Missouri Code of State Regulations
Title 9 - DEPARTMENT OF MENTAL HEALTH
Division 45 - Division of Developmental Disabilities
Chapter 2 - Eligibility for Services
Section 9 CSR 45-2.010 - Eligibility for Services From the Division of Developmental Disabilities

Universal Citation: 9 MO Code of State Regs 45-2.010

Current through Register Vol. 49, No. 6, March 15, 2024

PURPOSE: This amendment is necessary to increase the efficiency and effectiveness of the assessment process and update terminology.

This rule describes the process and terminology used to determine eligibility for Division of Developmental Disabilities services.

(1) Eligibility-Through this rule, the department intends to assist applicants for division services as they proceed through the eligibility determination process and to direct division staff so that they may assist applicants and individuals in expeditiously obtaining accurate, comprehensive evaluations and needed services. Specifically, the division intends to-

(2) Definitions-As used in this rule, unless the context clearly indicates otherwise, the following terms also mean:

(A) Applicant-A person who has applied for services from the division and/or that person's representative;

(B) Assessment-The process of identifying an individual's health status and intellectual, emotional, physical, developmental, and social functioning levels for use in determining eligibility or developing the service plan;

(C) Assessment team-Professionals employed by the Division of Developmental Disabilities with specialized training and experience in the field of developmental disabilities who determine the applicant's eligibility for services;

(D) Client-Any person who is placed by the department in a facility or program licensed and funded by the department or who is a recipient of services from a Regional Office (RO). Clients will be referred to as individuals throughout this rule;

(E) Cognitive or physical impairment-An impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques;

(F) Comprehensive evaluation-A study, including a sequence of observations and/or examinations of an individual, and/or a review of records such as medical and other relevant records, leading to conclusions and recommendations regarding eligibility.
1. For children from birth through age four (0-4), a comprehensive evaluation may include, but not necessarily be limited to, an assessment team's-
A. Assessment of the child using First Steps eligibility criteria, or review of evidence of one (1) of the at-risk factors set out in paragraphs (3)(A)1.-3. of this rule, coupled with a review of scores on the Vineland Adaptive Behavior Scales (Vineland);

B. Review of available educational and medical information;

C. Review of additional individualized assessment and interview results to provide evidence of cognitive or physical impairments likely to continue indefinitely, evidence of substantial functional limitations caused by cognitive or physical impairments, and evidence of a need for sequential and coordinated special services which may be of lifelong or extended duration; and

D. Formulation of conclusions and recommendations.

2. For individuals ages five (5) and older, a comprehensive evaluation may include but not necessarily be limited to an interdisciplinary assessment team's-
A. Review of the results of the Missouri Adaptive Abilities Scale (MAAS);

B. Review of available vocational and medical information, and educational information;

C. Review of additional individualized assessment and interview results to provide evidence of cognitive or physical impairments likely to continue indefinitely, evidence of substantial functional limitations caused by cognitive or physical impairments, and evidence of a need for sequential and coordinated special services which may be of lifelong or extended duration; and

D. Formulation of conclusions and recommendations.

E. Designated representative-A parent, relative, or other person designated by an adult who does not have a guardian. The designated representative may participate in the development of the individual support plan at the request of, and as directed by, the individual;

(G) Developmental delay-
1. A delay, as measured and verified by appropriate diagnostic measures and procedures, which results in a child having obtained no more than approximately fifty percent (50%) of the developmental milestones and skills that would be expected of a child of equal age and considered to be developing within normal limits. The delay must be identified in one (1) or more of the following five (5) developmental areas: cognitive, speech or language, self-help, physical (including vision and hearing), or psychosocial; or

2. Demonstrated atypical development in any one (1) of the five (5) developmental areas, based on professional judgment of an assessment team and documented by-
A. Systematic and documented observation of functional abilities in daily routine;

B. Developmental history; and

C. Other appropriate assessment procedures which may include but are not necessarily limited to parent report, criteria-referenced assessment, and developmental checklist;

(H) Developmental disability-A disability which-
1. Is attributable to-
A. Intellectual developmental disorder, cerebral palsy, epilepsy, head injury, autism, or a learning disability related to a brain dysfunction; or

B. Any other cognitive or physical impairment or combination of cognitive or physical impairments;

2. Is manifested before the person attains age twenty-two (22);

3. Is likely to continue indefinitely;

4. Results in substantial functional limitations in two (2) or more of the following six (6) areas of major life activities: self-care, receptive and expressive language development and use, learning, self-direction, capacity for independent living or economic self-sufficiency, and mobility; and

5. Reflects the person's need for a combination and sequence of special, interdisciplinary or generic care, habilitation, or other services which may be of lifelong or extended duration and are individually planned and coordinated;

(I) Eligible-Qualified through a comprehensive evaluation by the Division of Developmental Disabilities to receive services from the division, but not necessarily entitled to a specific service;

(J) First Steps- A program of the Department of Elementary and Secondary Education (DESE) offering coordinated services to Missouri families of children, birth to age three (3), who have delayed development or diagnosed conditions that are associated with developmental disabilities. First Steps is governed by 5 CSR 25-100.120 in accordance with Part C of the federal Individuals with Disabilities Education Act (IDEA);

(K) Individual support plan (ISP)-A document directed by the individual, with assistance as needed from a representative, in collaboration with a planning team. The ISP identifies strengths, capacities, preferences, needs, and desired outcomes of the individual. The ISP shall encompass a personalized mix of paid and nonpaid services and supports that will assist him/her to achieve personally defined outcomes. Training, supports, therapies, treatments, and/or other services to be provided for the individual become part of the ISP;

(L) Individual support plan team (ISP team)-The individual, the individual's designated representative(s), the support coordinator, and representatives of services required or desired by the individual;

(M) Initial Plan-A document that notifies the individual of eligibility for services and facilitates referral to case management;

(N) Intellectual developmental disorder- Significantly subaverage general intellectual functioning, at or below two (2) standard deviations below the mean, including a margin for measurement error when appropriate, as measured by an individually administered, comprehensive, and psychometrically sound test of intelligence. Intellectual developmental disorder originates before age eighteen (18) and is associated with significant impairment in adaptive behavior as assessed by both clinical evaluation and culturally appropriate, psychometrically sound measures;

(O) Intake-The process conducted prior to determination of eligibility by which data is gathered from an applicant;

(P) Legal representative-Parent of a minor child or legal guardian;

(Q) Logging-Recording in a uniform, consistent manner those dates and activities related to application, comprehensive evaluation, and other eligibility determination procedures as well as dates and activities related to applicant and individual appeals;

(R) Major life activities-
1. Self-care-Daily activities which enable a person to meet basic needs for food, hygiene, and appearance; demonstrated ongoing ability to appropriately perform basic activities of daily living with little or no assistance or supervision;

2. Receptive and expressive language-Communication involving verbal and nonverbal behavior enabling a person to understand and express ideas and information to the general public with or without assistive devices; demonstrated ability to understand ordinary spoken and written communications and to speak and write well enough to communicate thoughts accurately and appropriately on an ongoing basis;

3. Learning-General cognitive competence and ability to acquire new behaviors, perceptions, and information and to apply experiences in new situations; demonstrated ongoing ability to acquire information, process experiences, and appropriately perform ordinary, cognitive, age-appropriate tasks on an ongoing basis;

4. Mobility-Motor development and ability to use fine and gross motor skills; demonstrated ongoing ability to move about while performing purposeful activities with or without assistive devices and with little or no assistance or supervision;

5. Self-direction-Management and control over one's social and personal life; ability to make decisions and perform activities affecting and protecting personal interests; demonstrated ongoing ability to take charge of life activities as age-appropriate through an appropriate level of selfresponsibility and assertiveness; and

6. Capacity for independent living or economic selfsufficiency-Age-appropriate ability to live without extraordinary assistance from other persons or devices, especially to maintain normal societal roles; ability to maintain adequate employment and financial support; ability to earn a living wage, net (determined by the assessment team for each individual), after payment of extraordinary expenses caused by the disability; demonstrated ability to function on an ongoing basis as an adult independent of extraordinary emotional, physical, medical, or financial support systems;

(S) Markedly disturbed social relatedness-A condition found in children from birth through age four (0-4) and characterized by-
1. Persistent failure to initiate or respond in an age-appropriate manner to most social interactions; for example, absence of visual tracking and reciprocal play, lack of vocal imitation or playfulness, apathy, little or no spontaneity, or lack of or little curiosity and social interest; or

2. Indiscriminate sociability; for example, excessive familiarity with relative strangers by making requests and displaying affection;

(T) Missouri Adaptive Abilities Scale (MAAS)-A standardized, normative, and criterion-based instrument used to determine the existence and severity of substantial functional limitations of major life activities;

(U) Screening-Initial evaluation services, possibly including review by an assessment team of information collected during the intake and application processes to substantiate that the applicant is developmentally disabled or is suspected to be developmentally disabled and requires further assessment for eligibility determination;

(V) Substantial-At least two (2) or more standard deviations below the mean, taking into consideration the standard error of measure, on a standardized, norm-referenced measure;

(W) Substantial functional limitation-An inability, due to a cognitive or physical impairment, to independently perform a major life activity within expectations of age and culture; and

(X) Temporary action plan-A written plan authorizing additional time for the purpose of completing the comprehensive evaluation.

(3) Eligibility for services from the division is predicated on the applicant's either having an intellectual developmental disorder or developmental disability or being at risk of becoming developmentally delayed or developmentally disabled. The following criteria is used in carrying out comprehensive evaluations for determining eligibility for services from the division:

(A) Children From Birth Through Age Four (0-4). Individuals participating in the First Steps Program under DESE are eligible for services under the Division of Developmental Disabilities. The Division shall determine eligibility for those children not enrolled in First Steps based on one (1) of the following at-risk circumstances, when coupled with a score of at least one and one-half (1.5) standard deviations below the mean, taking into consideration the standard error of measure, in any one (1) area of a norm-referenced, standardized, and age-appropriate measure of adaptive function:
1. Receipt by the division of documentation, based upon an individualized assessment from a qualified developmental disabilities professional, that there is markedly disturbed social relatedness in most contexts which puts the child at risk of becoming developmentally delayed or developmentally disabled; or

2. Determination by a regional office that a child's primary caregiver has a developmental disability and that the developmental disability could put the child at risk of becoming developmentally delayed or developmentally disabled;

(B) Children Ages Five Through Seventeen (5-17).
1. Children scoring as follows on the MAAS shall be considered to have substantial functional limitations in two (2) or more areas of major life activity:
A. One and one-half (1.5) standard deviations below the mean in at least two (2) developmental areas; or

B. Two (2) or more standard deviations below the mean in only one (1) developmental area.

(C) Adults Ages Eighteen (18) and Older. Adults whose comprehensive evaluations, including results of the MAAS, indicate deficits in two (2) or more of the areas of major life activity shall be considered to have substantial functional limitations in those areas.

(4) Eligibility Process.

(A) Regional offices shall complete comprehensive evaluations within thirty (30) business days after receipt of valid applications and sufficient supporting medical, psychological, and/or educational reports. A Division of Developmental Disabilities staff member shall be designated to help ensure the eligibility determination process proceeds in a timely manner. The name of that individual shall be given to all applicants. This staff member shall have access to all necessary information relevant to the application for services.

(B) Individuals may apply for services only on application forms provided by the division.
1. By the end of the next business day after any referral, inquiry, or request for services, a regional office shall provide application forms and information about services offered by the division unless it is clearly evident that the inquiry, request, or referral has been made to the division inappropriately or is for a person who is clearly ineligible for services. In cases of evident ineligibility or inappropriate inquiries, requests, or referrals, regional offices shall refer individuals for whom services have been requested to appropriate agencies within five (5) business days after the inquiry, request, or referral.

2. For an individual's request for services to be considered, the regional office must receive a valid application for services. An application shall be valid only if signed or marked by the applicant. A mark must be witnessed.

3. Regional office staff shall contact the individual within ten (10) business days of receipt of an invalid application to obtain a valid application so that the eligibility process can continue.

4. If the regional office has not received an application within thirty (30) calendar days of the date it was provided to the individual, regional office staff shall contact the individual directly by telephone, electronic or regular mail, or in person to determine if the individual desires to continue the application for services and, if so, if assistance is needed in completing an application.

(C) A comprehensive evaluation includes-
1. A norm-referenced, standardized, and age-appropriate measure of adaptive function shall be used during assessment of children up to age five (5) to determine if substantial functional limitations exist; or

2. The MAAS shall be used during comprehensive evaluation of individuals age five (5) and older to determine if substantial functional limitations exist.

(D) When "in-person" meetings, including assessments, are required, the regional office staff shall conduct such meetings in applicants' homes as feasible unless applicants request other sites. If meetings are at the Regional Office, the regional office staff shall work with applicants to secure transportation to the offices.

(E) If an applicant who claims eligibility due to intellectual developmental disorder has not been found to have substantial functional limitations in two (2) or more areas of major life activity under this rule, the assessment team shall consider any additional assessments or other relevant information provided by the applicant to determine if the applicant has an intellectual developmental disorder. One (1) or more standardized testing tools currently defined by the American Association on Intellectual and Developmental Disabilities shall be used in conducting adaptive behavioral assessment.

(F) If within thirty (30) business days of receipt of a valid application the assessment team finds the applicant ineligible for services, the regional office shall-
1. Provide, to the applicant, within one (1) business day of the decision, written notice of right to appeal the decision, a statement of the legal and factual reasons for the denial, a notice of the appeals process contained in 9 CSR 45-2.020, and a brochure which explains the appeals process;

2. Orally provide to the applicant, within one (1) business day of the decision, if possible, the reasons for ineligibility and an explanation of the applicant's right to appeal, along with information about how and to whom to request an appeal; and

3. Make referrals within five (5) business days of the decision to other agencies and monitor services received by the applicant for at least thirty (30) calendar days from the date of the ineligibility determination.

(G) If the assessment team cannot make an eligibility determination within thirty (30) business days of receipt of a valid application because the regional office has not received collateral data or other information critical to the determination, the assessment team shall develop a temporary action plan within that thirty- (30-) business-day period, and the office may take up to thirty (30) additional business days to determine eligibility.
1. For an applicant then determined eligible during the additional thirty- (30-) business-day period, the assessment team also shall develop the initial plan within the thirty (30) business days of the determination of eligibility.

2. For individuals needing immediate services, the service coordinator also shall develop an initial ISP within five (5) business days after the eligibility determination unless an ISP has already been developed.

3. For an applicant determined ineligible during the additional thirty- (30-) business-day period, the regional office shall provide written and oral notices as set out in paragraphs (4)(F)1. and 2. of this rule and shall make referrals to other agencies and monitor services received by the applicant as set out in paragraph (4)(F)3. of this rule.

(H) If the assessment team has received collateral data and all other information necessary for the determination and does not make a determination within thirty (30) business days, they have an additional five (5) business days to make a determination.
1. For an applicant then determined eligible, the office shall proceed as set out in paragraphs (4)(I)1.-3. of this rule.

2. For an applicant then determined ineligible, the office shall proceed as set out in paragraphs (4)(F)1.-3. of this rule.

(I) For an applicant determined eligible within thirty (30) business days of receipt of valid application-
1. The regional office shall provide written notice of eligibility and client status within three (3) business days of the determination;

2. The planning team shall develop an ISP within thirty (30) business days after the date of the eligibility determination; and

3. For individuals needing immediate services, the service coordinator also shall develop an initial ISP within five (5) business days after the eligibility determination.

(J) The Regional Office (RO) shall reassess individuals through comprehensive evaluation as needed. RO shall discharge individuals who are no longer eligible for services and individuals for whom division services are no longer appropriate.
1. Not later than sixty (60) calendar days before a reassessment, the regional office shall provide to the individual a written notice of the upcoming reassessment and of the possibility that division services may be discontinued.

2. If, as a result of the comprehensive evaluation, an individual is found ineligible or no longer in need of services, the regional office shall provide written and oral notice as set out in paragraphs (4)(F)1. and 2. of this rule and shall prepare a discharge plan which shall provide at least sixty (60) calendar days from the date of that plan for the individual to transition from division services into services from other agencies. The regional office and the individual's support coordinator shall monitor and assist with that transition.

(K) Regional office staff shall log the disposition of all applications, including eligibility determinations, appeals, and referrals to other agencies. Comprehensive evaluation activities noted throughout this rule shall be logged immediately or on the same business day.

(L) If an applicant or legal representative disagrees with an ineligibility determination, the determination may be appealed under procedures contained in 9 CSR 45-2.020.

*Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008.

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