Section 152-7-4 - ELIGIBILITY DETERMINATION1. Application for ILS Program Services Any person who applies for services shall undergo an eligibility determination, the results of which shall be shared with the individual. An applicant is anyone who signs a dated application or letter requesting IL Services. An evaluation(s) will take place, at no cost to the consumer, to provide information for the eligibility decision. At any time in this process that it is determined the individual is not eligible for IL Services, the evaluation shall cease. Appropriate notification will be provided to the individual.
2. Eligibility Criteria and Evaluation An individual is eligible for ILS Program services if an evaluation documents the following:
A. That the individual has a significant physical or mental disability which for that individual constitutes or results in a severe limitation(s) in ability to function independently in family or community setting;B. That IL Services may reasonably be expected to assist the individual to function independently in a family or community setting; andC. The consumer's ability to direct the IL service planning and selection with or without assistance.D. The evaluation(s) shall take into consideration any relevant case record materials available from the ILS Program or other sources. A special diagnostic study(ies) shall be conducted for purposes of determining eligibility for IL Services only if already available information is not complete, relevant, or current. The evaluation(s) shall be sufficient in scope to determine which services will best meet the current needs of the individual for functioning more independently in family or community setting.3. Eligibility Decision and Documentation Upon completion of the evaluation, the ILS Program staff responsible for determining eligibility shall make one of the following decisions: The applicant is eligible; or, The applicant is ineligible.
A. Certification of Eligibility For each individual determined eligible for IL Program services, the case record must include documentation of the presence of a significant disability and a Certification of Eligibility which is signed and dated by the authorizing ILS Program staff and which documents:
(1) how the disability(ies) result in significant limitations in ability to function independently in family or community settings;(2) how there is a reasonable expectation that ILS Program services will assist the individual's ability to function independently in a family or community setting; and(3) how the consumer's direct and active participation in the process will be accomplished.B. Certification of Ineligibility In all cases where the authorizing ILS Program staff documents that IL Services cannot be expected to assist an individual to function more independently in family or community setting, there must be a certification dated and signed by the authorizing ILS Program staff. If an applicant has been determined to be ineligible, then the certification must be documented as follows:
(1) Reason(s) for Ineligibility (a) The service provider may determine an applicant to be ineligible for IL Services only after full consultation with the applicant or duly authorized representative, or after providing a clear opportunity for this consultation;(b) The applicant or duly authorized representative shall receive written, or by other appropriate media, notification of the agency action, appeal rights, and the availability of advocacy services through the Client Assistance Program;(c) The service provider shall provide a detailed explanation of the availability and purposes of the Client Assistance Program including information on how to contact the program; and(d) If appropriate, the service provider shall refer the applicant to other agencies and facilities, including the state's vocational rehabilitation program.(2) Review of Ineligibility Determination (a) If an applicant for IL Services has been found ineligible, the service provider shall review the applicant's current status no later than twelve (12) months after the determination has been made;(b) The review need not be conducted in situations where the applicant has refused the review, the applicant is no longer present in the state, or the applicant's whereabouts are unknown; and(c) All review efforts will be documented in the case record.4. Order of Selection A. At any time services cannot be provided within a reasonable time to all eligible individuals, the ILS Program Order of Selection shall be implemented. A reasonable time will be determined by the Director of DVR in consultation with the Statewide Independent Living Council.B. After determining eligibility, ILS Program staff shall follow the Order of Selection in purchasing services.C. A Statewide waiting list shall be established by the ILS Program provider in consultation with the DVR Grant Manager. The waiting list will be organized by Priority Status and chronological order of the Eligibility date. Eligible individuals shall be served in the following priority order:
(1) Priority 1 Status Those eligible adults who will lose their current level of independence and would be required to move to more restrictive setting immediately and permanently, unless they receive the assistance of a specific service or set of services which the ILS Program can provide.
(2) Priority 2 Status Those eligible adults who, with the assistance of a specific service or set of services which the ILS Program can provide, can immediately move to a less restrictive and more independent setting.
(3) Priority 3 Status Those eligible adults, who, with the provision of a service or set of services which the ILS Program can provide, will be able to overcome a specific barrier or set of barriers to independent living.
(4) Priority 4 Status All other eligible individuals.
D. All individuals in each priority shall be served before serving those in the next succeeding priority status.12- 152 C.M.R. ch. 7, § 4