Ala. Admin. Code r. 560-X-54-.05 - Application Process
(1) The
targeted case manager will receive referrals from hospitals, nursing homes,
physicians, the community and others for persons who may be eligible for home
and community-based services.
(2)
An assessment document will be completed by the targeted case manager in
conjunction with the applicant's physician. This document will reflect detailed
information regarding social background, living conditions, and medical
problems of the applicant. A copy of this document will be submitted to the
Alabama Medicaid Agency for approval.
(3) The targeted case manager, in conjunction
with the applicant's physician will develop a plan of care. The plan of care
will include objectives, services, provider of services, and frequency of
service. The plan of care must be submitted to the Alabama Medicaid Agency for
approval. Changes to the original plan of care are to be made as needed to
adequately care for an individual. Reasons for changes must be documented on
the client's plan of care, which is subject to the review of the Alabama
Medicaid Agency. The plan of care must be reviewed by the targeted case manager
as often as necessary and administered in coordination with the recipient's
physician.
(4) The targeted case
manager will coordinate completion of the medical need admissions form with the
applicant's physician and the financial application form for submission to the
Alabama Medicaid Agency.
(5)
Medicaid will review the medical application and determine if the individual
meets the criteria for nursing facility care, in accordance with Rule No.
560-X- 10-.10 of the Alabama Medicaid Administrative Code and submit the
"Waiver/Slot Confirmation Form" to the District Office for processing financial
determination.
(a) If approved, the applicant
and the targeted case manager will be notified in writing.
(b) If denied, the applicant and the targeted
case manager will be notified and the reconsideration process will be explained
in writing as described in Rule No.
560-X-10-.14.
(6) When an application is
approved by the Alabama Medicaid Agency, a payment date is also given for the
level of care for which a recipient has been approved. No charges for services
rendered under the Waiver Program prior to this approved payment date will be
paid.
(7) A current assessment
document, along with a new plan of care, and medical need admission form must
be submitted by the targeted case manager to the Alabama Medicaid Agency at
each re-determination of eligibility which shall be annually.
Notes
Author: Ginger Wettingfield, Director LTC Healthcare Reform Division
Statutory Authority:42 C.F.R. Section 441, Subpart G and the Home and Community-Based Technology Assisted Waiver for Adults.
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