subchapter 71m – community living services
10A NCAC 71M .0101 SPECIAL ELIGIBILITY REQUIREMENTS
In addition to basic eligibility requirements, it must be
documented that the individual is either mentally retarded or severely
physically disabled.
(1) For purposes of defining and classifying mental
retardation, the criteria of the American Association on Mental Deficiency
shall be employed. The diagnosis of mental retardation shall be determined by
a duly licensed physician, psychiatrist, practicing psychologist, or a
psychological associate under the supervision of a psychiatrist or practicing
psychologist; each of the former shall have expertise in the area of mental
retardation. Documentation verifying a diagnosis of mental retardation by
specified appropriate professionals shall be obtained by local departments of
social services for certification of eligibility for services. A signed
statement shall contain the level of retardation that best describes client
functioning. For purposes of determining initial eligibility for community
living services, documentation of a prior diagnosis of mental retardation is
acceptable if it were determined and undersigned by any of the persons
stipulated in this Subsection. Re‑evaluation of mental retardation is
not required unless there is reason to believe that the condition has changed
or suspected to have been diagnosed erroneously. There may also be a need for
an evaluation more complete than the initial one in order to determine the most
appropriate services for the client. Documentation of mental retardation shall
include behavioral descriptions as well as levels of intellectual and adaptive
functioning as determined (if at all and to any degree possible) by standard
tests.
(a) The American Association on Mental
Deficiency defines mental retardation as "significantly subaverage general
intellectual functioning existing concurrently with deficits in adaptive
behavior and manifested during the developmental period." "General
intellectual functioning" refers to results obtained by assessment with
one or more of the individually administered general intelligence tests
developed for that purpose, i.e., a standardized individual intelligence test.
"Existing concurrently with" emphasizes the two‑dimensional
nature of the definition ‑‑ significantly subaverage intellectual
functioning, and deficits in adaptive behavior. "Significantly
subaverage" refers to performance which is more than two standard
deviations below the mean of a standardized general intelligence test. This is
a guideline rather than a rigid limit since assessment of IQ is subject to some
variation because of technical factors. The judgment of a qualified
professional (as defined in this Rule) is required to determine the validity of
a given test score. A significantly subaverage IQ is a necessary, but not
alone sufficient, condition for a diagnosis of mental retardation.
"Adaptive behavior" is the effectiveness or degree with which an
individual meets the standards of personal independence and social
responsibility expected of his age and cultural group. It is a product of the
interactions of an individual's abilities and skills with the expectations of
society and of the opportunities to learn. Deficits are difficult to measure
precisely and the rating scales from which levels are inferred show lower
reliability than measurements of intelligence. The judgment of a qualified
professional (as defined in this Rule) that the diagnostic criteria are met is
required for each individual. "Developmental period" is defined as
the period of time between birth and the eighteenth birthday.
(b) Generally accepted classifications of mental
retardation are as follows:
(i) Mild mental retardation is used to describe
the degree of mental retardation present when intelligence testing scores range
between two and three standard deviations below the norm (52 to 67 on the
Stanford‑Binet and 55 to 69 on the Wechsler Scales); many educable
retarded individuals function at this level; such children usually can master
basic academic skills while adults at this level may maintain themselves
independently or semi‑independently in the community.
(ii) Moderate mental retardation is used to
describe the degree of mental retardation when intelligence testing scores
range between three and four standard deviations below the norm (36 to 51 on
the Stanford‑Binet and 40 to 54 on the Wechsler Scales); many trainable
individuals function at this level; such persons usually can learn self‑help,
communication, social, and simple occupational skills but only limited academic
or vocational skills.
(iii) Severe mental retardation is used to
describe the degree of mental retardation when intelligence testing scores
range between four and five standard deviations below the norm [20 to 35 on the
Stanford‑Binet and 25 to 39 on the Wechsler Scales (extrapolated)]; such
persons require continuing and close supervision but may perform self‑help
and simple work tasks under supervision.
(iv) Profound mental retardation is used to
describe the degree of mental retardation present when intelligence testing
scores are more than five standard deviations below the norm [19 and below on
the Stanford‑Binet and 24 and below on the Wechsler Scales
(extrapolated)]; such persons require continuing and close supervision but some
persons may be able to perform simple self‑help tasks; profoundly
retarded persons often have other handicaps and require total life support
systems for maintenance.
(2) The existence of a severe physical disability must
be established on the basis of a professional diagnosis by a person or
authority competent to make such a diagnosis. For purposes of determining
initial eligibility, documentation of a diagnosis of severe physical disability
made within the past 12 months is acceptable. The continuing existence of a
severe physical disability must be re‑documented at least every 12
months. Disabled means unable to engage in any substantial gainful activity by
reason of a medically determinable physical impairment which can be improved,
corrected, or ameliorated but which can be expected to last, or which has
lasted, for a continuous period of not less than 12 months. Specifically,
severe physical disability means a person:
(a) who has a severe physical disability which
seriously limits his functional capabilities, or
(b) who has one or more physical disabilities
resulting from amputation, arthritis, blindness, cancer, cerebral palsy, cystic
fibrosis, heart disease, hemiplegia, hemophilia, respiratory or pulmonary
dysfunctions, multiple sclerosis, muscular dystrophy, musculoskeletal
disorders, neurological disorders (including stroke and epilepsy), paraplegia,
quadriplegia, and end stage renal disease, and
(c) whose habilitation or rehabilitation can be
expected to require multiple habilitation or rehabilitation services over an
extended period of time.
History Note: Authority G.S. 143B‑153;
Eff. July 23, 1979;
Transferred from T10.43I .0202 Eff. July 1, 1983;
Amended Eff. June 1, 1990.