1. (a) When a Division of Developmental Disabilities Services service specialist receives a request for HDC placement, he or she will give the applicant a six-part initial application which includes:

   1. (1) Information letter;
   2. (2) Choice Form 102;
   3. (3) Social history;
   4. (4) Department of Human Services Form 703 (Evaluation of Medical Need Criteria);
   5. (5) Areas of Need Form; and
   6. (6) Results of the independent assessment.

2. (b)

   1. (1) The applicant will return the initial application to the division service specialist.
   2. (2) Once the specialist receives the completed initial application, the initial application will be sent to the division Eligibility Review Team for ICF eligibility determination.
   3. (3) Once determination has been made, the division Eligibility Review Team will notify the division Intake and Referral Program Administrator of the individual determined eligible.
   4. (4) Notice of ineligibility of individual who is determined not to meet the ICF/IID eligibility requirement will be sent by the Director of the Division of Developmental Disabilities Services or designee as well as the division’s rule Appeals, 20 CAR pt. 544.

   5. (5)

      1. (A) The Intake and Referral Unit Program Administrator will schedule a review within five (5) working days of notice of the applicant’s ICF eligibility with the division Appropriate Placement Review Team (APRT), which is comprised of the Intake and Referral Program Administrator, Program Manager, and the HDC admission coordinators.
      2. (B) The team will determine the appropriateness of the applicant for HDC services.
      3. (C) Once a decision has been made, the APRT will complete the Review of Referral for Placement Form.
      4. (D) On the review, the team will document if the preliminary decision is one (1) of the following:
3. (i)
4. (a) (a) The APRT has reviewed this initial application and has determined that this client is appropriate for placement and a vacancy exists at this time.
5. (b) (b) If the applicant is appropriate for placement and there is an appropriate vacancy, the applicant will be informed of the vacancy and asked to complete the formal application process through his or her division service specialist.

6. (c)

   1. (1) (c)(1) After the APRT determines a client appropriate for placement, the director or designee may allow an emergency respite placement if it is necessary to ensure the client’s health and safety prior to the independent assessment.
   2. (2) (2) However, the client must be referred for the independent assessment.
   3. (3) (3) A client will not be admitted to an HDC without the results of the independent assessment.

   4. (4) (4) The independent assessment must be completed within thirty (30) days of referral; or

      1. (ii)
7. (a) (a) The APRT has reviewed this initial application and has determined that this client is not appropriate for HDC placement.

8. (b) (b) If the applicant is not appropriate for HDC placement, the applicant will be informed of the right to reconsideration under 20 CAR pt. 544.

   1. (c) (c) Applicants may appeal a denial decision through the director or his or her designee.

      1. (c) The completed Review of Referral for Placement Form will be sent by the division Program Manager of Adult Services Intake to the applicant and/or legal representative and his or her division service specialist.

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: "III. PROCEDURAL RULES Perspective Eligibility Guidelines" "ICF/IID" means intermediate care facility for individuals with intellectual disabilities.