Medicaid Waiver for Home and Community Based Services 525-05-25-10
(Revised
9/16/11 ML #3288)
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In order for services to be payable under
the provisions of the Medicaid Waiver for Home and Community Based Services,
the person receiving the service must meet all of the following:
- Recipient of Medicaid Program
under the State Plan for Medical Assistance as set forth in Service Chapter
510-05, Medical Assistance Eligibility Factors;
- Age 18 or older and physically
disabled as determined by the Social Security Administration or the State
Review Team, or be at least 65 years of age;
- Eligible to receive care
in a skilled nursing facility;
- Participate to the best
of their ability in a comprehensive assessment to determine what services
are needed and the feasibility of receiving home and community-based services
as an alternative to institutional care.
- Have an Individual Care
Plan, SFN 1467, developed and approved by the applicant/client or legal
representative and HCBS case manager that adequately meets the health,
safety, and personal care needs of the recipient;
- Voluntarily choose to participate
in the home and community-based program after discussion of available
options. This
is documented by completion of Explanation of Client Choice, SFN 1597;
- Service/care is delivered
in the recipient’s private family dwelling (house or apartment) or recipient
is receiving a community-based service of adult foster care, adult day
care, non-medical transportation, or adult resident service. Congregate/group
meals may be available or meals may be eaten off site.
- Must receive services on
a monthly basis.
- Not eligible for and/or
receiving services through other Medicaid Waivers or private funding sources.
- The applicant/client(s)
impairment is not the result of a mental illness, intellectual disability
or a closely related condition.
