New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 630 - Eligibility Determinations For Children Who Are Aging Out › Section 630.5 - Eligibility for OPWDD services

Current through Register Vol. 46, No. 28, July 10, 2024
The following policy of OPWDD entitled "Eligibility for OPWDD
				  Services" is hereby inserted into this Part.
New York State Office for People With Developmental
				  Disabilities
ELIGIBILITY FOR OPWDD SERVICES
Important Facts
Revised December, 2008
OPWDD, through its local Developmental Disabilities Services
				  Offices (DDSO), determines whether a person has a developmental disability and
				  is eligible for OPWDD funded services. This fact sheet describes the Three-Step
				  process used by OPWDD to make an eligibility determination of developmental
				  disability.
NOTE: A determination of developmental disability does not
				  mean the person is eligible for all OPWDD funded services. Some OPWDD funded
				  services have additional eligibility criteria. For example, Intermediate Care
				  Facilities, and Home and Community Based (HCBS) waiver programs include an
				  additional level of care determination, and individuals are eligible for HCBS
				  services only when they reside in appropriate living arrangements. These and
				  other additional criteria for eligibility of specific OPWDD services are not
				  reviewed through this process
ELIGIBILITY DETERMINATION PROCESS
Eligibility Request
An OPWDD Transmittal Form must accompany all requests
				  submitted to the DDSO for eligibility determinations. The Transmittal Form
				  includes the name of the person, the name of the person's representative, and
				  relevant contact information. Documentation of the person's developmental
				  disability must also be included as part of the eligibility request
1st Step Review
DDSO staff review the eligibility request for completeness
				  and share the information with other staff designated by the Director, as
				  necessary. After this review, the DDSO notifies the person in writing
				  that:
(a) Eligibility or provisional
				eligibility has been determined; or
(b) The request is incomplete and requires
				additional documentation; or
(c)
				The request has been forwarded for a 2nd Step Review
2nd Step Review
DDSO clinicians designated by the DDSO Director conduct a 2nd
				  Step Review of the eligibility request forwarded by the 1st Step Review, along
				  with any additional documentation provided by the person. If these clinicians
				  require additional medical information, psychological test results, or
				  historical documentation, the person is notified in writing of the type of
				  information needed and the date by which it must be submitted to the
				  DDSO
Following the 2nd Step Review, the DDSO provides the person
				  with written notification of its determination. If the person is found
				  ineligible for OPWDD services because he or she does not have a developmental
				  disability, the letter shall offer the person and his or her representative the
				  opportunity to:
(a) Meet with DDSO
				staff to discuss the determination and documentation reviewed; and
(b) Request a 3rd Step Review; and
(c) Request a Medicaid Fair Hearing in cases
				where Medicaid funded services are sought
Note that a Notice of Decision informing the person of his or
				  her right to request a Medicaid fair hearing is sent only when the Transmittal
				  Form indicates that the person is interested in receiving Medicaid funded OPWDD
				  services if determined eligible. If the person has not indicated Medicaid
				  funded services, no fair hearing is offered and the decision of the DDSO is
				  final
The person may choose one, two or all three of the above
				  options. If a fair hearing is requested, a 3rd Step Review will automatically
				  be conducted
3rd Step Review
3rd Step Eligibility Determination Committees established by
				  OPWDD in NYC and Albany conduct the 3rd Step Reviews. Committee members include
				  licensed practitioners who are not directly involved in the determinations made
				  at the 1st and 2nd Step Reviews. The Committee reviews the submitted
				  eligibility request and any additional documentation provided by or on behalf
				  of the person. The Committee forwards its recommendations to the DDSO
				  Eligibility Coordinator. The DDSO Director or designated staff person considers
				  the 3rd Step recommendations and informs the person of any change in the DDSO's
				  determination. 3rd Step Reviews will be made prior to any fair hearing
				  date.