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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 3 a. Impaired judgment or insight b. Disorientation to time, place, or person c. Memory impairment d. Perceptual or thinking disturbance e. Lack of self-regulation or impulse control f. Diminished capacity to focus, concentrate, or maintain attention g. Propensity to engage in verbal or physical aggression towards others h. Marked changes in mood or affect i. Marked withdrawal, isolation, or depression j. Sleep disturbance k. Appetite disturbance with change in weight l. Marked difficulty in maintaining interpersonal relationships m. Propensity to elope 25300.6 DEFINITION OF ICF/MR LEVEL OF CARE An intermediate care facility for the mentally retarded (ICF/MR) is a residential setting which offers comprehensive habilitative and support services to persons with mental retardation or related conditions. Children who qualify for an ICF/MR level of care exhibit significant deficits in age-appropriate functioning in multiple domains. As a consequence, they require frequent assistance or supervision to competently or safely engage in activities of daily living (ADLs). Subject to full consideration of factors itemized in Section DSSM 25200, the presence of adaptive behavior deficits in the following contexts supports qualification under an ICF/MR level of care: a.Self care skills b.Domestic skills c.Community skills d.Self direction e.Social interaction f.Safety awareness g.Receptive and expressive communication h.Basic learning i.Co-occurrence of physical or behavioral health disorder j.Co-occurrence of alcohol or substance addiction or misuse 25400 APPROPRIATENESS OF COMMUNITY-BASED SETTING Program eligibility is contingent upon a finding that non-institutional care is appropriate and services are available (DSSM 25100). The community-based setting must meet the child’s needs safely and effectively to be appropriate. To fulfill this requirement, the Division will assess both the physical and social environment within the community–based setting. Given the State’s strong preference for non-institutional care of children, denial of eligibility based on environmental deficits is disfavored. If eligibility is jeopardized by environmental deficits, the division will affirmatively attempt to eliminate or reduce such deficits to an acceptable level through Departmental and community resources. 25500 DETERMINING MEDICAL PLAN OF CARE AND COSTS During the application and redetermination process, medical and social information is gathered from several sources including the primary caregivers, primary care practitioners, specialists and other health care providers, the schools, Child Development Watch (Part C) and/or other relevant sources. A listing of the services needed or currently being provided is recorded indicating whether there are ongoing costs (such as daily home health aides or 1-time costs (durable medical equipment). The cost for each are estimated as closely as possible and, to the extent possible, costs paid or defrayed by other insurance or other means of payment insurance settlement, donations, etc.) are deducted from the cost cap. Since Medicaid is generally payor of last resort [with exception of Individual with Disabilities Education Act (IDEA) services], the assessor may contact other potential payment sources to determine potential coverage especially when it appears the child might exceed the cost cap. Once the medical costs are computed the entire packet of assessment information is reviewed by the medial review team for the cost comparison and final eligibility determination. 25600 COST EFFECTIVENESS CALCULATION A determination of cost effectiveness for the Children's Community Alternative Disability's Program must be made using the following procedures. 25625 CALCULATION