561 EIS HCB WAIVER CODES

Use the eligibility code applicable to the individual if not receiving HCB waiver services (i.e., 20, 11, 24, 50, 54, etc.). EIS will read that code and the waiver type code, then convert the code into a special waiver eligibility code and enter it on the Medical Resource (MERE) screen.

561 A. CCMC OR IDD WAIVERS

(Special LTC Eligibility Category - State-Only Disability)

SEPA	MERE					APMM
	SUB-TYPES	ELIG CODE		WAIVER		HH TYPE
ME-AD	IN AS*	80	Complex Medical Condition	MC	Complex Medical Condition	WAV
		70	Intellectual and Developmental Disabilities	MD	Intellectual and Developmental Disabilities

* The AS code is only for Special Income category Medicaid recipients who reside in an Assisted Living Home or a Pioneer Home.

561 B. CCMC OR IDD WAIVERS

(Receiving SSI)

SEPA	MERE					APMM
	SUB-TYPE	ELIG CODE		WAIVER		HH TYPE
ME-AD	DC	81	Complex Medical Condition	MC	Complex Medical Condition	A1E
		71	Intellectual and Developmental Disabilities	MD	Intellectual Developmental Disabilities

Note:

The DC Subtype must be used for children under 19 years of age. Dental claims will not be processed when coded SI.

561 C. CCMC OR IDD WAIVERS

(DKC/FM Eligible - Waiting For DDS Determination)

SEPA	MERE					APMM
	SUB-TYPES	ELIG CODE		WAIVER		HH TYPE
ME-AF	BA,HC, H1, H2, SU, S1, S2, CP	81	Complex Medical Condition	MC	Complex Medical Condition	N/A (MIBW is used)
		71	Intellectual and Developmental Disabilities	MD	Intellectual and Developmental Disabilities

561 D. CCMC OR IDD WAIVERS

(In State Custody or Subsidized Adoption)

SEPA	MERE					APMM
	SUB-TYPES	ELIG CODE		WAIVER		HH TYPE
ME-AF	FC, IV, JC, SO, VO	81	Complex Medical Condition	MC	Complex Medical Condition	N/A (MIBW is used)
		71	Intellectual Developmental Disabilities	MD	Intellectual Developmental Disabilities

561 E. APDD OR IDD WAIVERS (Family Medicaid Eligible - Adult)

(Waiting for SSI, SSDS, or DDS Determination)

SEPA	MERE					APMM
	SUB-TYPE	ELIG CODE		WAIVER		HH TYPE
ME-AF	AF	31	Adults with Physical and Developmental Disabilities	DA	Adults with Physical and Developmental Disabilities	N/A (MIBW is used)
		71	Intellectual and Developmental Disabilities	MD	Intellectual and Developmental Disabilities

561 F. APDD, IDD, OR ALI WAIVERS WITH APA CASH ASSISTANCE

SEPA		MERE					APAS
		SUB-TYPES	ELIG CODE		WAIVER		HH TYPES
ME-AD	Under 65	SI ST	31	Adults with Physical and Developmental Disabilities	DA	Adults with Physical and Developmental Disabilities	A1E B1E A2C B2C A2S B2S A2E B2E
			34	Adults with Physical and Developmental Disabilities - QMB eligible
			71	Intellectual and Developmental Disabilities	MD	Intellectual and Developmental Disabilities
			74	Intellectual and Developmental Disabilities - QMB eligible
ME-AD ME-OA	21 and over	SI ST	41	Alaskans Living Independently	AG	Alaskans Living Independently
			44	Alaskans Living Independently - QMB eligible	AG	Alaskans Living Independently

561 G. APDD, IDD, OR ALI WAIVERS

(Special LTC Category)

SEPA		MERE					APAS
		SUB- TYPES	ELIG CODE		WAIVER		HH TYPE
ME-AD	Under 65	IN AS*	30	Adults with Physical and Developmental Disabilities	DA	Adults with Physical and Developmental Disabilities	WAV
			70	Intellectual and Developmental Disabilities	MD	Intellectual and Developmental Disabilities
ME-AD ME-OA	21 and over	IN AS*	40	Alaskans Living Independently	AG	Alaskans Living Independently
			70	Intellectual and Developmental Disabilities	MD	Intellectual and Developmental Disabilities

* The AS code is only for Special Income category Medicaid recipients who reside in an Assisted Living Home or a Pioneer Home.

561 H. ADULT WAIVERS WITH NO APA oR SSI CASH ASSISTANCE

(Medicaid-only cases using APA Income Need Standards require use of the ST Subtype even though the recipient is not actually receiving APA)

SEPA		MERE					APAS
		SUB-TYPE	ELIG CODE		WAIVER		HH TYPE
ME-AD	Under 65	ST PM	31	Adults with Physical and Developmental Disabilities	DA	Adults with Physical and Developmental Disabilities	A1E
			71	Intellectual and Developmental Disabilities	MD	Intellectual and Development Disabilities
ME-AD ME-OA	65 and over	ST PM	41	Alaskans Living Independently	AG	Alaskans Living Independently
			71	Intellectual and Developmental Disabilities	MD	Intellectual and Development Disabilities

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		MC #30 (07/13)