Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-36 - HOME - AND COMMUNITY-BASED SERVICES FOR THE ELDERLY AND DISABLED
Section 560-X-36-.01 - Authority And Purpose
Current through Register Vol. 43, No. 02, November 27, 2024
(1) Home-and community-based services to the elderly and disabled are provided by the Alabama Medicaid Agency to categorically needy individuals who would otherwise require institutionalization in a nursing facility. These services are provided through a Medicaid waiver under the provisions of Section 1915(c) of the Social Security Act for an initial period of three years and for three-year periods thereafter upon renewal of waiver by the Centers for Medicare and Medicaid Services (CMS). Upon approval by CMS, this waiver request will serve as the State's authority to provide home and community services to the target group under its Medicaid plan.
(2) The purpose of providing home- and community-based services to individuals at risk of institutional care is to protect the health, safety, and dignity of those individuals while reducing Medicaid expenditures for institutional care. Waiver services are not entitlements but are based on individual client needs. The State assures that each individual found eligible for the waiver will be given free choice of all qualified providers enrolled for each service included in his or her written plan of care.
(3) Waiver services provided to eligible Medicaid recipients must be identified on the individual's Plan of Care and the Services Authorization Form. Waiver services provided but not listed on the Plan of Care and the Services Authorization Form are not reimbursable. Payments rendered for services not documented on the Plan of Care and the Service Authorization Form will be recovered.
(4) It is not the intent of the E/D Waiver Services program to provide 24 hour in home care. Should 24 hour in home care become necessary in order to protect the health and safety of the waiver client, the appropriateness of waiver services should be assessed and other alternatives considered.
(5) Home and Community-Based Waiver Services are provided in compliance with the provisions of the HCBS Settings Final Rule (CMS 2249-F/2296-F). These provisions require the following:
Author: Monica Abron, Associate Director, LTC Program Management Unit
Statutory Authority: §1915(c) Social Security Act; 42 CFR § 441, Subpart G.