# COMAR Title 10 — Maryland Department of Health ## Subtitle 22 — Developmental Disabilities ### Chapter 12 — Eligibility for and Access to Community Services for Individuals with Developmental Disability **Authority:** Health-General Article, §7-401, Annotated Code of Maryland **Administrative History:** Effective date: March 4, 1991 (18:4 Md. R. 447) **Administrative History:** Regulation .03B amended effective September 28, 1992 (19:19 Md. R. 1708) **Administrative History:** Regulations .03B and .12A amended as an emergency provision effective June 14, 1996 (23:14 Md. R. 1006); amended permanently effective December 2, 1996 (23:24 Md. R. 1681) **Administrative History:** Regulation .07 amended effective September 28, 1992 (19:19 Md. R. 1708) **Administrative History:** Regulation .12A amended effective September 28, 1992 (19:19 Md. R. 1708) **Administrative History:** COMAR 10.22.18 recodified to COMAR 10.22.12 effective July 26, 1999 (26:15 Md. R. 1148) **Administrative History:** Regulation .02B amended effective November 25, 2013 (40:23 Md. R. 1934) **Administrative History:** Regulation .03B amended effective March 26, 2007 (34:6 Md. R. 627); November 25, 2013 (40:23 Md. R. 1934), March 30, 2026 (53:6 Md. R. 291) **Administrative History:** Regulation .05B amended effective March 30, 2026 (53:6 Md. R. 291) **Administrative History:** Regulation .07B amended effective November 25, 2013 (40:23 Md. R. 1934); March 30, 2026 (53:6 Md. R. 291) **Administrative History:** Regulation .08B amended as an emergency provision effective September 1, 2003 (30:20 Md. R. 1445); amended permanently effective December 22, 2003 (30:25 Md. R. 1845) **Administrative History:** Regulation .11A amended as an emergency provision effective September 1, 2003 (30:20 Md. R. 1445); amended permanently effective December 22, 2003 (30:25 Md. R. 1845) **Administrative History:** Regulation .11F adopted as an emergency provision effective September 1, 2003 (30:20 Md. R. 1445); adopted permanently effective December 22, 2003 (30:25 Md. R. 1845) #### Regulation .01 Purpose. *COMAR 10.22.12.01* A. These regulations specify the individuals with developmental disability who are eligible for Developmental Disabilities Administration (DDA) funded services, the eligibility criteria which are set forth in Health-General Article, Title 7, Annotated Code of Maryland, and the process of eligibility determination. B. These regulations delineate the eligibility and access determination process involved in obtaining funding for services from the Developmental Disabilities Administration. C. By outlining the eligibility and access process, these regulations comply with the requirements of Health-General Article, Title 7, Subtitle 4. They establish a uniformly applied Statewide policy that recognizes the needs of families and the comparative urgency of these needs. #### Regulation .02 Scope. *COMAR 10.22.12.02* A. This chapter is applicable to the eligibility and access process for individuals with developmental disability involved in seeking funding from the Developmental Disabilities Administration for services provided in community programs under the jurisdiction of the Administration. They do not apply to those similar processes which are related to services provided in State residential centers (SRCs) that are operated by the DDA. B. This chapter is not intended to address the criteria for access to specific services funded by the DDA. COMAR 10.22.13 addresses the admission of individuals with intellectual disabilities to State residential centers under the jurisdiction of the Developmental Disabilities Administration. C. Individuals committed to the Department through the Maryland court system are not subject to the procedures set forth in these regulations. #### Regulation .03 Definitions. *COMAR 10.22.12.03* A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Administration” means the Developmental Disabilities Administration (DDA). (2) “Alternative living unit (ALU)” means a residence that: (a) Provides residential services for individuals who, because of developmental disability, require specialized living arrangements; (b) Admits not more than three individuals; and (c) Provides 10 or more hours of supervision per unit, per week. (3) “Applicant” means the individual who files an application for services with the DDA. (4) “Application for services” means the instrument: (a) Used to make preliminary determination of eligibility for DDA services, the nature of the disability, the services required, and how these services are to be provided; (b) Providing the basis for preliminary determination of service priority. (5) “Appropriate evaluation” means the assessment of an individual using accepted professional standards to document the presence of a: (a) Developmental disability as defined in Health-General Article, §7-101, Annotated Code of Maryland; or (b) Disability that qualifies the individual for individual support services only as defined in Health-General Article, §7-403(c), Annotated Code of Maryland. (6) “Caregiver” means the person who is primarily responsible for the ongoing care of the individual who is applying for services from the DDA. If the applicant is the caregiver, this term is applicable to the applicant. (6-1) “Community Supported Living Arrangements Services (CSLA)” means one or more of the following services to assist an individual with developmental disability or an individual eligible for support services only in those nonvocational activities necessary to enable that individual to live in the individual's own home, apartment, family home, or rental unit, with not more than two other recipients of these services: (a) Personal assistance; (b) Supports that enhance the individual's opportunities for community participation and to exercise choice and control over the individual's own life; (c) Community integration training services necessary to assist the individual in achieving and maintaining increased integration, interdependence, and productivity; (d) 24-hour emergency assistance; (e) Assistive technology; (f) Adaptive equipment; (g) Case management services; (h) Environmental modification; (i) Respite care; and (j) Other services as approved by the Secretary or the Secretary's designee. (7) “Department” means the Maryland Department of Health. (8) “Developmental Disabilities Administration access unit” (“DDA access unit” or “unit”) means the component which is under contract with the DDA to conduct the preliminary assessment of eligibility and priority for services based on the information provided on the application. (9) “Developmental disability” means a severe, chronic disability of an individual that: (a) Is attributable to a physical or mental impairment other than the sole diagnosis of mental illness, or to a combination of mental and physical impairments; (b) Is manifested before the individual becomes 22 years old; (c) Is likely to continue indefinitely; (d) Results in an inability to live independently without external support or continuing and regular assistance; and (e) Reflects the need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are individually planned and coordinated for the individual. (10) “Director” means the Director of the Developmental Disabilities Administration. (11) “Eligibility for support services only” means an individual shall have a severe chronic disability that is: (a) Attributable to a physical or mental impairment other than the sole diagnosis of mental illness, or to a combination of mental and physical impairments; and (b) Likely to continue indefinitely. (12) “Family support services” means a program designed to enable a family to provide for the needs of a child with developmental disability living in the home. Family support services include: (a) Individual and family counseling; (b) Personal care; (c) Day care; (d) Specialized equipment; (e) Health services; (f) Respite care; (g) Housing adaptations; (h) Transportation; and (i) Other necessary services. (13) “Grabau class” means those individuals: (a) Who are confined in a SRC; (b) Whose level of intellectual and personal skills is sufficient to allow them to function outside the SRC; (c) Who have been characterized by the SRC as having maladaptive behavior or emotional disturbance of sufficient severity as to require their continued placement with the SRC; and (d) Who have been confirmed as members of the class through an appropriate evaluation and staffing process designated by the DDA. (14) “Home and Community Based Waiver (waiver)” means the document and any amendments to it submitted by the single State agency for Title XIX and approved by the Secretary of Health and Human Services, which authorizes the waiver of statutory requirements limiting coverage for home and community based services under the Medicaid State Plan. (15) “Individual” means the person for whom an application for services has been filed with the DDA. (16) “Individual family care home (IFC)” means a private single family residence licensed by the Department under COMAR 10.22.08 which: (a) Under supervision, provides a home for individuals with developmental disability in a family atmosphere; and (b) Provides habilitation services for one to three individuals who are not related to the caregiver. (17) Individual Support Services. (a) “Individual support services” means an array of services that are designed to increase or maintain an individual's ability to live alone or in a family setting. (b) “Individual support services” includes: (i) In-home assistance with meals and personal care; (ii) Counseling; (iii) Physical, occupational, or other therapies; (iv) Architectural modification; and (v) Any other services that the Administration considers appropriate to meet the individual's needs. (18) “Knott class” means individuals with intellectual disabilities who were or are deemed inappropriately placed within the Department’s operated behavioral health facilities. (19) “Local review committee (LRC)” means the committee established by the regional director to review the service needs of eligible persons and make recommendations to the regional director. (20) “Low intensity support services” means support services in accordance with COMAR 10.22.06. Services qualifying for this category are: (a) Designed to be one-time only; (b) Low cost with a cap of $3,000 per individual per year; or (c) Approved by the regional office only if the cost of the services exceeds $3,000 or the services are needed beyond 1 calendar year. (21) “Personal contact” means a discussion of circumstances with the applicant, caregiver, or other proponent, when one exists, with a representative of the DDA, who has knowledge in the disability or has access to the assistance of someone with knowledge in the disability, for the purpose of gathering information relevant to the determination of eligibility, service needs, and priorities. (22) “Preliminary determination” means the outcome of the review of information supplied by or for the individual applying for DDA-funded services to produce an initial assessment of eligibility, service needs, and priorities. (23) “Program” means a prescribed set of services and activities designed to achieve specific objectives related to the needs of the individuals served. (24) “Proponent” means any person or agency who has a legitimate interest in the welfare of the individual applying for DDA services or being served in a DDA-licensed, operated, or funded program. (25) “Provider” means a licensed agency which provides services through an appropriate agreement with the Department. (26) “Regional director” means the director's designee who is charged with the management of the service delivery system in a specific geographic area of the State. (27) “Resident” means an individual who: (a) Demonstrates that that individual is living in the State voluntarily with an intent to remain on a permanent basis, including children with parents or guardians who reside out of the State; (b) Resides out-of-State but whose parents or guardians are residents of Maryland; or (c) Is a migrant worker and, while in the State, needs medical care and is not receiving assistance from any other state or political jurisdiction. (28) “Secretary” means the Secretary of Health. (29) “Secretary's designee” means the Director of the Developmental Disabilities Administration. (30) “Service coordinator” means a professional who is assigned the responsibility for assisting the consumer in accessing the service delivery system more efficiently and effectively. This assistance is effected through planning, monitoring, and coordinating the medical, social, habilitative, and vocational services necessary to meet the identified needs of the consumer, as agreed upon and specified in the consumer's individualized service plan. (31) “State residential center (SRC)” means a place that: (a) Is owned and operated by the State; (b) Provides residential services for individuals with intellectual disabilities and who, because of intellectual disabilities, require specialized living arrangements; and (c) Admits nine or more individuals with intellectual disabilities. (32) “Waiting list” means, for the purpose of this chapter, those individuals considered eligible for services and who have not received those services under the auspices of these regulations. #### Regulation .04 Accessing the DDA Service Delivery System by Individuals with Developmental Disability. *COMAR 10.22.12.04* A. Referrals. (1) An individual may be referred for service or services funded by the DDA by anyone who has legitimate interest in the welfare of the individual. (2) Individuals shall make referrals to and obtain applications from the DDA or its designee. (3) Individuals making referrals on behalf of individuals purported to have a developmental disability shall make them either separately or together with an application for services. B. Application for Services. (1) An individual applying for services funded wholly or in part by the DDA shall complete, or with assistance given by the DDA or its designee shall complete, an application for services. (2) An application may be submitted by: (a) The individual, if an adult; or (b) A parent, guardian, caregiver, or other proponent, when one exists. (3) The individual submitting the application shall provide, at a minimum, sufficient information to make a preliminary determination of: (a) The nature of the disability; (b) Eligibility for DDA-funded services based on the characteristics of the individual; (c) The individual's priority for DDA-funded services which shall take into account the: (i) Urgency of need, (ii) Strengths and needs of the applicant and caregiver, (iii) Environment in which the applicant lives; (d) Service or services needed; (e) Type of environment in which any needed services could be provided with the least restriction on the liberty of the individual; and (f) Further evaluation, if any, the individual may require. C. Processing the Application. (1) The individual shall complete the application and send it to the DDA access unit. (2) The unit shall send the applicant, caregiver, or other proponent, when one exists, a letter indicating receipt of the application and the results of the preliminary determination within 7 calendar days from the date the application is received. #### Regulation .05 Eligibility Criteria and Preliminary Determination Process. *COMAR 10.22.12.05* A. Eligibility Criteria. To be eligible for services funded by the DDA as an individual with developmental disability, that individual shall: (1) Be a resident of Maryland; and (2) Have an evaluation that finds that a developmental disability is present. B. Preliminary Determination Process. (1) The DDA access unit shall complete the preliminary determination and send the applicant, caregiver, or other proponent, when one exists, a letter containing the results within 7 calendar days of receipt of the application as indicated in Regulation .04C(2),of this chapter. (2) The preliminary determination consists of a review of all information supplied by or for the individual to determine the presence of an apparent disability which meets the eligibility requirements. (3) The DDA access unit shall send a letter to the applicant, caregiver, or other proponent, when one exists, which contains the following information: (a) The DDA access unit has received the application; (b) The individual appears to have a developmental disability, or does not appear to have a developmental disability, but may be eligible for individual support services in accordance with Health-General Article, §7-403(c), Annotated Code of Maryland; (c) The applicant, caregiver, or other proponent, when one exists, shall receive a personal contact in accordance with Regulation .03B(21) of this chapter, or the individual is not eligible for services funded by the DDA and no further action shall be taken by the DDA, absent an appeal of this determination; (d) The individual may be eligible for services from the Behavioral Health Administration; and (e) The individual has the right to an informal hearing to appeal the decision in accordance with COMAR 10.22.16. #### Regulation .06 Eligibility Determination Process — Personal Contact and Determination of Service Needs. *COMAR 10.22.12.06* A. Determination of Service Needs. (1) When a personal contact is made by a representative of the DDA, in accordance with Regulation .05B(3)(c), of this chapter, the representative shall: (a) Establish if the individual has a developmental disability; (b) Establish the nature of the disability; (c) Collect sufficient information, including any existing evaluations, to make a recommendation concerning assignment to a services priority category, taking into account the strengths and needs of the family, caregiver, and the individual; (d) Describe the nature of the services that the individual may require through: (i) Discussion with the applicant, caregiver, or other proponent, when one exists, and (ii) Observation of the interaction between the applicant, caregiver, or other proponent, when one exists; (e) Describe the type of environment that the individual may require through: (i) Discussion with the applicant, caregiver, or other proponent, when one exists, and (ii) Observation of the interaction between the applicant, caregiver, or other proponent, when one exists. (2) A face-to-face personal contact shall be conducted for individuals living in the community. For individuals living in chronic hospitals, rehabilitation facilities, residential schools, or for a transitioning youth whose only service need is a day program, a personal contact may consist of interviews with staff or individuals by phone or in person. Knott class individuals shall receive a personal contact. Individuals with the sole diagnosis of mental illness or otherwise not eligible for DDA-funded services may not receive a personal contact. (3) A representative of the DDA shall give written results of the personal contact to the appropriate regional director with a recommendation regarding eligibility, service needs, and priorities. (4) If the regional director agrees that the individual is eligible for services, the regional director shall recommend to the Director that the individual be assigned to one or more of six service priority categories described in Regulation .07B of this chapter, for each service as appropriate. (5) The Director shall review the recommendation of the regional director concerning eligibility, service needs, and priorities. (6) The Director shall send a letter to the applicant notifying the individual of the decision regarding the applicant's: (a) Eligibility; (b) Service needs; (c) Priorities; and (d) Right to an informal hearing in accordance with COMAR 10.22.16. B. Eligibility and Access Time Frame. (1) The entire eligibility and access process may not exceed 60 days except under the following conditions: (a) Scheduled appointments are cancelled by the applicant, caregiver, or other proponent, when one exists, and new appointments cannot be scheduled in a timely manner; or (b) Requested information necessary to make recommendations regarding eligibility, service needs, and priorities has not been received from the applicant, caregiver, or other proponent, when one exists. (2) The regional director shall review the applicant's requests for extensions of the eligibility and access process. Requests may be approved if the above conditions have been corrected or if definite arrangements have been made to correct the above conditions. #### Regulation .07 Eligibility Determination Process — Determination of Service Priority Category and Description of Categories. *COMAR 10.22.12.07* A. Determination of Service Priority Category. (1) The regional director shall base the recommendation regarding service priority on the determination that the individual meets the criteria for one or more of the following categories, which are listed in the order of priority in which applicants shall receive services: (a) Category I — Crisis Resolution; (b) Category II — Crisis Prevention; and (c) Category III — Current Request. (2) Individuals shall be served according to their priority ranking as follows: (a) Individuals in Category I are to be served before those in Category II; and (b) Individuals in Category II are to be served before those in Category III. (3) Service delivery is dependent upon levels of funding allocated for the fiscal year for the following discrete categories: (a) Category IV — Transitioning Youth; (b) Category V — Knott Class Member; (c) Category VI — Inappropriate Institutionalization; and (d) Category VII — Innovation or Demonstration Projects. (4) Individuals may be in more than one priority category at the same time. For example, an individual in the transitioning youth priority category for a day program may also be in the crisis prevention priority category for a residential program if the individual is graduating or leaving a secondary school program and has no place to live after that program ends. B. Description of Categories. (1) Category I — Crisis Resolution. (a) To qualify for this category, the applicant shall meet one or more of the following criteria. The applicant shall be: (i) Homeless or living in temporary housing with clear time-limited ability to continue to live in this setting with no viable non-DDA-funded alternative; (ii) At serious risk of physical harm in the current environment; (iii) At serious risk of causing physical harm to others in the current environment; (iv) In danger of losing DDA-funded residential services because of a lack of current day services; (v) One who has lost DDA-funded day services; or (vi) Living with a caregiver who is unable to provide adequate care due to the caregiver's impaired health, which may place the applicant at risk of serious physical harm. (b) To qualify for Category I under §B(1)(a)(ii), of this regulation, evidence such as the following shall be necessary. The applicant: (i) Has recently received severe injuries due to the behavior of others in the home or community; (ii) Has recently been the victim of sexual abuse; (iii) Has been neglected to the extent that the individual is at serious risk of sustaining injuries which are life threatening or which substantially impair functioning; (iv) Engages in self-injurious behavior which puts the individual at serious risk of sustaining injuries which are life threatening or which substantially impair functioning; or (v) Is at serious risk of sustaining injuries which are life threatening or which substantially impair functioning due to the physical surroundings. (c) If the applicant qualifies for Category I under §B(1)(a)(v), of this regulation, the individual shall qualify for day services only. (d) If the applicant is living in a situation where the applicant is the caregiver, §B(1)(a)(vi), of this regulation, shall apply to the applicant. (e) Individuals who qualify for services under this category shall, at a minimum, remain in this category until they have been provided with those services required to resolve the situation. (f) Individuals become eligible to receive services as the need occurs. (2) Category II — Crisis Prevention. (a) To qualify for this priority category, the applicant: (i) Shall have been determined by the DDA to have an urgent need for services; (ii) May not qualify for services based on the criteria for Category I; and (iii) Shall be at substantial risk for meeting one or more of the criteria in §B(1)(a) of this regulation, within 1 year, or have a caregiver who is 65 years old or more. (b) Individuals who qualify for services under this category shall, at a minimum, remain in this category until they have been provided with those services required to resolve the situation. (c) Individuals become eligible to receive services from the date of approval of priority status, except when eligibility is determined by the age of the caregiver. In this case, priority is determined by the caregiver's date of birth so that individuals with caregivers born at an earlier date have priority over individuals with caregivers born at a later date. (3) Category III — Current Request. (a) To qualify for this priority category, the applicant shall indicate at least a current need for services. (b) Prioritization of Services. (i) Applicants shall be prioritized for services based on the number of fiscal years they have been on the waiting list, except as provided for in §B(3)(b)(iv) of this regulation. (ii) Applicants on the waiting list for the longest period of time shall receive services before those who have been on the list for fewer years, except as provided for in §B(3)(b)(iv) of this regulation. (iii) Applicants whose applications are received by the DDA access unit within a given fiscal year shall be ranked by the fiscal year of application, and the month and day of birth. Those applicants born at the beginning of the fiscal year have priority over those born later in the year. (iv) For day programs only, the period of time that shall be counted toward prioritizing an individual shall begin with the year of departure from school or the year of application, whichever is later. (4) Category IV — Transitioning Youth. (a) To qualify for funding for services in this priority category the applicant shall be eligible: (i) For DDA-funded services in this category from the individual's 21st to the individual's 22nd birthday. If the date of graduation is after the individual's 21st birthday, the individual shall continue to be eligible for 1 year after the date of graduation. (ii) To receive day services only. (b) Individuals in this priority category shall also be in one or more of the other priority categories. (c) Individuals become eligible to receive services from the date of approval of priority status. (5) Category V — Knott Class. (a) To qualify for this priority category, the applicant shall have: (i) An intellectual disability; and (ii) Been determined inappropriately retained in a Department operated behavioral health facility as set forth in Knott vs. Hughes Civil Action No. Y-80-2832 (Fed. Dist. Ct. Md). (b) Individuals become eligible to receive services based on the best clinical judgment of the professionals involved based on availability of allocated resources. (6) Category VI — Inappropriate Institutionalization. (a) To qualify for this priority category, the applicant shall be a: (i) Resident in a nursing facility and not meet the criteria for admission or retention for that facility; (ii) Resident of an intermediate care facility for individuals with intellectual disabilities or persons with related conditions (ICF/IID) and not meet the criteria for admission or retention for that facility as determined by the hearing examiner; (iii) Resident in a chronic hospital who does not meet the criteria for admission or retention for that facility; (iv) Resident in a behavioral health facility operated by the Department who has a developmental disability but is not an individual with an intellectual disability and who does not meet the criteria for admission or retention in a State psychiatric hospital and whose primary need is not for a mental health service. (b) An individual in this priority category shall also be in another priority category. (c) Funding may be allocated for one or more of the above groups in §B(6)(a)(i)—(iv) of this regulation. (d) Individuals become eligible to receive services based on the best clinical judgment of the professionals involved based on availability of allocated resources. (7) Category VII — Innovation or Demonstration Projects. (a) To identify those individuals for whom this priority category is appropriate, the Administration, after consultation with interested parties, shall publish a request for proposal (RFP) for innovation or demonstration projects. (b) To qualify for this priority category, an individual shall be identified in a proposal submitted to the Administration which is considered appropriate for funding by the Administration. (c) An individual served in this priority category may continue to receive services, to the extent that funds are allocated, after the termination of the innovation or demonstration period. (d) An individual in this priority category may also be in another priority category. (8) Eligible applicants may receive family support services and low intensity support services on a first-come, first-served basis, regardless of service priority determination. #### Regulation .08 Letter of Final Determination. *COMAR 10.22.12.08* A. Within 60 days of the receipt of the application, the final letter of determination indicating eligibility, priority, and service needs shall be sent to the applicant, caregiver, or other proponent, when one exists. B. The letter shall contain the following information: (1) A statement that the individual has a developmental disability or the individual does not have a developmental disability, but may be eligible for individual support services in accordance with Health-General Article, §7-403(c), Annotated Code of Maryland; (2) The nature of the services the individual may require; (3) The type of environment in which any needed services could be provided; (4) The types of evaluations, if any, the individual requires; (5) That determinations of priority status may be subject to modification if the applicant's or caregiver's circumstances change; (6) The individual has the right to an informal hearing to appeal the decision in accordance with COMAR 10.22.16; and (7) That the individual shall apply for Medical Assistance or other alternative funding before the initiation of services. #### Regulation .09 Local Review Committee. *COMAR 10.22.12.09* A. The regional director shall establish one or more local review committees. B. The function of the LRC is to review the service needs of eligible individuals and make recommendations regarding service needs to the regional director. The LRC shall be appointed by the regional director from among the following: (1) County government, including local health departments; (2) DDA; (3) Advocacy or developmental disability provider agencies; and (4) Parents. C. The regional director or designee shall serve as chairperson of the LRC. #### Regulation .10 Confirmation of Eligibility for Service Provision. *COMAR 10.22.12.10* A. Confirmation of eligibility, which is established before selection of the individual to receive services, is based on an evaluation in accordance with Health-General Article, §7-404, Annotated Code of Maryland. The exception shall be an emergency situation when a crisis needs to be immediately resolved as specified in Regulation .11B. B. The regional director shall be responsible for assuring that the evaluation required by Health-General Article, §7-404, Annotated Code of Maryland, has been completed before final determination of eligibility. The individual's evaluation shall confirm the following: (1) That the individual has a developmental disability as indicated by the preliminary determination; (2) The nature of the disability; (3) The nature of the services that the individual may require; (4) The type of environment in which any needed services could be provided with the least restriction on the liberty of the individual; and (5) The extent and timing of the services to be provided to the individual. C. If the regional director concludes that the evidence supports eligibility for service provision, a recommendation may be made to the Director that funding for services for the individual be approved. #### Regulation .11 Initiation of Services. *COMAR 10.22.12.11* A. Initiation of service delivery to an eligible individual seeking DDA-funded services shall be dependent upon: (1) Assigned service priority, except for family support services and low intensity support services which are provided on a first-come, first-served basis; (2) Availability and allocation of funds provided to the DDA; (3) Availability of an appropriate community vacancy; and (4) The individual's completing an application for Medical Assistance or other alternative funding. B. Emergency Situations. (1) If an emergency situation arises and immediate services are needed to resolve a crisis, the regional director may telephone the Director or the Director's designee to authorize the initiation of services for a maximum of 15 calendar days, provided that an: (a) Evaluation pursuant to Regulation .10B(2) is performed to confirm eligibility within 10 calendar days of the initiation of services. If the individual cannot afford evaluation services, the State shall arrange for them. (b) Application for services is processed pursuant to Regulation .04C and approved by the Director pursuant to Regulation .10. (2) If the Director or the Director's designee cannot be reached, the regional director may authorize services provided that the approval is obtained on the next working day. C. Ninety days after the receipt of services, the service needs and priority status of an individual shall be reviewed by the regional director or the regional director's designee, and adjusted if indicated. If the service meets the needs of the individual, the individual's name shall be removed from the waiting list for that service. D. Any time after the receipt of services, an eligible individual may: (1) Apply for or request a change in intensity of services or support, or apply for additional services; (2) Request a less intensive form of that service, and may receive the less intensive service if it is available. E. Individuals assigned to Category I who enter a State residential center because needed community services are not available or will not be available within a reasonable time, shall retain their eligibility and priority status for community services for 12 months after the date they enter the SRC. F. Except in an emergency situation or a case approved by the Director because of extenuating circumstances, DDA may not fund services for individuals with State-only dollars unless the individual has been denied: (1) Medical Assistance including waiver services; and (2) Related alternative funding. #### Regulation .12 Admission to and Discharge from DDA Community-Funded Services. *COMAR 10.22.12.12* A. Exception. This regulation does not apply to family services or low intensity support services. B. General Requirements for Assigning Vacancies or Providing Support Services. (1) Only those individuals seeking DDA-funded services and who have been deemed eligible by the DDA in accordance with Regulations .05—.10 of this chapter may be served by community service providers in DDA-funded vacancies or with DDA-funded support services. (2) Each provider shall report all DDA-funded vacancies to the appropriate regional office in accordance with a DDA-approved procedure, as soon as the potential vacancy is known to the provider. (3) The DDA shall authorize all admissions to or discharges from DDA-funded services in advance of these actions by providers. (4) In addition to a final determination of eligibility before authorizing the admission of an individual to a funded vacancy, the DDA shall also determine that the: (a) Individual is in need of the type of service to be provided; (b) Service is appropriate and is to be provided with the least restriction on the liberty of the individual; and (c) Individual wishes to be served by the particular provider or, at a minimum, agrees to accept the service from that provider. (5) If the individual does not qualify under Category I, the regional director shall determine that there is no one in that category who would be more appropriate for the vacancy or service. (6) If an appropriate vacancy exists, but the provider refuses to serve an individual whom the DDA has identified as qualified to receive services, the regional office may not authorize the provider to fill the vacancy. The funding for the vacancy may be transferred to another provider that offers an appropriate service and is willing to serve the individual. C. Specific Criteria for Assigning Community Program Vacancies or Providing Support Services. (1) The DDA shall develop a Statewide list of eligible individuals to fill a vacancy in a community program. The list should be organized according to priority ranking and according to the criteria for those categories. From this list: (a) The first eligible individual in the county where that vacancy exists who is appropriate for the service may be served; (b) Any other eligible individual whose name appears on the list before that of the individual described in §C(1)(a) of this regulation, may be served if appropriate for the service; and (c) The regional director shall define appropriateness for the service and shall consider the compatibility of residents for multi-person residences. (2) Individuals eligible under Category I, Crisis Resolution, as specified in Regulation .07B, may be served on a priority basis in an appropriate community program vacancy created by the movement of any client except a: (a) Client receiving services under the auspices of the Title XIX 1915(c) waiver; (b) Knott class member; (c) Grabau class member; or (d) Former SRC client who has been returned to the SRC. (3) Vacancies created by the movement of a waiver-eligible individual shall be filled by another client who is eligible for services under the waiver criteria as specified in COMAR 10.09.26. (4) Vacancies created by the movement of a Knott class member shall be filled in the following manner: (a) By another member of the Knott class; (b) If there is no Knott class member in need of that vacancy at the time that the vacancy occurs, the vacancy is to be filled by: (i) A member of the Grabau class, (ii) An individual eligible under Category I, Crisis Resolution, or (iii) An individual eligible under Category II, Crisis Prevention. (c) If the vacancy is filled by anyone other than a Knott class member, the Director may use funds provided for community expansion to create an equivalent placement for a Knott class member. (5) Vacancies created by the movement of a nonwaiver Grabau class member shall be filled in the following manner: (a) By another member of the Grabau class; (b) If there is no Grabau class member in need of that vacancy at the time that the vacancy occurs, the vacancy is to be filled by: (i) A member of the Knott class, (ii) An individual eligible under Category I, Crisis Resolution, or (iii) An individual eligible under Category II, Crisis Prevention; (c) If the vacancy is filled by anyone other than a Grabau class member, the Director may use funds provided for community expansion to create an equivalent placement for a Grabau class member. (6) Vacancies created by the movement of an institutional client out of a community day program shall be filled in the following manner: (a) By another institutional client; (b) If there is no appropriate institutional client at the time the vacancy occurs, the vacancy may be filled by an individual under Category I, II, or III in that order; (c) The regional director shall define “appropriate client”, taking into consideration the behavior of the client and the day program available; and (d) If the vacancy is filled by anyone other than an institutional client, the Director may use funds provided for community expansion to create an equivalent placement for an institutional client. (7) When filling vacancies for a multi-person community residence, such as an ALU or an IFC home, all available vacancies shall be filled through the procedures set forth in §B(1) of this regulation. (8) Vacancies for community expansion shall be filled in the order in which the individual's name appears on the Statewide eligibility list. When selecting individuals for multi-person community residential programs, the second and all subsequent individuals shall be selected as set forth in §C(1) of this regulation. D. Transfers to and from Community Program Vacancies. (1) Individuals currently enrolled in one provider's program may request a transfer to another provider by submitting a request in writing to the service coordinator or to the regional office. (2) The service coordinator shall review the request and make a recommendation to the regional director. (3) The regional director may authorize the request if an appropriate vacancy exists. (4) If an appropriate vacancy does not exist, the individual shall be placed on the region's waiting list for transfers based on the date of approval of the transfer. The individual on the transfer list shall have priority over those individuals in the Current Request priority category, but may not have priority over those individuals in the Crisis Resolution or Crisis Prevention priority categories. (5) Individuals requesting transfers outside the region shall have their requests forwarded to the appropriate regional office. (6) The individual has the right to an informal hearing to appeal the decision in accordance with COMAR 10.22.16. #### Regulation .13 Eligibility for Other Services. *COMAR 10.22.12.13* A. An individual's eligibility for services provided by any other public or private agency may not be affected by the individual's eligibility for services pursuant to these regulations. B. If an individual who is eligible for services funded by the DDA may also be eligible for services provided by another agency, the DDA or its agent shall refer the individual to that agency. #### Regulation .14 Reporting Requirements. *COMAR 10.22.12.14* The DDA access unit shall issue an annual report on the characteristics of applicants for DDA-funded services which shall include: A. Information on the total number of individuals waiting for services by service request and priority category; B. The number of individuals who have been added or removed by service request and priority category; and C. Other pertinent information which would assist in planning for future services or evaluating current performance. #### Regulation .15 Administrative and Judicial Review. *COMAR 10.22.12.15* A. Pursuant to COMAR 10.22.16: (1) On any action or inaction of the Secretary pursuant to Regulations .01—.14 of this chapter, an applicant for or recipient of DDA-funded services may request: (a) An informal hearing before the Secretary's designee, and (b) The Secretary to review the decision of the informal hearing if that decision is not acceptable. (2) Informal hearings under §A(1)(a) of this chapter shall be conducted in accordance with the Developmental Disabilities Law, Health-General Article, Title 7, Annotated Code of Maryland. (3) After a request for a review is made, the Secretary shall conduct the review in accordance with State Government Article, §§10-201—10-217, Annotated Code of Maryland. B. A person aggrieved by a final decision of the Secretary in a contested case as defined in State Government Article, §10-201, may take an appeal as allowed in State Government Article, §§10-215 and 10-216, Annotated Code of Maryland. C. Providers filing appeals in connection with these regulations shall do so in accordance with State Government Article, §§10-201—10-217 and 10-401—10-405, Annotated Code of Maryland.