221 HOME AND COMMUNITY-BASED CARE FOR THE ELDERLY AND CHRONICALLY ILL SR 94-04, 04/94 (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 the categorical requirements of either OAA, ANB, or APTD may be eligible to receive community-based services if all of the following are met:

• individual’s income and resources are within the categorically needy limits. See Part 601, Income Limits.

• medical necessity for individual to receive nursing facility (NF) level of care as determined by OLTC-DEAS,

• individual’s needs must 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, and

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