Section 16.03.10.509 - ADULT DEVELOPMENTAL DISABILITY SERVICES PRIOR AUTHORIZATION: ELIGIBILITY DETERMINATIONThe Department will make the final determination of an individual's eligibility, based upon the assessments and evaluations administered by the Department. Initial and annual assessments will be performed by the Department. The purpose of the assessment is to determine a participant's eligibility for developmental disabilities services in accordance with Section 66-402, Idaho Code, and Sections 500 through 506 of these rules and for ICF/IID level of care for waiver services in accordance with Section 584 of these rules.
01.Initial Assessment. For new applicants, an assessment will be completed within thirty (30) days from the date a completed application is submitted.02.Annual Assessments. Assessments will also be completed for current participants at the time of their annual eligibility redetermination. The assessor will evaluate whether assessments are current and accurately describe the status of the participant. At least sixty (60) days before the expiration of the current plan of service: a. The assessment process will be completed; andb. The assessor will provide the results of the assessment to the participant.03.Determination of Developmental Disability Eligibility. The evaluations or assessments that are required for determining developmental disabilities for a participant's eligibility for developmental disabilities services will include a medical/social history and a functional assessment. Participants must provide the results of psychometric testing if eligibility for developmental disabilities services is based on an intellectual disability and they have no prior testing or prior testing is inconclusive. Documentation of diagnosis is required for participants whose eligibility is based on developmental disabilities other than an intellectual disability. A Department-approved assessment tool will be administered by the Department for use in this determination.04.ICF/IID Level of Care Determination for Waiver Services. The assessor will determine ICF/IID level of care for adults in accordance with Section 584 of these rules.Idaho Admin. Code r. 16.03.10.509