If you are age sixteen or older, DDA determines you to be eligible for ICF/IID level-of-care from your SIS scores. Eligibility for ICF/IID level-of-care requires that your scores meet at least one of the following:

(1) You have a percentile rank over nine percent for three or more of the six subscales in the SIS support needs scale;

(2) You have a percentile rank over twenty-five percent for two or more of the six subscales in the SIS support needs scale;

(3) You have a percentile rank over fifty percent in at least one of the six subscales in the SIS support needs scale;

(4) You have a support score of one or two for any of the questions listed in the SIS exceptional medical support needs scale;

(5) You have a support score of one or two for at least one of the following items in the SIS exceptional behavior support needs scale:

(a) Prevention of assaults or injuries to others;

(b) Prevention of property destruction (e.g., fire setting, breaking furniture);

(d) Prevention of PICA (ingestion of inedible substances);

(e) Prevention of suicide attempts;

(f) Prevention of sexual aggression; or

(g) Prevention of wandering.

(6) You have a support score of two for any of the questions listed in the SIS exceptional behavior support needs scale; or

(7) You meet or exceed any of the qualifying scores for one or more of the following SIS questions:

Question # of SIS support needs scale	Text of question	Your score for "Type of support" is:	And your score for "Frequency of support" is:
A2	Bathing and take care of personal hygiene and grooming needs	2 or more	4
		3 or more	2
A3	Using the toilet	2 or more	4
		3 or more	2
A4	Dressing	2 or more	4
		3 or more	2
A5	Preparing food	2 or more	4
		3 or more	2
A6	Eating food	2 or more	4
		3 or more	2
A7	Taking care of clothes, including laundering	2 or more	2 or more
		3 or more	1
A8	Housekeeping and cleaning	2 or more	2 or more
		3 or more	1
B6	Shopping and purchasing goods and services	2 or more	2 or more
		3 or more	1
C1	Learning and using problem-solving strategies	2 or more	3 or more
		3 or more	2
C5	Learning self-management strategies	2 or more	3 or more
		3 or more	2
E1	Taking medications	2 or more	4
		3 or more	2
E2	Ambulating and moving about	2 or more	4
		3 or more	2
E3	Avoiding health and safety hazards	2 or more	3 or more
		3 or more	2
E6	Maintaining a nutritious diet	2 or more	2 or more
		3 or more	1
E8	Maintaining emotional well-being	2 or more	3 or more
		3 or more	2
F1	Using appropriate social skills	2 or more	3 or more
		3 or more	2
G7	Managing money and personal finances	2 or more	2 or more
		3 or more	1

PDFWAC 388-828-4400

How does DDA determine if you meet the eligibility requirements for ICF/IID level-of-care if you are age sixteen or older?