Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-5-30 - INTELLECTUAL DISABILITIES SERVICES › Section 580-5-30-.13 - Program Enrollment/ADMH Medicaid Waiver Programs

Current through Register Vol. 42, No. 9, June 28, 2024
Entities/providers that participate in the Medicaid Waiver
				programs for financial compensation must be enrolled as a provider of services
				to individuals with intellectual disabilities, must meet any applicable
				certification requirements established by the ADMH, and must be under contract
				or subcontract with the ADMH. Certification does not guarantee a contract will
				be approved or offered by ADMH. Monitoring of waiver services by ADMH is
				required to meet federal funding requirements and to protect the Medicaid
				funding source. This monitoring is conducted by ADMH in accordance with ADMH
				regulations
Entity/Provider Enrollment in the AMA HCBS Waiver Program for
				Persons with intellectual disabilities require the following:
(1) The entity/provider must meet any
			 applicable certification requirements established by DMH.
(2) The entity/provider must contract with
			 ADMH or subcontract with a ADMH contractor.
(3) The entity/provider must provide to ADMH
			 the services it proposes to provide and numbers of individuals it proposes to
			 serve if ADMH approves a contract with the entity/provider. The entity/provider
			 must also participate and comply with data reporting requirements established
			 by the ADMH. The ADMH fee-for-service reimbursement system requires each
			 entity/provider to comply with the established reimbursement rates for each
			 specific service/support delivered to individuals.
(4) Each contracting provider entity shall
			 acquire a National Provider Indicator (NPI) as required by HIPAA. The
			 Department will register the provider entity's NPI with the Medicaid Fiscal
			 Agent, which will issue a performing provider number for each program in which
			 the provider entity becomes enrolled. Each entity/provider will be assigned a
			 license to access ADMH electronic billing and payment system. This access will
			 allow the license holder to bill the ADMH, which will then approve, deny or
			 suspend the claim prior to submitting it to EDS or paying it
			 directly.
(5) Individuals enrolled
			 in ADMH Waiver programs also receive support coordination services. The support
			 coordinator serves as an advocate and a resource for the individual. The
			 support coordinator is also responsible for the person-centered assessment to
			 develop an individual' unique, person-centered plan and then monitor the
			 effective implementation of the plan as well as participant satisfaction and
			 quality of life. The person-centered assessment also includes risk assessment
			 evaluation.
(6) The Person-Centered
			 Plan includes learning opportunities and individualized goals as informed by
			 the person-centered plan assessment. The Support Coordinator continuously
			 monitors the process towards the individual achieving success in attaining the
			 goal, determines whether changes are needed to make the goal attainable or
			 determines whether the goal is no longer appropriate or chosen by the
			 individual.
(7) All individuals,
			 served through ADMH HCBS Waiver Programs must be given freedom of choice among
			 qualified contracted providers as to who is going to provide each waiver
			 service.
(8) Each individual
			 enrolled in an ADMH federally approved HCBS waiver must have a person-centered
			 plan which specifies the amount, duration, and frequency of needed services
			 appropriate to each individual within overall federally approved established
			 limits.
Original Rule .12 was renumbered to .13 due to certification
				  published November 30, 2020; effective January 14, 2021.
Author:
Division of Developmental
				  Disabilities
Statutory Authority:
Code of Ala.
				  1975
, §
										22-50-11.