Iowa Admin. Code r. 441-25.15
Current through Register Vol. 47, No. 11, November 27, 2024
Rule 441-25.15 - Eligibility, diagnosis, and functional assessment criteria(1)Eligibility for mental health services. An individual must comply with all of the following requirements to be eligible for mental health services under the regional service system:a. The individual complies with the financial eligibility requirements in rule 441-25.16 (225C).b. The individual is at least 18 years of age.c. The individual is a resident of this state.d. The individual has had at any time during the preceding 12-month period a mental health, behavioral, or emotional disorder or, in the opinion of a mental health professional, may now have such a diagnosable disorder. The diagnosis shall be made in accordance with the criteria provided in the most recent Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (published 2013, with all changes and updates approved by the American Psychiatric Association through September 2023 incorporated herein) and shall not include the manual's "V" codes identifying conditions other than a disease or injury. The diagnosis shall also not include substance-related disorders, dementia, antisocial personality, or developmental disabilities, unless co-occurring with another diagnosable mental illness.e. The results of a standardized functional assessment support the need for mental health services of the type and frequency identified in the individual's case plan. The standardized functional assessment methodology shall be designated for mental health services by the director in consultation with the state commission. A functional assessment must be completed within 90 days of application for services.(2)Eligibility for children's behavioral health services. An individual must comply with all of the following requirements to be eligible for children's behavioral health services under the regional service system: a. The individual is a child under 18 years of age.b. The child's custodial parent is a resident of the state of Iowa, and the child is physically present in the state.c. The child's family meets the financial eligibility requirements in rule 441-25.16 (225C).d. The child has been diagnosed with a serious emotional disturbance. A serious emotional disturbance diagnosis is not required to access comprehensive facility and community-based crisis services according to Iowa Code section 225C.66(4)"b."(3)Eligibility for intellectual disability services. An individual must comply with all of the following requirements to be eligible for intellectual disability services under the regional service system:a. The individual complies with the financial eligibility requirements in rule 441-25.16 (225C).b. The individual is at least 18 years of age.c. The individual is a resident of this state.d. The individual has a diagnosis of intellectual disability as defined by rule 441-83.60(249A).e. The results of a standardized functional assessment support the need for intellectual disability services of the type and frequency identified in the individual's case plan. The standardized functional assessment methodology shall be designated for intellectual services by the director in consultation with the state commission. A functional assessment must be completed within 90 days of application for services.(4)Other conditions of eligibility for intellectual disability services.a. An individual who is 17 years of age, is a resident of this state, and is receiving publicly funded children's services may be considered eligible for services through the regional service system during the three-month period preceding the individual's eighteenth birthday in order to provide a smooth transition from children's to adult services.b. An individual less than 18 years of age and a resident of the state may be considered eligible for those intellectual disability services made available to all or a portion of the residents of the region of the same age and eligibility class under the county management plan of one or more counties of the region applicable prior to formation of the region. Eligibility for services under this paragraph is limited to availability of regional service system funds without limiting or reducing core services, and if part of the approved regional service system management plan.(5)Eligibility for brain injury services. An individual must comply with all of the following requirements to be eligible for brain injury services under the regional service system, if such services were provided to the same class of individuals by a county in the region prior to regional formation. a. The individual complies with the financial eligibility requirements in rule 441-25.16 (225C).b. The individual is at least 18 years of age.c. The individual is a resident of this state.d. The individual has a diagnosis of brain injury as defined in rule 441-83.81(249A).e. The results of a standardized functional assessment support the need for brain injury services of the type and frequency identified in the individual's case plan. The standardized functional assessment methodology used is the methodology approved for brain injury services by the director in consultation with the state commission. A functional assessment must be completed within 90 days of application for services.(6)Other conditions of eligibility for brain injury services. An individual who is 17 years of age, is a resident of this state, and is receiving publicly funded children's services may be considered eligible for services through the regional service system during the three-month period preceding the individual's eighteenth birthday in order to provide a smooth transition from children's to adult services.(7)Eligibility for developmental disability services.a. Until funding is designated for other service populations, eligibility for the core service domains shall be as identified in Iowa Code section 225C.65(2)"b."b. If a county in a region was providing services to an eligibility class of individuals with a developmental disability other than intellectual disability prior to formation of the region, the class of individuals shall remain eligible for the services provided when the region is formed, providing that funds are available to continue such services without limiting or reducing core services. The individual must also meet the requirements in paragraphs 25.15(7)"c," "d," "e" and "f."c. The individual complies with the financial eligibility requirements in rule 441-25.16(225C).d. The individual is at least 18 years of age.e. The individual is a resident of this state.f. The individual has a diagnosis of a developmental disability other than an intellectual disability as defined in rule 441-24.1 (225C).Iowa Admin. Code r. 441-25.15
ARC 1173C, IAB 11/13/2013, effective 1/1/2014Amended by IAB January 2, 2019/Volume XLI, Number 14, effective 3/1/2019Amended by IAB February 12, 2020/Volume XLII, Number 17, effective 3/18/2020Amended by IAB November 2, 2022/Volume XLV, Number 9, effective 1/1/2023Amended by IAB July 10, 2024/Volume XLVII, Number 1, effective 8/14/2024