1. (1) The following groups of eligible Medicaid beneficiaries shall be included for coverage by an integrated care network (ICN):

   1. (a) Individuals that meet the current admission criteria for nursing facility care as described in Alabama Medicaid Administrative Code Rule 560-X-10-.10 and who are receiving nursing facility services in accordance with Alabama Medicaid Administrative Code Rule 560-X-10-.04(1);
   2. (b) Individuals that meet the eligibility criteria for the Home and Community-Based Services for the Alabama Community Transition (ACT) Waiver in accordance with Alabama Medicaid Administrative Code Rule 560-X-44-.02; and
   3. (c) Individuals that meet the eligibility criteria for the Home and Community-Based Services for the Elderly and Disabled Waiver in accordance with Alabama Medicaid Administrative Code Rule 560-X-36-.02.
2. (2) All groups of Medicaid beneficiaries not expressly included in (1) above will continue to be served by the Medicaid fee-for-service program outside of the ICN.

Author: Stephanie Lindsay, Administrator, Administrative Procedures Office

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. Part 438.

History: New Rule: Filed October 13, 2017; effective November 28, 2017. Amended: Filed June 11, 2018; effective July 26, 2018.