1. (a) To determine the existence of an applicant’s acquired brain disorder, the area agency shall perform a comprehensive screening evaluation consisting of:

   1. (1) Reviewing available information, including, but not limited to:

      1. a. Current physical, intellectual, cognitive, and behavioral evaluations;
      2. b. An age-appropriate standardized functional assessment; and
      3. c. As applicable, additional specialty medical, health, or clinical evaluations, such as communication, functional behavior, psychological, or psychopharmacological assessments, assistive technology, and personal safety or comprehensive risk assessments; and
   2. (2) Gathering additional information and preforming the additional evaluations among those listed in (1) above that are necessary to complete the determination, if the information available is not adequate to make a determination of eligibility.
2. (b) The results of the comprehensive screening evaluation pursuant to (a) above and any other information concerning the applicant’s disability shall be the basis for determination of eligibility pursuant to He-M 522.03(a) and assist in the identification of needs and provision of services.
3. (c) To the extent possible, the area agency shall utilize generic resources to pay for an applicant’s comprehensive screening evaluation. Such resources shall, with the applicant’s consent, include private and public insurance.

4. (d) An area agency shall review the information it has received regarding an applicant and, within 15 business days after the receipt of the completed application, make and communicate one of the following decisions on the eligibility of the applicant in accordance with He-M 522.03(a) to the applicant, guardian, or representative:

   1. (1) Eligible; or
   2. (2) Ineligible.
5. (e) If an area agency determines additional information is necessary in order to make a determination in accordance with (d) above, a communication detailing the additional information necessary shall be provided to the applicant, guardian, or representative, and the application shall not be determined complete until all necessary information has been received by the area agency.
6. (f) In cases where the information on eligibility is inconclusive, the area agency may consult with the bureau regarding determination of eligibility prior to making a decision in accordance with (d) above.
7. (g) Decisions by the bureau in (f) above shall be made within 5 business days.
8. (h) In instances where consultations in (f) above would cause the area agency’s decision pursuant to (d) above to exceed 15 business days, an additional 7 business days shall be allowed to make such decisions.
9. (i) A written denial of eligibility pursuant to (d)(2) above shall describe the specific legal and factual basis for the denial, including specific citation of the applicable law or department rule, and advise the applicant of their right to appeal pursuant to He-M 522.17.
10. (j) Following a denial of eligibility, the applicant, guardian, or representative, as applicable, may reapply for services if new information regarding the diagnosis, age of onset, or severity of the disability or functional impairment related to the acquired brain disorder becomes available.
11. (k) Communication of approval of eligibility in accordance with (d)(1) above shall include a contact person at the area agency.
12. (l) Preliminary planning to determine the services needed shall occur with the individual and guardian or representative at the time of intake or during subsequent discussions. Preliminary evaluations shall be completed and preliminary recommendations for services shall be made within 21 days of a completed application for service.
13. (m) Within 3 days of the determination of the applicant’s eligibility under He-M 522.05(d)(1), the area agency shall review 1915(c) of the Social Security Act, waiver services, with the applicant, guardian, or representative in order to make a decision.
14. (n) If the individual, guardian, or representative is interested in pursuing waiver services within the next 12 months, within 5 business days of the individual’s decision pursuant to (m) above, the area agency shall submit an application for waiver level of care eligibility pursuant to He-M 517.03 to the bureau.

15. (o) In an emergency situation, temporary service arrangements may be made prior to the completion of the evaluation in (a) above if the bureau administrator, or designee, first determines that the individual meets one of the following:

    1. (1) Is a victim of abuse or neglect pursuant to He-E 700;
    2. (2) Is abandoned and homeless;
    3. (3) Is without a caregiver due to death or incapacitation;
    4. (4) Is at significant risk of physical or psychological harm due to decline in their medical or behavioral status; or
    5. (5) Is presenting a significant risk to community safety.
16. (p) The determination of eligibility pursuant to He-M 522.03(a) by one area agency shall be accepted by every other area agency in the state.

Source. #7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08 New. #9734, eff 6-25-10; ss by #12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35