Alternative Community Services Home and Community Based Waiver

1. Alternative Community ServicesHome and Community Based Waiver LEVELS OF CARE

2. Intermediate Care Facility - Level of Care Arkansas Statute: Categorical Eligibility • Cerebral Palsy: As established by licensed physician • Epilepsy: As established by neurological examination provided by licensed neurologist or licensed physician • Autism: As established by team evaluation – at least licensed psychologist or psychological examiner and speech pathologist • Intellectual Disabilities: As established by significant intellectual limitations that exist concurrent with deficits in adaptive behavior • Other: Impairment similar to intellectual disabilities, intellectual/adaptive behavior; attributable to dyslexia; • Disability expected to continue indefinitely and Disability constitutes a substantial limitation to person’s ability to function without supports • All developmental disabilities must be manifest prior to age 22

3. Intermediate Care Facility – Level of Care • Recertification • Ages 22+ or 18-22 with diploma or certificate of high school completion: IQ score obtained at age 22 or thereafter and current adaptive behavior assessment every 5 years • Ages 5 – 22 without diploma or certificate of high school completion: public/private school documentation as to continued need and disability unless eligibility is questioned • Ages birth – 5: IQ and adaptive functional level assessment current within one year of last psychological assessment and each year thereafter until age 5 • Determined by a licensed psychologist or psychiatrist or individuals under the supervision of a licensed psychologist or psychiatrist

4. Plan of Care – Level of Care • Limited • Supports anticipated to be consistent for the foreseeable future • Individually time limited/may be intermittent • Requires fewer staff/less cost due to parental support, group settings and community assistance • Supports are for: primary care giver relief, employment training, transition, crisis behavior management and assisted living. • Maximum reimbursement $160.00/day

5. Plan of Care - Continued • Extensive • Needs that require daily supports in one or more of a work, home or community environment • Weekly supports that may be needed daily but less than 24 hours/day and 7 days/week. • Supports are long term. • Crisis intervention as characterized by episodic behavior needs • Limited parental support • Maximum reimbursement $160.00/day

6. Plan of Care - Continued • Pervasive • Needs require constant supports provided across environments • Potentially life sustaining in nature • Intrusive supports • Long term supports • Supports provided 24 hours/day, 7 days/week and 365 days/year • Requires ICAP assessment • May require behavior treatment plan • May require case management/ caregiver daily progress notes • Maximum reimbursement $356.32/day

7. Plan of Care – Level of Care • Determinations • Physician • Every 12 months, individual to each person