Current through Register Vol. 50, No. 9, September 20, 2024
A.
The re-determination process follows the same format as the system entry
process.
B. The face-to-face
interview will not be necessary if the OCDD entry staff has met with the person
in the past six months and has consulted with the person on the results of the
screening tool in order to ensure the measure is fair and meaningful. For
children in early intervention, a face-to-face team meeting is required
annually for redetermination.
C.
Re-determination for eligibility for the system shall be required under the
following conditions.
1. For children in
early intervention, there must be an annual redetermination.
2. If a child transitions from EarlySteps,
there must be a redetermination by age 3, reflective of the change in
eligibility requirements and legal definitions of developmental disability for
ages 3 and up, in accordance with the Louisiana Developmental Disability Law
(R.S.
28:451.2).
3. If initial eligibility is established on
or after age 3, but prior to age 10, redetermination will occur within 5 years
of the initial determination. If the re-determination occurs prior to the
person's tenth birthday and there are no additional questions that would
require an additional re-determination, then a review upon the person's tenth
birthday should be conducted due to changing eligibility requirements and
definitions at that age. (A person must have three substantial functional
limitations versus two substantial functional limitations for ages 3 to 10
years.)
4. If at age 10, when at
least two statements of approval (SOA) have been issued and the presence of a
clear lifelong developmental disability exists and is expected to persist
indefinitely, no additional redeterminations will be needed in adolescence and
adulthood.
5. If a person does not
meet criteria noted above or enters the system after age 10 but before 22 years
of age, redetermination will occur within 5 years of the initial determination.
If the re-determination occurs prior to the person's sixteenth birthday, and
there are no additional questions that would require an additional
re-determination, then a review upon the person's sixteenth birthday should be
conducted to coincide with transition period from school to work and to
reassess continued need for services into adulthood.
6. If at age 22, when at least two SOAs have
been issued and the presence of a clear, lifelong developmental disability
exists and is expected to persist indefinitely, then no additional
redeterminations will be required in adolescence and adulthood.
7. If a person enters the system after age 22
(or between ages 16-22), at least two determinations must occur within 3-5
years of one another to document and confirm presence of a lifelong
developmental disability that is expected to persist indefinitely. No further
redeterminations will be needed if there is no concern over transient nature of
existing symptoms and need for continued assessment based upon ERT
review.
D. If during the
course of the initial determination process the ERT can establish substantial
functional limitations in at least three life areas with scores greater than
three standard deviations below the mean, the prognosis of the individual is
such that there is no likelihood of significant improvements in those life
areas, and there are no co-occurring medical or behavioral health conditions
that may impact the limitations and necessitate re-evaluation, the ERT may
decide the person has no need for any further redetermination.
E. Any persons who were approved to
participate in the system without requiring redetermination as of the date of
adoption of this Rule will continue to be approved for entry into the system
without redetermination, unless redetermination is requested as specified in
this rule and/or required for participation in specific services.
F. Redetermination is required as outlined
above and/or when:
1. diagnosis of a
developmental disability, as defined by state law is tenuous:
a. the individual appears to have a
developmental disability that is diagnosable, but further assessment is needed
to verify that the disability will be life-long;
b. the individual has a co-occurring
behavioral health condition that is prominent, but it is not clear that the
limitations are solely attributable to mental illness, therefore further
assessment is needed;
c. the
individual has a medical condition and may have an accompanying developmental
disability; however, it is not clear whether the limitations experienced by the
individual are attributable to the developmental disability, therefore further
assessment is necessary;
2. prognosis of a chronic life-long condition
of a developmental disability is uncertain;
3. new assessment information is obtained
that may impact prior determination of a presence of a developmental
disability. (This will also apply to individuals who were granted a "lifetime
SOA" prior to the adoption of this Rule.)
G. Redetermination may be requested by any
one of the following parties:
1. LGE entry
review team;
2. person requesting
supports;
3. persons family or
legal representative;
4. persons
support coordinator;
5. persons
service provider;
6. persons
planning team;
7. persons physician
determining level of care;
8. staff
involved in the provision of supports;
9. state monitoring authorities;
10. courts of appropriate
jurisdiction.
H. If a
person requires redetermination for approval, the LGE entry unit staff will
notify the person in writing, and as appropriate, the persons support
coordinator and/or provider, sixty days prior to the SOA expiration date. The
person then has thirty days in which to contact the EU staff to coordinate the
redetermination process.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
28:454.2.
