Sec. 120.80 - Program assurances

ยง 120.80. Program assurances

In addition to program requirements specified in other Sections of this Part, assurances for the Medicaid home and community-based services waiver program will include:

a) Level of care determination.

An evaluation and periodic (at least annual) reevaluations of the individual's need for the level of care provided in an ICF/MR, as defined by 42 CFR 440.150(1996), shall be conducted for an individual when there are indications that the individual might need such services in the near future. Only individuals who, without the availability of the Medicaid home and community-based services waiver program, would require placement in a State-operated developmental center or a community ICF/MR shall be served under this Part (see Section 120.140).

b) Informing individuals of choice

All individuals requesting program services shall be given a choice of alternative services through the PASARR process. The choice shall include both ICF/MR and community-based services.

c) Average per capita expenditures

The average per capita Medicaid expenditures, including home and community-based services, must be less than or equal to the average per capita cost of the level of care provided in an ICF/MR under the State Medicaid Plan, which the State expects would have been made in the absence of this program. The State must therefore limit participating individuals and expenditures under this program to meet the per capita cost requirements.

d) Rate methodology

Rates for reimbursement of program services shall be established by the Department and approved by the Department of Public Aid. Rate levels shall be determined for each type of Medicaid home and community-based service by unit of service provided, e.g., per hour, per day. Providers shall receive written notification of rates and rate changes at least annually.

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Amended at 20 Ill. Reg. 4762, effective March 8, 1996

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