 9ou are
informing them of a denial and reason. $ou must terminate the provider with a
ten-da9 notice, unless 9ou believe the client is in imminent Jeopard9, in which
case termination is immediate, or the I1 has a conviction for a disqualif9ing
crime or negative action.
WAC 388-71-0540
WAC 388-71-0551
Obtaining, Reviewing, and aking !ction on "egative !ctions
5hen there is a negative action against an I1, 9ou will receive a EConvictions and/or
"ther Degative #ction #gainst the #pplicant are on the Secretar9=s Cist of &isqualif9ing
Crimes and Degative #ctionsF letter from BCC3, with the term Source b9 &ocument.
$ou will not receive an9 specific information because of laws that prohibit dissemination
of this information. 0owever, 9ou must tae the following action and den9 or terminate
an I1 who has a/an>
Child Protective Services &inding> C1S findings that follow due process are
sent to BCC3. 1re-due process findings are not. If 9ou receive information that
a provider has a C1S finding before due process, contact Sue %c&onough. She
will wor with the Children=s #dministration to obtain the information necessar9 to
tae action on the provider.
Dependency Action> This is a court proceeding and there are, potentiall9, a
number of people that can be a part of a dependenc9. Therefore, onl9 the ##N
can obtain this information. Contact Sue %c&onough so that she can enlist the
##N to obtain, review, and inform her about whether the dependenc9 resulted in
a finding against the I1.
APS &inding. @air hearing rights were established for alleged perpetrators on
"ctober 2, -**(. #1S sends final findings to BCC3 and these findings are part
of the bacground chec. If 9ou learn that there was an #1S finding that was
previous to "ctober 2, -**(, contact Sue %c&onough. She will wor with #1S to
obtain the information necessar9 to tae action on the provider.
Protection 6rder. This is a court proceeding. $ou need to have the I1 provide
9ou with a cop9 of the protection order so that 9ou can determine whether the
order involves a minor or vulnerable adult. If the order does not involve a minor
or vulnerable adult, the I1 can complete an affidavit swearing that the protection
order did not involve a minor or vulnerable adult. "nce it has been completed,
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)ote. 1roviders do not have the right to a fair hearing for denial or termination.
Clients do have fair hearing rights based on denial of their choice of provider.
In-0ome 1roviders
send it to BCC3, and eep a cop9 in the I1=s file. $ou also need to complete a
character, competence, and suitabilit9 determination.
Department o& Health ;D6H< &inding. &"0 sends all findings to BCC3, and
BCC3 sends 9ou a EConvictions and/or "ther Degative #ction #gainst the
#pplicant are on the Secretar9=s Cist of &isqualif9ing Crimes and Degative
#ctionsF letter. $ou need to go onto the &"0 web site www.doh.wa.gov and view
the findings. If the finding is for abuse, neglect, abandonment, or financial
e<ploitations, the I1 is disqualified. If not, 9ou need to complete a character,
competence, and suitabilit9 determination on the I1.
)65,. The detailed results of an @BI chec cannot be disclosed to the field, per federal
regulation. Contact Sue %c&onough with questions.
WAC 388-71-0520
Completing a Contract #or Individual Provider Service
"nce 9ou have taen the steps to initiate the contract, and the bacground chec
results allow the provider to wor, 9ou must>
2. Complete two '-+ contracts. @ollow the instructions in #C& on how to complete
the contracts. 4<plain to the provider the terms, conditions, and the statement of
wor. The contract is available in other languages, but it is the 4nglish version
that must be signed.
-. !eview the 1ersonal Care Services definitions.
(. 1rovide and discuss the clientIs C#!4 Service Summar9 and #ssessment
&etails with the provider. 5#C (66-,2-*.2.'2+ sa9s that the I1 must
E3nderstand the clientIs service plan that is signed b9 the client or legal
representative and social worer/case manager, and translated or interpreted, as
necessar9, for the client and the providerO.F
8. &iscuss the following training requirements 'See 5#C (66-,2-*.)). through
5#C (66-,2-*.7*7 for detailed information on training+ with the provider>
a. Caregiver "rientation, including the worboo and video, must be completed
within 28 da9s of beginning emplo9ment. (ote- 1arents who are I1s for their
adult children are e<empt from Caregiver "rientation.
)ote. Training requirements for parent providers, as outlined in 5#C (66-,2-
*.,). and (66-,2-*.,,* are different than for other providers.
b. !evised @undamentals of Caregiving must be completed within 2-* da9s of
emplo9ment 'or 26* da9s for parent providers+.
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)ote. #n I1 ma9 tae the %odified @undamentals of Caregiving Self-Stud9 course in
lieu of the full @undamentals course if the I1 documents successful completion of
training as an !D, C1D, nursing assistant certified, 1T, "T, or a %edicare-certified home
health aide.
i. If an I1 does not successfull9 complete the training within these time
periods, the &epartment, ###, or managed care entit9 will den9 pa9ment
for services, including training, per 5#C (66-,2-*.8* ')+. Send a 1#D to
the client and an I1 Dotification letter to the I1 ten da9s before the
required training time frame e<pires, if the I1 has not completed a required
training before then. Termination of pa9ment must be on the tenth da9 if
training has not been successfull9 completed.
ii. In the case of i. above, the I1 cannot be re-qualified as a provider until
she/he completes !@"C training on his/her own time and cost.
c. Continuing education of 2* hours must be completed each calendar 9ear
following the fundamentals training. (ote- This training is not required for
parent providers.
i. If an I1 has a brea in service and returns to wor on or before &ecember
(2st, the caregiver must complete the C4 requirements for that 9ear.
ii. If an I1 has a brea in service and returns to wor after &ecember (2st,
the caregiver must complete the C4 requirements in the 9ear s/he returns
to wor.
iii. If an I1 has a pattern of quitting wor at the end of a 9ear without
completing the C4 requirement and returning to wor in the following 9ear,
9ou ma9 tae action to terminate the provider=s contract for convenience
per 5#C (66-,2-*.8*'7+ and 5#C (66-,2-*..).
iv. If an I1 does not complete continuing education b9 the end of the 9ear, or
in the case of iii. above, the I1 cannot be re-qualified as a provider until
s/he completes C4 training on his/her own time and cost.
d. !equired training as outlined in 5#C (66-,2-*.6*. through 5#C (66-,2-
*.6(*, for an I1 who will be performing a nurse delegated tas.
e. Dot completing the required training within the time limits, listed above, results
in termination of the I1=s pa9ment and potentiall9 the contract if the I1 does
not compl9.
)ote. The I1 is given the original certificate of successful completion of training. #
cop9 of the certificate verif9ing completion of each training must be placed in the
provider=s record. Dot completing the required training within the time limits listed above
results in termination of the I1=s pa9ment, per !C5 ,8.(7#.*.* '2*+, and potentiall9 the
contract if the I1 does not compl9.
!ev. *2/28
2(
)65,. I1s cannot be paid without an accurate and complete contract: #ltered,
incomplete, or inaccurate contracts will be returned, unsigned to the originator.
In-0ome 1roviders
.. Complete the following in order to e<ecute the contract and pa9 the provider>
a. Create the contract;
b. 0ave the provider sign two copies;
c. 0ave the designated person's+ in 9our office countersign the contract. The
person who countersigns the contract must be someone other than the person
who creates the contract, obtains the provider number, and authori:es services;
d. 4nsure that I-7 information was received and documented in the #C&; and
e. 1ut the contract in HSigned Status= in #C&.
). "btain a SS1S provider file number. See Netting a 1rovider Dumber @#Bs for
instructions. Nive the contractor one cop9 of their signed/e<ecuted contract,
retain one for records, and give the I1 an 4mplo9ment !eference Nuide for
Individual 1roviders, &S0S -----2 'M+.
,. Complete a new contract ever9 four 9ears. # name change does not require a
new contract as long as 9ou are sure that the provider is the same person,
through viewing picture I&, etc. @or additional information, see the E0ow &o I
Complete the Contracting 1rocess with an Individual 1roviderF section.
$sing the Individual Provider "oti#ication Letter
There are a number of actions that will require 9ou to complete the Individual 1rovider
Dotification>
Denial of a contract. 5hen 9ou den9 an initial I1 contract or 9ou will not renew
the contract because, but not limited to, the I1>
Self-discloses a disqualif9ing crime and/or has no contact orders related to
minors or vulnerable adults;
0as a conviction for a disqualif9ing crime or negative action;
&oesn=t provide the documents required for contracting, such as picture I&
or authori:ation to wor in the 3S;
0as a pending conviction for a disqualif9ing crime and must be denied
based on character, competence, and suitabilit9;
0as pending charges for non-disqualif9ing convictions, or convictions for
non-disqualif9ing crimes, and is denied based on character, competence,
and suitabilit9;
$ou have a reasonable, good faith belief that the I1 will not be able to
appropriatel9 meet the client=s care needs.
Denial or termination of payment: 5hen an I1 has a contract but cannot be a
paid I1 because of non-compliance with provider requirements, including, but not
limited to, the I1>
0as not completed required training;
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In-0ome 1roviders
0as poor performance;
Is not following the terms and conditions of the contract.
Summary suspension: 5hen the I1 has a contract and 9ou have reasonable
cause to believe that the client=s health, safet9, and well-being are in imminent
Jeopard9 'for e<ample, 9ou have reasonable cause to believe abuse or neglect
has occurred+. Summar9 suspension requires immediate termination of
pa9ment.
Termination of an IPs Individual Provider Client Services Contract: 5hen
the I1 has a contract and 9ou are taing action to terminate the contract for
default based on 5#C/!C5, or for convenience when the I1 no longer wants to
be contracted.
The Individual 1rovider Dotification Cetter contains>
o The effective date of the action;
o 5hat the action is;
o The reason for the action. 3nder the reason, the 5#C and !C5 are included, and
there is space for 9ou to document the specific reason's+ wh9 9ou are taing the
action's+.
)ote. There will be instances when 9ou will chec more than one action on the
Individual 1rovider Dotification letter. @or e<ample, 9ou ma9 summaril9 suspend a
contract for imminent Jeopard9, stop pa9ment, and tae action to terminate a contract.
WAC 388-71-0551
WAC 388-71-0556
erminating an %&isting Contract
$ou ma9 terminate an I1 contract for default or for convenience.
&efault> The provider is not in compliance with the e<pectations or requirements
of the contract, including, but not limited to> performance failure; ris to the health
and safet9 of the client; falsification of information; violation of the contract, law,
or regulation; and/or criminal charges. #n e<ample would be a substantiated
#1S finding.
Convenience> Termination when the I1 and &epartment agree to end the
contract. 4<amples would be when an I1 wors for a client who dies and the I1
does not want to be an I1 for an9one else.
De&ault 5erminations.
5#C (66-,2-*..2 provides the &epartment or ### with the authorit9 to tae action to
terminate or summarily suspend an I1Is contract if the providerIs inadequate
performance or inabilit9 to deliver qualit9 care is Jeopardi:ing the clientIs health, safet9,
well-being or the client is in imminent Jeopard9. !eview this 5#C for specific details.
Advance (otice /ermination-
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2.
In-0ome 1roviders
a. Send the client a 2*-da9 notice when taing action to terminate the I1 contract. $ou
must provide a 2*-da9 notice unless 9ou>
0ave been notified b9 BCC3 that the I1 has been convicted of a disqualif9ing
crime;
0ave been notified b9 BCC3 that the I1 has a negative action/is on a registr9;
and/or
Believe the client is in imminent Jeopard9.
In each of these situations, taing action to terminate must be immediate.
b. Send the client a 2*-da9 advance 1lanned #ction Dotice, informing the client of the
I1 contract termination, the reason, and 5#C. This notice includes the client=s right
to a fair hearing;
c. Send the I1 a 1rovider Dotification letter. Include the reason, the 5#C, and the
effective date of the action;
d. Terminate pa9ment and submit a 1rovider @ile #ction !equest '1@#!+ to SS1S to
request that the file be closed and include a reason; and
e. Send 9our request for default contract terminations with a memo, a cop9 of the entire
contract, and the Individual 1rovider Dotification Cetter to>
#pril Bo:e-0assett
#ging P &isabilit9 Services #dministration
1" Bo< 8.)**
"l9mpia, 5# 76.*8-.)**
5he e&&ective dates must match on *oth letters:
$ou ma9 attach documentation Justif9ing the termination if the request is for default.
Qustification ma9 include> a memo e<plaining #1S findings, bacground reports showing
criminal charges, audit reports, reports b9 case managers or other documentation
indicating that the contractor has breached the terms of the contract or failed to ensure
client health or safet9.
f. Send a request to SS1S to establish a Code 8 Status. # Code 8 is a tool through
which 9ou and other 0CS/### staff can communicate default actions related to a
provider.
Immediate /ermination'Summar& Sus#ension.
a. 1rovide a notice to the I1 that the effective date is immediate when 9ou have>
o Been notified b9 BCC3 that the I1 has been convicted of a disqualif9ing
crime;
o Been notified b9 BCC3 that the I1 has a negative action/is on a registr9;
o !easonable cause to believe that the client=s health, safet9, and well being
are in imminent Jeopard9.
b. Send the client a 1#D; the effective date is immediate. It should match the effective
date on the Individual 1rovider Dotification Cetter.
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In-0ome 1roviders
c. Terminate pa9ment immediatel9; and
d. @ollow the same instructions outlined under 2*-da9 notice above.
@or contract terminations, #CTS# 0B will>
a. @orward a cop9 of the memo and Individual 1rovider Dotification Cetter to Central
Contract Services 'CCS+ for termination; and
b. Send a cop9 of the termination letter to 0CS or ###, once it is received from CCS.
Convenience 5erminations.
Send a cop9 of the contract and a memo to #pril Bo:e-0assett, and #CTS# will>
a. Terminate the contract;
b. Send 0CS or the ### a cop9 of the termination letter; and
c. &irect SS1S to terminate pa9ment and close the SS1S number.
$ou do not need to request a contract termination for contracts that have e<pired. The
contract automaticall9 ends on the end date and does not require a letter of termination.
Provider !iles
The provider=s file must include>
Copies of the I1=s I&;
Contractor Intae;
Signed and counter signed contract;
Bacground #uthori:ation;
Bacground !esults Cetter and rap sheet;
Character, competence, and suitabilit9 determination;
Copies of training certificates;
I1 Dotification Cetter;
&ocumentation related to contract terminations;
Cetters that 9ou send to the I1, for e<ample training reminders, etc.; and
"ther documentation that 9ou determine is appropriate.
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In-0ome 1roviders
!ingerprint Chec$ !A#s
When is a &ingerprint card re%uired?
# complete blue and white provider fingerprint card is required when the provider has
lived in the state of 5ashington less than three consecutive 9ears from the date of the
application for emplo9ment. BCC3 processes these through the 5ashington State
1atrol '5S1+ and the @BI, and provides 9ou with the results.
Which *o-es must I complete on the &ingerprint card?
The @BI requires that the following bo<es be completed. Complete the bo<es before
9ou roll the fingerprints, to avoid smudging>
Signature of the person fingerprinted;
Signature of official taing fingerprints and the date;
Cast name, first name, and middle name of the person fingerprinted;
Social Securit9 K;
Se<; and
&ate of birth.
Why is a thum*print re%uired on some *ac$ground chec$s?
# thumbprint is required when the 5S1 has two or more people in their s9stem with the
same name and birth date, or so close that the9 are unable to determine which person
the record belongs to. In these instances, a thumbprint is required. This ma9 be
required even if the provider has lived in the state of 5ashington more than three
consecutive 9ears. Complete a thumbprint onl9 when BCC3 informs 9ou that a
thumbprint is required. BCC3 will provide 9ou with a pacet of directions to follow. This
pacet includes the document on which the thumbprint must be rolled. &o not use a
blue and white provider card to roll a thumbprint. "nce rolled, send the thumbprint with
the bacground inquir9 application to the 5S1. The9 will send the results to the
bacground unit, who will notif9 9ou of the results.
Is it possi*le to have law en&orcement roll the &ingerprints on our providers?
Caw enforcement charges a fee to roll fingerprints, which the &epartment cannot require
the provider to pa9. If an agenc9 elects to have law enforcement roll fingerprints, the9
must use e<isting funds. The &epartment cannot be billed and the agenc9 cannot
request additional funding for this purpose.
Can AAA>HCS>home care agencies re%uire that all providers *e &ingerprinted?
The law does not preclude the ###=s or home care agencies from requiring that all
providers be fingerprinted. The statute, however, allows the &epartment to complete
@BI fingerprint-based bacground checs onl9 on those providers who have lived in the
state of 5ashington less than three consecutive 9ears. In addition, the funding that was
allocated b9 the legislature for the implementation of the statute did not provide for
fingerprint-based checs on all providers.
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In-0ome 1roviders
What does the ?2@3-day provisional hireA mean?
The 2-*-da9 provisional hire means that the provider can wor up to 2-* da9s pending
the outcome of the @BI fingerprint-based chec after the provider is cleared through the
web-based bacground chec. The fingerprints must be rolled at the same time the
contract process occurs. This does not mean that the provider has 2-* da9s to get their
fingerprints rolled.
What i& the provider lies a*out how long he>she has lived in the state o&
Washington?
The statute sa9s that an @BI fingerprint-based bacground chec is required if the
provider has lived in the state of 5ashington less than three consecutive 9ears from the
date of application for emplo9ment. If the provider has lived in the state, moved for a
short time within the three-9ear period, and returned to the state, that person has lived
in the state of 5ashington less than three consecutive 9ears. If the provider lies, he/she
has committed perJur9 because of the signature required when completing the
bacground inquir9 application. If the perJur9 has resulted in harm to the client, law
enforcement ma9 tae action. If 9ou have reasonable cause to believe that the provider
has lived in the state of 5ashington less than three 9ears, 9ou must fingerprint the
provider. If the provider refuses to get fingerprints, 9ou must den9 the contract of a new
provider or terminate pa9ment for an e<isting provider.
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In-0ome 1roviders
Dis%uali&ying Crimes !A#s
What are the dis%uali&ying crimes?
&isqualif9ing crimes for I1s and 0ome Care #genc9 1roviders include>
#bandonment of a child 1romoting prostitution 2
#bandonment of a dependent person 1rostitution '( or more 9ears+
#buse or neglect of a child !ape
#rson 2 !ape of child
#ssault 2 !egistered se< offender
#ssault - !obber9
#ssault ( Selling or distributing erotic material to a minor
#ssault 8/simple assault '( or more 9ears+ Sending or bringing into the state depictions of a
minor
#ssault of a child Se<ual e<ploitation of minors
Burglar9 2 Se<ual misconduct with a minor
Child bu9ing or selling Theft 2
Child molestation Theft - '. or more 9ears+
Commercial Se<ual #buse of a %inor/1atroni:ing a
Juvenile prostitute
Theft ( '( or more 9ears+
Communication with a minor for immoral purposes 3nlawful imprisonment
Criminal mistreatment Lehicular homicide 'negligent homicide+
Custodial assault
Custodial interference Liolation of child abuse restraining order
Custodial se<ual misconduct Liolation of protection/contact/restraining order
&ealing in depictions of minor engaged in se<ual
e<plicit conduct
Liolation of the Imitation Controlled Substance
#ct 'manufacture/deliver/intent+
4<tortion Liolation of 3niform Controlled Substance #ct
'manufacture/deliver/intent+
@orger9 '. or more 9ears+ Liolation of the 3niform Cegend &rug #ct
'manufacture/deliver/intent+
Incest Liolation of the 3niform 1recursor &rug #ct
'manufacture/deliver/intent+
Indecent e<posure/1ublic indecenc9 '@elon9+
Indecent liberties
Ridnapping
%alicious harassment
%anslaughter
%urder/#ggravated murder
)egative Actions are considered under individual program law and rule and ma9 lead to denial of
unsupervised access to vulnerable adults. # negative action is an administrative action taen against an
individual and ma9 include>
# decision issued after a due process hearing b9 an agenc9 or an #dministrative Caw Qudge showing
a finding of abuse, neglect, e<ploitation, or abandonment of a vulnerable adult, Juvenile or child.
Termination, revocation, suspension, or denial of a license, certification, and/or State or @ederal
contract.
!elinquishment of a license, certification, or contract in lieu of an agenc9 negative action.
!evocation, suspension, denial or restriction placed on a professional license.
&epartment of 0ealth disciplining authorit9 findings.
Crimes >
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In-0ome 1roviders
# person who has a crime listed is denied unsupervised access to vulnerable adults,
Juveniles, and children.
If E'. or more 9ears+F or E'( or more 9ears+F appears after a crime, the person cannot
be in a position to be left alone with a vulnerable adult unless . or more 9ears or unless
( or more 9ears has passed since the date of the conviction.
#fter . or ( 9ears has passed, an overall assessment of the person=s character,
competence, and suitabilit9 to have unsupervised access will determine denial.
Does the list o& crimes include protection orders?
This list does include protection orders, as required in !C5 8(.8(.6(- and !C5
8(.8(.6(8. 1rotection orders that affect provider eligibilit9 are those that relate to the
protection of minors and vulnerable adults.
!ev. *2/28
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In-0ome 1roviders
'ac$ground Chec$ !A#s
How should I su*mit 'ac$ground AuthoriBations to 'CC7 that donCt re%uire
&ingerprints?
3se the web-based s9stem to submit all Bacground #uthori:ations to BCC3. BCC3
will send bac the results using the web-based s9stem. The results will include the rap
sheet's+, if applicable.
How should I su*mit 'ac$ground AuthoriBations to 'CC7 when &ingerprints are
re%uired?
If a fingerprint card is required, send in the Bacground #uthori:ation through the web-
based s9stem. 5hen 9ou receive the results, put the I& K for the client and the BCC3
I&K on the authori:ation and mail them to>
Bacground Chec Central 3nit
%S 8.*()
1.". Bo< 8.*()
"l9mpia, 5# 76.*8-.*()
BCC3 will run them through 5S1 and @BI and send the results 9our office or agenc9.
The authori:ation will not be included with the results.
When must I deny or terminate a provider?
$ou must deny or terminate a provider when 9ou receive a EConvictions and'or Other
(e)ative Action A)ainst the A##licant are on the Secretar&*s +ist of is,ualif&in)
Crimes and (e)ative Actions0 letter from BCC3.
Who do I share the results o& the *ac$ground chec$ with?
!C5 8(.-*#.,2* '.+ states, EThe secretar9 shall provide the results of the bacground
chec on individual providers to the persons hiring them SclientT or to their legal
guardiansOF The results ma9 be given to the provider. @BI results ma9 be provided to
the provider with a release, but @BI results ma9 not be released to the client or to field
staff. Contact Sue %c&onough with questions.
When a *ac$ground chec$ is run+ does it chec$ &or Adult and Child Protective
Services &indings?
BCC3 retains a list of persons with #1S findings and C1S findings post due process.
$ou will not be provided with details. $ou must den9 or terminate when 9ou receive this
information. If 9ou learn that a provider had a finding with #1S or C1S pre-due process,
contact Sue %c&onough, and review findings based on character, competence, and
suitabilit9.
What letter will 'CC7 send when there is an APS &inding?
BCC3 will issue a EConvictions and'or Other (e)ative Action A)ainst the A##licant are
on the Secretar&*s +ist of is,ualif&in) Crimes and (e)ative Actions0 letter.
!ev. *2/28
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In-0ome 1roviders
Why donCt the letters that 'CC7 sends provide more in&ormation+ such as why a
provider is dis%uali&ied?
BCC3 uses standardi:ed letters for all administrations. The rap sheets provide specific
information about pending crimes and convictions.
What letter does 'CC7 issue when the *ac$ground chec$ results state DEiolation
o& the 7ni&orm Controlled Su*stance ActC ;E7CSA<?
BCC3 will issue a EConvictions and'or Other (e)ative Action A)ainst the A##licant are
on the Secretar&*s +ist of is,ualif&in) Crimes and (e)ative Actions0 letter until the
provider has the court fa< court records to BCC3 that clarif9 the conviction. # felon9
E1ossessionF conviction will result in a EA Record of Convictions and'or Other (e)ative
Actions A)ainst the A##licant which re,uires a Character$ Com#etence$ and Suita%ilit&
Review0 letter$ which requires a character, competence, and suitabilit9 determination
that is documented.
What does 'CC7 do when the *ac$ground chec$ results are unclear?
If a bacground chec result is unclear, 'does not specif9 the degree, the seriousness or
nature of the crime/action+, BCC3 is unable to mae a determination. To ensure the
safet9 of clients and to avoid potential ris b9 acting contrar9 to the law, BCC3 sends a
EConvictions and'or Other (e)ative Action A)ainst the A##licant are on the Secretar&*s
+ist of is,ualif&in) Crimes and (e)ative Actions0 letter. If the provider believes that
the result should not be considered disqualif9ing, BCC3 should be contacted. BCC3
will e<plain the basis for the letter, how to gather further information and how to request
correction of the record through the 5S1 or @BI. The provider must have the court in
which the9 were convicted fa< court documents to BCC3. In conJunction with the ##N,
BCC3 determines whether the crime is disqualif9ing and will re-issue a letter
accordingl9. The disqualification determination must stand pending the provider taing
the responsibilit9 to clear/clarif9 their record.
What happens i& a potential provider answers DyesC to %uestions F22 through F29
on the 'ac$ground AuthoriBation !orm?
BCC3 must issue a EConvictions and'or Other (e)ative Action A)ainst the A##licant
are on the Secretar&*s +ist of is,ualif&in) Crimes and (e)ative Actions0 letter, until
receipt of court documents clarif9ing the conviction/action or a document signed b9 the
provider that e<plains the basis for disclosing the conviction/action.
Does the complete *ac$ground chec$ need to *e done i& the provider sel&-
discloses a conviction &or a dis%uali&ying crime? $es. $ou can den9 the contract at
the point of self-disclosure, but a bacground chec must be completed. The provider
has agreed b9 their signature to have &S0S conduct a bacground chec and release
the results to the agenc9 and client. The process, as stated on the form, must be
completed to assure that &S0S has fulfilled its part of the agreement and to ensure that
an9 criminal conviction information is recorded in the s9stem.
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In-0ome 1roviders
When does a character+ competence+ and suita*ility determination need to *e
made?
5hen 9ou receive a EA Record of Convictions and'or Other (e)ative Actions A)ainst
the A##licant which re,uires a Character$ Com#etence$ and Suita%ilit& Review0 letter
from BCC3, 9ou need to mae this determination. 5hen maing a character,
competence, and suitabilit9 determination, 9ou need to consider, but not limit 9our
determination to, the following>
The crime's+. #n e<ample> There are convictions for driving while into<icated,
suspension of a driver=s license, and/or other such convictions, and the provider is
going to be providing transportation to the client.
5hen the conviction's+ occurred> #n e<ample> There are convictions for a time-
limited crime, such as assault 8 'domestic violence+, but the time has elapsed. The
client has no informal supports/famil9 that visit.
# pattern of convictions that reflect poor choices and further ma9 reflect poor
decision maing. #n e<ample> Convictions for misdemeanor possession of
substances, driving while into<icated, driving without insurance, etc. The I1 is
responsible to provide adequate care, observe the client for issues related to their
health, and ensure the client is safe.
In most instances, the I1 and client have a one-to-one relationship Hbehind closed
doors,= and the client is vulnerable. $ou must mae the determination on a case-b9-
case basis and not limit 9our determination of character, competence, and suitabilit9 to
the above e<amples onl9.
5hen 9ou disqualif9 a provider, 9ou need to document the reason's+ wh9. 5hen 9ou
disqualif9 a provider, send a 1lanned #ction Dotice to the client and a separate 1rovider
Dotification letter to the provider. !efer providers to the court in which the9 were
convicted to provide written clarification to BCC3 of bacground chec results that the9
dispute. BCC3 must provide the notification to us based on the bacground information
the9 receive and cannot change the notification letter without clarif9ing information from
the court. The court must @#M the court documents to BCC3. BCC3 will re-issue a
finding letter when their review of the documents and consultation with the ##N indicate
a change. Send a 1lanned #ction Dotice to the client and a 1rovider Dotification letter
to the provider when den9ing or terminating.
How o&ten does a *ac$ground chec$ need to *e completed on a provider?
4ver9 two 9ears, unless 9ou have reasonable cause to believe that the provider has
been arrested or convicted of a disqualif9ing crime. In this circumstance, 9ou need to
re-run another bacground chec.
Where should I address %uestions a*out the *ac$ground chec$ %uali&ication
process?
#ddress questions regarding polic9 to Sue %c&onough, at '()*+ ,-.--.((, or e-mail
at %c&onSC/dshs.wa.gov.
!ev. *2/28
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In-0ome 1roviders
#ddress process questions to the BCC3, b9 calling '()*+ 7*--*-77, and selecting K
- from the menu options. $ou can also e-mail BCC3 at bccua/dshs.wa.gov.
(etting a Provider )um*er !A#s
How do I get a provider num*er &or a new provider?
$ou will initiate the 1rovider @ile #ction !equest '1@#!+ through the #genc9 Contracts
&atabase '#C&+ s9stem. This can be done as part of 9our contracting process. The
SS1S 1rovider @ile 3nit will assign the provider number.
I& I have an e-isting green contract and the provider in&ormation changes+ e:g:
change o& address+ am I re%uired to initiate a new contract through the ACD
system?
Do, 9ou can establish a new contract through #C&, but a new contract is not required.
$ou will need to mae the changes to the 1@#! manuall9 after downloading it from the
forms website and e-mail it to the P6EID, !IL, 7)I5, as described below.
How do I ma$e changes to an e-isting P!A?
$ou will access the 1@#!, which will be blan, mar the EchangeF bo< in field K2, mae
the changes, and submit via e-mail to the P6EID, !IL, 7)I5.
Is the SSPS Provider !ile still going to *e availa*le to the &ield?
Do.
Can I get a P!A in electronic &ormat?
$es, the form, 1rovider @ile #ction !equest &S0S K*)-*7,, is available in electronic
format.
How will the P!A get &rom ACD to SSPS?
5hen 9ou have completed the 1@#!, send an e-mail to 1rovider@ile3nit/dshs.wa.gov,
with the 1@#! as an attachment.
Who will noti&y me o& the provider num*er and how long will it ta$e?
If 9ou send in a completed 1@#!, the 1rovider @ile 3nit will notif9 9ou of the provider
number within -8 hours.
What i& there is an emergency?
4mergencies will be input upon receipt with a same da9 response, if received b9 noon.
3se the !equest for 4<pedited SS1S 1rovider @ile Input form '&S0S K*)-287+.
What a*out ma$ing deadline? IsnCt that an emergency?
It is onl9 an emergenc9 if 9ou are contracting with the provider on the date of the
deadline. In all other instances 9ou will be initiating a 1@#! as part of the contracting
process.
What are the steps in ACD that I must ta$e to o*tain a provider num*er?
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In-0ome 1roviders
6*tain a contract number, which is assigned as part of the #C& process, and
@ollow the 1@#! Instructions.
Central Contract Services has a website that contains further instructions and visual
information to assist 9ou in this process. The website is>
http>//asd.dshs.wa.gov/ccs/CCS-acd-usertip.htm.
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In-0ome 1roviders
ules and Policy
5#C (66-,2-*.** through (66-,2-*.7*7 Individual 1rovider and 0ome Care #genc9
1rovider Bualifications
Chapter (66-2*) 5#C Cong Term Care Services
!C5 8(.-*#.,2* Investigation of conviction records or pending
charges of state emplo9ees and individual
providers.
!C5 ,8.(7#.*7. Case management services -- #genc9 on
aging oversight -- 1lan of care -- Termination
of contract -- !eJection of individual provider.
!C5 ,8.(7# Cong-Term Care Services "ptions--
4<pansion
!C5 ,8.*7..-* %edical assistance -- Care and services
included -- @unding limitations.
!C5 8(.8(.6(* through 8(.8(.68- 5ashington State 1atrol
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