Suspect a Developmental Disability?
If you suspect that your family member or someone else you know has an intellectual or developmental disability or delay, it is important to have that individual evaluated. An evaluation can confirm or remove suspicions, and put the individual on the road to obtaining appropriate assistance. The evaluation process will consist of a psychological evaluation and a psychosocial evaluation that will include an assessment of adaptive behavior.
Signs of delayed development are different at every age but indicate that an individual is having difficulty doing what is expected of others in the same age group. For example, a toddler who has difficulty sitting or moving or walking or eating; a young child who does not understand spoken language or cannot communicate; a school-age child that has not learned to read or do other school-related tasks; an adult who has not been toilet trained or who does not engage in any meaningful activities or speak in more than one word utterances.
Children aged birth – 3 years can receive evaluations at no direct cost to families through the Early Intervention service system. These services are funded through the state and city in accordance with federal law. The child with a suspected developmental delay will need an Early Intervention Services Coordinator. A Service Coordinator can be obtained by contacting the New York City Department of Health and Mental Hygiene.
To make a referral, call 311, and ask for Early Intervention.
If outside of New York City, 212-New-York (212 639-9675) – DOH TTY: 212-504-4115
People ages 3 through the senior years can be evaluated at AHRC New York City New York City’s Article 16 Clinic. Request evaluations to confirm OPWDD eligibility by calling AHRC New York City’s Referral and Information Center at 212-780-4491 or by sending an email to firstname.lastname@example.org.
In general, services may be provided to eligible individuals with documented developmental disabilities, (or delays in the case of children,) of all ages and their families including individuals with multiple disabilities, autism spectrum disorder, medically fragile individuals, and those with other disabilities that result in impaired intellectual and adaptive functioning. Services are also available to individuals with traumatic brain injuries. Limited select services are open to individuals with dual diagnoses and disadvantaged youth.
Each service and support has its own eligibility requirements. Services and supports for children from birth through age three are dictated by the New York City Department of Mental Health and Alcoholism Services. Most services for children from three through age 21 are prescribed by the New York City Department of Education and the New York State Education Department. Most services for adults are under the auspices of New York State Office of People with Developmental Disabilities, (OPWDD,) and are paid for by some form of Medicaid or the Medicaid Waiver.
Information for Families and Advocates
OPWDD, through its local Developmental Disabilities Regional Offices (DDROs), determines whether a person has a developmental disability and is eligible for OPWDD-funded services. This fact sheet describes the Three-Step process and the type of information OPWDD needs to make an eligibility determination of developmental disability.
NOTE: Even when someone is determined to have a developmental disability, the person may not be eligible for all OPWDD-funded services. Some OPWDD-funded services require additional reviews that are not described in this fact sheet.
Three-Step Review Process
The process for determining eligibility may involve multiple review steps and is designed to make sure that every person receives a fair and thorough review.
1st Step Review
DDRO staff reviews the eligibility request for completeness. After this first review, the DDRO notifies the person in writing that:
(a) Eligibility or provisional eligibility has been confirmed,; or
(b) The request is incomplete and requires additional documentation, or
(c) The request has been forwarded for a 2nd Step Review.
2nd Step Review
If the Eligibility Request is forwarded for a Second Step Review, a committee of DDRO clinicians evaluates the request. They also review any additional information that has been provided by the person. If these clinicians require additional information, the person is notified in writing of the type of information needed and the date by which it must be submitted to the DDRO. Following the 2nd Step Review, the DDRO provides the person with written notification of its determination. If the person is found ineligible for OPWDD services because he or she does not have a developmental disability, the letter offers the person and his or her representative the opportunity to:
(a) Meet with DDRO staff to discuss the determination and documentation reviewed, and
(b) Request a 3rd Step Review, and
(c) Request a Medicaid Fair Hearing in cases where Medicaid-funded services are sought.
Note: That a Notice of Decision informing the person of his or her right to request a Medicaid Fair Hearing is sent only when the Transmittal for Determination of Developmental Disability Form indicates that the person is interested in receiving Medicaid-funded OPWDD services. If the person has not sought Medicaid-funded services, no Fair Hearing is offered, and the decision of the DDRO is final.
The person may choose one, two or all three of the above options. If a Fair Hearing is requested, a 3rd Step Review will be conducted automatically.
3rd Step Review
3rd Step Reviews are conducted by an independent Eligibility Review Committee of licensed practitioners not involved in the First and Second Step Reviews. The committee reviews the eligibility request and provides recommendations to the DDRO Second Step Review coordinator. The Third Step recommendations are considered by the DDRO Director (or designee) and the person is informed of the results, including any changes in the DDRO’s determination.
3rd Step reviews are completed before Fair Hearing dates.
The DDRO will need the following information, in most cases, to determine whether someone is eligible for OPWDD services:
• A medical or specialty report (for example, a neurological report), including health status and diagnostic findings, to support a qualifying diagnosis other than mental retardation; For persons qualifying with an intellectual disability only, a recent general medical report, if available.
• A psychological report which includes assessment of intellectual functioning with reporting of all summary intelligence scores (subscale, Index, part, and full-scale scores) and, for people with IQs above 60, standardized assessment of adaptive behavior with reporting of scale/domain and summary scores. For people with IQ’s below 60, the adaptive assessment may be based on qualitative review via an interview with care-providers, review of records, and direct observations.
• A social/developmental history, psychosocial report, or another background report that shows that the person became disabled before age 22 years (background information is still needed if the person is a child or adolescent).
In some cases, the DDRO will not be able to decide whether someone is eligible based on the information in reports that are provided initially. In those cases, the DDRO may request additional information/different reports or further evaluation and will either recommend where such assessments may be done or arrange for them to be done.
Additional information can be found on OPWDD’s website at https://opwdd.ny.gov/opwdd_services_supports/eligibility/faqs.
Contact the Referral & Information Center
If you would like to speak to someone about how AHRC New York City can help you or your loved one, please call 212-780-4491 or use the form below.