Prioritization for Supports

(1) Priority Determination. (a) Except as to individuals who have special eligibility pursuant to 115 CMR 6.05, all supports, including assessments, planning and the development and implementation of Individual Service Plans, are subject to the availability of resources. The area director shall determine priority for supports on the basis of criteria set forth in 115 CMR 6.07. (b) Assessments. 1. The determination of need for supports shall be based upon an assessment of the individual’s functional limitation(s), cognitive impairment, medical needs and behavioral needs as well as generic resources and natural supports available to meet the individual’s needs. The Department shall, in its sole discretion, determine which clinical assessments it deems necessary to determine the individual’s need for all categories of requested supports as well as the qualifications needed to administer the assessments. The Department shall conduct such assessments in accordance with the standards set forth in 115 CMR 6.22. 2. Assessment(s) shall be completed by the intake and eligibility teams, in consultation with the area offices, upon an individual’s application for Department services for those who meet the eligibility requirements. Additional assessments may be requested thereafter upon a significant change in the individual’s functioning or in the generic or family resources available to meet the individual’s needs. (c) Notification. The area office will notify the person, his or her family, unless the person knowingly objects, the guardian, if any, or other appropriate person of the person’s priority to receive services from the Department, the category and intensity of supports available, and the right to appeal the priority assigned within 30 days of being notified. The notice given under 115 CMR 6.07 shall clearly state the reason for the prioritization decision. (2) Prioritization for Children's Supports. (a) The Department seeks to provide certain supports to children, birth to five years of age with developmental delay, or five through 22 years of age with developmental disabilities and their families, to enable the family to stay together and to be contributing members of their communities. These supports are intended to assist, not to replace or substitute for, the child's family. The responsibility to provide a home and parental care and guidance rests with the child's parents or, in the event of their absence or incapacity, with the public agency responsible for ensuring the care and protection of children generally, i.e., the Department of children and families or its successor. (b) Priority for the allocation of available Children's Supports provided, purchased or arranged by the Department shall be determined by the area director, based on the severity of the child's, or young adult's and family's needs. Individuals seeking enhanced or specialized services under 115 CMR 6.07(3) must first be assessed by the Department to determine the severity of their need. (c) The Department shall not provide residential supports to children from birth through 22 years of age and eligible for or receiving residential services from a local educational authority, local school district, or any other public agency. The failure of an individual to apply for or the voluntary refusal of services that may be available from another public agency and for which an individual is otherwise entitled shall not constitute ineligibility to receive those services for the purpose of establishing priority to receive Department services under 115 CMR 6.07. (d) If the child is eligible but is currently in the care or custody of, committed to, subject to court-ordered supervision of or is eligible for or receiving 24-hour residential services through another public agency, including, but not limited to the department of children and families, department of youth services, department of mental health, department of public health, and state or local education agencies, then the Department will presume that such agency is providing supports which are necessary and sufficient to ensure the appropriateness and adequacy of the child's placement. (e) Whenever another agency is providing supports or services to the child or family, or a child is eligible to receive supports from another agency, the area office shall consider that agency's involvement in determining the severity of the child's, young adult's, and family's needs and their priority for the Department's supports. (3) Prioritization for Adult Intellectual Disability Services. (a) The area director shall determine priority for supports provided, purchased or arranged by the Department to eligible adults 22 years of age or older based upon the severity of the individual's needs. (b) For individuals with intellectual disability who are determined to need Intellectual Disability Supports (Intensive Supports, Community Living Supports, or Adult Supports) the following priorities shall apply: 1. First Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to protect the health or safety of the individual or others. 2. Second Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to meet one or more of the individual's needs or to achieve one or more of the needs identified in his or her Individual Service Plan. (4) Prioritization for Adult Community Developmental Disability Supports. (a) Subject to the availability of resources, the area director shall determine priority for supports provided, purchased or arranged by the Department to eligible adults 22 years of age or older based upon the severity of the individual's needs. (b) For individuals who are determined to need Community Developmental Disability Supports the following priorities shall apply: 1. First Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to protect the health or safety of the individual or others 2. Second Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to meet one or more of the individual's needs. (5) If another Massachusetts public agency, including, but not limited to the department of children and families, department of youth services, department of mental health, department of public health, and state or local education agencies is providing services to an eligible individual, the Department may consider that agency's involvement in determining the severity of the individual's need and their priority for Department supports. The failure of an individual to apply for or the voluntary refusal of services that may be available from another public agency and for which an individual is otherwise entitled shall not constitute ineligibility to receive those services for the purpose of establishing priority to receive Department services under 115 CMR 6.07.