Harris County DMR

Program Name:	Mental Retardation Eligibility Determination (DMR) Unit
Location:	7011 Southwest Freeway Houston, TX 77074
Phone:	Office: 713-970-7100 Fax: 713-970-7133

WHAT WE DO

Our unit determines whether consumers are eligible for Mental Retardation Division Services through the MHMRA of Harris County. The eligibility determination process includes three (3) parts:

A financial eligibility assessment with a financial counselor to explain MHMRA financial policies and to determine whether co-payments or other fees apply and whether MHMRA is a part of your Insurance Provider Network.
A diagnostic assessment is performed by a Licensed Psychologist or a psychologist certified by the Department of Aging and Disabilities Services (DADS) to perform a Determination of Mental Retardation (DMR) in accordance with the "Diagnostic Eligibility Rule" (formerly "The DMR Rule"). The DMR Rule is published in the Texas Administrative Code, Title 40, Part I, Chapter 5, Subchapter D.
An intake interview with a staff member called an Eligibility Coordinator to explain consumer rights, programs and services and to obtain needed consents.

WHO QUALIFIES FOR SERVICES

Any Harris County resident who is at least three years of age and is believed to have one or more of the following may apply for a DMR evaluation:

Mental Retardation
Pervasive Developmental Disorder: Autistic Disorder, Asperger's Disorder, Rett's Disorder, Childhood Disintegrative Disorder or Pervasive Developmental Disorder-NOS.
WHAT IS MENTAL RETARDATION?
Mental Retardation is a developmental disability that is expected to be lifelong and to require ongoing services. The DMR rule defines Mental Retardation as "Significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period (birth to 18 years of age.)"

WHAT IS A PERVASIVE DEVELOPMENTAL DISORDER?
Pervasive Developmental Disorders are a class of developmental disorders that are also expected to be lifelong and to require ongoing services similar to those needed by persons with mental retardation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) states that:

"Pervasive Developmental Disorders are characterized by severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication skills, or the presence of stereotyped behavior, interests and activities."

Autistic Disorder is probably the most familiar of the Pervasive Developmental Disorders. Mental Retardation and other developmental disorders are frequently seen together in the same consumer. For example, the DSM IV-R states that 75% of children with Autistic Disorder function intellectually in the range of mental retardation.

HOW TO ACCESS THIS SERVICE

The parent, legal guardian, primary caregiver or consumer may request a DMR by calling the MHMRA of Harris County Help Line (713-970-7070). The information you provide is forwarded to the MR Eligibility Center and you will be contacted by a Consumer Services Assistant who will ask for more detailed information, explain the intake process and explain what documentation is needed. An Eligibility Coordinator will also be assigned to assist you through the intake process.

ABOUT TRANSPORTATION

Consumers provide their own transportation to and from the DMR appointment. In special cases, consumers may be able to make transportation arrangements by contacting Metrolift or Red Cross.

FEES YOU MAY HAVE TO PAY FOR THIS SERVICE

There is no cost for the DMR evaluation or to meet with the eligibility coordinator.

You will meet with a financial counselor who will determine whether there would be co-payments or other fees for other mental retardation services. The financial counselor will review your insurance and determine whether MHMRA is a part of your Insurance Provider Network.

All persons accessing MHMRA services must provide financial and demographic documentation at the initial appointment and annually thereafter or as financial status changes. If the necessary documents are not presented at the initial appointment then your appointment will be rescheduled, in order that the required documents may be obtained.

HOW DOES THE DMR PROCESS WORK?

STEP 1: To request an eligibility determination, call the MHMRA Help Line at (713) 970-7070 and tell them you would like to apply for mental retardation services. The Help Line will take your information and send a referral for you to the MR Eligibility Center.
STEP 2: When the referral is received, an MR Eligibility Center representative will contact you to verify demographic information and provide explain the Intake/DMR process and the documents you will need.
STEP 3: An Eligibility Coordinator is also assigned to provide additional information and assistance and to meet with you during the intake process. The Eligibility Coordinator will schedule the Intake/DMR when copies of past assessments have been received.
STEP 4: The Intake will include the financial eligibility assessment and an interview with a psychologist to determine if further evaluations are needed and an interview with an Eligibility Coordinator.
STEP 5: If you are found eligible for MR services, the Eligibility Coordinator will make a referral to a Service Coordinator who will begin the service planning process.

ABOUT THE DIAGNOSTIC EVALUATION (DMR)

The DMR evaluation is conducted by a DMR Certified Psychologist or Licensed Psychologist and typically consists of the following:

Review of Past Testing: The psychologist will review previous evaluation reports to help understand the individual's historic levels of functioning. The review of past testing may also reveal improving or declining levels of functioning over time. Previous test results are also used to verify that the diagnostic criteria for Mental Retardation existed before 18 years of age.
Interview: This typically includes the consumer and caregiver. The psychologist will usually ask about developmental history, family history, educational history, physical/medical problems, psychiatric history, problem behaviors, services needed and other concerns the family and consumer have.
Adaptive Behavior Assessment: The psychologist administers an adaptive behavior assessment. The adaptive behavior assessment is performed by interviewing a person who is familiar with the consumer's communication, self-help and social skills. The individual's adaptive behavior level is then compared to what is typically expected of persons in his or her age group to determine if the individual's adaptive behavior level falls within the range of mental retardation.
Intellectual Assessment: The psychologist administers an intelligence test (IQ test) to determine if the individual's level of intellectual functioning falls within the range of mental retardation. The IQ test is given to the individual directly and requires the individual to solve a variety of problems that measure reasoning abilities.
Other Assessments: The psychologist may administer other assessments on an as needed basis to aid in the diagnosis of Autism or other Pervasive Developmental Disorders.

WHAT DOCUMENTATION DO I NEED?

DOCUMENTATION REQUIRED FOR THE FINANCIAL ASSESSMENT

Proof of residency for Harris County (Utility bills or a tax statement)

Proof of your income (Pay check stub, IRS W-2 form (for consumer if 18 years of age or older, for parent/guardian if under 18 years of age)

Any extraordinary expenses

The number of family members

Proof of any insurance coverage (Medicaid, SSI, or other insurance card)

Proof of Guardianship or Power Of Attorney (If you are the individual's Legal Guardian, bring a copy of the current guardianship letter from the court. If you have been given Power of Attorney to consent for treatment for the individual, bring a copy of the Power of Attorney.)

Copies of Previous Evaluation Reports (If the individual has received Special Education services, send copies of their Full Individual Evaluations (FIE's) and Comprehensive Individual Assessments (CIA's) ahead of time for review. You will need to request both FIE's and CIA's because FIE's have only been done since about the year 2000. Prior to that, the evaluations were called CIA's (see Terminology section below). If you do not have copies of these evaluations, you may be able to get them from the school. Also, send copies of any other evaluations, including psychological evaluations by private psychologists, and other agencies medical and developmental evaluations.)

DOCUMENTATION REQUIRED FOR THE DMR

If the individual has received Special Education services, you will need to obtain copies of their Full Individual Evaluations (FIE's) and Comprehensive Individual Assessments (CIA's) for review by the psychologist.

Copies of any other evaluations, including psychological evaluations by private psychologists, and other agencies medical and developmental evaluations.

Proof of Guardianship or Power Of Attorney: If you are the individual's Legal Guardian, bring a copy of the current guardianship letter from the court. If you have been given Power of Attorney to consent for treatment for the individual, bring a copy of the Power of Attorney.

TERMINOLOGY

Legal Guardian: It is important for parents and others who were given guardianship of minor children to understand that they are not automatically the legal guardians, even of their own child, once that child becomes an adult on the child�s 18^th birthday. This is true regardless of how severely impaired their child may be. A legal guardian has legal authority to make certain decisions on behalf of another person, whether that other person agrees with those decisions or not. Most people with mental retardation do not need legal guardians. However, for those who do, in order to be the legal guardian of anyone 18 years of age or older, a hearing must be held in a probate court to determine the extent to which the person who is said to need a guardian is capable of managing his or her own affairs. The court will then determine if that person needs a guardian and what decisions the guardian may make on behalf of that person. Once a guardian has been appointed, the court will set the length of time before the guardianship has to be renewed. In other words, guardianships must be kept current, or they will expire at the end of the time specified by the court for renewal. Once a person reaches her or his 18^th birthday, only someone with power of attorney or a legal guardian may request the consumer�s school records, for example. A power of attorney is not the same thing as a legal guardianship (see "Power Of Attorney" below). To learn more about guardianship you may call any of the Harris County Probate Court offices:

Court No1: 713-755-6084

Court No2: 713-755-6090

Court No3: 713-755-6953

Court No4: 713-755-5959

Power Of Attorney: Most people with mental retardation do not need a guardian. These consumers typically need someone who can help them with certain tasks and responsibilities they cannot handle on their own. A power of attorney is a simple and relatively inexpensive way for caregivers to assist a consumer with mental retardation who does not need a guardian. The power of attorney is a document stating that the consumer gives her or his consent for another person to do certain things on her or his behalf. These could include handling finances, requesting school records, applying for government assistance, making doctor�s appointments, and the like. The power of attorney is given voluntarily and can be revoked by the person granting it at any time.

Full Individual Evaluation (FIE): Previously, this evaluation was known as a CIA (see below). Texas public schools changed the name from CIA to FIE several years ago. An FIE is an evaluation conducted by professionals in order to determine whether a student qualifies for special education services and to identify areas of strength and need. The FIE consists of evaluations in the following seven areas:

Reason for referral
Speech and language
Physical
Sociological
Emotional
Intelligence (IQ testing) and adaptive behavior
Academic achievement

The FIE is conducted every 3 years for special education students. The school may elect not to perform new testing every time an FIE is due. However, the parent may disagree and ask that new testing be performed.

Comprehensive Individual Assessment (CIA): This is an obsolete designation and was replaced by the "Full Individual Evaluation" (see above).

Admission, Review and Dismissal (ARD): A meeting involving school personnel, assessment professionals, the student and parents for purposes of educational placement, program planning and to address other needs or difficulties the student has. An ARD report is written after the meeting and the student/parent receive a copy. ARD reports usually do NOT contain test results.

Individual Education Plan (IEP): A written educational program plan that spells out instructional goals and objectives and the criteria for mastery. The IEP is developed based on information supplied by the FIE and input from ARD committee members. The student and/or parents receive a copy of the IEP. An IEP usually does NOT contain test results.

State Audit Folder: The Texas Education Agency (TEA) requires the school to maintain copies of the student�s special education documents, including CIA�s, FIE�s, ARD reports and IEP�s in a file called a State Audit Folder. School personnel may have to go to the State Audit Folder to retrieve copies of older documents. Records in the State Audit Folder must be retained for at least 5 years after a student graduates or leaves the school district.

Texas Education Agency (TEA): The state agency that regulates the public school system in the State of Texas. Problems that cannot be resolved with the school or school district itself can be appealed to the TEA.

WHO CAN OBTAIN CONFIDENTIAL RECORDS?

The discussion that follows focuses on school records; however, it applies equally to confidential records of any sort.

The parent/legal guardian of a minor child has a legal right to review and obtain copies of their child's special education records. The school cannot legally refuse to release copies of CIA's, FIE's, ARD reports or IEP's to the parent/legal guardian of a minor child.

Once a student has passed his or her 18th birthday, she or he is automatically considered to be a legally competent adult. In order to respect the consumer's right to confidentiality, at the age of majority (18 years of age) the school can require the now legally-competent adult student to give written consent to release records, even to the consumer's parent. Once the consumer reaches 18 years of age, the parent is no longer legally entitled to obtain school records , unless the parent has one of the following:
- Power of attorney
- Legal guardianship
- Written consent from their son or daughter to do so
The school must have written consent from the proper person in order to release records to MHMRA of Harris County. The following people may give consent to the school to release information to MHMRA of Harris County.
- The parent or guardian of a minor child
- For consumers 18 years of age and older:
  - The consumer himself or herself
Anyone authorized to obtain school records must use a "consent for release of information" form in order to have records released directly from the school to MHMRA. It makes no difference whether the form used is an MHMRA or school district form. MHMRA consent forms may be obtained from the DMR Consumer Service Representative. School district consent forms may be obtained from the school or school district main office.