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

Current through Register Vol. 49, No. 14, July 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.