R9-28-307. The ALTCS Transitional Program for a Member who is Elderly or Physically Disabled (EPD) or Developmentally Disabled (DD)

A. The ALTCS transitional program serves members enrolled in the ALTCS program who, at the time of reassessment as described in R9-28-306, no longer meet the threshold specified in R9-28-304 for EPD or in R9-28-305 for DD but do meet all other ALTCS eligibility criteria. The Administration shall compare the member’s PAS assessment to a scoring methodology for eligibility in the ALTCS transitional program as defined in subsections (B) and (C). B. The Administration shall transfer a member who is DD from the ALTCS program to the ALTCS transitional program if, at the time of a reassessment, the total PAS score is less than the threshold described in R9-28-305 but is at least 30, or the member is diagnosed with moderate, severe, or profound mental retardation. C. The Administration shall transfer a member who is EPD from the ALTCS program to the ALTCS transitional program if, at the time of a reassessment, the PAS score is less than the threshold described in R9-28-304 but is at least 40. D. For a member residing in a NF or ICF-IID, the program contractor or the Administration shall ensure that the member is moved to an approved home- and community-based setting within 90 continuous days from the enrollment date of the member’s eligibility for the ALTCS transitional program. E. A member in the ALTCS transitional program shall continue to receive all medically necessary covered services as specified in Article 2. F. A member in the ALTCS transitional program is eligible to receive up to 90 continuous days per NF or ICF-IID admission when the member’s condition worsens to the extent that an admission is medically necessary. G. For a member requiring medically necessary NF or ICF-IID services for longer than 90 days, the program contractor shall request the Administration to conduct a reassessment under R9-28-306.