Extended Care Health Option (ECHO)
Chapter 9
Section 2.2
Eligibility
- Qualifying Condition: Intellectual Disability
Issue Date: July 3, 1997
Revision:
1.0 POLICY
1.1 A diagnosis
of moderate or severe mental retardation (hereafter referred to
as “intellectual disability”) in accordance with the criteria in
the current edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM), published by the American Psychiatric
Association (APA), is an Extended Care Health Option (ECHO) qualifying
condition.
1.2 For a beneficiary less than
three years of age, the following conditions (International Classification
of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes
cited for services provided before the mandated date, as directed
by Health and Human Services (HHS), for International Classification
of Diseases, 10th Revision (ICD-10) implementation, or ICD-10-CM
codes cited for services provided on or after the mandated date,
as directed by HHS, for ICD-10 implementation) may be presumed to
precede a diagnosis of moderate or severe intellectual disability:
• Rett’s syndrome: ICD-9-CM 330.8
/ ICD-10-CM F84.2
• Down syndrome: ICD-9-CM 758.0
/ ICD-10-CM Q90.0-Q90.9
• Fragile X syndrome: ICD-9-CM
759.83 / ICD-10-CM Q99.2
• Fetal alcohol syndrome: ICD-9-CM
760.71 / ICD-10-CM Q86.0
1.3 For
a beneficiary less than three years of age, a developmental delay
qualifies as moderate or severe intellectual disability when standardized
diagnostic psychometric tests demonstrate developmental delay equivalent
to two standard deviations below the mean in adaptive, cognitive,
or language function.
2.0 EXCLUSIONS
2.1 Unless
the requirements of
paragraph 1.3 are met, the spectrum of Attention-Deficit
and Disruptive Behavior Disorders are not considered qualifying
conditions for the ECHO.
2.2 Learning
disorders, individually and collectively, are not qualifying conditions
for eligibility under the ECHO.
3.0 EFFECTIVE DATE
September 1, 2005.
- END -