Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-36 - HOME - AND COMMUNITY-BASED SERVICES FOR THE ELDERLY AND DISABLED › Section 560-X-36-.01 - Authority And Purpose

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Home-and community-based services to the elderly and disabled are provided by
			 the Alabama Medicaid Agency to categorically needy individuals who would
			 otherwise require institutionalization in a nursing facility. These services
			 are provided through a Medicaid waiver under the provisions of Section 1915(c)
			 of the Social Security Act for an initial period of three years and for
			 three-year periods thereafter upon renewal of waiver by the Centers for
			 Medicare and Medicaid Services (CMS). Upon approval by CMS, this waiver request
			 will serve as the State's authority to provide home and community services to
			 the target group under its Medicaid plan.
(2) The purpose of providing home- and
			 community-based services to individuals at risk of institutional care is to
			 protect the health, safety, and dignity of those individuals while reducing
			 Medicaid expenditures for institutional care. Waiver services are not
			 entitlements but are based on individual client needs. The State assures that
			 each individual found eligible for the waiver will be given free choice of all
			 qualified providers enrolled for each service included in his or her written
			 plan of care.
(3) Waiver services
			 provided to eligible Medicaid recipients must be identified on the individual's
			 Plan of Care and the Services Authorization Form. Waiver services provided but
			 not listed on the Plan of Care and the Services Authorization Form are not
			 reimbursable. Payments rendered for services not documented on the Plan of Care
			 and the Service Authorization Form will be recovered.
(4) It is not the intent of the E/D Waiver
			 Services program to provide 24 hour in home care. Should 24 hour in home care
			 become necessary in order to protect the health and safety of the waiver
			 client, the appropriateness of waiver services should be assessed and other
			 alternatives considered.
(5) Home
			 and Community-Based Waiver Services are provided in compliance with the
			 provisions of the HCBS Settings Final Rule (CMS 2249-F/2296-F). These
			 provisions require the following:
(a) Services
			 may only be provided in settings that:
1. Are
			 integrated in and support full access to the greater community, including
			 opportunities to seek employment and work in competitive integrated settings,
			 engage in community life, control personal resources, and receive services in
			 the community, to the same degree of access as individuals not receiving
			 Medicaid HCBS;
2. Are selected by
			 the individual from among setting options;
3. Ensure individual rights of privacy,
			 dignity and respect, and freedom from coercion and restraint;
4. Optimize autonomy and independence in
			 making life choices including, but not limited to, daily activities, physical
			 environment, and with whom to interact; and
5. Facilitate choice regarding services and
			 who provides them.