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By Traci Blake Salami, Esq., Littman Krooks LLP

The Office for People with Developmental Disabilities (OPWDD) recently changed its eligibility criteria for individuals seeking OPWDD services in New York.  These services can be life-changing for individuals with disabilities. Effective October 2018, OPWDD now requires a physician’s written confirmation that an applicant has a qualifying diagnosis to support an application for OPWDD funded services.

OPWDD Requirements:

Generally, OPWDD expects applicants to show that they can meet the (4) minimum eligibility requirements by demonstrating:

  1. the presence of a developmental disability that is described by certain qualifying diagnoses, or conditions including intellectual disability, autism, cerebral palsy, epilepsy, familial dysautonomia, neurological impairment, and Prader-Willi syndrome;
  2. that the qualifying diagnosis occurred prior to the age of 22;
  3. that the qualifying diagnosis is expected to continue indefinitely; and
  4. prior to the age of 22, the qualifying diagnosis caused substantial deficits in adaptive functioning.

OPWDD considers all relevant clinical information based upon a history and presence of developmental disability prior to the age of 22, standardized intelligence testing, and standardized measures of adaptive functioning that can detect substantial handicaps or functional limitations.

What Changed?

FERPA and HIPAA Medical EmergencyPrior to the new rule, an applicant could provide reports of psychological testing of their intellectual functioning, adaptive behavior functioning, social/developmental history, and medical reports after receiving treatment and/or a diagnosis from psychologists, neuropsychologists, nurse practitioners,  physician’s assistants, and other practitioners who were otherwise qualified without the endorsement of a medical doctor. Before the implementation of the new rule, OPWDD respected assessments conducted by qualified practitioners who could also provide interpretations of standardized measures of intelligence and adaptive behavior.  These assessments were deemed valid and counted in eligibility reviews without a confirmation from a physician. Prior to the new rule, a qualified practitioner was described by the agency as a person holding a directly relevant masters or doctoral level education with training and supervised experience in the use and interpretation of such measures.

However, the new requirement adds a burden for applicants who receive treatment under otherwise qualified practitioners by requiring a validation from a medical doctor despite the practitioner’s education, training, and overall expertise in the field. Talk to an experienced attorney or advocate if you have questions.


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