1. (a)

   1. (1) Once a vacancy becomes available, the HDC admission coordinator will notify the appropriate Division of Developmental Disabilities Services specialist and the applicant and/or legal representative, and the formal application packet will be completed.

   2. (2) In order to be considered, the packet must contain:

      1. (A) An application for HDC services;
      2. (B) Authorization to Disclose Health Information (Department of Human Services Form 4000);
      3. (C) Freedom of Choice Form (102);
      4. (D) A cover memo by the individual’s division children service specialist or adult service specialist stating the reason or reasons for the referral and the specialist’s impressions and recommendations;
      5. (E) A current medical evaluation signed by a physician;
      6. (F)

2. (i) Physical therapy, occupational therapy, and speech therapy evaluations that are relevant to the reason or reasons for the referral.

   1. (ii) Evaluations must be completed within the preceding twelve (12) months;

      1. (G)

         1. (i) A psychological evaluation including intellectual functions levels and adaptive behavior scale.
         2. (ii) The evaluation must be completed within the preceding twelve (12) months;
      2. (H) The results and report of the independent assessment performed by the third-party vendor; and

      3. (I)

         1. (i) A written social history completed within the preceding ninety (90) days by the individual’s division specialist.
         2. (ii) The social history shall include:
3. (a) (a) A description of the individual’s immediate situation and need for services, relating those needs to the services provided by the HDC;

4. (b) (b) A general and behavioral description of the individual;

   1. (c) (c) A family status and profile;

      1. (d) (d) A developmental history;
5. (e) (e) Medical status signed by a physician and stating the individual’s current problems including general medical, vision, dental, hearing, medications and treatments, allergies, and any communicable diseases;
6. (f) (f) Diet requirements;
7. (g) (g) Financial questionnaire completed within the preceding twelve (12) months;

8. (h) (h) History of agency and professional contacts and outcomes, including without limitation reports, evaluations, and discharge summaries;

   1. (i) (i) Review of alternate placement options and efforts;

9. (j)

   1. (1) (j)(1) For school age applicants, a copy of the most recent individualized education plan.
   2. (2) (2) For others, program plans established by current and past providers of developmental disabilities services; and
10. (k) (k) A determination by a physician other than the physician on the individual’s interdisciplinary team that the individual qualifies for and is in need of human development center services.

11. (b) Field service review of formal application packet.

    1. (1) The applicant’s service specialist will compile the formal admission packet and send it to the division Program Manager.

    2. (2)

       1. (A) Within five (5) business days of receiving the packet, the division Program Manager will review the packet to determine if the packet is complete.
       2. (B) If the packet is incomplete, the division Program Manager will notify the service specialist that the packet is incomplete.

       3. (C) If the packet is complete, the division Program Manager will send the packet to the HDC admission coordinator for review.

          1. (c) Human development center review.
    3. (1) The HDC admission team and/or interdisciplinary team will review each formal referral packet within five (5) business days of receipt and determine if the individual remains appropriate for admission.

    4. (2)

       1. (A) If the team determines that the individual is now inappropriate for placement there, the HDC will notify the applicant of the determination.
       2. (B) The notice must state the reason for inappropriate placement at its center and explain the individual’s right to appeal.
       3. (C) If the team determines that the individual remains appropriate for placement at the center, the team will make a recommendation as to the appropriateness of admission to the HDC superintendent.

       4. (D)

          1. (i) The HDC superintendent will determine whether to admit each eligible individual and will notify the applicant and the service specialist of the decision.
          2. (ii) If the admission is denied, the notice must state the reason for the denial and explain the applicant’s right to appeal.
          3. (d) Admission requirements. Upon receiving notification of admission, the applicant’s service specialist will furnish the following to the HDC:
    5. (1) Copy of birth certificate;
    6. (2) Copy of Social Security card or valid Social Security number;
    7. (3) Copy of Medicaid card or verification of insurance, if any;
    8. (4) Completed Agreement to Pay worksheet;
    9. (5) Copy of immunization history;
    10. (6) Copy of the results of a tuberculosis test performed within two (2) weeks prior to admission;
    11. (7) Copy of the results and report of the independent assessment and tier determination for the individual;
    12. (8) Copy of the results of a physical examination, including any diagnosis made by the examining physician, performed within the preceding thirty (30) days;
    13. (9) Letters of acknowledgement from the local education agency for individuals who have not completed high school and are under twenty-two (22) years old, certificate of completion/high school diploma, and/or GED; and
    14. (10) All court orders rendered in connection with the individual’s custody, guardianship, or adoption proceedings, if any.
12. (e) The HDC admission coordinator will work with the applicant and division specialist on admission arrangements.

13. (f) Admission.

    1. (1) Upon successful completion of preadmission requirements, the HDC admission coordinator will schedule an admission date and notify the division service specialist of any diagnostic and evaluation assistance available.
    2. (2) The division specialist will contact the applicant and offer to assist in admission.

14. (g) Periodic reviews and independent assessment.

    1. (1) Evaluations, assessments, and periodic reviews shall conform to 42 C.F.R. § 483.400 et seq.
    2. (2) Each client shall have an annual status review, which will occur more often than annually if warranted.
    3. (3) The independent assessment will be conducted prior to admission.

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: "III. PROCEDURAL RULES Perspective Eligibility Guidelines" "GED" means General Educational Development test.