1. POLICY STATEMENT—PHILOSOPHY

   It is the policy of Delaware Health & Social Services (DHSS) to ensure that publicly funded services are available to the state’s citizens in an equitable and fair manner. In instances where resources are not adequate to serve all citizens qualifying for a service, DHSS recognizes the need to maintain waiting lists. These waiting lists must be developed and maintained with the best interests of Delaware’s most vulnerable citizens in mind.

2. PURPOSE

   The purpose of this policy is to ensure that public resources are allotted fairly to citizens in need of DHSS services.

3. SCOPE

   This policy applies to all publicly funded services (state or federal) provided by DHSS for which a waiting list becomes necessary, unless federal or state laws or rule requires a different procedure. This policy also applies to DHSS agents including contractors who are determining slots in public programs.

   This policy applies to participation in programs and services, but not each service delivered in that program. For example, it does not apply to physicians participating in the Medicaid program, but it does apply to the Health Benefits Manager.

4. PROCEDURE
   1. All services for which a waiting list becomes necessary shall maintain that list in one of the following two fashions:
      1. According to the date on which eligibility was approved (first come, first served), with clients served in the order in which they were deemed eligible.
      2. According to the relative need of each client/potential client, with those having critical needs being served first.
   2. All residential service waiting lists shall be maintained according to client need.
   3. Guidelines for determining need shall be written, maintained and available for public inspection. These guidelines may include, for example:
      • Danger or risk of losing support systems, especially living settings or supports necessary for self-maintenance
      • Risk of institutionalization
      • Current residence unnecessarily segregated
      • Significant risk of abuse or neglect
      • Basic health, safety, and welfare needs not being met through current supports
      • Risk of functional loss without intervention or ongoing skill maintenance services
      • Exhibition of behavior that presents a significant risk of harm to self or others.
      • Ability to obtain services without state assistance (e.g., income and assets)

      It is strongly recommended that the division choose accessible automated record keeping capabilities for building, storing and statistically analyzing services/program consumer waiting lists.

   4. Waiting lists may assign each person a unique ranking, a category of need into which a number of clients/potential clients fall, or by another method established in written guidelines.
   5. Waiting lists based on need must be reviewed periodically to re-evaluate the relative needs of clients/potential clients. This does not apply to first come, first served lists except to verify, as needed, that the client/potential client is still eligible for the service and still wants the service.
   6. The written guidelines shall be followed in all placements/service decisions. When necessary, other considerations may be included in decisions, such as the client’s compatibility with the available service. An example of this would be considering geography in a group home placement. In the case where compatibility is considered, clients shall be considered in turn in the order of the waiting list.
   7. In cases where need is determined by category, in no instance shall someone from a lower category of need receive publicly funded services before all clients in a higher need category receive the service. This does not apply in cases where the needs of a person lower on the list changes and becomes critical. The Division Director in consultation with the DHSS Secretary or his/her designee may make exceptions to this rule.
5. EFFECT
   1. This policy becomes effective immediately for all services and placements not previously committed. Written policies must be in place no later than 60 days from adoption.
   2. This Department Policy supersedes all other polices, directives, or rules related to the subject.

Vincent P. Meconi
Vincent P. Meconi, Secretary
Delaware Health & Social Services

VPM/drl