65G-4.014: Eligibility for Services
65G-4.015: Eligibility Criteria
65G-4.016: Application Process
65G-4.017: Establishing Eligibility
PURPOSE AND EFFECT: Establish the process and criteria for eligibility for services provided to persons with developmental disabilities by the Agency.
SUMMARY: Defines qualifying conditions, defines the application process and establishes objective standards for eligibility
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 393.065, 393.501, 393.063 FS.
LAW IMPLEMENTED: 393.065 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting: Terri McGarrity, (850)414-7452 or SC 994-7452. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Terri McGarrity, Sr. Management Analyst Supervisor, Agency for Persons with Disabilities, 4030 Esplanade Way, Tallahassee, Florida 32399, (850)414-7452 or SC 994-7452
THE FULL TEXT OF THE PROPOSED RULE IS:
65G-4.014 Eligibility for Agency Services – Definitions.
(1) Autism – As used in this rule for eligibility for services from Agency for Persons with Disabilities (Agency), autism is limited to the definition of autistic disorder as described in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM IV). While characteristics of autism occur on a spectrum, autism in this rule refers only to autistic disorder as defined in the DSM IV. Autistic disorder refers to qualitative impairments in social interaction, qualitative impairments in communication and restricted repetitive and stereotyped patterns of behavior, interests and activities and delays or abnormal functioning of one of the following with onset prior to age 3:
(a) Social interaction,
(b) Language as used in social communication, or
(c) Symbolic of imaginative play.
(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 are motor dysfunction caused by medical events, including stroke or progressive diseases, such as muscular dystrophy.
(3) Mental Retardation or Intellectual Disability – means (a) significantly sub average general intellectual functioning: an Intelligence Quotient (IQ) of 70 or below on an individually administered IQ or for infants and young children, and a clinical judgment of significantly sub average intellectual functioning, existing concurrently with paragraph (b) deficits in adaptive functioning in at least two of the five following areas – communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety, which are paragraph (c) manifested prior to age 18.
(4) Prader-Willi Syndrome – means a non-inherited, genetic syndrome which is most often associated with a random deletion of chromosome 15. Commonly associated characteristics include diminished fetal activity, insatiable appetite and chronic overeating. Individuals diagnosed with Prader-Willi Syndrome generally have mental retardation; however, an individual with Prader-Willi syndrome can be determined as eligible for AGENCY 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.
Rulemaking Authority 393.065, 393.501, 393.063 FS. Law Implemented 393.065 FS. History–New ________.
65G-4.015 Eligibility Criteria.
(1) In order to be determined eligible for Agency services the applicant must:
(a) Be at least three years of age.
(b) 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.
(c) Have a confirmed diagnosis of one of the following developmental disabilities as defined in this rule: autism, cerebral palsy, mental retardation, Prader-Willi Syndrome, Spina Bifida, or children between 3 and 5 years of age who are at high risk of later diagnosis of one of these disabilities. 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.
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. Mail or facsimile, to the Agency service area where the applicant resides. The application for services is available on the Agency website at www.APD.myflorida.com or by contacting the Agency.
(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. 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.
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 this rule, may only be made by one or more of the following who has specific training and experience in making such diagnoses:
(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) If the diagnosis of autism is not clear, an instrument such as the Autism Diagnostic Observation Schedule (ADOS) or the Autism Diagnostic Interview – Revised (ADI-R) may be administered by a qualified psychologist or psychiatrist with experience and training in use of the tool administered to confirm the diagnosis.
(f) 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. There are two requirements for establishing that an individual has mental retardation:
(a) The first requirement is that the individual’s performance is measured at two or more standard deviations below the mean on a currently used version of a standardized, normed and individually administered assessment of intelligence at the time of the assessment. The assessment administered must have been the version of the assessment that was accepted at the time of evaluation.
(b) When there are several assessments that have been conducted with varying I.Q.s, the Agency may rely on patterns or clusters of scores and shall reject those scores that appear to be significantly lower or higher than the average of the other scores. A single subtest should not be used alone to determine eligibility when multiple test results are available. 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, 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.
(c) The second requirement is that the individual has a documented deficit in adaptive functioning. Mental retardation is indicated if there are significant deficits in adaptive functioning (usually 2 or more standard deviations below the mean in at least two areas.) in areas such as ability to meet self-care needs, understanding and use language and self-direction.
(d) 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 either:
(i) A Florida-licensed psychologist,
(ii) A Florida-licensed school psychologist,
(iii) A certified school psychologist.
(e) Accepted standardized tests of intelligence to establish eligibility for mental retardation are:
(i) Stanford-Binet Intelligence Test (all ages),
(ii) Wechsler Preschool and Primary Scale of Intelligence (under six years of age),
(iii) Differential Ability Scales – Preschool Edition (under six years of age),
(iv) Wechsler Intelligence Scale for Children (WISC) (children up to fifteen years, eleven months),
(v) Differential Ability Scales (children up to fifteen years, eleven months),
(vi) Wechsler Adult Intelligence Scale (WAIS),
(vii) Test of Nonverbal Intelligence-3 (TONI-3),
(viii) Comprehensive Test of Nonverbal Intelligence-2 (C-TONI 2),
(ix) Universal Nonverbal Intelligence Test (UNIT),
(x) Leiter International Performance Scale-Revised (Leiter-R).
(f) The following are Tests of Adaptive Functioning accepted in the determination:
(i) Vineland Adaptive Behavior Scales,
(ii) AAMR Adaptive Behavior Scale,
(iii) Adaptive Behavior Assessment System (ABAS),
(iv) Adaptive Behavior Evaluation Scale (ABES).
(g) In all cases, assessments or evaluations for eligibility should be obtained from appropriately licensed professionals with experience and training with 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:
(a) A medical doctor;
(b) A doctor of osteopathy; or
(c) 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 – High Risk Children, 3 to 5 years of age. Evidence under this category requires an area office determination 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.
(7) 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 wait list.
(8) 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, the child’s 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.
Rulemaking Authority 393.065, 393.501, 393.063 FS. Law Implemented 393.065 FS. History–New________.