Current through Register Vol. 54, No. 44, November 2, 2024
(a) The essential
feature of mental retardation is significantly subaverage general intellectual
functioning that is accompanied by significant limitations in adaptive
functioning in at least two of the following skill areas: communication,
self-care, home living, social/interpersonal skills, use of community
resources, self-direction, functional academic skills, work, leisure, health,
and safety. The onset must occur before the individual's 22nd birthday.
(1) Except as specified in subsection (b)(2),
significantly subaverage general intellectual functioning shall be determined
by a standardized, individually administered, intelligence test in which the
overall full scale IQ score of the test and of the verbal/performance scale IQ
scores are at least two standard deviations below the mean taking into
consideration the standard error of measurement for the test. The full scale IQ
shall be determined by the verbal and performance IQ scores (See Appendix A-DSM
IV).
(2) Diagnosis of mental
retardation is made by using the IQ score, adaptive functioning scores and
clinical judgment when necessary. Clinical judgment is defined as reviewing the
person's test scores, social and medical history, overall functional abilities,
and any related factors to make an eligibility determination. Clinical judgment
is used when test results alone cannot clearly determine eligibility. The
factors considered in making an eligibility determination based on clinical
judgment shall be decided and documented by a licensed psychologist, a
certified school psychologist, a physician or a psychiatrist. In cases when
individuals display widely disparate skills or achieve an IQ score close to 70,
clinical judgment should be exercised to determine eligibility for mental
retardation services.
(3) If
eligibility cannot be determined through a review of the individual's record
and social history, necessary testing (for example, adaptive functioning) shall
be completed by a licensed psychologist, a certified school psychologist, a
physician or a psychiatrist. This includes determining the eligibility for an
individual who is 22 years of age or older, has never been served in the mental
retardation service system and has no prior records of testing. Clinical
judgment may be used to determine whether the age of onset of mental
retardation occurred prior to the individual's 22nd birthday.
(b) Everyone can be evaluated or
assessed.
(1) Standard tests with adaptations
for the individual's visual, motor and language impairments are available and
valid. Other efforts to adapt the IQ test to the individual's particular
visual, motor and language impairments shall be described and
documented.
(2) Developmental
scales may be used for people who do not or cannot participate in testing. The
use of these scales reflects a necessity to use scoring matrices for
populations outside the sample used to develop the normative data. They should
only be used when no other standard testing technique is available.
(c) Genetic conditions and
syndromes defined by particular physical features or behaviors such as
Klinefelter syndrome are not, by themselves, sufficient to qualify for a mental
retardation eligibility determination.
(d) The policy for legal and illegal aliens
is is as follows:
(1) Citizenship is not an
eligibility requirement for receipt of mental retardation services and supports
in this Commonwealth. The only distinction in this matter is between those who
are lawfully in this country (both citizens and aliens) and those who are here
unlawfully (illegal aliens).
(2)
Illegal aliens are not eligible for the Medicaid Program unless an emergency
medical condition is present (42 U.S.C.A. §
1396b(v)). Counties are not
required to provide mental retardation services for illegal aliens.
(e) An individual who is currently
eligible for mental retardation services will remain eligible for mental
retardation services unless eligibility testing indicates otherwise.
(f) An individual moving into this
Commonwealth from another location will receive a mental retardation
eligibility determination for mental retardation services based on the
clarification described in this section.
(g) Except for waiver services, appeals from
a denial of eligibility follow the county administrative process designed for
appeals under
2
Pa.C.S. §§ 551-555 and
751-754 (relating to Local
Agency Law) and appealing through the courts. The Local Agency Law is a State
law governing procedures for appeals of local agency determinations.
(h) Fiscal issues, such as access to testing
and payment for testing, should be referred to the appropriate Office of Mental
Retardation Regional Office for resolution.
