Current through Bulletin 2024-06, March 15, 2024
(1) The division
shall only offer services for an intellectual disability or a related condition
to an eligible applicant with a disability as defined in Subsection
62A-5-101(9).
(2) An eligible applicant must meet the
following requirements:
(a) have a diagnosed
intellectual disability or related condition as defined in Subsection
62A-5-101(9)
and Section
R414-502-8;
(b) have three or more functional
limitations; and
(c) be a resident
of the state.
(3)
Functional limitations are defined as:
(a)
"Self-care" means an applicant requires assistance, training, or supervision
with eating, dressing, grooming, bathing, or toileting.
(b) "Expressive and receptive language" means
an applicant:
(i) lacks functional
communication skills;
(ii) requires
the use of an assistive device to communicate;
(iii) does not demonstrate an understanding
of requests; or
(iv) cannot follow
a two-step instruction.
(c) "Learning" means an applicant has a valid
diagnosis of intellectual disability based on the criteria found in the fifth
edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-5
(2013), incorporated by reference.
(d) "Mobility" means an applicant:
(i) requires the use of assistive devices for
mobility; and
(ii) cannot
self-evacuate from a building during an emergency without the assistive
device.
(e) "Capacity for
Independent Living" means the following:
(i)
A minor applicant, at least seven years of age, cannot:
(A) locate and use a telephone;
(B) cross a street safely; or
(C) understand that it is not safe to accept
a ride, food, or money from a stranger.
(ii) An adult applicant who lacks basic
survival skills in the areas of shopping, preparing food, housekeeping, or
paying a bill.
(f)
"Self-direction" means an applicant is:
(i)
unable to provide informed consent for medical care, personal safety, legal
matters, financial matters, habilitative care, or residential matters;
(ii) declared legally
incompetent;
(iii) a significant
danger to self or any other individual without supervision; or
(iv) a minor applicant, at least seven years
of age, significantly at risk in making an age appropriate decision.
(g) "Economic self-sufficiency"
means an adult applicant:
(i) receives
disability benefits; and
(ii)
cannot work more than 20 hours a week or is paid less than minimum wage without
employment support.
(4) The division determines eligibility.
(a) The division shall determine if an
applicant is eligible for non-waiver services within 90 days of receiving
needed documentation.
(b) To
determine functional limitations for an applicant aged seven years or older,
the division shall consider age appropriate ability.
(c) The division shall keep eligibility
documentation in the applicant's electronic record.
(5) The division shall use the following
documents to determine eligibility:
(a)
Eligibility for Services Form 19 or Eligibility for Services Form 19C for a
child younger than seven years of age;
(b) an assessment of functional limitations
and need;
(c) a social history of
the applicant completed within one year of the date of application;
(d) a psychological evaluation or a
developmental assessment for a child younger than seven years of age;
and
(e) supporting documentation
for each eligibility requirement. Supporting documentation includes mental
health assessment, educational record, neuropsychological evaluation, and
medical healthcare visit summary.
(6) An applicant shall submit to the division
the supporting documentation needed to determine eligibility.
(a) If needed supporting documentation is not
submitted within 90 days of initial contact, the division shall change the
intake case status to inactive. The division shall send the applicant written
notification of an intake status change to inactive.
(b) An applicant may reactivate the intake
case by submitting any needed supporting documentation.
(c) An applicant must update eligibility
documentation as needed.
(7) The division shall notify an applicant of
the eligibility determination by mailing a Notice of Agency Action Form 522-I
and a Hearing Request Form 490S.
(a) The
Notice of Agency Action Form 522-I indicates:
(i) the eligibility determination;
and
(ii) placement on the waiting
list, when applicable.
(b) An applicant may challenge the
eligibility determination by filing a written request for an administrative
hearing before the Department of Human Services, Office of Administrative
Hearings.
(8) The
division shall annually re-determine eligibility for each person receiving a
service. If a person receiving a service is determined to be ineligible, the
division shall develop a transition plan to discontinue each service that
ensures any health and safety need is met.
(9) A person who receives a non-waiver
service may have their non-waiver service package reduced or terminated because
of:
(a) a division budget shortfall;
(b) a reduced legislative allocation;
or
(c) a reevaluation of
eligibility.
(10) Section
R539-1-4 does not apply to an applicant who meets the eligibility criteria for
physical disability or brain injury as described in Sections
R539-1-5
and
R539-1-6,
respectively.
