Ala. Admin. Code r. 560-X-36-.02

Current through Register Vol. 43, No. 3, December 31, 2024

Section 560-X-36-.02 - Eligibility

(1) Financial eligibility is limited to those individuals receiving SSI, individuals deemed to be receiving SSI, the optional categorically needy at a special income level of 300 percent of the Federal Benefit Rate (FBR) who are receiving HCBS waiver services, individuals receiving State Supplementation, and individuals receiving State or Federal Adoption Subsidies.

(2) Medical eligibility is determined based on current admission criteria for nursing facility care as described in Rule No. 560-X-10-.10.

(3) No waiver services will be provided to recipients in a hospital or nursing facility. Discharge planning by a case manager is a reimbursable service.

(4) The Alabama Medicaid Agency or its operating agencies acting on Medicaid's behalf may also deny home- and community-based services if it is determined that an individual's health and safety is at risk in the community; if the cost of serving an individual on the waiver exceeds the cost of caring for that individual in a nursing facility; if the individual does not cooperate with a provider in the provision of services; or if an individual does not meet the goals and objectives of being on the waiver program.

(5) The Alabama Medicaid Agency is restricted by the waiver to serving the estimated annual unduplicated number of beneficiaries approved by CMS.

Ala. Admin. Code r. 560-X-36-.02

Emergency rule effective March 18, 1985. Permanent rule effective July 13, 1985. Amended: effective November 18, 1987, June 6, 1990. Amended: Filed August 7, 1995; effective September 12, 1995. Amended: Filed June 11, 2003; effective July 16, 2003. Amended: Filed May 12, 2005; effective June 16, 2005. Amended: Filed September 9, 2005; effective October 14, 2005. Amended: Filed April 11, 2008; effective May 16, 2008.

Author: Ginger Wettingfeld, Administrator, LTC Project Development/Program Support Unit

Statutory Authority:42 CFR Part 441, Subpart G; Home- and Community-Based Waiver for the Elderly and Disabled.