Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 208 - Home and Community Based Services (HCBS) Long Term Care
Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver
Rule 23-208-5.4 - Evaluation/Reevaluation of Level of Care (LOC)
Universal Citation: MS Code of Rules 23-208-5.4
Current through September 24, 2024
A. A participant's level of care (LOC) is determined by an initial evaluation and required reevaluations to assess the needs for services through the Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver.
1. All LOC initial evaluations and required
reevaluations must be conducted by one (1) of the five (5) Diagnostic and
Evaluation (D&E) Teams housed at the Department of Mental Health's (DMH's)
five (5) comprehensive regional programs.
2. The specific battery of standardized
diagnostic and assessment instruments must accurately assess the individual's
level of function in all areas of development and serve as a baseline for
future reassessments.
3. There is
not a single instrument/tool required to determine LOC eligibility requirements
for Intermediate Care Facility for Individuals with Intellectual Disabilities
(ICF/IID).
B. Initial LOC evaluations must:
1. Be conducted in an
interdisciplinary team format that includes, at a minimum, a psychologist and
social worker with other disciplines participating, as needed, based on the
applicant's needs.
2. Be
administered by evaluators:
a) Whose
educational/professional qualifications are the same as evaluators of ID/DD
Waiver and ICF/IID services, and
b) Who are appropriately licensed/certified
under state law for their respective disciplines.
3. Include an ID/DD Waiver LOC reevaluation
tool to establish a baseline for future assessments.
C. Reevaluations of LOC must be:
1. Conducted at least annually or when a
significant change occurs which is defined as a decline or improvement in a
participant's status including, but not limited to, a change:
a) In mental or physical status that will not
normally resolve itself without intervention by staff or implementing standard
disease-related clinical interventions,
b) That is not self-limiting for declines
only,
c) That impacts more than
one area of the participant's health status,
d) Which requires interdisciplinary review
and/or revision of the Plan of Services and Supports (PSS),
2. Administered by ID/DD Waiver
support coordinators,
3. Reviewed
by Master's level staff before submission to DMH,
4. Reviewed by the Diagnostic and Evaluation
(D&E) team if a significant change occurred since the baseline LOC
assessment, and
5. Reviewed by
DMH.
D. All participants must be initially certified by DMH as needing ICF/IID LOC before services provided through the ID/DD Waiver can begin.
42 USC § 1396 n; 42 CFR §§440.180, 441.302, 483.20; Miss. Code Ann. § 43-13-121.
Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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