<html> <head> <title>Rule 67:54:03:0A Criteria for Inventory for Client and Agency Planning (ICAP).</title> <META NAME="Keywords" Content="Administrative Rules 67:54:03:0A"> <META NAME="Description" Content="Administrative Rules 67:54:03:0A Criteria for Inventory for Client and Agency Planning (ICAP)."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <title>DEPARTMENT OF SOCIAL SERVICES</title> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">DEPARTMENT OF SOCIAL SERVICES</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">MEDICAL PROGRAMS ADMINISTERED BY DEPARTMENT OF HUMAN SERVICES</font></p> <p align=center><font size=3 face="Times New Roman">(ICF-MR/DD)</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">CRITERIA FOR INVENTORY FOR CLIENT AND AGENCY PLANNING (ICAP)</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">Chapter 67:54:03</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">APPENDIX A</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">SEE: §§&nbsp;67:54:03:05 and 67:54:04:06</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 21 SDR 34, effective August 29, 1994.</font></p> <font size=3 face="Times New Roman"><br clear=all> </span></font> <p align=center><b><font size=3 face="Times New Roman">APPENDIX A</font></b></p> <p align=center><b><font size=3 face="Times New Roman">CRITERIA FOR INVENTORY FOR CLIENT AND AGENCY PLANNING (ICAP)</font></b></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <p align=center><font size=3 face="Times New Roman">&nbsp;</font></p> <table border=0 cellspacing=0 cellpadding=0> <tr> <td width=98 valign=top> <p align=center><b><font size=2 face="Times New Roman">&nbsp;</font></b></p> </td> <td width=179 valign=top> <p align=center><b><font size=2 face="Times New Roman">PERSONAL</font></b></p> </td> <td width=187 valign=top> <p align=center><b><font size=2 face="Times New Roman">SOCIAL AND</font></b></p> </td> <td width=136 valign=top> <p align=center><b><font size=2 face="Times New Roman">COMMUNITY</font></b></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><b><font size=2 face="Times New Roman">AGE</font></b></p> </td> <td width=179 valign=top> <p align=center><b><font size=2 face="Times New Roman">LIVING</font></b></p> </td> <td width=187 valign=top> <p align=center><b><font size=2 face="Times New Roman">COMMUNICATION</font></b></p> </td> <td width=136 valign=top> <p align=center><b><font size=2 face="Times New Roman">LIVING</font></b></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><b><font size=2 face="Times New Roman">&nbsp;</font></b></p> </td> <td width=179 valign=top> <p align=center><b><font size=2 face="Times New Roman">&nbsp;</font></b></p> </td> <td width=187 valign=top> <p align=center><b><font size=2 face="Times New Roman">&nbsp;</font></b></p> </td> <td width=136 valign=top> <p align=center><b><font size=2 face="Times New Roman">&nbsp;</font></b></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 0</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">336</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">340</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">343</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 1</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">376</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">388</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">373</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 2</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">405</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">428</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">394</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 3</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">423</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">429</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">409</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 4</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">432</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">440</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">420</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 5</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">444</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">448</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">431</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 6</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">451</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">453</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">441</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 7</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">457</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">456</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">452</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 8</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">461</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">463</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">461</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">&nbsp;&nbsp; 9</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">468</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">468</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">469</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">10</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">473</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">475</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">476</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">11</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">479</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">482</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">482</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">12</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">484</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">486</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">489</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">13</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">490</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">488</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">494</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">14</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">493</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">490</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">497</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">15</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">497</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">493</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">501</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">16</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">500</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">497</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">503</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">17</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">502</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">500</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">507</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">18</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">505</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">501</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">510</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">19</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">505</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">504</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">513</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">20</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">507</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">507</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">516</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">21</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">509</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">509</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">518</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">22</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">510</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">511</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">520</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">23</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">512</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">515</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">521</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">24</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">516</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">516</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">524</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">25</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">517</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">518</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">525</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">26</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">520</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">519</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">527</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">27</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">522</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">521</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">529</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">28</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">525</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">522</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">530</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">29</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">528</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">522</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">530</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">30</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">531</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">523</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">530</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">31</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">533</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">524</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">531</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">32</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">524</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">531</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">33</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">525</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">531</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">34</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">525</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">531</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">35</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">525</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">531</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">36</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">526</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">531</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">37</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">526</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">530</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">38</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">526</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">530</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">39</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">527</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">530</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">40</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">527</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">530</font></p> </td> </tr> <tr> <td width=98 valign=top> <p align=center><font size=2 face="Times New Roman">41</font></p> </td> <td width=179 valign=top> <p align=center><font size=2 face="Times New Roman">534</font></p> </td> <td width=187 valign=top> <p align=center><font size=2 face="Times New Roman">527</font></p> </td> <td width=136 valign=top> <p align=center><font size=2 face="Times New Roman">530</font></p> </td> </tr> </table> <font size=3 face="Times New Roman"><br clear=all> </span></font> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html>