TRANSMITTAL SHEET FOR
NOTICE OF INTENDED ACTION
Control 580 Department or Agency Alabama Department of Mental Health
Rule No. 580-5-30-'13
Rule Title: Prosram Enrollment/DMH Medicaid Waiver Proeram New X Amend ---RePeal doPt bY Reference public health, welfare, or Would the absence of the proposed rule significantly harm or endanger the safety? YES power protection of the public ls there a reasonable relationship between the state's police and the health, safety, or welfare? NO protect the ls there another, less restrictive method of regulation available that could adequately public? NO costs of any goods or Does the proposed rule have the effect of directly or indirectly increasing the services involved and, if so, to what degree? NO might result from the ls the increase in cost, if any, more harmful to the public than the harm that absence of the ProPosed rule? NO have, as their Are all facets of the rulemaking process designed solely for the purpose of, and so they primary effect, the protection of the public? YES agency is a party to Does the proposed action relate to or affect in any manner any litigation which the concerning the subject matter of the proposed rule? NO ****************,(:t<{.*i(**x***************:i*************d.*****************,<*
proposed rule has an Does the proposed rule have an economic impact? NO lf the prepared in economic impact, the proposed rule is required to be accompanied by a fiscal note accordance with subsection (f) of Section 4I-22-23, Code of Alabama 1975' ****i(***********x***************d.*****,r**********************************
Certification of Authorized Offi cial with the requirements of I certify that the attached proposed rule has been proposed in full compliance requirements of chapter 22, Title 41, code of Alabama 1975, and that it conforms to all applicable filing the Administrative Procedure Divisjgp of the Legislative servq; Agency.
ng officer APA-2
Alabama Department of Mental Health
NOTICE OF INTENDED ACTION
AGENCY NAME: Alabama Department of Mental Health
RULE NO. & TITLE: 580-5-30-.13 Program Enrollment/DMH Medicaid Waiver Program
INTENDED ACTION: Amend
SUBSTANCE OF PROPOSED ACTION:The Developmental Disabilities Division of the Alabama Department of Mental Health proposes to amend Chapter 580-5-30, lntellectual Disabilities Services, and repeal Chapter 580-5-33, Administrative and Support Requirements for Community Providers of lntellectual Disabilities Services. These proposed changes are intended to streamline and consolidate requirements and replace language deemed outdated and inappropriate current professional standards of practice. All requirements recommended for deletion from the Administrative Code shall be adopted in ADMH Policies andlor in DDD Operational Procedures as appropriate.
TIME. PLACE. MANNER OF PRESENTING VIEWS: All interested persons may submit data, views, or arguments in writing to Debbie Popwell, Director, Office of Certification Administration, Alabama Department of Mental Health, 100 North Union Street, Suite 540, Montgomery, Alabama 36130 by mail or in person or by electronic means to
.:,,,1,:..1,, i.r, i:,t:':_lr.r.,-:r'1r,...-:..',1 ,, ,, ,:, until and including November 4,2020. Persons wishing to submit data, views, or arguments orally should contact Ms. Popwell by telephone at (334) 353- 2069 during this period to arrange for an appointment.
FINAL DATE FOR COMMENT AND COMPLETION OF NOTICE: November 4,2O2O
CONTACT PERSON AT AGENCY:
Persons wishing a copy of the proposed may contact Debbie Popwell, Department of Mental Health, L00 North Union Street, Suite 540, Montgomery, Alabama 36130.
(334) 3s3-206e
A copy of the proposed change is available on the department's website at i-..i:,_,,::,,, .'i.rl;.,,: ,..1.::,:,:\i. Click on Provider Portal and then Certification to find code with changes.
(Signature of officer authorized to promulgate and adopt rules or his or her deputy) Chapter 580-5-30 Mental Hea1th 580-5-30-.13 Fr++g+b+++Ey And Le . Proqram Enrollment/DMH Medicaid vfaiver I Proqrams. Ehre Alabarna Medieaid Agenelr desiqnaEes the DMH as Ehe enEity autshorized Ee determine individuals' eliqi=bility fer parE+e+pat+en + iver- €er individuals wiEh InEel}eeEtraI DisabiliEies (ID Waiver) and fer Ehe A+abama t+v+ng aE fi eversiqhE and meniEorinq of day Eo day operaEions o€ Ehe 4iaiver pregrams are ee i-€€- Ehrot*gh iEs eenEral effiee and iEs Reqienal eenununiElr Serv*ee OFfiees.
in eiEher ef Ehese Ewo preqrams rnusE be submiEEed by Ehe designaEed supports eoerdinaEion ageney Eo Ehe desiqnaEed DMH- Reqienal eernrntrnity # (a) ICAP ({nvenEery for e}ienE and Aqeney f}anninq) ef determininq eliqibiliEy fer Ehe waiver preqrams, Thris eornrnereial produet wi}L predt*e e a Ehree paqe surnrnary reporE j by Ehe Wa+ver lreqr eEherwise be eliqible fer and require Ehre level ef eare previded @ fe) Designated Suppert eeerdinat*on Aqeney The i-es- resperts,lble for submittinq appli eatiens and informatien reqarding. (d) CriEieali€}r Sununary - The assessment teel ereaEed UV tne Bepartment t eeerdinator- rr*th Ehe DesiqnaEed SupperE CoerdinaEion Agener esi i+q-.- (e) Intelleetual Disabilitsy' - A preferred term fer l.lenEal ReEardaEien, The use ef this preferred Eerrn 4n Ehe presenE eenEexE earries exaeEly Ehre same elin*eal speeifieaEiens EhaE preqrams and regti+ i-en-- Menta]. Hea].th Chapter 580-5-30 i-es- Thre aerertym sEands fer Ehe Alabama Division o€ DevelopmenEa* Bisab{}it*es Infermatsien System, (q) Qualifyinq Psyehteleqiea} Evaluatien A f thran- (19 years or ehildren less eiqhrteen ) I of aqei a daEe ef Ehe applieaEion- (6) (7) Eliqibil*Ey fer the Waiver l{edieaid Heme and Co*ununiE}' P'ased Wa+vers ar i{res-- te instiEuEional eare EhaE would eEhierrrise be rein#ursed by the deterrnined te be eliqible fer thaE instiEtrEional eare; of Ehe serviee or serviees under Ehe waiver. The waivers operaEed psyeholoq+ea+ eva eiqhrEeen (18) lrears of age; a psyeheleqieal should be eempleted w4thin three (3) years ef the daEe ef Ehe applieaEi'on. In erder fer Ehe submitted psyeholeqieal_evalt*ati=on Ee qualify the individual fer the wai,vers; iE must shew s,|gnifieanE preblems in a full seale IQ seore belevr sevenElr (70); and mt*st dernonsEraEe er be aeeempan+ed by p disabil*Ey had an onseE- before Ehe aqe ef eiqhEeen (tr8), In adminisbered Eo the individualr nene ef Ehem shot*}d doeument a full seale IQ seore ef seventy (70) or abeve, Ehe hightesE seore i*ary- eause(s) of tshe impaired funetieninq er the ful* seale IQ seere Iess than seventlz (70) shall neE be Ehe presenee ef menEal illness or the result of exEernal faeEers st+ehr as heavlz inq-- i-eff- i_{rer__i_s_ deEermined in Ehree sEeps. In the firsE sEep; preliminarlr eliqibility is deEer+nined se an individual's name ean be added Eo a statewide waiti+gi list. Ehe seeond step eeeurs r+hen the or her turn to be enrelled in the waiver, The Ehird sEep eeeurs when Ehe individt*al has been reeeivinq seryiees for a peried ne longer than one (1) year and his or her eliqibility mt*st be re determined. Re-deEerminaEierris requi'red annually fer as long as the i=ndiv*dual reee*ves serviees trnder Ehe waiver, (b) In the firsE sEepi elinieal eyidenee *lusE be Bresentee tnat t Chapter 580-5-30 Menta1 Health i *ndiv*dual will neE be able to esEablish lledieaid finaneial Reg4ena4 effiee to make Ehre elinieal deEerminatien fellows: I , A qual j=f yinq psY ehieleqieal evalt*aE*en. 2, Tk+e preof EhaE an individtral htad a d*agnesis ef never had an e'v-aluation prior te aq'e eiqhEeert (18) bruE there *s substanEial eorellarlr evidenee frem sehoel er soeia* er i_€,_ requj rement, Etle Dep 3- An IeAf eempuseore repert; eempleEed wiEhrin nirteElr (90) days prior Ee the appliea€ion tse be added Ee thte waitsinq '1 .i ffi ^+ 4 - A eritieal4Ey assessrnenE eempleted rrithin rt{neElr i-e+ (e) Submission of required ferms for enrel]menE in El^te rsa*ver, a+rd determinatien by Ehte Reqi=onal effiee EhaE, but €or i-se- requ.i i-n- t4ed+ea+d f+nane+ tr. A Sununary ef Hab*&iEatien €erm may be eempleted 2, A Freedem ef eheiee of Erevider ferm; siqned by l-ary- st*bstanE*atinq Ehe irrdiv*dual's freedem of eheiee of previders ,ln eomputer and aEtaehed to the individual's ADIDIS reeord as a +otre- 3 = A BissatisfaeEien of Serv*ee form (NetifieaEien of due proeess rights)i whieh is siqnedi Ehen ean be seanned inte a eempt+ter and atEaehred Ee Ehte individual's ADIDIS reeord as a aetre-- 4, The Flan ef eare; whrieh ean be eompleEed wiEhrin Mental Hea].th Chapter 580-5-30 i (d) Re determ*naEion requires Ehe subntission ef: 1, 1\ rey*ew ef eligib*liEyz 4neludinq updaEinq any ne+r--ingermat+en tna psyet-)oloq+ea+ eva 2. A Sunnnary of HabiliEatien forrn speeif ie te Ehe new peried of eliqibility beinq requesEed' 3, The Plarr ef eare; speeifie Ee Ehte ners peried ef l. A Freedem ehteiee ef I'reuider €ormr siqned blr Ehe substanEiaEinq the individual's freedem ehtoiee of providers in the eeunEy of seryiee; er Ehe ehoiee of differenE previders' (3) The ldait*nq LisE The DMH mainEains a sEaEevride l+aitinq lisE of indiyiduals applling fer seryiees Ehretighr eiEher of thre lledieaid waiver preqrams iE adminisEers under deleqation of auEherity frern Ehe Alabama lledieaid /\qeney, 1\pplieatien te be plaeed en Ehe ieaiEing }ist requires a deEerm*naEien ef preliminary eliqibiliEy- The Dl{H wi}} net; lcnewinq}}r add an Ehe ind{vidt*a}; enee enre}}ment in a rsaj.ver preqrarn beeomes available; wiIl neE be e}*qible- To Ehe exEenE pess*blei IlsE is neE reqt*4red to be re submiEEed rrhen Ehe indiyidual is reaehed en the waiEinq lisE and the waiver applieatien needs to Ue subm+ttee. Ene +o @ (a) IniEial een€aeE: Individuals ea}l Ehe Dl{H usi-rg a EeII-free nt*mber Ee beqin Ehe applieatien preeess, Infermati en is Ealcen durinq Ehis Eelephone lnterview and a referral is made either Ehat same day er Ehe nexE business day fellerrinq te Ehe desiqnaEed supporE eeerdinaEion aqenelr respensible fer Ehe eeuntlr j (b) Referral Preeessing: Upen reeeipt ef the referral from the Dt{H; Ehe desiqnaEed support eoordinatien aq.eney ass*gns /=intal 1, A qualifyinq ps,'eheleqieal evaluaEion as defined 2, Froef that the indiYidual had a diagrtes'ls ef DevelopmenEal disability prier to aqe eiqhEeen (18); 3 - A develepmenEal sunrnrar!'i Ee assist in deEermininq eliqibiliEyr ineluding assuri+q Ehte enseE of a develepmental disability befere tshe aqe ef eiqhteen (18)r eempleted within ninety (90) day's prier te Ehe applieaEien; 4, An eliqibiliEy assessment vqithin Ehe ADID{S system; sununarizinq ] NEW er UPDATE worl suppert eoordinaEien aqeney of anl,' additional informat*en needed' i-en-i-s- sr*ppliedi and the appli=eation *s appreved, l-irer-proqrares- (f ) Thte waiEinq lisE is serEed by eriEiealitlr sumrnary seere and blr lenqEh of Eime waiEinq; and a ranl< is esEablishied fer eaeh indit-idtral waiting; r+ith number ene being the ra+k wiEh M (q) Rank is reesEablished v+henever a eriEieality st*rnrnarlr is added er ehanqed to aeeemr'ftedate nerg applieants and er@ i_s (4) 4n*Eial Enrellment 4rr a Waiver Preqram When an individual frem Ehe waitinq IisE ean be admitted Eo eiElrer ef the Ewe Waiyer Eroqrams; a}l forrns required by the DMH and the A+abama lled+€a+d Menta]. IleaLth Chapter 580-5-30 supperE eoordinat*on aqenelr submits the reqt*ired forms and in i-en- reperts or sununariesi unless prevj.eusIl,' submitted te qualiflz thte individual fer thre waiEinq list; as noted in thre paraqraphs ffi1^ ^ I ^, , . (a) 1l eopy of a qualifying pslehroloqieal assessment- If the applieant is eurrently less Ehan eiqhEeen (18) years ef aqe; a previeusly strbmitEed pslreholeqieal is adequaEe enly if it was administered wiEhin €hree (3) ]rears pri=or Eo Ehe eurrenE @ (b) Infermatsien frem an TeAl adminisEered withirt *inety (90) days prior Eo the date ef waiver applieatien, Thre IeAf eempuseere reporE is required, eEher assessmenEs sueh as Ehe Vineland er /\daptive Behtavior Seale (ABS) may be used Ee st*pplenrenE Elre infermatien previded blr the IeAP- (e) A eepy of- a physieal examinaEion performed and si-gned b,' a ]ieensed physieianz Iieensed physieian assistant or a eertified regisEered nur-e praetiEiener; er a medieal st*rnrnary er e+ (d) 1t seeial developnent sunnriarl' eempleted iritshin nineEy (90) days prior Ee waiver applieaEien, (e) eEher professional evaluatiens as neeessarl,' Ee supperE the individual's applieaEion for an IeF }evel ef eare, (5) lrnnual EliqibiliEy Re determinatiens The supperE eoerdinatien aqeney submits Ehe followinq requ*red reportsz assessmenEs er sunrnary sEaEements: (a) The supperE eoordiriaEer eornpleEes a ners ++aS+++tat+en eeYe (b) Fer an adulEr Ehe qualifyinq psyehelegieal evalt*atien frem rshieh the eligibiI.i,EY eriEerien of deye*opmenEal disability was establ*shed is valid until Ehe original evaluation is t-en_-i-s- eompleEed, The support eoerdinator submits a eepy of Ehe psyehe+eq+ea+ a Regienal e ennntrnitl,' Serviees ef f iee. (e) For a ehildr the Eliqrbility Assessment must refleet the mesE reeenE qualiflrinq psyeholoqieal evalt+atien resulEs, Thrat evaluaEion must be ne mere than thtree (3) l,ears Chapter 580-5-30 l'Iental- Ileal-th pf-i i-on Eo Ehte redeEerminaE{on daEe and Ehe eurrenE sehee} fEf tean'l has remains aeeuratei Ehe date of the IEP meetinq at vshiehr trh*s determinaEien was made will be aeeepEable in the EliqibiliEy AssessrnenE - Thre supporE eeerdinaEor dee t*menEs Ehrreuqhr a nete and eoplr of Ehe {EE Ehat Ehre ehi}d/ s tsesE seores rgere revierred and @Lenjng- (d) A eepy ef an ICAF administered withrin the prev*eus twenty four (24) menEhrs (2 years) ineludingi a notation that Ehe same, I€ infermatien has ehranqed; a new IeftP musE be adm-i-n-i-sbere+.- (e) A sEatement sununarizinq any ehanges that may have eeeurred in the indiv{dt*a}'s hea}th staEus sinee thre previous Ieve* ef eare deEermi=naEi'en - (f ) A staEemenE sunrmarizi-rg' any soe*al or finarteial ehanqes that hrave eeeurred rsith the *ndividualr famil\r er eareqivers sinee the previous level o€ eare determinaEien, (q) Freedem ehreiee ef pre-;*der €orm *f Ehre *ndividual will be ehanginq previder(s) er reeej=v*nq new serviees €rem any profti-der- (6) Applieatiens fer supported enrployment under tkre wa-t=ver regtt+re t DeparEment ef RehabilitaEien Serviees (ADRS) eerEif!'inq Ehats Ehe individual is eiEher noE eliqible fer empleyment serviees throuqh Ehat aqeney er Eha€ ADRS has pro';r ded -erv*ees Ee Ehte *nd*v*dt*a} serviee €hreuqh /\DRS are not eliqible fo:r employment rela€ed seryiees Ehreugh thre F{eB Waiver unti} Ehey have exhat+sEed Eheir M (7) Thre des*qnaEed supponE eoordinaEion ageney fer eaehr eeunEy/area serves as the peint ef enEry fer rraiver i-en--aqefi-e'i-- eelleeEs neeessarl,' doetrrnenEaEien and f*les Ehre applieatien reith Serviee effiee preeesses all eemplete wa*ver applieaEiens te eiEher deEermine an indiv*dual ineliqible fer Ehe lraiver or eliqible btrt plaeed en a waiEiaq lisE, SubsequenE enrellmenE in of reseureesz and spaee w*Eh*n Ehte rsa*ver eaps en Ehe nunber who # (8) The LAH Wa*ver Freqram has the fellew*nq MentaL HeaJ.th Chapter 580-5-30 requirements in addiEien to the neeessiEy ef meeEing the DD Waiver lreqram requirernenEs - (a) Ehre Livi-+q aE Home Waiver serves individt*als whe @ (b) The Li,v*nq at Heme Waiver has e' Ff++g+b+++Ey det i:on--a€- requ*red fer Ehe DD Waiyer F'rogram, Aqeneies/previders thaE f,ar€+e+paEe +n eempensatien musE be enrelled as a previder ef ser-;iees te *ndiv*duals i*ith intelleeEtral disabilities; mtrsE be eerEified blr Ehe DepartmenE ef l{enta} Hea}th(D}4H);- and mtrst be under eontraet er subeonEraeE wiEh thte DMH- eerEifieatien does neE qtraranEee a eenEraet isiII be appreved by DMH- MeniEering of waiver serviees UV BUt+ +s regu+re preteet the l+ed i*g-i-s- eendueted blr DllH in aeeerdanee rrith Df4H requlaEiens, Agencies/providers that participate in the Medicaid Waiver proqrams for financial compensation must be enrolled as a provider of services to individuals with intellectual disabillties, must be certified by the DMH, and must be under contract or subcontract with the DMH. Certification does not quarantee a contract will be approved by DMH. Monitoring of waiver services by DMH is requlred to meet federal fundinq requirements and to protect the Medicaid funding source. This monitorinq is conducted by DMH in accordance with DMH regulatlons. Aqency/Provider Enrollment in the Alabama Medlcaid Aqency (AMA) HCBS Waiver Program for Persons wit.h intellectual disabilities require the following: (1) The agency/provider must be certified by DMH. (2) The agency/provider must contract with DMH or subcontract with a DMH contractor. (3) The agency/provi-der musL provide to DMH the services it proposes to provide and numbers of individuals it proposes to serve if DMH approves a contract with the agency/provider. The DMH fee- for-service reimbursement system requires each agency/provider to comply with the established reimbursement rates for each specific Chapter 580-5-30 Mental Health service/support delivered to individuals' (4) Each contractin rovider aqency shall acquire a National rn which will issue a rformln rovider number for each Program s enrol-led' Each egelcy/Provid:r nqe lolder to bill the DMH, rt-rr-.n to submitting it to EDS or inq it directl (s) Individuals enrolled in DMH-DDD Waiver rams also receive su ort coordination services - The support coordinator SCIVCS AS in advocate and a resource for the (6) Atl persons, alon with thei-r families or uardians, served through DMH*DDD Hqlq Waiver Proqrams must be iven freedom of choice amonq qualified roviders as to who is oinq to provide each waiver service - (7)EachpersonenrolledinHCBswaiversmusthave lan of the services and the number of uni-t s of each ffi or she is expected to receive. Author: Division of Developmental Disabilities, DM++ Statutory Authority: Code of Ala. 1975, 522-50-11' History: New Rule: Fl1ed January 11 , 207L; effective Februaiy 21, ZOl2. Asrended: Filed August 26, 20\9; effective October 10, 2OIg. Amended: Filed September 18, 2020 '