The AMA designates the ADMH as the entity authorized to
determine individuals' eligibility for participation in the Medicaid HCBS
Waivers. Within the ADMH, the oversight and monitoring of day-to-day operations
of the Medicaid HCBS programs are conducted by the DDD through its Central and
Regional Community Services offices. Information for eligibility determinations
and redeterminations of individuals with intellectual disabilities for
enrollment and continued participation in these programs is gathered by DDD
Support Coordinators or designated 310 Board and submitted to the appropriate
ADMH Regional Community Services office as described in the DDD Operational
Guidelines. Appropriately qualified Regional Community Services office staff
make the eligibility determinations and redeterminations based on information
submitted.
(1) Definitions:
(a) ICAP (Inventory for Client and Agency
Planning) -
The standard functional assessment instrument used in the
process of determining eligibility for the waiver programs.
This commercial product will produce a three-page summary
report known as the Compuscore. An eligibility assessment within ADMH's
electronic information system summarizes key information from the ICAP
Compuscore, from which the Regional Office can determine the individual's level
of care.
(b) Level of Care
Evaluation (LOC) - The form required by the Waiver Programs to document that
the applicant would otherwise be eligible for and require the LOC provided in
an Intermediate Care Facility (ICF).
(c) Designated Support Coordination Entity -
The entity or Regional Office designated by ADMH in each county or group of
counties responsible for coordinating waiver services and supports for
individuals waiting for services.
(d) criticality Summary - The assessment tool
created by the Department to evaluate the criticality of an individual's need
for services.
(e) Intellectual
Disability - A disability characterized by a) significant limitations in both
intellectual functioning and b) adaptive behavior, which covers many everyday
social and practical skills; c) and is a condition that originates before the
age of 18.
(f) Qualifying
Psychological Evaluation - A psychological evaluation administered and
interpreted by a qualified individual.
(2) Eligibility for the Waiver - Medicaid
HCBS Waivers are approved only as cost-effective alternatives to institutional
care that would otherwise be reimbursed by the Medicaid Chapter 580-5-30 Mental
Health Program. The waivers operated by ADMH are alternatives to a Medicaid
reimbursed ICF. For eligibility requirements for HCBS waivers operated by ADMH,
refer to the Long-Term Care Waiver section of the AMA's website.
(a) In Alabama, eligibility for the waiver is
determined in three steps. In the first step, preliminary eligibility is
determined so an individual's name can be added to a statewide waiting list.
The second step occurs when the individual can be reached on the waiting list
and it becomes his or her turn to be enrolled in the waiver. The third step
occurs when the individual has been receiving services for a period no longer
than one (1) year and his or her eligibility must be re-determined.
Re-determination is required annually for as long as the individual receives
services under the waiver.
(3) The Waiting List - The ADMH maintains a
statewide waiting list of individuals applying for services through the
Medicaid waiver programs it administers under delegation of authority from the
AMA. Applicants initially placed on the waiting list requires a determination
of preliminary clinical eligibility as defined in the HCBS waiver. If an
applicant is financially ineligible for Medicaid at the time of Waiver
eligibility determination, the applicant may still be placed on the waiting
list, so long as the intellectual disabilities and adaptive functioning
criteria are met. However, the requirement of financial eligibility for
Medicaid must be met in order to enter services from the waiting
list.
Notes
Ala. Admin. Code
r. 580-5-30-.14
Adopted 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 .13 was renumbered to .14 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.
