560-X-35-.02 Description Of Services

The Alabama Medicaid Agency filed a Notice of Intended Action on October 20, 2026, to amend Rule 560-X-35-.02, which governs the Description of Services under the Home and Community-Based Waiver for Persons with Intellectual Disabilities (ID Waiver). The amendment updates rule language to conform to the terms of the recently renewed ID Waiver documents as approved by CMS. The comment period closes December 4, 2026. The rule defines covered HCBS as Title XIX Medicaid-funded services for individuals with intellectual disabilities who, without those services, would require placement in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). To qualify for Medicaid reimbursement, each service must be necessary to prevent institutionalization of the waiver individual, and each provider must hold a signed provider contract and meet all applicable state and federal requirements. Services reimbursable through Medicaid's EPSDT Program are excluded from reimbursement as HCBS under the ID Waiver. The rule enumerates nine covered service categories: Residential Habilitation Services, Supported Living Services, Day Habilitation Services, Prevocational Services, Supported Employment Services (including Individual Assessment/Discovery, Small Group, and Individual variants), Occupational Therapy Services, Speech and Language Therapy Services, Physical Therapy Services, and Positive Behavior Support Services. Day Habilitation Services are capped at five hours per day and 247 days per waiver year (248 in leap years). Occupational and Physical Therapy Services are each limited to no more than 50 hours or 200 units for the initial treatment plan, billed in 15-minute units. For Residential Habilitation and Supported Living Services, a fraction of each service may be delivered remotely via remote supports or monitoring if the participant's person-centered plan (PCP) team determines it appropriate, all service definition requirements are met, and all requirements in Appendix C-1-d are satisfied. In those circumstances, ADMH staff will evaluate the provider's use of remote support on a case-by-case basis to determine whether a rate adjustment is warranted. Supported Living Services are capped at three persons per residence, and reimbursement excludes dwelling maintenance and residential living expenses.