Ala. Admin. Code r. 560-X-43-.06

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-43-.06 - Individual Assessments

(1) Alabama Medicaid Agency will require an individual plan of care for each waivered service recipient. Such plan, entitled "Individual Habilitation Plan" (IHP), is subject to review by the Alabama Medicaid Agency and Department of Health and Human Services. Client assessment procedures in place in the Alabama Department of Mental Health, which are based on eligibility criteria for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) developed jointly by the Alabama Department of Mental Health (ADMH) and the Alabama Medicaid Agency, will be utilized by ADMH (or its contract service providers) in screening for eligibility for the waivered services as an alternative to institutionalization. Whether performed by a qualified practitioner in ADMH, its contract service providers, or provided by qualified (Diagnostic and Evaluation Team) personnel of the individual/agency arranging the service, review for "medical assistance" eligibility determination will be based on client assessment data, and the criteria for admission to an ICF/IID, as described in Rule No. 560-X-43-.03. Re-evaluation of clients shall be performed on an annual basis. Written documentation of all assessments will be maintained in the client's case file and subject to review by the Alabama Medicaid Agency and Department of Health and Human Services.

(2) The Alabama Medicaid Agency will give notice of services available under the waiver as required by federal regulations, particularly to primary care givers for the target group, including but not limited to, programs operated by ADMH, the statewide network of community MH centers, and to other appropriate care-giving agencies such as county Department of Human Resources offices, hospitals, hospital associations, and associations for individuals with intellectual disabilities.

Rule effective August 10, 1988. Amended: Effective October 8, 1991; November 13, 1991. Amended: Filed May 6, 1994. Effective June 14, 1994.

Repealed by Alabama Administrative Monthly Volume XXXVI, Issue No. 10, July 31, 2018, eff. 8/26/2018.

Adopted by Alabama Administrative Monthly Volume XL, Issue No. 06, March 31, 2022, eff. 5/15/2022.

Author: Mattie Jackson, Associate Director, Specialized Waiver Unit, LTC Healthcare Reform Division

Authority: Section 1915(c) Social Security Act; 42 C.F.R. Section 441, Subpart G; and the Home and Community-Based Waiver for Persons with Intellectual Disabilities.