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COMBINED MANUAL

ISSUE DATE 04/2022

SPECIAL MEDICAL CRITERIA

0011.36

optimal health, independence, safety and community integration. People must be younger than 65 years old at the time of opening to the program for the first time, and may remain on the waiver after age 65 if warranted by their needs and service plan. For specifics regarding BI waiver eligibility and services, see CBSM - Brain Injury (BI) Waiver.

Developmental Disabilities (DD) Waiver A program that provides home and community-based services to children and adults of any age with a diagnosis of a developmental disability or a related condition who require the level of care provided in an intermediate care facility for persons with developmental disabilities (ICF/DD). These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration. For specifics regarding DD waiver eligibility and services, see CBSM - Developmental Disabilities (DD) Waiver.

Elderly Waiver (EW) A program that funds home and community-based services for people age 65 and older who require the level of care provided in a nursing home and choose to live in the community. EW promotes community living and independence with services and supports that address each person's individual needs and choices. EW offers services that go beyond what is available through Medical Assistance. For specifics regarding EW eligibility requirements and services, see CBSM - Elderly Waiver.

● SEVERE EMOTIONAL DISTURBANCE (SED) There is a child or children in the household who meet the following definition of “severe emotional disturbance” as determined by a qualified professional such that he/she:

- Has been admitted within the last 3 years or is at risk of being admitted to inpatient or residential treatment for an emotional disturbance.

OR

- Is a Minnesota resident receiving inpatient treatment or residential treatment for the emotional disturbance through the interstate compact.

OR

- Has been determined by a mental health professional to have psychosis or clinical depression, to be at risk of harming self or others as a result of emotional disturbance, or to have psychopathological symptoms that resulted from physical or sexual abuse or psychic trauma within the past year.

OR

- Has significantly impaired home, school, or community functioning for at least 1 year or for a period that a mental health professional documents as presenting substantial risk of lasting at least a year.

● SERIOUS AND PERSISTENT MENTAL ILLNESS (SPMI) There is an adult or adults who meet the definition of “serious and persistent mental illness” as determined by a qualified professional such that he/she:

- Has undergone 2 or more episodes of inpatient care for a mental illness within the preceding 24 months.

OR

- Continuously experienced a psychiatric hospitalization or residential treatment exceeding 6 months' duration within the preceding 12 months.

OR

- Has been treated by a crisis team 2 or more times within the preceding 24 months.

OR