016.20.98 Ark. Code R. 003
Federal Regulations at 42 CFR 435.217 allow states to provide home and community based waiver services to physically disabled individuals to avoid institutionalization. On July 1, 1997, Arkansas implemented the statewide Alternatives for Adults with Physical Disabilities (AAPD) Home and Community-Based Waiver Program for individuals age 21 through 64.
The Division of Aging and Adult Services (DMS) have idmfo-1 strati vk responsibility for the AAPD Waiver's operation. The AAPD Waiver ihas?fc?en approved for an initial three (3) year period. There will be a Vimitied number of recipients who will be served by this Waiver; 200 in the first year, 300 in the second and 400 in the third.
AAPD Waiver recipients will receive the full range of Medicaid services plus will be eligible for the added Waiver services of environmental accessibility adaptations and attendant care.
The following requirements must be met to be found eligible for the AAPD Waiver program:
or
Categorically Related Blind, or Disabled individuals who would be Medicaid eligible if in an institution (Re. MS#3322).
Although an uncompensated transfer will not effect SSI eligibility, it does affect Medicaid and a penalty will be imposed for resources transferred without compensation. If a penalty is imposed, the individual will not be eligible for AAPD Waiver services. Counties will check the WRTR screen, "SSI Recipients with Reported Transfer of Resources," prior to initial certification and thereafter at each annual case review.
NOTE: Medicaid will accept, by the individual's receipt of SSI that income and resources have been determined and verified to meet all applicable SSI income and resources limits by the Social Security Administration. The county office need not reverify income and resources (except for transferred resources) of SSI recipients, unless questionable.
The Waiver application will not be certified until any discrepancies in income and/or resources, including uncompensated transfers, have been resolved. Income or resources discovered by DCO that result in ineligibility will be reported to SSA. DAAS will be notified via the DHS-3330, Slot 1412.
It may be assumed by DCO that an individual applying for the AAPD Waiver program will meet the cost effectiveness criteria. If at any time DAAS determines that cost effectiveness is not met, DCO will be notified via the DHS-3330 and the AAPD Waiver case will be closed.
SSA Disability Determination - Applicants currently receiving SSI (or SSA) on the basis of a disability will be considered disabled. If a disability determination was made by SSA within the past year but the SSI or SSA benefits were terminated for nondisability reasons, documentation from SSA will be obtained for the case record. The applicant will be considered disabled based on the previous SSA disability determination.
MRT Disability Determination - For all non-SSI and non-SSA individuals for . whom an SSA disability determination has not been made within the past year, an MRT referral must be made. The DCO-106 will be completed, and disability guidelines at MS 3322 will be followed. Any Waiver recipient whose certification was based on a previous SSA disability determination / must have a disability redetermination made by MRT at the first revaluation for Waiver eligibility.
Individuals applying at the county office for the AAPD Waiver program will be assisted in calling a toll free number ( 1-800-981 -4457) to contact the Division of Aging and Adult Services for an application packet. The packets will be issued by DAAS and will contain a DCO-777, Application for Assistance; DCO-727, Disposal of Assets Disclosure; and an AAS-703, Evaluation of Need for Nursing Home Care. A pamphlet (AAS-9558) giving instructions on completion of the packet will also be included. Individuals will be instructed to return the packet to their resident county office when all forms have been completed.
The county office will schedule an application interview immediately upon receipt of the completed packet. The application will be registered on WIMA in category 41 or 31. A waiver indicator code of "PD" will be entered in the WVR field (f.11).
* Other forms to be completed during the application process are the DCO-86, DCO-87, DCO-662, DCO-707, and DCO-769. Forms DCO-106, DCO-107, DCO-108 and DHS-81's will be completed if the disability is to be established by MRT.
Individuals will be referred to DAAS, Slot 1412, via the DHS-3330 for development of the Plan of Care and determination of medical necessity. The completed AAS-703 will be attached and submitted along with the DHS-3330. If the individual does not meet the level of care requirement, the Medicaid Waiver application will be denied.
The county office worker will have a maximum of 45 days to dispose of the application. Within 30 days of filing the application, the county office worker will check with the DAAS CO and/or the LTCU screen to determine if the AAS-703 has been processed. If the worker learns that the AAS-703 is being processed, the application will be held pending receipt of the DCO-704. If the AAS-703 is not being processed, the county office worker will forward the applicant a 10 day notice that the application will be denied. If there 1s no indication within 45 days of filing the application that the AAS-703 is being processed, the application will be denied. DAAS will be notified of applications certified (and denied) via the DHS-3330.
DAAS Waiver Counselors will be responsible for developing an Individualized Plan of Care and determining cost effectiveness for each individual under the Waiver. The Plan of Care will describe the services to be provided and the type of provider who will furnish each service. Periodic reviews of the individual's plan of care will be conducted at a minimum of every 12 months.
DAAS Utilization Review Committee will determine if the applicant meets, the Intermediate Level of Care requirement. The results will be routed via the DCO-704 to the resident county office and to the Waiver Counselors. The individual's level of care will be reviewed annually by the Utilization Review Committee.
DAAS will have the responsibility of tracking the number of individuals approved under the Waiver. The county offices will be notified by DAAS when no more applications can be certified.
If an individual living in a residential care facility (RCF) applies for AAPD waiver services, the county office worker will explain to the applicant that, according to current LTC and RCF policy, he/she does not meet the required level of care to receive waiver services and the application will be denied (Denial Reason 58).
After all eligibility criteria have been established, the worker will complete form DCO-57 (or DCO-765) to certify the case on ACES. The effective date of AAPD Waiver eligibility will be the date on which the Medicaid Waiver eligibility is finalized (completion of the DCO-57) by the county office. Retroactive coverage for AAPD Waiver services will not be given under this program. The SSI case number, if one is available, will be used to open the AAPD Waiver case.
* Application approvals will be entered first on WASM and then WAIV, unless the case is an open SSI. For open SSI, entries will be made on WAIV prior to entry on WASM. An Action Type of "NA" with Action Reason 103 and all other appropriate fields (Re. DCOUM 3721) will be entered. The gross income of the individual will be entered in the appropriate fields on the DCO-57 and also in the PROT MAINT field on WAIV. AAPD Waiver individuals will not be required to make a contribution to the cost of their care.
Waiver numbers "2930" will be entered in the WVNO field (f.15) to identify individuals entering the Waiver from a community setting and "2935" to identify individuals entering the Waiver from a LTC facility.
On WASM, a "B" Action type and Action Reason 101 will be entered.
Once an AAPD application has been approved, Waiver services must be provided in the home for eligibility to continue. Unless stated otherwise below, the county office will be notified immediately by the Waiver Counselor when Waiver services are discontinued, and action will be initiated by the county office to close the Waiver case.
An individual cannot receive AAPD Waiver services while in an institution. However, the following policy will apply to active Waiver cases when the individual is hospitalized or enters a nursing facility.
When a Waiver recipient enters a hospital, the county office will not be notified and no action is necessary unless the recipient does not return home within 20 days from the date of entry. If after 20 days the recipient has not returned home, the Waiver Counselor will notify the county office via Form DHS-3330, and action will be, initiated by the county office to close the Medicaid Waiver case.
If the county becomes aware that an AAPD Waiver recipient has entered a nursing facility and it is anticipated that the stay will be short, the case will be closed on WAIV effective the date of entry. The Medicaid case will be left open on WASM. When the individual returns home, the AAPD Waiver case may be reopened on WAIV effective the date of return home, if the Waiver Counselor has provided the county with a copy of Page 2 of the Plan of Care showing election of AAPD. A new DCO-703 and DCO-704 will not be required unless the last review was completed more than 6 months prior to facility entry. A new DCO-777 will not be required unless it is time for the annual case revaluation. It will not be necessary to register a new application in this situation.
If the individual requests payment for the temporary stay in the nursing facility, a signed DCO-777 must be obtained and registered, along with a DCO-703 and DCO-704. If it is time for the annual case reevaluati on, the reevaluati on must be completed pri or to certification on WNHU. If all eligibility requirements are met, eligibility for vendor will begin effective the date of entry into the nursing facility. If the stay in the facility was less than 30 days, vendor may still be authorized because AAPD recipients are considered to be "institutionalized" for Medicaid purposes and the AAPD eligibility prior to the facility stay may be applied toward the 30 day institutionalization requirement.
If the individual does not return home, i.e., stays in the facility and requests LTC services, the Medicaid SSI case on WASM will be left open while processing the registered LTC application.
If found eligible for vendor, the case will be opened on WNHU effective the date of NF entry. When approving the recipient, first key on WNHU an NA Action Type, Action Reason 102 and all appropriate fields (Re. DCOUM 3721). Next key on WASM, the register number, application date, action date, B Action Type, Worker number, Notice indicator, and Action Reason 102.
If found NOT eligible for vendor payment (or if after 20 days in a facility the individual does NOT apply for vendor payment), appropriate notice will be given for permanent closure of the AAPD Waiver case on WAIV.
When a waiver recipient is absent from the home for reasons other than institutionalization, the county office will not be notified unless the recipient does not return home within 20 days. If after 20 days the recipient has not returned home and the providers can no longer deliver services as prescribed by the plan of care (e.g., the recipient has left the state and the return date is unknown), the Waiver Counselor will notify the county office via form DHS-3330 and action will be taken by the county office to close the Medicaid Waiver case.
Eligibilty for AAPD Waiver cases will be redetermined every 12 months, or at any time a change occurs which effects eligibilty. Completion of forms DCO-777, DC0-707, DC0-727,and DC0-769 are necessary for each reevaluation.
The AAPD Waiver Counselor will be responsible for coordinating the completion of the AAS-703 and submission to the Utilization Review Committee for a redetermination of medical necessity.
Recipients will be informed to report changes within 10 days. When a change occurs that results in ineligibility, a 10 day advance notice must be given unless an advance notice is not required (MS 3633), A copy of the 10 day notice will be sent to the AAPD Waiver Counselor. Eligibility will terminate at the end of the 10 day advance notice period. The Waiver Counselors will be notified of any change resulting in closure via the DHS-3330.
AAPD Waiver services will terminate for any recipient who reaches the age of 65 while certified under the AAPD Waiver. A 10 day advance notice will be issued prior to closure. Closure code 191 will be utilized for this purpose. The county office will determine eligibility for the individual under the ElderChoices Waiver program.
016.20.98 Ark. Code R. 003