Sec. 10.22.12.07. Eligibility Determination Process — Determination of Service Priority Category and Description of Categories

A. Determination of Service Priority Category.

(1) The regional director shall base the recommendation regarding service priority on the determination that the individual meets the criteria for one or more of the following categories, which are listed in the order of priority in which applicants shall receive services:

(a) Category I - Crisis Resolution;

(b) Category II - Crisis Prevention; and

(c) Category III - Current Request.

(2) Individuals shall be served according to their priority ranking as follows:

(a) Individuals in Category I are to be served before those in Category II; and

(b) Individuals in Category II are to be served before those in Category III.

(3) Service delivery is dependent upon levels of funding allocated for the fiscal year for the following discrete categories:

(a) Category IV - Transitioning Youth;

(b) Category V - Knott Class Member;

(c) Category VI - Inappropriate Institutionalization; and

(d) Category VII - Innovation or Demonstration Projects.

(4) Individuals may be in more than one priority category at the same time. For example, an individual in the transitioning youth priority category for a day program may also be in the crisis prevention priority category for a residential program if the individual is graduating or leaving a secondary school program and has no place to live after that program ends.

B. Description of Categories.

(1) Category I - Crisis Resolution.

(a) To qualify for this category, the applicant shall meet one or more of the following criteria. The applicant shall be:

(i) Homeless or living in temporary housing with clear time-limited ability to continue to live in this setting with no viable non-DDA-funded alternative;

(ii) At serious risk of physical harm in the current environment;

(iii) At serious risk of causing physical harm to others in the current environment;

(iv) In danger of losing DDA-funded residential services because of a lack of current day services;

(v) One who has lost DDA-funded day services; or

(vi) Living with a caregiver who is unable to provide adequate care due to the caregiver's impaired health, which may place the applicant at risk of serious physical harm.

(b) To qualify for Category I under §B(1)(a)(ii), of this regulation, evidence such as the following shall be necessary. The applicant:

(i) Has recently received severe injuries due to the behavior of others in the home or community;

(ii) Has recently been the victim of sexual abuse;

(iii) Has been neglected to the extent that the individual is at serious risk of sustaining injuries which are life threatening or which substantially impair functioning;

(iv) Engages in self-injurious behavior which puts the individual at serious risk of sustaining injuries which are life threatening or which substantially impair functioning; or

(v) Is at serious risk of sustaining injuries which are life threatening or which substantially impair functioning due to the physical surroundings.

(c) If the applicant qualifies for Category I under §B(1)(a)(v), of this regulation, the individual shall qualify for day services only.

(d) If the applicant is living in a situation where the applicant is the caregiver, §B(1)(a)(vi), of this regulation, shall apply to the applicant.

(e) Individuals who qualify for services under this category shall, at a minimum, remain in this category until they have been provided with those services required to resolve the situation.

(f) Individuals become eligible to receive services as the need occurs.

(2) Category II - Crisis Prevention.

(a) To qualify for this priority category, the applicant:

(i) Shall have been determined by the DDA to have an urgent need for services;

(ii) May not qualify for services based on the criteria for Category I; and

(iii) Shall be at substantial risk for meeting one or more of the criteria in §B(1)(a) of this regulation, within 1 year, or have a caregiver who is 65 years old or more.

(b) Individuals who qualify for services under this category shall, at a minimum, remain in this category until they have been provided with those services required to resolve the situation.

(c) Individuals become eligible to receive services from the date of approval of priority status, except when eligibility is determined by the age of the caregiver. In this case, priority is determined by the caregiver's date of birth so that individuals with caregivers born at an earlier date have priority over individuals with caregivers born at a later date.

(3) Category III - Current Request.

(a) To qualify for this priority category, the applicant shall indicate at least a current need for services.

(b) Prioritization of Services.

(i) Applicants shall be prioritized for services based on the number of fiscal years they have been on the waiting list, except as provided for in §B(3)(b)(iv) of this regulation.

(ii) Applicants on the waiting list for the longest period of time shall receive services before those who have been on the list for fewer years, except as provided for in §B(3)(b)(iv) of this regulation.

(iii) Applicants whose applications are received by the DDA access unit within a given fiscal year shall be ranked by the fiscal year of application, and the month and day of birth. Those applicants born at the beginning of the fiscal year have priority over those born later in the year.

(iv) For day programs only, the period of time that shall be counted toward prioritizing an individual shall begin with the year of departure from school or the year of application, whichever is later.

(4) Category IV - Transitioning Youth.

(a) To qualify for funding for services in this priority category the applicant shall be eligible:

(i) For DDA-funded services in this category from the individual's 21st to the individual's 22nd birthday. If the date of graduation is after the individual's 21st birthday, the individual shall continue to be eligible for 1 year after the date of graduation.

(ii) To receive day services only.

(b) Individuals in this priority category shall also be in one or more of the other priority categories.

(c) Individuals become eligible to receive services from the date of approval of priority status.

(5) Category V - Knott Class.

(a) To qualify for this priority category, the applicant shall have:

(i) An intellectual disability; and

(ii) Been determined inappropriately retained in a Mental Hygiene Administration facility as set forth in Knott vs. Hughes Civil Action No. Y-80-2832 (Fed. Dist. Ct. Md).

(b) Individuals become eligible to receive services based on the best clinical judgment of the professionals involved based on availability of allocated resources.

(6) Category VI - Inappropriate Institutionalization.

(a) To qualify for this priority category, the applicant shall be a:

(i) Resident in a nursing facility and not meet the criteria for admission or retention for that facility;

(ii) Resident of an intermediate care facility for individuals with intellectual disabilities or persons with related conditions (ICF/IID) and not meet the criteria for admission or retention for that facility as determined by the hearing examiner;

(iii) Resident in a chronic hospital who does not meet the criteria for admission or retention for that facility;

(iv) Resident in an institution under the auspices of the Mental Hygiene Administration who has a developmental disability, but is not an individual with an intellectual disability and who does not meet the criteria for admission or retention in a State psychiatric hospital and whose primary need is not for a mental health service.

(b) An individual in this priority category shall also be in another priority category.

(c) Funding may be allocated for one or more of the above groups in §B(6)(a)(i)-(iv) of this regulation.

(d) Individuals become eligible to receive services based on the best clinical judgment of the professionals involved based on availability of allocated resources.

(7) Category VII - Innovation or Demonstration Projects.

(a) To identify those individuals for whom this priority category is appropriate, the Administration, after consultation with interested parties, shall publish a request for proposal (RFP) for innovation or demonstration projects.

(b) To qualify for this priority category, an individual shall be identified in a proposal submitted to the Administration which is considered appropriate for funding by the Administration.

(c) An individual served in this priority category may continue to receive services, to the extent that funds are allocated, after the termination of the innovation or demonstration period.

(d) An individual in this priority category may also be in another priority category.

(8) Eligible applicants may receive family support services and low intensity support services on a first-come, first-served basis, regardless of service priority determination.