Section 7 AAC 130.206 - Waiver options for the recipient category of individuals with intellectual and developmental disabilities(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).Eff. 10/1/2018, Register 227, October 2018; am 1/1/2021, Register 236, January 2021; am 3/31/2021, Register 238, July 2021; am 9/9/2021, Register 239, October 2021Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.045