Evaluation/Reevaluation of Level of Care (LOC)

Evaluation/Reevaluation of Level of Care (LOC) A. A participant’s level of care (LOC) is determined by an initial evaluation and required reevaluations to assess the needs for services through the Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver. 1. All LOC initial evaluations and required reevaluations must be conducted by one (1) of the five (5) Diagnostic and Evaluation (D&E) Teams housed at the Department of Mental Health’s (DMH’s) five (5) comprehensive regional programs. 2. The specific battery of standardized diagnostic and assessment instruments must accurately assess the individual’s level of function in all areas of development and serve as a baseline for future reassessments. 3. There is not a single instrument/tool required to determine LOC eligibility requirements for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). B. Initial LOC evaluations must: 1. Be conducted in an interdisciplinary team format that includes, at a minimum, a psychologist and social worker with other disciplines participating, as needed, based on the applicant’s needs. 2. Be administered by evaluators: a) Whose educational/professional qualifications are the same as evaluators of ID/DD Waiver and ICF/IID services, and b) Who are appropriately licensed/certified under state law for their respective disciplines. 3. Include an ID/DD Waiver LOC reevaluation tool to establish a baseline for future assessments. C. Reevaluations of LOC must be: 1. Conducted at least annually or when a significant change occurs which is defined as a decline or improvement in a participant’s status including, but not limited to, a change: a) In mental or physical status that will not normally resolve itself without intervention by staff or implementing standard disease-related clinical interventions, b) That is not self-limiting for declines only, c) That impacts more than one area of the participant’s health status, d) Which requires interdisciplinary review and/or revision of the Plan of Services and Supports (PSS), 2. Administered by ID/DD Waiver support coordinators, 3. Reviewed by Master’s level staff before submission to DMH, 4. Reviewed by the Diagnostic and Evaluation (D&E) team if a significant change occurred since the baseline LOC assessment, and 5. Reviewed by DMH. D. All participants must be initially certified by DMH as needing ICF/IID LOC before services provided through the ID/DD Waiver can begin.