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:

  1. Recipient of Medicaid Program under the State Plan for Medical Assistance as set forth in Service Chapter 510-05, Medical Assistance Eligibility Factors;  
  2. 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;
  3. Eligible to receive care in a skilled nursing facility;
  4. 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.  
  5. 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;
  6. 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;  
  7. 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.
  8. Must receive services on a monthly basis.
  9. Not eligible for and/or receiving services through other Medicaid Waivers or private funding sources.
  10. The applicant/client(s) impairment is not the result of a mental illness, intellectual disability or a closely related condition.

 

 

 

 

 

 

 

 

 

 

 

 

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