b) The application package shall include:

1. 1) A letter explaining the Department's eligibility verification process;
2. 2) Instructions for submitting the necessary clinical information to verify the severity of the disability and other eligibility criteria;
3. 3) A listing of Department-designated agencies in the applicant's region which may assist with verification of disability;
4. 4) Written instructions to the primary examiners on what they must do to verify eligibility;
5. 5) Eligibility criteria for individuals with severe mental illness or emotional disturbance, severe autism, severe mental retardation and severe and multiple impairments; and
6. 6) Eligibility determination forms that must be signed by the primary examiner (see Section 117.Appendix B).

f) Documentation of severe and multiple impairments shall be based on a comprehensive, documented evaluation by a licensed clinical psychologist or a physician; and, depending on the individual's disability, one or more specialists. The evaluation shall verify that the individual has a substantial disability that can be expected to continue indefinitely. The individual meets the criteria for severe and multiple impairments based on a finding that criteria in subsections (f)(1) through (3) of this Section are met. Each item has its own sub-criteria which also shall be met, e.g., under subsection (f)(1)(A) or (B) of this Section, shall apply.

1. 1) The evaluation determines the presence of a developmental disability based on:

   1. A) Mental retardation, which is defined as general intellectual functioning that is two or more standard deviations below the mean; or
   2. B) Cerebral palsy, epilepsy, autism or any other condition which results in impairment similar to that caused by mental retardation and which requires services similar to those required by persons with mental retardation.

2. 2) The evaluation determines multiple handicaps in physical, sensory, behavioral and/or cognitive functioning which constitute a severe or profound impairment attributable to one or more of the following:

   1. A) Physical functioning, which severely impairs or restricts the individual's motor performance that may be due to neurological, psychological or physical involvement resulting in a variety of disabling conditions, such as hemiplegia, quadriplegia, ataxia, in severe organ systems involvement such as congential defects, and other physical abnormalities resulting in the individual being non-mobile and non-ambulatory or confined to bed and receiving assistance in transferring, or requiring regular medical or nursing supervision such as gastrostomy care and feeding.

   2. B) Sensory, which involves severe restriction due to hearing and/or visual impairment limiting the individual's movement and creating dependence in completing most daily activities.

      1. i) Hearing impairment is defined, based on an evaluation by a board eligible or certified otolaryngologist or an audiologist with a Certificate of Clinical Competency, as loss of 70 dB aided or speech discrimination of less than 50% aided.
      2. ii) Visual impairment is defined, based on an evaluation by a board eligible or certified ophthamologist or a licensed optometrist, as 20/200 in the better eye or a visual field of 20 degrees or less.

   3. C) Behavioral, which involves severe or profound deficits in adaptive hehavior or severe maladaptive behavior.

      1. i) Adaptive behavior, which is at a severe or profound level of functioning for the age group in self-care skills such as feeding, dressing, grooming or bathing, in social skills such as responses or interactions with others or in communication skills such as use of words or gestures expressively or receptively.
      2. ii) Maladaptive behavior, which presents a danger to self or others, is destructive to property by deliberately breaking, destroying or defacing objects, is disruptive by fighting or prolonged arguing or crying, or has other socially offensive behaviors in sufficient frequency and/or severity to seriously limit social integration.
   4. D) Cognitive, which involves severe or profound intellectual functioning at a measured I.Q. of 40 or below.

3. 3) The evaluation determines that development is substantially less than expected for the individual's age in cognitive, affective or psychomotor behavior.

   1. A) Cognitive, which involves intellectual functioning at a measured I.Q. of 70 or below.
   2. B) Affective behavior, which involves over and under responding to stimuli in the environment and may be observed in mood, attention or awareness, or in behaviors such as euphoria, anger or sadness that seriously limit integration into society.
   3. C) Psychomotor, which includes a severe developmental delay in fine or gross motor skills so that development in self-care, social interaction, communication or physical activity shall be greatly delayed or restricted.

g) Individuals or their guardians may use existing evaluations if they meet the criteria above and were completed within the following time frames:

1. 1) For assessment of severe mental illness described in subsection (d) of this Section, within one year prior to the date submitted to the Department.
2. 2) For assessment of the maladaptive behavior component of severe and multiple impairment described in subsection (f)(2)(C)(ii) of this Section, within one year prior to the date submitted to the Department.
3. 3) For all other assessments required by subsections (c)(e) and (f) of this Section, within three years prior to the date submitted to the Department.