Ala. Admin. Code r. 580-5-30-.13
Current through Register Vol. 43, No. 1, October 31, 2024
Section 580-5-30-.13 - Program Enrollment/ADMH Medicaid Waiver Programs Entities/providers that participate in the Medicaid Waiver programs for financial compensation must be enrolled as a provider of services to individuals with intellectual disabilities, must meet any applicable certification requirements established by the ADMH, and must be under contract or subcontract with the ADMH. Certification does not guarantee a contract will be approved or offered by ADMH. Monitoring of waiver services by ADMH is required to meet federal funding requirements and to protect the Medicaid funding source. This monitoring is conducted by ADMH in accordance with ADMH regulations
Entity/Provider Enrollment in the AMA HCBS Waiver Program for Persons with intellectual disabilities require the following:
(1) The entity/provider must meet any applicable certification requirements established by DMH.(2) The entity/provider must contract with ADMH or subcontract with a ADMH contractor.(3) The entity/provider must provide to ADMH the services it proposes to provide and numbers of individuals it proposes to serve if ADMH approves a contract with the entity/provider. The entity/provider must also participate and comply with data reporting requirements established by the ADMH. The ADMH fee-for-service reimbursement system requires each entity/provider to comply with the established reimbursement rates for each specific service/support delivered to individuals.(4) Each contracting provider entity shall acquire a National Provider Indicator (NPI) as required by HIPAA. The Department will register the provider entity's NPI with the Medicaid Fiscal Agent, which will issue a performing provider number for each program in which the provider entity becomes enrolled. Each entity/provider will be assigned a license to access ADMH electronic billing and payment system. This access will allow the license holder to bill the ADMH, which will then approve, deny or suspend the claim prior to submitting it to EDS or paying it directly.(5) Individuals enrolled in ADMH Waiver programs also receive support coordination services. The support coordinator serves as an advocate and a resource for the individual. The support coordinator is also responsible for the person-centered assessment to develop an individual' unique, person-centered plan and then monitor the effective implementation of the plan as well as participant satisfaction and quality of life. The person-centered assessment also includes risk assessment evaluation.(6) The Person-Centered Plan includes learning opportunities and individualized goals as informed by the person-centered plan assessment. The Support Coordinator continuously monitors the process towards the individual achieving success in attaining the goal, determines whether changes are needed to make the goal attainable or determines whether the goal is no longer appropriate or chosen by the individual.(7) All individuals, served through ADMH HCBS Waiver Programs must be given freedom of choice among qualified contracted providers as to who is going to provide each waiver service.(8) Each individual enrolled in an ADMH federally approved HCBS waiver must have a person-centered plan which specifies the amount, duration, and frequency of needed services appropriate to each individual within overall federally approved established limits.Ala. Admin. Code r. 580-5-30-.13
New Rule: Filed January 17, 2011; effective February 21, 2012.Amended by Alabama Administrative Monthly Volume XXXVII, Issue No. 11, August 30, 2019, eff. 10/10/2019.Amended by Alabama Administrative Monthly Volume XXXIX, Issue No. 02, November 30, 2020, eff. 1/14/2021.Amended by Alabama Administrative Monthly Volume XL, Issue No. 06, March 31, 2022, eff. 5/15/2022.Original Rule .12 was renumbered to .13 due to certification published November 30, 2020; effective January 14, 2021.
Author: Division of Developmental Disabilities
Statutory Authority:Code of Ala. 1975, § 22-50-11.