(a) The following
services are not eligible for waiver services reimbursement:
(i) The care of individuals residing in a
hospital, nursing facility, ICF/IID, or other institutional
placement;
(ii) Wavier services
provided by:
(A) A spouse of the participant,
if the spouse is also the participant's legally authorized
representative;
(B) A legally
authorized representative of a participant who is eighteen (18) years of age or
older; or
(C) An owner or officer
of a provider organization if the organization is serving a participant for
whom they are the legally authorized representative;
(iii) Room and board, except when provided as
part of respite in a facility, other than a private residence, approved by
Medicaid;
(iv) Services currently
covered under the Medicaid State Plan;
(v) Services to an individual if it is
reasonably expected that the cost of these services would exceed the
institutional cost limit specified in the most current Comprehensive Waiver
application approved by CMS, which is incorporated by reference; or
(vi) Service settings reimbursed by another
state agency, such as the Department of Family Services or Department of
Education.
(b) No direct
service that is the responsibility of the school system shall be authorized as
a waiver service. The Division shall not authorize direct waiver services for
the hours the child is attending school or in a vocational program.
(i) Regular school hours and days apply for a
child who receives home schooling or an adjusted school day.
(ii) Waiver services may be used if an
individualized educational plan identifies specific times when the school
system shall not cover services for the individual.
(c) Any individual eligible for funding for
specialized services under the Developmental Disabilities Services Act shall
apply for and accept any federal Medicaid benefits for which they may be
eligible and benefits from other funding sources within the Department of
Health; the Department of Education; the Department of Workforce Services and
Division of Vocational Rehabilitation; and other agencies to the maximum extent
possible.
