Section 16.03.10.323 - AGED AND DISABLED WAIVER SERVICES: PARTICIPANT ELIGIBILITY DETERMINATIONWaiver eligibility will be determined by the Department or its contractor. The participant must be eligible for Medicaid as described in IDAPA 16.03.05, "Eligibility for Aid to the Aged, Blind, and Disabled (AABD)." In addition, waiver participants must meet the following requirements.
01.Requirements for Determining Participant Eligibility. The Department or its contractor must determine that:a. The participant would qualify for nursing facility level of care under Sections 222 and 223 of these rules, if the waiver services listed in Section 326 of these rules were not made available; andb. The participant could be safely and effectively maintained in the requested or chosen community residence with appropriate waiver services. Prior to any denial of services on this basis, the Department or its contractor must verify that services to correct the concerns of the team are not available.c. The average daily cost of waiver services and other medical services to the participant would not exceed the average daily cost to Medicaid of nursing facility care.d. Following the approval by the Department or its contractor for services under the waiver, the participant must receive and continue to receive a waiver service as described in these rules. A participant who does not use a waiver service for thirty (30) consecutive days will be terminated from the waiver program.02.Admission to a Nursing Facility. A participant who is determined by the Department or its contractor to be eligible for services under the waiver may elect to not utilize waiver services and may choose admission to a nursing facility.03.Redetermination Process. Case Redetermination will be conducted by the Department or its contractor. The redetermination process will verify that the participant continues to meet nursing facility level of care and the participant's continued need for waiver services.Idaho Admin. Code r. 16.03.10.323