1. Alternative Community Services Home 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 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 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 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 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 Determinations –Physician –Every 12 months, individual to each person