Ch. 46, § 11. Waiver Cost Limits and Individual Budget Amounts

(a) The allocation of Medicaid waiver funds that may be available to a participant to purchase services shall be based on his or her assessed needs. (b) Eligible individuals shall be assigned a Level of Service score. (c) Participants enrolled in the Supports Waiver shall be assigned a designated budget amount outlined in the most current Supports Waiver application, which is incorporated by reference. Transition to the Comprehensive Waiver shall only occur as funding and a slot on the Comprehensive Waiver becomes available. (d) Participants shall meet criteria outlined in Section 4(d) of this Chapter to be eligible for Comprehensive Waiver Services. (i) Participants enrolled on the Comprehensive Waiver shall be assigned an individual budget amount based on the following factors: (A) Functional and medical assessments; (B) The participant's age group; (C) The participant's living situation; (D) The participant's need for a higher level of services; (E) An amount for annual case management services; and (F) Any temporary or permanent increase or decrease as determined by the ECC. (ii) The factors in subsection (d)(i) determine the participant's Level of Service score in order to plan for appropriate services and supports. (iii) A participant's individual budget amount on the Comprehensive Waiver shall not exceed the institutional cost limit specified in the most current Comprehensive Waiver application approved by CMS, which is incorporated by reference. A participant who needs services in excess of this amount shall have the individualized plan of care and budget approved by the ECC.