65G-4.014 Eligibility for Agency Services – Definitions.
(1) Autism means a condition which meets the requirements of Section 393.063, F.S., that the condition is:
(a) Pervasive, meaning always present and without interruption;
(b) Neurologically based, meaning that the condition is not the result of physical impairment;
(c) A developmental disability with age of onset during infancy or childhood;
(d) With extended duration, meaning that the condition reasonably can be expected to continue indefinitely into the future;
(e)
Causes severe learning disorders resulting in both severe communication
disorders affecting both verbal and nonverbal skills, and severe
behavior disorders. Autism is characterized by an individual evidencing
at least six of the following twelve features from the following
subparts 1 and 2:
1. Severe communication disorders, which may include:
i.
A delay in, or total lack of, the development of spoken language (not
accompanied by an attempt to compensate through alternative modes of
communication such as gesture or mime);
ii. Stereotyped and repetitive use of language or idiosyncratic language;
iii.
For those applicants with speech, marked impairment in the use of
multiple nonverbal behaviors such as eye-to-eye gaze, facial
expression, body postures, and gestures to regulate social interaction;
iv. Failure to develop peer relationships appropriate to developmental level;
v.
A lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people (e.g., by a lack of showing, bringing,
pointing out objects of interest, or achievements to others);
vi. Lack of social or emotional reciprocity;
vii. Marked impairment in the ability to initiate or sustain a conversation with others in individuals with adequate speech; or
viii.
Impaired imaginative ability evidenced by a lack of varied, spontaneous
make-believe play or social imitative play appropriate to developmental
level.
2.
Severe behavior disorders, which are restricted, repetitive and
stereotyped patterns of behavior, interests, and activities which may
include:
ix.
Encompassing preoccupation with one or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus;
x. Apparently inflexible adherence to specific, nonfunctional routines or rituals;
xi. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements); or
xii. Persistent preoccupation with parts of objects.
(2)
Cerebral Palsy – means a group of disabling symptoms of extended
duration that result from damage to the developing brain during the
prenatal period and characterized by paralysis, spasticity, or abnormal
control of movement or posture, such as poor coordination or lack of
balance, which is manifest prior to three years of age. For purposes of
the rule, cerebral palsy also means the presence of other significant
motor dysfunction appearing prior to age 18 due to perinatal or
external events such as anoxia, oxygen deprivation, or traumatic brain
injury. Excluded from this definition is motor dysfunction caused by
medical events, including stroke or progressive diseases such as
muscular dystrophy. The impairment from cerebral palsy must constitute
a substantial handicap which is reasonably expected to continue
indefinitely.
(3) Mental Retardation or Intellectual Disability – is evidenced by the concurrent existence of:
(a)
Significantly subaverage general intellectual functioning evidenced by
an Intelligence Quotient (IQ) two or more standard deviations below the
mean on an individually administered standardized intelligence test, and
(b) Significant deficits in adaptive functioning in one or more of the following areas:
1. Communication skills,
2. Self-care, home living,
3. Social and interpersonal skills,
4. Use of community resources and self-direction,
5. Functional academic skills,
6. Work, leisure, health and safety awareness and skills,
(c) Which are manifested prior to age 18; and
(d) Constitute a substantial handicap which is reasonably expected to continue indefinitely.
(4)
Prader-Willi Syndrome – means a genetic disorder which is most often
associated with a random deletion of chromosome 15. Commonly associated
characteristics include insatiable appetite, chronic overeating,
hypotonia, short stature, obesity, and behavioral issues. Individuals
diagnosed with Prader-Willi syndrome generally have mental retardation;
however, an individual with Prader-Willi syndrome can be determined as
eligible for services without an accompanying diagnosis of mental
retardation.
(5)
Spina Bifida – For the purposes of agency eligibility, spina bifida
refers to a confirmed diagnosis of spina bifida cystica or
myelomeningocele.
(6)
Down Syndrome – means a condition caused by the presence of extra
chromosomal material on chromosome 21. This disorder is often
associated with impairment in cognitive ability, characteristic
physical growth and features, and congenital medical conditions.
(7)
Eligibility Rules – Rules 65G-4.014 through 65G-4.017, Florida
Administrative Code, inclusive, which apply to eligibility
determinations for services provided through the Agency for Persons
with Disabilities for individuals with developmental disabilities.
(8)
DD Waiver – Home and Community-Based Services (HCBS) waiver authorized
by 42 U.S.C. 1396n(c)(1) of the federal Social Security Act and Section
409.906, F.S., that provides a package of Medicaid-funded home and
community-based supports and services to eligible persons with
developmental disabilities who live at home or in a home-like setting.
(9)
Agency Services – home and community based supports and services to
eligible persons funded through general revenue allocations or sources
other than the DD Waiver.
Rulemaking Authority 393.065, 393.501, 393.063 FS. Law Implemented 393.065 FS. History–New ________.
65G-4.015 Eligibility Criteria.
In order to be determined eligible for agency services the applicant must:
(1) Be at least three years of age.
(2)
Be a resident of and domiciled in the state of Florida in accordance
with Sections 222.17(1) and (2), F.S. Domicile may not be established
in Florida by a minor who has no parent domiciled in Florida, or by a
minor who has no legal guardian domiciled in Florida, or by any alien
not classified as a resident alien. Dependents of active duty military
personnel stationed in the state of Florida are exempt from residency
and domicile requirements.
(3)
Have a confirmed diagnosis of one of the following developmental
disabilities as defined in this these rules, Rules 65G-4.014, 4.015,
4.016 and 4.017, F.A.C.:
(a) Autism,
(b) Cerebral palsy,
(c) Mental retardation or intellectual disability,
(d) Prader-Willi syndrome,
(e) Spina Bifida,
(f) Down Syndrome, or
(g)
Children between 3 and 5 years of age who are at high risk of later
diagnosis of one of the disabilities listed above. Such high-risk
children shall not be placed on the waiting list for waiver services
until a confirmed diagnosis of a qualifying disability is given.
(4)
DD Waiver services are only available (conditioned upon the wait list)
to persons who meet the requirements of 42 CFR § 435.217(b)(1) for
receiving home and community-based services. It is mandatory that the
determination is made that without DD Waiver services these individuals
would otherwise require the level of care furnished in a hospital,
nursing home, or an Intermediate Care Facility for People with
Intellectual Disabilities (referred to in the CFR as an “ICF/MR”).
Rulemaking Authority 393.065, 393.501, 393.063 FS. Law Implemented 393.065 FS. History–New________.
65G-4.016 Application Process.
(1)
Application for services from the agency shall be made by submitting an
application by hand delivery, U.S. Postal Service, or facsimile to the
agency office in the service area where the applicant resides. The
application for services is available on the agency website at
www.APD.myflorida.com,
http://www.apd.myflorida.com/customers/application/ or by contacting
the agency. The application is available in English and Spanish and is
hereby incorporated by reference.
(2)
Upon receipt of a completed, signed, and dated Application for
Services, the area agency staff shall review the application and
supporting documentation and, within 45 days for children under the age
of 6 and 60 days for individuals 6 years of age and older, shall notify
the applicant of the final determination of eligibility for agency
services. If requests for collateral information or additional
evaluations are necessary to determine eligibility, the time may be
extended for no more than an additional ninety (90) days.
(3)
If an applicant is unable to produce an existing evaluation that
establishes eligibility or if there is concern that the information
provided is inaccurate, incorrect, or incomplete, the agency area
office will be responsible for obtaining an evaluation to establish
eligibility. Professional diagnoses under Rule 65G-4.017, F.A.C., must
document all criteria for eligibility as set forth in Rules
65G-4.014-.017, F.A.C. The evaluation process includes only those
assessments necessary to determine eligibility that were administered
by a person qualified to administer the instrument(s).
(4)
When the eligibility determination is complete, the agency area office
shall notify the applicant in writing within five (5) business days of
the decision. If the applicant is determined ineligible for agency
services, the agency area office shall notify the applicant of the
right to appeal the decision in accordance with Chapter 120, F.S.
(5)
If the applicant is determined to be ineligible to receive services
from the agency, the agency area office shall offer suggestions
regarding other programs, agencies, or services for which the applicant
may be eligible.
(6)
If a category of covered conditions in this rule is not also covered by
the state’s Medicaid developmental disabilities waiver (DD waiver) at
the time an individual is determined to be eligible, those individuals
will be placed on the waiting list and may be provided services funded
through general revenue allocations or sources other than the DD Waiver.
Rulemaking Authority 393.065, 393.501, 393.063 FS. Law Implemented 393.065 FS. History–New________.
65G-4.017 Establishing Eligibility.
(1)
Establishing Eligibility – Autism. A diagnosis of autism, as defined by
Rule 65G-4.014, F.A.C., may only be made by one or more of the
following who has specific training and experience in making such
diagnosis:
(a) A Florida-licensed psychiatrist,
(b) A Florida-licensed psychologist,
(c) A board-certified pediatric neurologist who is qualified by training and experience to make a diagnosis of autism,
(d) A board-certified developmental pediatrician.
(e)
Collateral information received from another state may be accepted if
the evaluator is licensed through the same credentials required for
licensure in Florida for the professions listed in paragraph (1)(a)
above.
(2)
Establishing Eligibility – Cerebral Palsy. Diagnosis is confirmed by
written documentation from one or more of the following:
(a) A medical doctor;
(b) A doctor of osteopathy; or
(c) Medical records documenting a diagnosis of cerebral palsy before the age of 18.
(3)
Establishing Eligibility – Mental Retardation or Intellectual
Disability. To establish that an individual has mental retardation the
following criteria shall be applied:
(a)
A single test or subtest should not be used alone to determine
eligibility. If a person has significantly different (statistically
defined) scores on different scales of a test or tests, or a great deal
of variability on subtest scores of an IQ test, the full-scale score
may not indicate mental retardation and should not be relied on as a
valid score. In that instance, closer scrutiny is required to make an
appropriate differential diagnosis. This may include review of school
records, school placement, achievement scores, medical records,
medication history, behavior during testing and the psychosocial
situation at the time of testing. Closer scrutiny must also be required
when there is a great deal of variability between IQ scores on
different IQ tests or different administrations of the same IQ test.
Nothing here is intended to preclude clinical judgment from
appropriately determining that a single full-scale IQ score of 70 or
below, or two or more standard deviations below the mean, on an
individually administered intelligence test is sufficient to establish
eligibility.
(b)
The performance measures for this category of adaptive functioning
deficits must be validated by the professional judgment of a
psychologist who is experienced in working with people who have
retardation, who has specific training and validation in the assessment
instrument that is used, and who is one of the following:
1. A Florida-licensed psychologist,
2. A Florida-licensed school psychologist,
3. A certified school psychologist.
(c)
Any standardized test may be submitted as proof. However, the applicant
must demonstrate that any test not presumptively accepted by the agency
is valid. The following are presumptively accepted standardized tests
of intelligence to establish eligibility for mental retardation:
1. Stanford-Binet Intelligence Test (all ages),
2. Wechsler Preschool and Primary Scale of Intelligence (under six years of age),
3. Differential Ability Scales – Preschool Edition (under six years of age),
4. Wechsler Intelligence Scale for Children (WISC) (children up to 15 years, 11 months),
5. Differential Ability Scales (children up to 15 years, 11 months),
6. Wechsler Adult Intelligence Scale (WAIS),
7. Test of Nonverbal Intelligence-3 (TONI-3),
8. Comprehensive Test of Nonverbal Intelligence-2 (C-TONI 2),
9. Universal Nonverbal Intelligence Test (UNIT),
10. Leiter International Performance Scale-Revised (Leiter-R).
(d) The following tests of adaptive functioning are presumptively accepted in the determination:
1. Vineland Adaptive Behavior Scales,
2. AAMR Adaptive Behavior Scale,
3. Adaptive Behavior Assessment System (ABAS),
4. Adaptive Behavior Evaluation Scale (ABES).
5. Scales of Independent Behavior – Revised
(e)
In all cases, assessments or evaluations for eligibility should be
obtained from appropriately licensed professionals with experience and
training in the instruments and population for whom eligibility is to
be determined.
(4)
Establishing Eligibility – Prader-Willi Syndrome. Diagnosis is
confirmed by written documentation from one or more of the following:
1. A medical doctor;
2. A doctor of osteopathy; or
3. Medical records that document a diagnosis of Prader-Willi syndrome before the age of 18.
(5) Establishing Eligibility – Spina Bifida. Diagnosis is confirmed by written documentation from one or more of the following:
a. A medical doctor;
b. A doctor of osteopathy; or
c. Medical records that document a diagnosis of spina bifida cystica or myelomeningocele before the age of 18.
(6)
Establishing Eligibility – Down Syndrome. Evidence under this category
requires medical records documenting a chromosome analysis (also
referred to as a karyotype) finding the individual has an extra genetic
material on their number 21 chromosome.
(7)
Establishing Eligibility – High-Risk Children, 3 to 5 years of age.
Evidence under this category requires a determination by an APD area
office that a medical diagnosis of developmental delay evidenced by the
child indicates a high probability that the child is likely to have an
eventual diagnosis of a qualifying condition under Rule 65G-4.014,
F.A.C., if early intervention services are not provided, or the child
has one or more physical or genetic anomalies associated with a
developmental disability, such as:
a. Genetic or chromosomal disorders (such as Down syndrome or Rett syndrome);
b. Metabolic disorders (such as phenylketonuria);
c. Congenital malformations (such as microcephaly or hydrocephaly);
d. Neurological abnormalities and insults;
e. Congenital and acquired infectious diseases;
f. Chronic or catastrophic illnesses or injuries;
g. A parent or guardian with developmental disabilities who requires assistance in meeting the child’s developmental needs; or
h.
Other conditions or genetic disorders generally associated with
developmental disabilities, such as tuberous sclerosis, congenital
syphilis, fetal alcohol syndrome, or maternal rubella, as documented by
a physician.
i.
If a child between three and five years of age already has been
determined to have a developmental disability in one of the five
categories identified in Chapter 393, F.S., that child shall be
eligible for services from the agency under the appropriate diagnosis
and shall be added to the waiting list.
j.
If a child served under the category of high risk does not have a
confirmed diagnosis by his or her fifth birthday, they shall be given a
notice of case closure and the case will be closed at the agency. The
agency shall make the child’s parent or guardian aware of appropriate
agencies, programs or school programs which the agency is aware of
which might be able to assist the child.