1. (1) Home and community-based services for the SAIL Waiver are provided by the Alabama Medicaid Agency to disabled individuals who would otherwise require institutionalization in a nursing facility. These services are provided through a Medicaid waiver under the provisions of Section 1915(c) of the Social Security Act.
2. (2) The purpose of providing home and community-based services to individuals at risk of institutional care is to protect the health, safety, and dignity of those individuals while reducing Medicaid expenditures for institutional care.

3. (3) Home and Community-Based Services for the SAIL Waiver are provided in compliance with the provisions of the HCBS Settings Final Rule (CMS 2249-F/2296- F). These provisions require the following:

   1. (a)    Services may only be provided in settings that:

      1. 1. Are integrated in and support full access to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS;
      2. 2. Are selected by the individual from among setting options;
      3. 3. Ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
      4. 4. Optimize autonomy and independence in making life choices including but not limited to, daily activities, physical environment, and with whom to interact; and
      5. 5. Facilitate choice regarding services and who provides them.

   2. (b) Services may not be provided in:

      1. 1.    Excluded settings that include nursing facilities, institutions for mental disease, intermediate care facilities for individuals with intellectual disabilities, and hospitals; and
      2. 2. Presumed institutional settings that include those in a publicly or privately-owned facility that provides inpatient treatment; on the grounds of, or immediately adjacent to, a public institution; or that have the effect of isolating individuals receiving Medicaid-funded HCBS from the broader community of individuals not receiving Medicaid-­funded HCBS.

Author: Keisha Hawkins, Administrator, LTC Healthcare Reform Unit

Statutory Authority: §1915(c) Social Security Act; 42 C.F.R. §441, Subpart G.

History: Emergency rule effective April 1, 1992. Permanent rule effective June 12, 1992. Amended: Filed September 6, 1996; effective October 12, 1996. Amended: Filed June 11, 2003; effective July 16, 2003. Amended: Filed June 12, 2012; effective July 17, 2012. Amended: Published October 30, 2020; effective December 14, 2020. Amended: Published March 31, 2023; effective May 15, 2023.