A. To qualify for the ARChoices Program, a person must meet the targeted population as described in section 211.000 in this manual and must be found to require an intermediate level of care in a nursing facility.

The ARChoices Program processes for participant intake, assessment and service plan development include:

B. Applicants for participation in the program (or their representatives) must make application for services at the Division of County Operations (DCO) office in the county of their residence or on any electronic format provided by DHS for application through an interactive process. Medicaid eligibility is determined by the DCO based on non-medical and medical criteria. The participant must be a participant individual with a functional need.

C. Each waiver applicant to the ARChoices program will be assessed by the Independent Assessment Contractor. The independent assessment is performed utilizing the approved assessment instrument to assess functional need.

The approved assessment instrument will recommend tiers designed to help further differentiate participants by need. The tiers do not replace the Level of Care criteria, waiver eligibility determinations, or the PCSP process.

These indications notwithstanding, the final determination of Level of Care and medical eligibility is made by DCO.

This assessment of functional need is used as part of the process to determine if the person is medically and financially eligible as well in the development of a participant's PCSP. Medical eligibility is valid for twelve (12) months, unless a shorter period is specified.

Evaluations will continue to be performed at least every twelve (12) months, with the medical eligibility reaffirmed or revised and a written determination issued. In cases where it is reported a participant has experienced a significant change in circumstances (e.g., an inpatient hospital admission, skilled nursing facility admission, or the loss of a primary family caregiver), an evaluation will be performed, and based on the review of the evaluation, a reassessment may be requested.

D. For more information please see the ARIA Manual.

E. No participant who is otherwise eligible for waiver services shall have his or her eligibility denied or terminated solely as the result of a disqualifying episodic medical condition that is temporary and expected to last no more than twenty-one (21) days. However, that participant shall not receive waiver services or benefits when subject to a condition or change of condition that would render the participant ineligible if the condition or change in condition is expected to last more than twenty-one (21) days.

F. Beneficiaries diagnosed with a serious mental illness or intellectual disability are not eligible for the ARChoices Waiver program unless they have medical needs unrelated to the diagnosis of mental illness or intellectual disability and meet the other qualifying criteria. A diagnosis of severe mental illness or intellectual disability must not bar eligibility for beneficiaries having medical needs unrelated to the diagnosis of serious mental illness or intellectual disability when they meet the other qualifying criteria.

G. Eligibility for the ARChoices Waiver program begins the date DCO approves the application. (If a waiting list is implemented in order to remain in compliance with the waiver application as approved by CMS, the eligibility date determination will be based on the waiting list process.) If a participant is moving from a Provider-Led Arkansas Shared Saving Entity (PASSE) to the ARChoices waiver program, the eligibility date will be no earlier than the first day following disenrollment from the PASSE.

H. The ARChoices Waiver program provides for the entrance of all eligible persons on a first-come, first-served basis, once participants meet all medical and financial eligibility requirements.

However, once all the waiver slots are filled, a waiting list will be implemented for this program and the following process will apply. Each ARChoices application will be accepted and eligibility will be determined. If all waiver slots are filled, the applicant will be notified of his or her eligibility for services; that all waiver slots are filled; and that the applicant is number X in line for an available slot. It is not permissible to deny any eligible person based on the unavailability of a slot in the ARChoices Waiver Program.

Entry to the waiver will then be prioritized based on the following criteria and in the following order: