Current through November 28, 2024
(a) An individual
who submitted an application under
7
AAC 130.207(a)(2), and determined by
the department to be a person with a developmental disability under
AS
47.80.900, may request placement on a waiting
list established under
AS
47.80.130(d) for the
individualized supports waiver, the individuals with intellectual and
developmental disabilities waiver, or both waivers. If funding for waiver
services is available, and if the applicant meets all eligibility requirements
under 7 AAC 130.205 for the recipient
category of individuals with intellectual and developmental disabilities, the
applicant may be eligible for one of the following:
(1) individualized supports waiver benefits
up to an individual cost limit of 517,500 annually, adjusted for inflation
using the CMS from Health Agency Market Basket in the most recent quarterly
publication of Global Insight's
Healthcare Cost Review
available 60 days before July 1, for the following services:
(A) day habilitation services under
7
AAC 130.260;
(B) residential habilitation services for
recipients of either supported-living habilitation services under
7
AAC 130.265(d) and (e) or in-home
support habilitation services under
7
AAC 130.265(h) and (i);
(C)employment services under
7
AAC 130.270;
(D) intensive active treatment services for
recipients 21 years of age and older under
7
AAC 130.275;
(E) respite care services under
7
AAC 130.280;
(F) transportation services under
7
AAC 130.290; or
(2) individuals with intellectual and
developmental disabilities waiver benefits for all services offered in
accordance with
7
AAC 130.235 -
7
AAC 130.305.
(b) When an applicant's name is drawn from a
waiting list, the department will send to the applicant, by certified mail, a
notice-to-procced letter specifying the waiting list from which the applicant's
name has been drawn. If the applicant chooses to continue the process to apply
for the waiver specified in the notice-to-proceed letter, the care coordinator
selected by the applicant must submit, in a format provided by the department,
the following not later than 30 days after the date of the notice-to-proceed
letter;
(1) the applicant's choice to proceed
to determine eligibility for waiver benefits;
(2) appointment of a care coordinator
certified under
7
AAC 130.238;
(3) a signed release of information form
permitting communication between the department and the care
coordinator.
(c) If an
applicant does not respond to the notice-to-proceed letter during the time
period described in (b) of this section, the department will close the
applicant's case file and remove the applicant's name from the waiting list
from which the name was drawn.
(d)
Not later than 30 days alter the care coordinator submits to the department the
information described in (b)(2) and (3) of this section, the care coordinator
appointed by the applicant must submit to the department the following
documentation in a format provided by the department:
(1) consent for an assessment using the
Inventory for Client and Agency Planning (ICAP), adopted by
reference in 7 A AC 160.900, and
(A) a signed
release of information form for each of three named ICAP respondents;
or
(B) for applicants less than 36
months of age, information as specified in the notice-to-proceed
letter;
(2) a
certification of a qualifying diagnosis indicating one of the following:
(A) intellectual disability;
(B) other intellectual disability-related
condition;
(E) autism spectrum
disorder;
(3) the date of
a scheduled evaluation, or documentation of an evaluation that supports a
diagnosis specified in (e)(2) of this section and that was completed within the
prior 12 months for individuals less than 36 months of age or within the prior
36 months for individuals 36 months of age and older.
(e) The documentation required under (d)(2)
of this section must support
(1) a finding
that the disability originated before the individual reached 22 years of age,
is likely to continue indefinitely, and results in substantial functional
limitations to three or more of the following major life activities, limited to
(A) - (E) of this paragraph for an individual under 16 years of age. and
including (A) - (G) of this paragraph for an individual 16 years of age or
older:
(B) understanding and use of
language;
(F) capacity for independent
living;
(G) economic
self-sufficiency; and
(2)
a diagnosis by a professional qualified to practice under AS 08 or
7
AAC 105.200(c) made in accordance
with the following:
(A) for intellectual
disability,
(i) assessment with an
individually-administered, standardized intelligence and adaptive skills test;
and
(ii) diagnosis by a
psychologist or psychological associate of a condition that meets the criteria
for a diagnostic code for intellectual disability as defined in the
Diagnostic and Statistical Manual of Mental Disorders, adopted
by reference in
7
AAC 160.900;
(B) for other intellectual disability-related
condition, diagnosis by a psychologist, neuropsychologist, or psychological
associate of a condition that
(i) results in
an impairment of general intellectual functioning and adaptive skills, and
requires treatment or services similar to that required for an individual with
intellectual disability; and
(ii)
is other than mental illness, psychiatric impairment, or serious emotional or
behavioral disturbance;
(C) for cerebral palsy, diagnosis by a
physician of the condition in which an intellectual impairment need not be
present;
(D) for seizure disorder,
diagnosis by a physician of the condition in which an intellectual impairment
need not be present; or
(E) for
autism spectrum disorder, diagnosis by a neurologist, clinical psychologist,
child psychiatrist, or developmental pediatrician of a condition that meets the
criteria for a diagnostic code for autism spectrum disorder as defined in the
Diagnostic and Statistical Manual of Mental Disorders, adopted
by reference in
7
AAC 160.900.
(f) The department will conduct an assessment
in accordance with
7
AAC 130.213, and make a level-of-care determination in
accordance with
7
AAC 130.215(3). Following
notification of the department's determination, the care coordinator shall
develop and submit to the department a support plan in accordance with
7
AAC 128.010,
7
AAC 130.217, and
7
AAC 130.218.
(g) If, based on a review of the assessment
or the support plan developed under (f) of this section, the department
determines that the expected cost of the services that the applicant requires
exceeds the cost limit for individualized supports waiver benefits, the
department will not authorize the applicant for initial or continued enrollment
in the individualized supports waiver program.
(h) During any three-year period, a recipient
of individualized supports waiver services may request, by an amendment to the
recipient's support plan, up to an additional $5.000 for services and supports
to address needs related to
(1) a
lime-limited change in the recipient's health, behavior, or functional
capacity; or
(2) the unavailability
of the recipient's primary unpaid caregiver for a reason stated in
7
AAC 130.209(a)(3) - (5).
Authority:AS
47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.045
