La. Admin. Code tit. 50 § XV-11303

Current through Register Vol. 50, No. 11, November 20, 2024

Section XV-11303 - Recipient Qualifications

A. In order to be eligible to receive case management services, the EPSDT recipient shall be between the age of 0 and 21 and meet one of the following criteria:

1. placement on the Request for Services Registry and determined to be eligible for OCDD services through the statement of approval process; or

2. for those who do not meet eligibility, or who are not undergoing eligibility determination, may still receive case management services if they meet the definition of a person with special needs.

a.Special Needs-a documented, established medical condition, as determined by a licensed physician or other qualified licensed health care practitioner in accordance with §10501.C 10, that has a high probability of resulting in a developmental delay or that gives rise to a need for multiple medical, social, educational, and other services. In the case of a hearing impairment, the determination of special needs must be made by a licensed audiologist or physician or other qualified licensed health care practitioner in accordance with §10501.C 10.

3. Documentation that substantiates that the EPSDT recipient meets the definition of special needs for case management services includes, but is not limited to:

a. receipt of special education services through the state or local education agency; or

b. receipt of regular services from one or more physicians or other qualified licensed health care practitioner in accordance with §10501.C 10; or

c. receipt of or application for financial assistance such as SSI because of a medical condition, or the unemployment of the parent due to the need to provide specialized care for the child; or

d. a report by the recipient's physician or other qualified licensed health care practitioner in accordance with §10501.C 10 of multiple health or family issues that impact the recipient's ongoing care; or

e. a determination of developmental delay based upon:

i. the Parents' Evaluation of Pediatric Status;

ii. the Brigance Screens;

iii. the Child Development Inventories;

iv. an appropriate screening tool; or

v. any other nationally-recognized diagnostic tool.

La. Admin. Code tit. 50, § XV-11303

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 26:2797 (December 2000) repromulgated for inclusion in LAC, LR 30:1042 (May 2004), Amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 471130 (8/1/2021), Amended LR 492111 (12/1/2023).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.