20-48-703. Eligibility.

20-48-703. Eligibility. (a)(1) Eligibility for services and appropriate placement in the least restrictive environment for individuals with intellectual and developmental disabilities under any of the service models included in the state's Medicaid plan with the Centers for Medicare & Medicaid Services or for services covered from state general revenue dollars shall be made by the interdisciplinary team composed in keeping with federal and state laws pertaining to individuals with special needs. (2) Subdivision (a)(1) of this section does not negate or preclude the rights of individuals with intellectual and developmental disabilities under existing federal and state laws. (b)(1) Subject to approval by the Centers for Medicare & Medicaid Services, the Department of Human Services will accept an individualized family service plan or an individualized program plan developed in conformity with all applicable state and federal laws as prior authorization for Medicaid-covered therapies provided to persons with intellectual and developmental disabilities. (2) Prior authorization does not preclude post-payment reviews or other utilization control measures. (c)(1) For individuals with intellectual and developmental disabilities who, pursuant to the diagnosis, evaluation, and assessments conducted by the interdisciplinary team, in conformity with all applicable federal and state laws, are found to fall within the eligibility guidelines adopted pursuant to this subchapter, and where the individual's primary care physician, independent of the service provider, serves as the gatekeeper and prescribes early intervention day treatment or adult developmental day treatment services, or both, prior approval is not required for up to five (5) hours of daily services. (2) If the funding model for the early intervention day treatment and adult developmental day treatment services is changed in the state's Medicaid plan with the Centers for Medicare & Medicaid Services, the five (5) hours per day shall remain the minimum number of hours to afford those families who choose to keep their child or adult with an intellectual or other developmental disability in the community, thereby bearing a considerable responsibility for the care and expenses related to the treatment and care.