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An Overview of Home and Community-Based Waiver Services Alabama Medicaid Agency Long Term Care Division Revised: December 2007 Home Community-Based Service (HCBS) Waivers

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An Overview of Home and Community-Based Waiver Services


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an overview of home and community based waiver services
An Overview of

Home and Community-Based

Waiver Services

Alabama Medicaid Agency

Long Term Care Division

Revised: December 2007

home community based service hcbs waivers
Home Community-Based Service (HCBS) Waivers
  • In 1981, Congress authorized the waiver of certain federal requirements to enable a state to provide home and community-based services (other than room and board) to individuals who would otherwise require SNF, ICF, or ICF/MR services reimbursable by Medicaid.
hcbs waivers
HCBS Waivers
  • The waiver programs are called 1915(c) waivers, named after the section of the Social Security Act that authorized them.
  • Under 1915(c) waiver authority, states can provide services not usually covered by the Medicaid program, as long as these services are required to keep a person from being institutionalized.
hcbs waivers4
HCBS Waivers
  • Under HCBS Waiver programs, both the comparability and statewideness requirements may be waived to enable states to target distinct groups of recipients.
  • HCBS Waiver Services can be provided only as a vehicle to provide an alternative to institutional care.
hcbs waivers5
HCBS Waivers
  • Initial waivers are approved for three (3) years and renewed every five (5) years thereafter.
what are waiver slots
What are waiver “slots”?
  • Each waiver program is allotted a certain number of “slots” to be filled by clients approved to receive waiver services within a waiver year.
types of waiver slots
Types of waiver slots
  • An active waiver slot is one in which a person is actively receiving waiver services and is not in a nursing facility.
  • A pending waiver slot is one that is pending approval for a person to receive waiver services.
types of waiver slots8
Types of waiver slots
  • A filled waiver slot is one which has a person currently receiving waiver services or who has been receiving waiver services, but had subsequent placement in a nursing facility, has moved or has requested termination from the waiver during the waiver year.
more about waiver slots
More about waiver slots
  • A filled slot cannot be refilled by another individual within the same waiver year that the vacancy occurred; however, the same individual who previously left the slot may fill the slot.
when can a waiver slot be refilled
When can a waiver slot be refilled?
  • Although a waiver slot cannot be refilled within the same waiver year, available slots may be refilled in subsequent waiver years.
transfer of waiver slots
Transfer of Waiver Slots
  • If a client transfers from one waiver to another within the same waiver year, the slot that was left vacant is considered filled, and therefore may not be refilled by a different individual.

For example, the client is on the MR Waiver and transfers to the LAHW, the MR Waiver slot cannot be refilled until the next waiver year.

medicaid approved home and community based waivers
Elderly and Disabled (E&D) Waiver

State of Alabama Independent Living (SAIL) Waiver

Mentally Retarded

(MR) Waiver

Living At Home Waiver

HIV/AIDS Waiver

Technology Assisted (TA) Waiver for Adults

Medicaid Approved Home and Community-Based Waivers
administering state agency
Administering State Agency
  • The Alabama Medicaid Agency has administrative authority over the Home and Community-Based Waivers.
responsibilities of the alabama medicaid agency
Responsibilities of the Alabama Medicaid Agency

To assure Centers for Medicaid and Medicare Services that:

  • The Operating Agency adheres to all federal guidelines described in the approved waiver document;
  • The health and welfare of the client is protected;
  • The client has free choice of providers and waiver service workers;
  • All direct service providers meet the qualifications as outlined in the approved waiver document; and
  • The client is aware of their right to express concerns regarding service provision and/or direct service provider.
operating state agencies responsibility
Operating State AgenciesResponsibility
  • State agencies are charged with the responsibility of operating the home and community-based waiver programs.
responsibilities of the operating agencies
Responsibilities of the Operating Agencies
  • Manage the program by focusing on improving care for the client;
  • Protect the health and welfare of the client;
  • Give the client free choice of providers and waiver service workers;
  • Make sure all direct service providers meet the qualifications as outlined in the approved waiver document.
e d waiver
E & D Waiver
  • Assists elderly and/or disabled individuals to live in the community who would otherwise require nursing facility care.
e d waiver19
E & D Waiver
  • Operating Agencies:

▪ Alabama Department of Public Health

▪ Alabama Department of Senior Services

  • No age requirement
  • 9,205 waiver slots
financial eligibility criteria
Financial Eligibility Criteria
  • Individuals receiving SSI and/or State Supplementation;
    • Widows and Widowers under age 60;
    • Widows and Widowers age 60 – 64;
    • Adult children who lose supplemental security income benefits upon entitlement to the child’s insurance benefits based on disability;
financial eligibility criteria continued
Financial Eligibility Criteria…continued
  • SSI related protected groups deemed to be eligible for SSI/Medicaid;
  • Individuals who would be eligible for Medicaid in an institution because income from either parents or a spouse is not deemed available to them (referred to as institutional deeming).
medical criteria
Medical Criteria
  • Must meet current level of care admissions criteria for nursing facility care.
covered services
Covered Services
  • Case Management
  • Homemaker Services
  • Personal Care
  • Adult Day Health
  • Respite Care (Skilled and Unskilled)
  • Adult Companion Services
  • Home Delivered Meals
mr waiver
MR Waiver
  • Provides Home and Community-Based Services to Medicaid eligible individuals who would otherwise require the level of care available in an Intermediate Care Facility for the Mentally Retarded (ICF/MR).
mr waiver26
MR Waiver
  • Operating Agency
    • Alabama Department of Mental Health and Mental Retardation
  • 3 years of age and above
  • 5260 waiver slots
financial eligibility criteria27
Financial Eligibility Criteria
  • Social Security Income (SSI) – protected groups deemed to be recipients of SSI
  • Special home and community-based optional categorically needy groups whose income is not greater than 300% of the SSI federal benefit rate.
medical eligibility
Medical Eligibility
  • Must meet current level of care admissions criteria for an ICF/MR (Intermediate Care Facility for the Mentally Retarded) Facility.
characteristics of persons requiring icf mr care
Characteristics of Persons Requiring ICF/MR Care
  • Intermediate care services for the mentally retarded are those services which are needed because of the severe, chronic nature of the mental impairment that results in substantial functional limitations in three or more of the following areas of life activities:
characteristics of persons requiring icf mr care continued
Characteristics of Persons Requiring ICF/MR Care…continued
  • Self Care
  • Receptive and expressive language
  • Learning
  • Mobility
  • Self Direction
  • Capacity for independent living
covered services31
Residential Habilitation Training

Residential Habilitation – Other Living Arrangement

Day Habilitation – Levels 1-4

Day Habilitation with Transportation – Levels 1-4

Prevocational Services

Supported Employment

Occupational Therapy Services

Speech and Language Therapy

Physical Therapy

Behavior Therapy – Levels 1-3

In-Home Respite Care

Out-of-Home Respite Care

Institutional Respite Care

Personal Care

Personal Care on Worksite

Personal Care Transportation

Environmental Accessibility Adaptations

Specialized Medical Equipment and Supplies

Skilled Nursing

Assistive Technology

Adult Companion Services

Crisis Intervention

Community Specialist Services

Covered Services
living at home waiver
Living At Home Waiver
  • Provides Home and Community-Based Services to Medicaid eligible individuals who would otherwise require the level of care available in an Intermediate Care Facility for the Mentally Retarded.
living at home waiver34
Living At Home Waiver
  • Operating Agency

▪ Alabama Department of Mental Health and

Mental Retardation

  • 3 years of age and older
  • 569 waiver slots
financial eligibility criteria35
Financial Eligibility Criteria
  • Social Security Income (SSI) - protected groupsdeemed to be recipients of SSI.
medical criteria36
Medical Criteria
  • Must meet current level of care admissions criteria for an ICF/MR (Intermediate Care Facility for the Mentally Retarded)
covered services37
Residential Habilitation In-Home

Day Habilitation – Level 1-4

Day Habilitation with Transportation – Level 1-4

Prevocational Services

Supported Employment

Occupational Therapy Services

Speech and Language Therapy

Physical Therapy

Behavior Therapy – Level 1-3

In-Home Respite

Out-of-Home Respite

Personal Care

Personal Care on Worksite

Personal Care Transportation

Environmental Accessibility Adaptations

Specialized Medical Equipment and Supplies

Skilled Nursing

Community Specialist

Crisis Intervention

Covered Services
operating agency
Operating Agency
  • Alabama Department of Rehabilitation Services
target population
Target Population
  • The SAIL Waiver is approved to serve disabled adults with specific medical diagnosis who are at risk of being institutionalized in a nursing home.
target population41
SAIL Waiver Services are provided to, but not limited to persons with the following diagnoses:

Quadriplegia

Traumatic brain injury

Amyotrophic Lateral Sclerosis

Multiple Sclerosis

Muscular Dystrophy

Spinal Muscular Atrophy

Severe Cerebral Palsy

Stroke

Other substantial neurological impairments, severely debilitating diseases, or rare genetic diseases (such as Lesch-Nyhan disease).

Target Population
waiver slots
Waiver Slots
  • The SAIL Waiver is approved to serve 660 individuals.
financial eligibility criteria43
Financial Eligibility Criteria
  • Individuals receiving SSI;
  • Individuals receiving State Supplementation;
  • SSI related protected groups deemed to be eligible for SSI/Medicaid;
  • Special HCBS Waiver disabled individuals whose income is not greater than 300% of the SSI Federal Benefit Rate.
covered services44
Covered Services
  • Case Management*
  • Personal Care Services
  • Environmental Accessibility Adaptations*
  • Personal Emergency Response System (Initial Set-up)
  • Personal Emergency Response System (Monthly)
  • Medical Supplies
  • Minor Assistive Technology
  • Assistive Technology
  • Evaluation for Assistive Technology*
  • Assistive Technology Repairs
  • Personal Assistance Services

*Includes Transitional Services

operating state agency
Operating State Agency
  • Alabama Department of Public Health
target population47
Target Population
  • The HIV / AIDS Waiver is designed to address the needs of individuals with a diagnosis of HIV, AIDS, and related illness who meet the nursing facility level of care criteria.
waiver slots48
Waiver Slots
  • The HIV/AIDS Waiver is approved to serve 150 individuals.
financial eligibility criteria49
Financial Eligibility Criteria
  • Individuals receiving SSI
  • Disabled individuals with income up to 300% of the SSI income level.
covered services50
Covered Services
  • Case Management
  • Personal Care
  • Homemaker Services
  • Respite Care
  • Skilled Nursing
  • Companion Services
operating state agency52
Operating State Agency
  • Alabama Medicaid Agency
target population53
Target Population
  • Individuals who received private duty nursing services through the Early Periodic Screening Diagnostic Test (EPSDT) Program under the Alabama Medicaid State Plan, who will no longer be eligible for this service upon turning age 21 and for whom private duty nursing services continues to be medically necessary based uponapproved private duty nursing criteria.
waiver slots54
Waiver Slots
  • The TA Waiver is approved to serve 40 individuals.
financial eligibility criteria55
Financial Eligibility Criteria
  • Individuals receiving SSI
  • Individual receiving State Supplementation
  • SSI related protected groups deemed to be eligible for SSI/Medicaid
  • Special HCBS Waiver disabled individuals whose income is not greater than 300% of the SSI Federal Benefit Rate
  • Low income families with children.
covered services56
Covered Services
  • Private Duty Nursing
  • Personal Care/Attendant Service
  • Medical Supplies
  • Assistive Technology
  • Targeted Case Management (TCM)

TCM for the TA Waiver for Adults is under the Medicaid State Plan and is provided by the Alabama Department of Rehabilitation Services

slide57

HCBS Waiver Contact Information:

AIDS Waiver Melody Tompkins (334 353-4383)

Technology Assisted Waiver Melody Tompkins (334 353-4383)

State of Alabama Independent Latonda Cunningham (334 353-4122)

Living Waiver – SAIL (formerly Homebound)

Elderly and Disabled Waiver (ADSS) Latonda Cunningham (334 353-4122)

(ADPH) Ginger Wettingfeld (334 242-5018)

Living at Home Waiver Monica Abron (334 242-5642)

MR Waiver Samantha McLeod (334 242-5584)