Developmental Services - Case Management Manual

Eligibility for Developmental Services

3.1 Policy Statement on Mental Retardation

 As part of its process for the provision of services to persons with mental retardation, the Office utilizes the definition of mental retardation as adopted by the American Association on Mental Retardation and the American Psychiatric Association.

"Mental retardation refers to significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period". (34-B MRSA §5001(3)).

1. Sub-average intellectual functioning is defined as an intelligence quotient obtained by assessment with one or more of the individually administered general intelligence tests, e.g. Wechsler Scales, Stanford-Binet, Cattell or comparable tests. Individuals obtaining a score more than two standard deviations below the mean (average) score (approximate I.Q. score of 70) will be assessed as having subnormal intelligence, e.g., Wechsler approximately 69, Stanford-Binet, approximately 67.

2. Adaptive behavior is defined as the effectiveness or degree with which the individual meets the standards of personal independence and social responsibility expected of his age and cultural group. Level of adaptive behavior will be appropriately determined through the use of developmental scales, such as the AAMD Adaptive Behavior Scales, Vineland Social Maturity Scale, Fairview Developmental Scale, Callier-Azusa Scale, the Alpern Bolls Assessment Scale, etc. Other scales may be used, but must have appropriate standardization and norms to effectively assess adaptive behavior. Individuals having scored more than two standard deviations below the mean for normal age peers, or otherwise falling within a similar normative classification of 'Developmental Retardation" (depending on instrument used), shall be determined to have deficits significant enough to be considered as potentially having mental retardation.

3. Developmental period is defined as age eighteen (18) years or younger.

Once an applicant has been determined ineligible for services, reapplications shall only be considered if there is new information concerning the applicant's functioning during the developmental period.


3.2.      Policy Statement on Pervasive Developmental Disorders

The Office uses the definition of autism codified in 34-B MRSA §6002. Autism refers to a developmental disorder characterized by a lack of responsiveness to other people, gross impairment in communicative skills and unusual responses to various aspects of the environment, all usually developing within the first 30 months of age. In addition, for purposes of this rule, an adult person with autism is one:

1.Whose diagnosis, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association) is within the category of Pervasive Developmental Disorders, including Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, or Pervasive Developmental Disorder, Not Otherwise Specified; and manifested during the developmental period, (Developmental period is defined as age eighteen (18) years or younger).and

2. Who has been assessed as having an adaptive behavior score at least two standard deviations below the mean as measured by an adaptive behavior scale as described below. The office will require an adaptive behavioral scale test that has been completed within two years of the date of eligibility determination and reserves the right to request further testing.

3.2.1.Assessment Tools. Only the following assessment tools shall be used to determine a person’s adaptive behavior score: Adaptive Behavior Assessment System (2d ed., known as ABAS-II), the Vineland Adaptive Behavior Scales (2d ed., known as Vineland-II), or other substantially similar assessment tool as approved by the Office. Adaptive behavior shall be assessed using one of these tools in the context of a clinical interview where, as deemed clinically necessary, the examiner is able to evaluate responses from one or more participants in the testing environment. Testing must occur in the least restrictive setting available.

3.2.2.    Assessment Process. The intake process described in 34-B MRSA §5467 shall be followed. In addition, as part of the assessment process, the office will establish an advisory committee whose members shall be appointed by the Office Director as follows:

1. One member who is a employee of the Office of Adults with Cognitive and Physical Disabilities who shall act as the committee chair;

2. One member who is not an employee of the Department and is a psychologist who has a working background in the testing and treatment of Pervasive Developmental Disorders, is licensed to practice in Maine and meets the requirements to perform a comprehensive evaluation as set out in 34-B MRSA §5468; and

3. One member who is not an employee or provider with the department for any other service, is a professional with knowledge of clinical evaluation standards, testing protocols and eligibility criteria and has a working background in the testing and treatment of Pervasive Developmental Disorders.

 When requested by the office, this committee shall render an opinion, at any time, on an application for eligibility by reviewing the complete record, including the intake record, and all evaluation and test results. The committee may request additional information or testing. The committee may provide opinions or concerns regarding the tests and evaluations reviewed. The committee shall provide its opinions in a written report to the office.

3.3      Appeal Process

It is the policy of the Office to ensure that needed services are provided to persons with mental retardation and/or autism in accordance with the laws of the State of Maine to the extent resources permit.

Further, it is the policy of the Office to provide for review of a decision in which a person is found ineligible for services from the Office.

Whenever the regional office of the Office determines that an applicant is not eligible to receive services, the applicant, the applicant's legal guardian, or anyone acting on his/her behalf, shall be advised by the regional office, in writing, of such a determination and of his/her right to appeal that decision and of the availability of an advocate to assist, if the applicant so desires, in pursuing a review of the determination. In the absence of anyone acting on behalf of the applicant, the applicant shall be notified, both verbally and in writing, of the ineligibility determination and the Office of Advocacy shall be notified.

Office Director Review

The applicant, the applicant's legal guardian or anyone acting on behalf of the applicant, may request a review of the decision. The request for review shall be in writing and be submitted to the director of the Office. The written request shall be submitted within sixty (60) calendar days of the date of receipt of the written determination from the regional office. In the absence of anyone acting on behalf of the applicant, the applicant shall be notified, both verbally and in writing, and the sixty (60) day timeframe shall begin to run on the date when both forms of notification have been completed.

Upon receipt by the Director, and within twenty-one (21) working days of receipt of the written request for review, the Director, or his/her designee, shall schedule a meeting. The meeting shall include the applicant, his/her representative and the appropriate regional staff of the Department.

The Director or designee shall hear and give consideration to all relevant information presented at this meeting and render a decision within twenty-one (21) calendar days of the date of the meeting.

This meeting shall be electronically recorded. The Director's decision shall be in writing, sent to all parties present at the meeting, and shall contain the following:

  1. a statement of the issue,
  2. relevant facts brought out at the meeting,
  3. pertinent provision of law related to the decision,
  4. the decision and the reason for the decision,
  5. the procedure to request an appeal.

Commissioner Review

The applicant or anyone acting on his/her behalf may request that the Commissioner review the Office Director's decision. A request for this review shall be submitted in writing within fifteen (15) working days of the date of receipt of the Office Director's decision. The request shall be submitted to the Commissioner who shall arrange, within twenty-one (21) calendar days of receipt of the request, for a meeting to be conducted by the Commissioner’s designee.

The meeting shall include the applicant, his/her representative and the appropriate regional staff of the department.

The Commissioner or designee shall review the decision made by the Director. The Commissioner shall hear and give consideration to any relevant information presented at the hearing and render a decision within twenty-one (21) calendar days of the date of the meeting.

The meeting shall be electronically recorded. The Commissioner's decision shall be in writing, sent to an parties present at the meeting, and shall contain the following:

  1. a statement of the issue,
  2. relevant facts brought out at the meeting,
  3. pertinent provision of law related to the decision,
  4. the decision and the reason for the decision,
  5. the right of the applicant to appeal this final agency action

Further review may be sought through the procedures as set forth In the Maine Administrative Procedure Act, Chapter 375, sub-chapter VII (5 MRSA, Section 11001, at seq.). This statute provides for further appeal.