Ariz. Admin. Code § R6-6-303 - Requirements for Determining Eligibility for the Division of Developmental Disabilities

A. For the purpose of eligibility determination, the Department shall accept the diagnoses of autism, cerebral palsy, epilepsy, and cognitive/intellectual disability as follows:

1. Autism. A psychiatrist, neurologist, licensed psychologist, or developmental pediatrician who has expertise in diagnosing autism shall make an autism diagnosis. A pediatrician who has completed specialized training approved by the Department in the diagnosis of autism may also make an autism diagnosis. The psychiatrist, neurologist, licensed psychologist, developmental pediatrician, or pediatrician with specialized training shall submit a diagnostic report regarding the individual documenting the presence of diagnostic criteria for autism, including the presence of the required number of symptoms of autism based on current guidelines established by the American Psychiatric Association.

2. Cerebral palsy. A licensed physician with expertise in diagnosing neurological disorders, such as a neurologist, or specialist in rehabilitation medicine, shall diagnose cerebral palsy. The physician shall submit a report to the Department documenting the diagnosis of cerebral palsy and include available medical records supporting the diagnosis.

3. Epilepsy. A physician specializing in neurology shall diagnose epilepsy.

a. The physician specializing in neurology shall submit a report to the Department documenting the active diagnosis of epilepsy and include the following:

i. Electroencephalogram (EEG) report;

ii. A description of the nature and frequency of the seizures, including current anti-seizure medication; and

iii. Confirmation of the ongoing nature of the disorder.

b. If the records of a neurological evaluation cannot be obtained or a diagnosis is not made by a physician specializing in neurology, the Division Medical Director shall review the available medical records to confirm a diagnosis of epilepsy.

4. Cognitive/Intellectual Disability.

a. A licensed psychologist trained to perform psychological evaluations utilizing standardized, culturally appropriate, and psychometrically sound measures shall diagnose cognitive/intellectual disability by considering the following:

i. Other mental disorders identified in current guidelines established by the American Psychiatric Association, including Schizophrenia, Bipolar Disorder, Attention Deficit Hyperactivity Disorder, and Substance Abuse;

ii. Significant disorders related to language or language differences;

iii. Physical factors, including sensory impairments, motor impairments, acute illness, chronic illness, and chronic pain;

iv. Testing performed during an acute inpatient hospitalization;

v. Educational or environmental deprivation; and

vi. Psychosocial factors.

b. To be eligible for the program, in the presence of co-existing mental illness, an individual's cognitive/intellectual disability shall not be the result of the onset of mental illness.

c. If an existing psychological evaluation cannot be obtained, or an initial psychological evaluation cannot be completed, the Division's Assistant Director or designee shall review the available records to confirm eligibility.

B. An individual, who acquires an impairment or condition after age six as a result of illness or traumatic brain injury, is not eligible in the absence of a qualifying diagnosis.

B. C. The Department shall determine substantial functional limitations in three or more areas of the major life activities as documented in records provided to the Department. These limitations are defined as follows:

1. Self-care. Self-care means the performance of personal activities that sustain the health and hygiene of the individual appropriate to the individual's age and culture. This includes bathing, toileting, tooth brushing, dressing, and grooming. A functional limitation regarding self-care occurs when an individual requires significant assistance with eating, hygiene, grooming, or health care skills or when the time required for an individual to complete these tasks is so excessive as to impede the ability to retain employment, attend school, or to conduct other activities of daily living. Documentation of substantial functional limitations for self-care may include recent:

a. Medical or behavioral records;

b. IEP that addresses limitations of self-care goals and objectives;

c. Relevant comments in a psychological or psychoeducational evaluation;

d. Relevant scores on the ALTCS assessment, Preadmission Screening (PAS) tool;

e. Relevant scores on the Vineland Adaptive Behavior Scales; or

f. Other structured standardized tests of adaptive functioning.

2. Receptive and expressive language.-- Receptive and expressive language means the process of understanding and participating in conversations in the individual's primary language, and expressing needs and ideas that can be understood by another individual who may not know the individual. A functional limitation regarding receptive and expressive language occurs when an individual is unable to communicate with others, or is unable to communicate effectively without the aid of a mechanical device, a third person, or a person with special skills. Documentation of substantial functional limitations for receptive and expressive language may include recent:

a. Psychological, psychoeducational, or speech evaluation records;

b. IEP references of severe communication deficits;

c. Use of sign language, a communication board, or an electronic communication device; or

d. Relevant scores on the ALTCS assessment, PAS tool.

3. Learning. - Learning means the ability to acquire, retain, and apply information and skills. A functional limitation regarding learning occurs when an individual's cognitive factors, or other factors related to the acquisition and processing of new information are impaired to the extent that the individual is unable to participate in age-appropriate learning activities without utilization of additional resources. Documentation of limitations for learning may include verification of placement in a special education program.

4. Mobility. Mobility means the skill necessary to move safely and efficiently from one location to another within the individual's residence, neighborhood, and community. A functional limitation regarding mobility occurs when an individual's fine or gross motor skills are impaired to the extent that the assistance of another individual or mechanical device is required to move from place to place or when the effort required to move from place to place is so excessive as to impede ability to retain employment and conduct other activities of daily living. Documentation of limitations for mobility may include:

a. Relevant scores on the ALTCS assessment, PAS tool; or

b. Medical or educational records indicating the need to regularly use a wheelchair, walker, crutches, or other assistive devices, or to be physically supported by another person when ambulating.

5. Self-direction.

a. Self-direction means the ability to manage one's life, including:

i. Setting goals,

ii. Making and implementing plans to achieve those goals,

iii. Making decisions and understanding the consequences of those decisions,

iv. Managing personal finances,

v. Recognizing the need for medical assistance,

vi. Behaving in a way that does not cause injury to self or others, and

vii. Recognizing and avoiding safety hazards.

b. A functional limitation regarding self-direction occurs when an individual requires assistance in managing personal finances, protecting self-interest, or making independent decisions that may affect well-being. For children under the age of 18, the Department shall compare the child's abilities in this area with age and developmentally appropriate abilities based on the current guidelines of Centers for Disease Control and Prevention and American Academy of Pediatrics.

c. Documentation of limitations for self-direction may include:

i. Court records appointing a legal guardian or conservator,

ii. Relevant comments in medical or behavioral records,

iii. Relevant comments in psychoeducational or psychological evaluation,

iv. Relevant objectives in the IEP, or

v. Relevant scores on the ALTCS assessment, PAS tool.

6. Capacity for independent living.

a. Capacity for independent living means the performance of necessary daily activities in one's own residence and community, including:

i. Completing household chores;

ii. Preparing simple meals;

iii. Operating household equipment such as washing machines, vacuums, and microwaves;

iv. Using public transportation; and

v. Shopping for food, clothing, and other essentials.

b. A functional limitation regarding the capacity for independent living occurs when an individual needs supervision or assistance for the individual's safety or well-being, on at least daily basis in the performance of health maintenance and housekeeping. For children under the age of 18, the Department shall compare the child's abilities in this area with age and developmentally appropriate abilities based on the current guidelines of Centers for Disease Control and Prevention and American Academy of Pediatrics, including:

i. Age of the child,

ii. Culture,

iii. Language,

iv. Length of time to complete task,

v. Level and type of supervision or assistance needed,

vi. Quality of task performance,

vii. Effort expended to complete the task performance,

viii. Consistency and frequency of task performance, and

ix. Impact of other health conditions.

c. Documentation of limitations for the capacity for independent living may include:

i. Relevant comments in a psychoeducational or psychological evaluation,

ii. Related objectives on the IEP, or iii. Relevant comments in medical records.

7. Economic self-sufficiency. -- Economic Self-Sufficiency means when an individual is unable to perform the tasks necessary for regular employment or is limited in productive capacity to the extent that earned annual income, after extraordinary expenses occasioned by the disability, is below the poverty level. For children under the age of 18, the Department shall compare the child's abilities in this area with age and developmentally appropriate abilities based on the current guidelines of Centers for Disease Control and Prevention and American Academy of Pediatrics. Documentation of limitations for economic self-sufficiency may include:

a. The receipt of Supplemental Security Income (SSI) or Social Security Disability Income (SSDI) benefits, or

b. Eligibility for Vocational Rehabilitation Services.

Notes

Ariz. Admin. Code § R6-6-303

Adopted effective October 31, 1978 (Supp. 78-5). Repealed effective March 30, 1983 (Supp. 83-2). New Section adopted effective June 7, 1993, under an exemption from A.R.S. Title 41, Chapter 6 (Supp. 93-2). Amended effective September 30, 1993, under an exemption from A.R.S. Title 41, Chapter 6 (Supp. 93-3). Adopted by final rulemaking at 24 A.A.R. 2013, effective 8/24/2018.