Library: Policy

340:100-3-33.1. Criteria to establish service necessity

Issued 7-31-02

(a) The goal of service delivery is to promote the independence of persons with developmental disabilities. The purpose of publicly funded supports is to strengthen the individual's capacity for self-care and self-sufficiency and to lead to a lesser reliance on paid supports. Because of the unpredictable nature of government funding, promoting reliance on publicly funded supports is often not in the person's best interest. In order to minimize dependence on public funds, Developmental Disabilities Services Division (DDSD) staff use the criteria given in subsection (b) of this Section to determine the necessity of publicly funded supports.

(b) Services provided through DDSD must meet all of the requirements given in this subsection.

(1) Services appropriate to meet the individual's need are not available from another funding source.
(2) Services are authorized only to the extent necessary to achieve, maintain, or promote functional capacity.
(3) Services provided are consistent with accepted practice standards and guidelines.
(4) Services must be necessary to achieve a specific outcome and must be required for other than the convenience of the client, family, staff, or provider.
(5) Documentation submitted to request a service must contain objective evidence supporting the need, including evidence to support orders or prescriptions for the service.
(6) Services must be delivered in the most cost-effective manner and most appropriate setting.
(7) Services must be based on reasonable and predictable outcomes.
(8) Services are not provided to meet hypothetical situations.