Clinical Eligibility Criteria

(A) All members, except those who are residents of an NF, must meet the following clinical eligibility criteria for receipt of DH: (1) have ID or DD as defined in 130 CMR 419.402 and as certified by a PCP; and (2) need DH to acquire, improve, or retain their maximum skill level and independent functioning. (B) In order for a member residing in an NF to be eligible for receipt of DH, DDS must have determined via a Level II PASRR that the member requires specialized services. (C) In order for a member receiving hospice services to be eligible for receipt of DH, the DH provider must obtain in writing from the member’s hospice provider that the DH is not providing services related to the member’s terminal illness, and that the DH services to be provided are not equivalent to or duplicative of hospice services.