1905 LEVEL OF CARE

1905.1 When an individual is determined to be likely to require a level of care as set forth in section 1902.1(e) of these rules and meets all other eligibility requirements, the individual or his or her authorized representative shall be informed by the case manager, as evidenced by the signed Waiver Beneficiary Freedom of Choice Form of:

(a) any feasible alternatives under the Waiver; and

(b) the choice of either institutional or home and community- based services.

1905.2 Each individual who is not given the choice of home or community-based services as an alternative to institutional care in an. ICF/MR as set forth in subsection 1909.1, shall be entitled to a fair hearing in accordance with 42 CFR Part 431, Subpart E.

1905.3 A registered nurse or qualified mental retardation professional, employed by MRDDA, shall perform the initial evaluation of the level of care and make a level of care determination.

1905.4 Re-evaluations of the level of care shall be conducted every twelve (12) months or earlier when indicated.

1905.5 Each re-evaluation shall be performed by persons with the same educational and professional qualifications as those for persons conducting the initial evaluations.

1905.6 Written documentation of each evaluation and re-evaluation shall be maintained for a minimum period of three (3) years, except when there is an audit or investigation, the records shall be maintained until the review has been completed.

SOURCE: Final Rulemaking published at 51 DCR 10207 (November 5, 2004).