(1) A person in order to be considered by the department for enrollment in the program, must be determined by the department to qualify for enrollment in accordance with the criteria in this rule.
(2) A person is qualified to be considered for enrollment in the program if the person:
(a) meets one of the following criteria:
(i) is 65 years of age or older; or
(ii) is certified as disabled by the social security administration but does not have a primary diagnosis of mental retardation or serious mental illness.
(b) is medicaid eligible;
(c) requires the level of care of a nursing facility as determined in accordance with the preadmission screening provided for in ARM 37.40.202, 37.40.205, 37.40.206 and 37.40.207.
(d) does not reside in a hospital or a nursing facility; and
(e) has needs that can be met through the program.
(3) The department considers for an available opening for services those persons who, as determined by the department:
(a) are actively seeking services;
(b) are in need of the services available;
(c) are likely to benefit from the available services; and
(d) have a projected total cost of plan of care that is within the limits specified at ARM 37.40.1421.
(4) The department offers an available opening for services to the person, as determined by the department, who is most in need of the available services and most likely to benefit from the available services.
(5) Factors to be considered in the determinations of whether a person is in need of the available services and likely to benefit from those services and as to which person is most likely to benefit from the available services include, but are not limited to, the following:
(a) medical condition;
(b) degree of independent mobility;
(c) ability to be alone for extended periods of time;
(d) presence of problems with judgment;
(e) presence of a cognitive impairment;
(f) prior enrollment in the program;
(g) current institutionalization or risk of institutionalization,
(h) risk of physical or mental deterioration or death;
(i) willingness to live alone;
(j) adequacy of housing;
(k) need for adaptive aids or environmental modifications;
(l) need for 24 hour supervision;
(m) need of person's caregiver for relief;
(n) need, in order to receive services, of a waiver of the medicaid deeming financial eligibility requirement;
(o) appropriateness for the person, given the person's current needs and risks, of services available through the program;
(p) status of current services being purchased otherwise for the person; and
(q) status of support from family, friends and community.
(6) A person enrolled in the program may be removed from the program by the department. Bases for removal from the program, include, but are not limited to, the following:
(a) a determination by the case management team that the services, as provided for in the plan of care, are no longer appropriate or effective in relation to the person's needs;
(b) the failure of the person to use the services as provided for in the plan of care;
(c) the behaviors of the person place the person, caregivers or others at serious risk of harm or substantially impede the delivery of services as provided for in the plan of care;
(d) the health of the person is deteriorating or in some other manner placing the person at serious risk of harm;
(e) a determination by the case management team that the service providers necessary to the delivery of services as provided for in the plan of care are unavailable; and
(f) a determination that the total cost of plan of care is not within the limits specified at ARM 37.40.1421.