Washington's Draft ABA Rule Says Lack of Progress Doesn't Justify More Hours

HCA's early draft of Chapter 182-531A WAC expands recertification from four documentation items to sixteen, adds stabilization as a reason to reduce services, narrows harmful behavior to physical behavior, and requires family signatures on every visit note.

Washington's Health Care Authority circulated an early draft of its Apple Health ABA rules, Chapter 182-531A WAC, on August 21. The informal comment window closed August 31, so if you didn't send tracked changes, that round has passed. HCA says “there will be another opportunity to comment after the official draft is published.” That's the formal CR-102 proposal, which hasn't been filed yet.

The draft rewrites four sections: the Center of Excellence evaluation, the treatment plan, service delivery, and prior authorization and recertification.

The turn: recertification becomes the gate

Today's recertification asks for a reevaluation showing progress, with four listed items. The draft lists sixteen and adds a signed Level of Support Requirement form, HCA 12-411. Among the new ones:

  • Documented efforts to identify and mitigate barriers when goals aren't met, and one sentence that decides a lot of cases: “Lack of progress or regression does not inherently warrant an increase in service hours.”
  • “Confirmation that the requested direct service hours are not more than what is required to achieve goals.”
  • Treatment intensity that doesn't exceed “the client's and family's functional ability to participate.”
  • “A discharge plan that includes a transition to a less intensive treatment model.”
  • Behavioral graphs showing change from baseline.

New reasons to reduce or deny

  • “The member has achieved adequate stabilization of the behavior(s) and less-intensive treatment options are appropriate and indicated.”
  • Harmful behavior narrows to “harmful physical behaviors, meaning behaviors that cause imminent physical contact to self or others,” with self-injury and elopement named as examples.

Treatment plans and notes

  • Requested intensity must reflect “the least intensive level capable of achieving medically necessary goals” and the family's ability to participate.
  • In the treatment plan section, the participation goal drops school and employment: “home or community activities.” The Center of Excellence eligibility wording still names school.
  • Every visit note needs the rendering provider's and LBAT's names, credentials and signatures, plus “signatures from the client or family confirming the visit occurred.”
  • The fixed 15-day renewal deadline becomes “before the expiration date.” Authorization stays at three-month increments.

The limits

This is an early draft, not a proposed rule, and it can change. The text binds “the agency” and tells providers to “follow the MCO process” for managed care, so how far it reaches plan reviews depends on the plans. No effective date exists yet.

What you must know or do

  • Clinical directors: take your last three recertification packets and score them against the sixteen items. The misses are your comment and your training plan.
  • Find every case where hours went up after a plateau or regression. Under the draft, each one needs documented barrier analysis and protocol changes, not just more hours.
  • Owners: work out how you'd collect a family signature on every visit note, including technician sessions in the community, before the proposal is filed.
  • Sign up for HCA rulemaking notices so the CR-102 hearing and comment dates reach you.