Alabama Medicaid AgencyLong Term Care Division

February 2008

Technology Assisted Technology Assisted (TA) Waiver for (TA) Waiver for

AdultsAdults

Home and Community Based Home and Community Based Service (HCBS) WaiversService (HCBS) Waivers

In 1981, Congress In 1981, Congress authorized the waiver of authorized the waiver of certain federal certain federal requirements to enable a requirements to enable a state to provide home and state to provide home and community based services community based services (other than room and (other than room and board) to individuals who board) to individuals who would otherwise require would otherwise require SNF, ICF, or ICF/MR SNF, ICF, or ICF/MR services reimbursable by services reimbursable by Medicaid.Medicaid.

HCBS WaiversHCBS Waivers

The waiver programs are called 1915(c) The waiver programs are called 1915(c) waivers, named after the section of the waivers, named after the section of the Social Security Act that authorized them.Social Security Act that authorized them.

Under 1915(c) waiver authority, states can Under 1915(c) waiver authority, states can provide services not usually covered by the provide services not usually covered by the Medicaid program, as long as these services Medicaid program, as long as these services are required to keep a person from being are required to keep a person from being institutionalized. institutionalized.

HCBS WaiversHCBS Waivers

Under HCBS Waiver programs, both the Under HCBS Waiver programs, both the comparability and state wideness comparability and state wideness requirements may be waived to enable states requirements may be waived to enable states to target distinct groups of recipients.to target distinct groups of recipients.

HCBS Waiver Services can be provided only as HCBS Waiver Services can be provided only as a vehicle to provide an alternative to a vehicle to provide an alternative to institutional care.institutional care.

HCBS WaiversHCBS Waivers

Initial waivers are approved for three (3) Initial waivers are approved for three (3) years and renewed every five (5) years years and renewed every five (5) years thereafter.thereafter.

Target Group Target Group for Technology Assisted for Technology Assisted

WaiverWaiver Individuals who received Individuals who received

private duty nursing services private duty nursing services through the EPSDT Program through the EPSDT Program under the Alabama Medicaid under the Alabama Medicaid State Plan, who will no State Plan, who will no longer be eligible for this longer be eligible for this service upon turning age 21 service upon turning age 21 and for whom private duty and for whom private duty nursing services continues nursing services continues to be medically necessary to be medically necessary based upon approved based upon approved private duty nursing criteria.private duty nursing criteria.

Covered ServicesCovered Services

Private Private Duty Duty

NursingNursing

Medical Medical SuppliesSupplies

Personal Personal Care/Attendant Care/Attendant

ServicesServices

Assistive Assistive TechnologyTechnology

Targeted Case Targeted Case Management Management

*(TCM)*(TCM)

*TCM for the Technology Assisted Waiver is *TCM for the Technology Assisted Waiver is under the Medicaid State Planunder the Medicaid State Plan

Administering State AgencyAdministering State Agency

The Alabama Medicaid Agency has administrative The Alabama Medicaid Agency has administrative authority over the Technology Assisted (TA) Waiver authority over the Technology Assisted (TA) Waiver for Adultsfor Adults..

Operating AgencyOperating Agency

The Alabama Medicaid Agency The Alabama Medicaid Agency is charged with the responsibility is charged with the responsibility of operating the Technology Assisted of operating the Technology Assisted Waiver.Waiver.

Case ManagementCase Management

The Alabama Department of Rehabilitation The Alabama Department of Rehabilitation Services is the Case Management Agency Services is the Case Management Agency for the Technology Assisted Waiver for for the Technology Assisted Waiver for Adults.Adults.

Age RequirementAge Requirement

Individuals age 21 years of age and olderIndividuals age 21 years of age and older

Financial Eligibility CriteriaFinancial Eligibility Criteria

Individuals receiving SSI and/or State Individuals receiving SSI and/or State supplementationsupplementation

Categorically needy groups whose income is Categorically needy groups whose income is not greater than 300% of the SSI federal not greater than 300% of the SSI federal benefit ratebenefit rate

What are waiver “slots”?What are waiver “slots”?

Each waiver program is Each waiver program is allotted a certain allotted a certain number of “slots” to number of “slots” to be filled by clients be filled by clients approved to receive approved to receive waiver services within waiver services within a waiver year.a waiver year.

Distribution of SlotsDistribution of Slots

Waiver slot distribution will be determined Waiver slot distribution will be determined by the Alabama Medicaid Agency.by the Alabama Medicaid Agency.

Approved Waiver SlotsApproved Waiver Slots

Available slots for the Available slots for the Technology Assisted Technology Assisted Waiver increases over Waiver increases over three (3) year period as three (3) year period as follows:follows: Year 1: 30 Year 1: 30 Year 2: 35Year 2: 35 Year 3: 40Year 3: 40

Types of waiver slotsTypes of waiver slots

An An activeactive waiver slot is one in which a person is waiver slot is one in which a person is actively receiving waiver services and is not in a actively receiving waiver services and is not in a nursing facility.nursing facility.

A A pendingpending waiver slot is one that is pending waiver slot is one that is pending approval for a person to receive waiver servicesapproval for a person to receive waiver services..

Types of waiver slotsTypes of waiver slots

A A filledfilled waiver slot is one which has a waiver slot is one which has a person currently receiving waiver services person currently receiving waiver services or who has been receiving waiver services, or who has been receiving waiver services, but had subsequent placement in a nursing but had subsequent placement in a nursing facility has moved or has requested facility has moved or has requested termination from the waiver during the termination from the waiver during the waiver year.waiver year.

More about waiver slotsMore about waiver slots

A A filledfilled slot cannot be refilled by another slot cannot be refilled by another individual within the same waiver year that individual within the same waiver year that the vacancy occurred, however, the same the vacancy occurred, however, the same individual who previously left the slot may individual who previously left the slot may fill the slot.fill the slot.

When can a When can a waiver slot be refilled?waiver slot be refilled?

Although a waiver slot cannot be refilled Although a waiver slot cannot be refilled within the same waiver year, available slots within the same waiver year, available slots may be refilled in subsequent waiver years.may be refilled in subsequent waiver years.

Transfer of Waiver SlotsTransfer of Waiver Slots

If a client transfers from one waiver to If a client transfers from one waiver to another within the same waiver year, the another within the same waiver year, the slot is considered filled and therefore may slot is considered filled and therefore may not be refilled by a different individual.not be refilled by a different individual.

Medical Supplies and Medical Supplies and AppliancesAppliances

Medical supplies and Medical supplies and appliances includes devices, appliances includes devices, controls, or appliances controls, or appliances specified in the Plan of Care, specified in the Plan of Care, not presently covered under not presently covered under the State Plan, which enables the State Plan, which enables the individual to increase the individual to increase their abilities to perform their abilities to perform activities of daily living, or to activities of daily living, or to perceive, control, or perceive, control, or communicate with the communicate with the environment in which they environment in which they live.live.

Request for Request for Medical Supplies and Medical Supplies and

AppliancesAppliances Request for Medical Supplies and Request for Medical Supplies and

Appliances should be approved by the Appliances should be approved by the client’s case manager.client’s case manager.

Assistive TechnologyAssistive Technology

Assistive technology includes devices, Assistive technology includes devices, pieces of equipment or products that are pieces of equipment or products that are modified, customized and are used to modified, customized and are used to increase, maintain or improve functional increase, maintain or improve functional capabilities of individuals with disabilities capabilities of individuals with disabilities as specified in the plan of care.as specified in the plan of care.

It also includes services that directly assists It also includes services that directly assists an individual with a disability such as an individual with a disability such as acquisition, selection, design, fitting, acquisition, selection, design, fitting, customizing, adaptation, applications, etc.customizing, adaptation, applications, etc.

Additional InformationAdditional Information

If you have further questions regarding the If you have further questions regarding the Technology assisted waiver for adults, Technology assisted waiver for adults, please contact:please contact:

Melody Tompkins, RN, MSN, Long Term Care Melody Tompkins, RN, MSN, Long Term Care Policy/Advisory Unit, 334-353-4383, Policy/Advisory Unit, 334-353-4383, melody.tompkins@medicaid.alabama.govmelody.tompkins@medicaid.alabama.gov