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.
Notes
Ala. Admin. Code
r. 580-5-30-.13
New Rule: Filed January
17, 2011; effective February 21, 2012.
Amended by
Alabama
Administrative Monthly Volume XXXVII, Issue No. 11, August 30,
2019, eff. 10/10/2019.
Amended by
Alabama
Administrative Monthly Volume XXXIX, Issue No. 02, November 30,
2020, eff. 1/14/2021.
Amended by
Alabama
Administrative Monthly Volume XL, Issue No. 06, March 31, 2022,
eff. 5/15/2022.
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, ยง
22-50-11.
