221 HOME AND COMMUNITY-BASED CARE FOR THE ELDERLY AND CHRONICALLY ILL SR 00-07, 02/00 (AAM-A)

Home and Community-Based Care for the Elderly and Chronically Ill (HCBC-ECI) offers a variety of home and community-based services that an elderly or chronically ill individual may need in order to prevent institutionalization.

Individuals who meet OAA, ANB, or APTD categorical requirements may be eligible to receive community-based services if all of the following are met:

• the individual’s income and resources are within the categorically or medically needy limits for HCBC-ECI services. See Part 601, Table B , Income Limits for HCBC Individuals;

• Division of Elderly and Adult Services’ Office of Long-Term Care (OLTC-DEAS) has determined there is medical necessity for the individual to receive nursing facility (NF) level of care;

• the individual’s needs can be met with community services at the same or lower cost than the Medicaid cost of NF level of care as determined by OLTC-DEAS;

• the individual is residing in either an independent living arrangement or a Residential Care Facility; and

• the individual or their representative has chosen appropriate community-based care as an alternative to institutional care and a physician has approved the choice.

See Medical Assistance Manual, Item 952, for OLTC-DEAS procedures in determining medical necessity and cost effectiveness of HCBC-ECI.