ARSD 67:54:04:18. Initial level of care

The following documentation is required to determine the initial level of care: (1) A completed ICAP that indicates a minimum of three substantial functional limitations; (2) A copy of the psychological evaluation; (3) An HCBS Waiver Choice and Rights Form signed by a CSP staff member and the individual, the individual's parent if the individual is under 18 years of age, or the individual's guardian; and (4) A provisional plan of care that designates the specific waiver service that the individual will receive.