7 Alaska Admin. Code § 130.205 : Health and Social Services — Medicaid Coverage and Payment — Medicaid Coverage; Home and Community-Based Waiver Services — Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care — Eligibility for home and community-based waiver services

(a) The department will pay for home and community-based waiver services provided in accordance with the applicable requirements of this chapter to an individual that is
(1) eligible for coverage under AS 47.07.020, 7 AAC 100.002, and (d) of this section; and
(2) enrolled in accordance with 7 AAC 130.219.
(b) Home and community-based waiver services are not available to an individual
(1) while the individual is an inpatient of a nursing facility, a hospital, or an intermediate care facility for individuals with an intellectual disability or related condition (ICF/MR);
(2) if the individual's services, supports, devices, or supplies may be provided for entirely by services under 7 AAC 105 - 7 AAC 160 without the services specified under this chapter.
(c) A recipient enrolled in the home and community-based waiver services program is eligible to receive other Medicaid services for which the recipient is otherwise eligible.
(d) For the department to determine whether an applicant is eligible to receive home and community-based waiver services under this section, the applicant must be found eligible for one of the following recipient categories:
(1) children with complex medical conditions; to qualify for this recipient category, the applicant must
(A) be under 22 years of age;
(B) have a medical condition that would require care in a general acute care hospital or a nursing facility for more than 30 days per year if the applicant did not receive home and community-based waiver services;
(C) has a severe, chronic physical condition that results in a prolonged dependency on medical care or technology to maintain health and well-being;
(D) experiences periods of acute exacerbation or life-threatening conditions;
(E) need extraordinary supervision and observation;
(F) either need frequent or life-saving administration of specialized treatment or be dependent on mechanical support devices; and
(G) require, as determined under 7 AAC 130.215, a level of care provided in a nursing facility;
(2) adults with physical and developmental disabilities; to qualify for this recipient category the applicant must
(A) be 21 years of age or older;
(B) meet the criteria specified in AS 47.80.900(6); and
(C) require, as determined under 7 AAC 130.215, a level of care provided in a nursing facility;
(3) individuals with intellectual and developmental disabilities; to qualify for this recipient category the applicant must
(A) meet the criteria specified in 7 AAC 140.600(c) and (d); and
(B) require, as determined under 7 AAC 130.215, a level of care provided in an ICF/MR;
(4) older adults or adults with physical disabilities; to qualify for this recipient category the applicant must require, as determined under 7 AAC 130.215, a level of care provided in a nursing facility and must be
(A) 65 years of age or older; or
(B) 21 years of age or older and have a physical disability.

7 AAC 130.205

Eff. 2/1/2010, Register 193; am 11/3/2012, Register 204; am 7/1/2013, Register 206; am 11/5/2017, Register 224, January 2018; am 10/1/2018, Register 227, October 2018

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040

AS 47.07.045