§ 388-106-0050(1). A beneficiary who disagrees with his CARE evaluation may appeal the evaluation in an administrative hearing. Id. § 388-106-1305. A beneficiary who remains dissatisfied with his allocated hours of assistance may request additional hours through an Exception to Rule ("ETR"). Id. § 388-440-0001. DSHS will grant an ETR when "[t]he client's situation differs from the majority; . . . [i]t is in the interest of overall economy and the client's welfare; and [i]t increases opportunities for the client to function effectively." Id. § 388-440-0001(1)(b)-(d).
Once the CARE evaluation sets the number of hours to which a beneficiary is entitled, the beneficiary and his DSHS case manager work together to design a plan of care that specifies the services that the beneficiary will receive as well [*10] as the caregivers who will provide those services. Id. §§ 388-106-0045, 388-106-0130. At all times, a beneficiary has the right to choose where he will receive authorized services (for example, in his home, in a residential facility, or in a nursing home), id. § 388-106-0030; to "[t]ake part in and have [his] wishes included in planning [his] care," id.