441—25.15 (331) Eligibility, diagnosis, and functional assessment criteria.
	   25.15(1) Eligibility for mental health services. An individual must comply with all of the following requirements to be eligible for mental health services under the regional service system:
	      a.    	 The individual complies with the financial eligibility requirements in rule 441—25.16(331).
	      b.    	 The individual is at least 18 years of age.
	      c.    	 The individual is a resident of this state.
	      d.    	 The individual has had at any time during the preceding 12-month period a mental health, behavioral, or emotional disorder or, in the opinion of a mental health professional, may now have such a diagnosable disorder. The diagnosis shall be made in accordance with the criteria provided in the most recent Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and shall not include the manual’s “V” codes identifying conditions other than a disease or injury. The diagnosis shall also not include substance-related disorders, dementia, antisocial personality, or developmental disabilities, unless co-occurring with another diagnosable mental illness.
	      e.    	 The results of a standardized functional assessment support the need for mental health services of the type and frequency identified in the individual’s case plan. The standardized functional assessment methodology shall be designated for mental health services by the director of human services in consultation with the state commission. A functional assessment must be completed within 90 days of application for services.
	   25.15(2) Other conditions of eligibility for mental health services.
	      a.    	 An individual who is 17 years of age, is a resident of this state, and is receiving publicly funded children’s services may be considered eligible for services through the regional service system during the three-month period preceding the individual’s eighteenth birthday in order to provide a smooth transition from children’s to adult services.
	      b.    	 An individual less than 18 years of age and a resident of the state may be considered eligible for those mental health services made available to all or a portion of the residents of the region of the same age and eligibility class under the county management plan of one or more counties of the region applicable prior to formation of the region. Eligibility for services under this paragraph is limited to availability of regional service system funds without limiting or reducing core services, and if part of the approved regional service system management plan.
	   25.15(3) Eligibility for intellectual disability services. An individual must comply with all of the following requirements to be eligible for intellectual disability services under the regional service system:
	      a.    	 The individual complies with the financial eligibility requirements in rule 441—25.16(331).
	      b.    	 The individual is at least 18 years of age.
	      c.    	 The individual is a resident of this state.
	      d.    	 The individual has a diagnosis of intellectual disability as defined by Iowa Code section 4.1(9A).
	      e.    	 The results of a standardized functional assessment support the need for intellectual disability services of the type and frequency identified in the individual’s case plan. The standardized functional assessment methodology shall be designated for intellectual services by the director of human services in consultation with the state commission. A functional assessment must be completed within 90 days of application for services.
	   25.15(4) Other conditions of eligibility for intellectual disability services.
	      a.    	 An individual who is 17 years of age, is a resident of this state, and is receiving publicly funded children’s services may be considered eligible for services through the regional service system during the three-month period preceding the individual’s eighteenth birthday in order to provide a smooth transition from children’s to adult services.
	      b.    	 An individual less than 18 years of age and a resident of the state may be considered eligible for those intellectual disability services made available to all or a portion of the residents of the region of the same age and eligibility class under the county management plan of one or more counties of the region applicable prior to formation of the region. Eligibility for services under this paragraph is limited to availability of regional service system funds without limiting or reducing core services, and if part of the approved regional service system management plan.
	   25.15(5) Eligibility for brain injury services. An individual must comply with all of the following requirements to be eligible for brain injury services under the regional service system, if such services were provided to the same class of individuals by a county in the region prior to regional formation and if funds are available to continue such services without limiting or reducing core services.
	      a.    	 The individual complies with the financial eligibility requirements in rule 441—25.16(331).
	      b.    	 The individual is at least 18 years of age.
	      c.    	 The individual is a resident of this state.
	      d.    	 The individual has a diagnosis of brain injury as defined in Iowa Code section 83.81.
	      e.    	 The results of a standardized functional assessment support the need for brain injury services of the type and frequency identified in the individual’s case plan. The standardized functional assessment methodology used is the methodology approved for brain injury services by the director of human services in consultation with the state commission. A functional assessment must be completed within 90 days of application for services.
	   25.15(6) Other conditions of eligibility for brain injury services. An individual who is 17 years of age, is a resident of this state, and is receiving publicly funded children’s services may be considered eligible for services through the regional service system during the three-month period preceding the individual’s eighteenth birthday in order to provide a smooth transition from children’s to adult services.
	   25.15(7) Eligibility for developmental disability services.
	      a.    	 Until funding is designated for other service populations, eligibility for the core service domains shall be as identified in Iowa Code section 331.397(1)“b.”
	      b.    	 If a county in a region was providing services to an eligibility class of individuals with a developmental disability other than intellectual disability prior to formation of the region, the class of individuals shall remain eligible for the services provided when the region is formed, providing that funds are available to continue such services without limiting or reducing core services. The individual must also meet the requirements in paragraphs 25.15(7)“c,” “d,” “e” and “f.”
	      c.    	 The individual complies with the financial eligibility requirements in rule 441—25.16(331).
	      d.    	 The individual is at least 18 years of age.
	      e.    	 The individual is a resident of this state.
	      f.    	 The individual has a diagnosis of a developmental disability other than an intellectual disability as defined in rule 441—24.1(225C).
[ARC 1173C, IAB 11/13/13, effective 1/1/14]