Policy
General Policy Information specific to the Redetermination of Eligibility can be found in this chapter of the Eligibility Policy Manuel.
What is Chapter 600 "Redetermination of Eligibility"?
Uplined packets in need of further committee review can be located in this particular folder in the shared drive.
What is "(ERC) Eligibility Review Committee"?
Substantial Functional Limitations must be attributable to this.
What is one of the five DDD qualifying diagnoses?
These scores are necessary in order to substantiate a DDD qualifying diagnosis of Intellectual Disability.
What are appropriate IQ scores as well as Adaptive test scores?
Accessing all Standard Work and other resources here will ensure that you have the most up to date version.
What is the DDD Eligibility Shared Drive?
If a diagnosis of Cerebral Palsy is established after the age of six, this is where we elevate the evaluation.
Who is the Chief Medical Officer (CMO)?
Per policy, documentation of onset prior to the age of 6 is required for this DDD qualifying diagnosis.
What is Cerebral Palsy?
This column of the Redetermination Monitoring Tool is used to consistently identify the current roadblock in the case.
What is Column V "Type of ANDON"?
Eligibility for DDD services prior to the age of six does not guarantee a member will continue to be eligible after turning six years old when made eligible with this specific category.
What is "at-risk"?
Contact information for all eligibility staff can be found in this resource available in the Shared Drive.
What is the "DDD Eligibility Contacts"?
The qualified providers for a DDD diagnosis of Autism
What is a Licensed Psychologist, Psychiatrist, Child Neurologist, Developmental Pediatrician, or a Pediatrician who has completed the Early Access to Care Training?
If received, a member's school 504 Plan should be uploaded into this section of OnBase.
What is Section 3.2 "Other Plans"?
The inability to manage personal finances would belong in this substantial functional limitation category.
What is self-direction?
This is where we look to determine whether or not we can use a specific test for IQ testing.
What is Training and Guides --> CID
This is the evaluation and qualified provider criteria for a DDD qualifying diagnosis of Down Syndrome.
The Division shall require an evaluation report including a description of how the practitioner came to the decision based on prenatal or postnatal genetic testing completed by a licensed primary care physician, developmental pediatrician, neonatologist, and/or clinical geneticist.