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2.0 Confirmation of Eligibility for Ministry-Funded Adult Developmental Services and Supports

Applicable to: Application Entities
Legislative Authority for Policy Directive:
Section 7(2) 2i
Functions of Application Entity under the Act:
Sections 14, 15
Effective Date:
August 15, 2013

Purpose

The purpose of this policy directive is to outline the procedures used by Application Entities to confirm whether an applicant is eligible for Ministry-funded adult developmental services and supports.

Policy

The Application Entity shall confirm whether an individual is eligible for Ministry-funded adult developmental services and supports in accordance with the Act and the General regulation (O. Reg. 276/10).

Directive

The Application Entity shall review supporting documentation provided by the individual or representative of their choice, to confirm whether an applicant is eligible for ministry funded adult developmental services and supports.

Documents may be originals or photocopies. The Application Entity reserves the right to view the original documents upon request.

Required documentation includes:

  • a psychological assessment or report signed by a psychologist or psychological associate registered with the College of Psychologists of Ontario (or equivalent body in another province) that states the individual has a developmental disability in accordance with the Act and Regulation;

  • proof of age (document displays individual’s name and date of birth); and

  • proof of Ontario residency (documents displaying the individual’s name, address and citizenship status).

Documents confirming age include but are not limited to a:

  • birth or baptismal certificate;

  • passport;

  • Ontario health card; or

  • driver’s licence.

Documents confirming Ontario residency include but are not limited to a:

  • Ontario photo card
  • rental or lease agreement;
  • statement of direct deposit for Ontario Disability Support Program;
  • employer record (pay stub or letter from employer on company letterhead);
  • mailed bank account statements (does not include automated teller receipts or bank books); or
  • utility bill; or
  • proof of Canadian citizenship and/or immigration documents.

Definitions

Under the Act and Regulation, a person has a developmental disability if the person has the prescribed significant limitations in cognitive functioning and adaptive functioning and those limitations:

  • originated before the person reached 18 years of age;

  • are likely to be life-long in nature; and

  • affect areas of major life activity, such as personal care, language skills, learning abilities, the capacity to live independently as an adult or any other prescribed activity.

“Adaptive functioning” means a person’s capacity to gain personal independence, based on the person’s ability to learn and apply conceptual, social and practical skills in his or her everyday life.

“Cognitive functioning” means a person’s intellectual capacity, including the capacity to reason, organize, plan, make judgments and identify consequences.

Under the Regulation, a person has significant limitations in cognitive functioning if the person meets one of the following criteria:

  • The person has an overall score of two standard deviations below the mean, plus or minus standard error measurement, on a standardized intelligence test; or

  • The person has a score of two standard deviations below the mean in two or more subscales on a standardized intelligence test and the person has a history of requiring habilitative support; or

  • On the basis of a clinical determination made by a psychologist or a psychological associate, the person demonstrates significant limitations in cognitive functioning and the person has a history of requiring habilitative support.

“Habilitative support” means support where the objective of the support is to enable the person to acquire, retain and improve skills and functioning related to activities of daily living in the areas of self-care, communication and socialization.

“History of requiring habilitative support” means a history of having support needs that are life-long in nature and are due to functional impairment caused by a congenital injury, condition or disease or by an injury, condition or disease acquired prior to age 18.

A person has significant limitations in adaptive functioning if the person has a score of at least two standard deviations below the mean, plus or minus standard error measurement, in at least one of the areas of conceptual skills, social skills or practical skills, as measured on a standardized test of adaptive behaviour.

Note: Individuals who have previously been determined eligible for ministry funded adult developmental services and supports under the Developmental Services Act and are currently receiving supports, or are on a wait list to receive supports, have been deemed to be eligible under sections 42 and 43 of the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008.

In addition, Ontario Regulation 414/12, made under SIPDDA, deems the following groups of people eligible for adult developmental services:

  • Adults with a developmental disability who were receiving support under the Passport program on April 1, 2012, or who transitioned from the Special Services at Home program (SSAH) to the Passport program on April 1, 2012;
  • Adults with a developmental disability who were on the SSAH waitlist as of March 31, 2012;
  • Children with a developmental disability receiving SSAH who turned 18 before March 31, 2013;
  • Children with a developmental disability who turned 18 between April 1, 2012 and March 31, 2013 and who were on a waitlist for SSAH before they turned 18; and
  • Individuals who applied and were found eligible for adult services and supports under the Developmental Services Act between January 1, 2011 and June 30, 2011 and began to receive support or were placed on a waitlist for support during that time.

These individuals are not required to undergo eligibility confirmation in accordance with the Act and Regulation.

Confirming Whether an Applicant is Eligible

The Application Entity shall use ministry approved decision-making tools to confirm whether an applicant is eligible for ministry funded adult developmental services and supports.

Where an individual’s documentation demonstrates the individual has a developmental disability in accordance with the Act and Regulation, and meets all eligibility criteria, the Application Entity shall confirm the individual’s eligibility for ministry funded adult developmental services and supports.

Where an individual’s documentation indicates the individual does not have a developmental disability or does not meet all eligibility criteria in accordance with the Act and Regulation, the Application Entity shall find the individual ineligible for ministry funded adult developmental services and supports.

Where an individual’s documentation does not provide sufficient information, diagnostic conclusions, or a clear determination by a psychologist or psychological associate that the individual has a developmental disability, the Application Entity cannot confirm the individual’s eligibility for ministry funded adult developmental services and supports. The following procedures are to be followed in these cases:

  • If the individual is 18 years of age or older and does not have a psychological assessment or report by a psychologist or psychological associate but the documentation provided indicates the presence of a developmental disability (e.g., school or medical records), the Application Entity will facilitate referral to a ministry funded agency for assessment by a psychologist or psychological associate to determine whether the individual has a developmental disability as defined in the Act and regulation.

  • If the individual is 18 years of age or older and the psychological assessment or report by a psychologist or psychological associate provided indicates the presence of a developmental disability but the information in the assessment or report is unclear or insufficient to confirm whether the individual has a developmental disability as defined in the Act and Regulation, the Application Entity shall ask the individual to obtain the required information from the psychologist or psychological associate who prepared the original report. If the individual cannot obtain the information required from the psychologist or psychological associate who completed the assessment, the Application Entity shall forward the individual’s documentation to a Ministry-funded agency to determine whether the individual has a developmental disability as defined in the Act and Regulation.

  • Following a review of the individual’s documentation, if the psychologist or psychological associate determines that additional assessment of the individual is required to determine whether the individual has a developmental disability as defined in the Act and Regulation, the psychologist or psychological associate shall advise the Application Entity. The Application Entity shall refer the applicant to a Ministry-funded agency for assessment by a psychologist or psychological associate to determine whether the individual has a developmental disability as defined in the Act and Regulation.

Note: Individuals may also purchase the services of a psychologist or psychological associate at their own expense.

Communicating the Decision on Eligibility

The Application Entity shall advise the individual, or representative of their choice, in writing whether the individual is eligible for Ministry-funded adult developmental services and supports in accordance with the Act and Regulation, within 20 business days of receipt of all documentation, including receipt of any documentation review or the results of (re)assessment by a psychologist or psychological associate required to confirm eligibility for developmental services and supports.

Recording the Eligibility Decision

Once eligibility or ineligibility has been confirmed, the Application Entity shall record the decision in the individual’s file. Copies or electronic records/copies of all required documentation shall be retained for individuals who have been confirmed eligible for adult developmental services and supports for a minimum of seven years after the Application Entity has assessed the person’s needs for services and supports (in accordance with the Regulation on Quality Assurance Measures).