Alabama Administrative Code Chapter 795-8-1 — Sail/Homebound Program

795 Alabama Division of Rehabilitation Services

Ala. Admin. Code r. 795-8-1-.01 General Information

(1) SAIL/Homebound is a rehabilitation program that provides medical and attendant care and adjustment aids to an individual with a disability who meets certain eligibility requirements contained within Administrative Code Rule No. 795-8-1-.03. The Alabama Department of Rehabilitation Services shall be responsible for the administration of the program but may contract with other state agencies or private organizations in connection with the program.

(2) The SAIL/Homebound Program shall not discriminate against individuals with disabilities or with regard to sex, race, creed, age, color, religion, or national origin.

(3) The SAIL/Homebound Program will assist an individual with a disability in securing any similar benefit available from other agencies and organizations in order to meet, in whole or in part, the cost of SAIL/Homebound services and to avoid duplication of services. The individual with a disability and/or their family member will be expected to cooperate in the provision of SAIL/Homebound services.

(4) It is the policy of the SAIL/Homebound Program to ensure that an individual with a disability is provided the services that increase independence in performing the activities of daily living and enhance quality of life, while upholding the right of individuals with disabilities to be treated with respect and dignity.

(5) Individual SAIL/Homebound services are not an entitlement but are based on the needs of the individual with a disability.

(6) After adoption of these new SAIL/Homebound rules, those individuals who were at that time receiving services in the SAIL/Homebound Program will remain eligible for the program until such time as their case is closed according to Rule 795-8-1-.07.

(7) All employees of the SAIL/Homebound Program will comply with the policies and procedures of the Alabama Department of Rehabilitation Services.

History

• Author: Alabama Board of Rehabilitation Services .
• Authority: Code of Ala. 1975, §21-6-1, et seq
• Emergency adoption filed January 17, 1995; effective January 18, 1995. New Rule: filed April 13, 1995; effective May 18, 1995. Repealed and New Rule: Filed July 29, 1999; effective September 2, 1999. Repealed and New Rule: Published July 29, 2022; effective September 12, 2022.

Ala. Admin. Code r. 795-8-1-.02 Definitions

(1) Severe Disability - A physical or mental impairment that seriously limits one or more functional capacities resulting from arthritis, cerebral palsy, head injury, heart disease, hemiplegia, multiple sclerosis, muscular dystrophy, musculo-skeletal disorders, neurological disorders ((including amyotrophic lateral sclerosis (ALS) and Parkinson's disease)), paraplegia, quadriplegia, and other spinal cord conditions and injuries. Severe disability does not include individuals in an acute stage of recovery who have not reached maximum medical improvement.

(2) Homebound - An individual with a severe disability who is dependent on others to perform activities of daily living and lives in an unrestricted environment.

(3) Medical Care - Prescription medications prescribed by a licensed physician, monitoring health status, and providing nursing education. Prescription medications will only be provided if funding permits, and the SAIL/Homebound Program will be the payor of last resort.

(4) Adjustment Training - Patient and family counseling, training and disability management education provided by registered nurses and counselors.

(5) Attendant Care - Personal care services, such as transferring, toileting, bathing, dressing, preparing meals, feeding, or light housekeeping, provided to an individual with a disability who is dependent on others for assistance with limited activities of daily living.

(6) Family Member - Relative, guardian, or in their absence, a responsible person. Responsible persons are those willing to advocate or mediate on behalf of the individual with a disability.

(7) Home Modification - Modification that will make the home more accessible for the individual with a disability and will promote independence in activities of daily living.

(8) Assistive Devices/Technology - Equipment, products and devices that are used to increase, maintain or improve functional capabilities of an individual with a disability.

(9) Transportation - Medically specialized transportation to and from doctor's office and clinic, but only as payor of last resort; transportation to and from a place of employment.

(10) Medical Supplies - Supplies provided for medical needs related to the individual's disability.

History

• Author: Alabama Board of Rehabilitation Services .
• Authority: Code of Ala. 1975, §21-6-1, et seq
• New Rule: Filed July 29, 1999; effective September 2, 1999. Repealed and New Rule: Published July 29, 2022; effective September 12, 2022.

Ala. Admin. Code r. 795-8-1-.03 Application And Eligibility

(1) An individual with a severe disability may be referred for SAIL/Homebound services by written or verbal referrals by the person seeking services or from a physician, medical institution, social agency, or interested individual.

(2) Due to limited funding of the SAIL/Homebound Program, individuals with spinal cord injuries and/or traumatic brain injuries shall be served first. Individuals with other disabilities, e.g., severe cerebral palsy, multiple sclerosis, ALS, Parkinson's disease, or severe arthritis, will be served should funding permit. All individuals served must be dependent on others for at least six out of eight activities of daily living.

(3) An individual with a severe disability must make application to the Coordinator of the SAIL/Homebound Program of the Alabama Department of Rehabilitation Services. Application is made through SAIL/Homebound staff in SAIL/Homebound offices located throughout the State of Alabama.

(4) An individual is eligible for SAIL/Homebound services if the individual:

(a) Has a severe disability as defined in Rule 795-8-.1-.02(1),

(b) Resides in their own home, provided said home is safe and does not put the individual at risk,

(c) Is dependent on others for at least six of the eight activities of daily living listed:

1. Bowel and/or bladder therapy,

2. Feeding self,

3. Preparing all meals, ·

4. Checking for skin integrity,

5. Bathing self,

6. Dressing self,

7. Taking medication,

8. Transferring from bed to chair.

(d) Is 16 years of age or older,

(e) Has insufficient income or resources, including family income or resources, insurance, etc., to meet the cost of SAIL/Homebound services applied for,

(f) Is under the care of a family member who is free for employment,

(g) Would require institutionalization without SAIL/Homebound services, and

(h) Is a resident of the State of Alabama.

(5) An individual is deemed to be an applicant when the individual and/or family member has completed and signed the application form, has requested services, and has provided the necessary information to determine eligibility and services needed.

(6) An applicant's final determination of eligibility for SAIL/Homebound services shall be made by a regional rehabilitation committee who shall be appointed by and serve at the pleasure of the Commissioner of the Alabama Department of Rehabilitation Services. Such regional rehabilitation committee shall be comprised of the following members:

(a) Medical specialist,

(b) Vocational rehabilitation counselor,

(c) Registered nurse,

(d) Physical therapist, and

(e) Social worker.

(7) An individual and/or family member must apply for, and obtain, any similar services that they may need prior to receiving comparable services from the SAIL/Homebound Program.

History

• Author: Alabama Board of Rehabilitation Services .
• Authority: Code of Ala. 1975, §21-6-1, et seq
• New Rule: Filed July 29, 1999; effective September 2, 1999. Repealed and New Rule: Published July 29, 2022; effective September 12, 2022.

Ala. Admin. Code r. 795-8-1-.04 Ineligibility

(1) An individual with a disability is determined ineligible when:

(a) An applicant does not have a severe disability as defined in Rule 795-8-.1-.02(1).

(b) There exists a risk to the health and safety of the applicant in their home.

(c) An applicant does not meet the eligibility requirements as set out in Rule 795-8-1-.03(4).

(d) An applicant fails to provide the necessary documentation to determine eligibility and services needed, or the applicant does not complete the application process.

(e) An applicant fails to prove residency.

(f) An applicant fails to cooperate with SAIL/Homebound staff.

(2) The applicant for SAIL/Homebound services, or family member, must be notified in writing of the determination of ineligibility and of the rights of the applicant, in the event the applicant disagrees with the ineligibility determination.

History

• Author: Alabama Board of Rehabilitation Services .
• Authority: Code of Ala. 1975, §21-6-1, et seq
• New Rule: Filed July 29, 1999; effective September 2, 1999. Repealed and New Rule: Published July 29, 2022; effective September 12, 2022.

Ala. Admin. Code r. 795-8-1-.05 Services

(1) The SAIL/Homebound Program may make available the following services to an individual with a disability who is determined eligible for those services.

(a) Medical Care.

(b) Adjustment Training.

(c) Attendant Care to assist an individual with a disability with personal care services.

1. If an eligible individual becomes employed, the SAIL/Homebound Program will re-evaluate the determination to provide the individual with attendant care. Such care may be discontinued or may be provided in the workplace as well as in the home.

2. Attendant care will be subject to the individual's financial resources and will be provided only to the extent that the individual has a financial reporting of need that prohibits the individual from obtaining such services without the SAIL/Homebound assistance.

(d) Home modification, that enables an eligible individual with a disability to remain in the home may be provided by the SAIL/Homebound Program; however, no more than $1,000.00 shall be expended on any one home in any one year or for any single client in any one year. Home modification may be made when it is determined that the home modification will make the home more accessible for the individual in order for the individual to become more independent in activities of daily living. Home modification on rental property may be provided only with the written consent of the owner and/or rental agency.

(e) Assistive Devices/Technology. An individual who receives assistive devices or technology must sign a statement agreeing to return the devices or technology to the SAIL/Homebound Program when the devices or technology are no longer needed by the individual or when the individual is terminated from the SAIL/Homebound Program.

(f) Transportation provided to and from medical appointments only if Medicaid/Medicare or other funding resources do not pay. The SAIL/Homebound Program will be the payor of last resort. Transportation to and from a place of employment may also be provided.

(g) Medical supplies provided when the need for such supplies is related to the individual's primary disability and the SAIL/Homebound Program will be the payor of last resort.

History

• Author: Alabama Board of Rehabilitation Services .
• Authority: Code of Ala. 1975, §21-6-1, et seq
• New Rule: Filed July 29, 1999; effective September 2, 1999. Repealed and New Rule: Published July 29, 2022; effective September 12, 2022.

Ala. Admin. Code r. 795-8-1-.06 Financial Accountability

(1) Only those funds necessary to provide the appropriate services to an eligible individual in the SAIL/Homebound Program shall be expended.

(2) Each eligible individual may be required to contribute financial resources and in-kind services towards the cost of their services, and the individual's financial situation will be reviewed periodically to determine the extent of their participation.

(3) Any vendor providing services authorized by the SAIL/Homebound Program must agree not to make any charge to or accept any payment from the individual with a disability or their family for the services unless the amount of the charge or payment is previously known and, when applicable, approved by the SAIL Division Director.

(4) SAIL/Homebound will assist an individual, who is eligible for similar services and benefits under any other agency or organization, in securing those services and benefits, and those services and benefits will be utilized to meet, in whole or in part, the cost of SAIL/Homebound services.

History

• Author: Alabama Board of Rehabilitation Services .
• Authority: Code of Ala. 1975, §21-6-1, et seq
• New Rule: Filed July 29, 1999; effective September 2, 1999. Repealed and New Rule: Published July 29, 2022; effective September 12, 2022.

Ala. Admin. Code r. 795-8-1-.07 Case Closure

(1) An eligible individual's services shall be terminated and/or the case shall be closed when it has been determined that:

(a) There is an existing risk to the health and safety of the SAIL/Homebound eligible individual in their home, or

(b) The services being provided by the SAIL/Homebound Program to the individual are no longer needed or appropriate, or

(c) An individual has secured similar benefits from other agencies or organizations that are comparable to all services being provided by SAIL/Homebound, or

(d) An individual is no longer eligible for SAIL/Homebound services, such as when:

1. The individual is no longer dependent on others for at least six of the eight activities of daily living, or

2. The individual is financially ineligible, or

3. The individual is placed in a nursing home, or

4. The individual no longer meets the definition of an individual with a severe disability.

(e) The individual moves out of state, or

(f) The location of the individual is unknown, or

(g) The individual refuses further SAIL/Homebound services and chooses to no longer participate in the program, or

(h) The individual has failed to cooperate with SAIL/Homebound services. Examples include:

1. Destruction, misuse or abuse of provided assistive devices, technology, and equipment.

2. Refusal or failure to provide accurate financial information or providing false information.

3. Fraudulent use of SAIL/Homebound funds, such as falsifying personal care timesheets or acquiring goods through SAIL/Homebound for resale or other distribution.

(i) The individual dies, or

(j) The health and safety of SAIL/Homebound staff is at risk in delivery of services.

(2) When a determination is made to terminate services, the SAIL/Homebound Program shall notify the individual or family member in writing that the services are terminated, the reason for termination, and their appeal rights.

History

• Author: Alabama Board of Rehabilitation Services .
• Authority: Code of Ala. 1975, §21-6-1, et seq
• New Rule: Filed July 29, 1999; effective September 2, 1999. Repealed and New Rule: Published July 29, 2022; effective September 12, 2022.