7 AAC 130.205 - Eligibility for home and community-based waiver services
(a) The
department will pay for home and community-based waiver services provided in
accordance with the applicable requirements of this chapter to an individual
that is
(1) eligible for coverage under AS
47.07.020, 7 AAC 100.002, and (d) of this section; and
(2) enrolled in accordance with 7 AAC
130.219.
(b) Home and
community-based waiver services are not available to an individual
(1) while the individual is an inpatient of a
nursing facility, a hospital, or an intermediate care facility for individuals
with an intellectual disability or related condition (ICF/MR);
(2) if the individual's services, supports,
devices, or supplies may be provided for entirely by services under 7 AAC 105 -
7 AAC 160 without the services specified under this chapter.
(c) A recipient enrolled in the
home and community-based waiver services program is eligible to receive other
Medicaid services for which the recipient is otherwise eligible.
(d) For the department to determine whether
an applicant is eligible to receive home and community-based waiver services
under this section, the applicant must be found eligible for one of the
following recipient categories:
(1) children
with complex medical conditions; to qualify for this recipient category, the
applicant must
(A) be under 22 years of
age;
(B) have a medical condition
that would require care in a general acute care hospital or a nursing facility
for more than 30 days per year if the applicant did not receive home and
community-based waiver services;
(C) has a severe, chronic physical condition
that results in a prolonged dependency on medical care or technology to
maintain health and well-being;
(D)
experiences periods of acute exacerbation or life-threatening
conditions;
(E) need extraordinary
supervision and observation;
(F)
either need frequent or life-saving administration of specialized treatment or
be dependent on mechanical support devices; and
(G) require, as determined under 7 AAC
130.215, a level of care provided in a nursing facility;
(2) adults with physical and developmental
disabilities; to qualify for this recipient category the applicant must
(A) be 21 years of age or older;
(B) meet the criteria specified in AS
47.80.900(6); and
(C) require, as
determined under 7 AAC 130.215, a level of care provided in a nursing
facility;
(3)
individuals with intellectual and developmental disabilities; to qualify for
this recipient category the applicant must
(A) meet the criteria specified in 7 AAC
140.600(c) and (d); and
(B)
require, as determined under 7 AAC 130.215, a level of care provided in an
ICF/MR;
(4) older adults
or adults with physical disabilities; to qualify for this recipient category
the applicant must require, as determined under 7 AAC 130.215, a level of care
provided in a nursing facility and must be
(A) 65 years of age or older; or
(B) 21 years of age or older and have a
physical disability.
Notes
Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.045
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.