441—83.42 (249A) Eligibility. To be eligible for AIDS/HIV waiver services a person must meet certain eligibility criteria and be determined to need a service(s) allowable under the program.
	 83.42(1) Eligibility criteria. All of the following criteria must be met. The person must:
	  a.   	 Be diagnosed by a physician as having AIDS or HIV infection.
	  b.   	 Be certified in need of the level of care that, but for the waiver, would otherwise be provided in a nursing facility or hospital. The IME medical services unit shall be responsible for approval of the certification of the level of care. AIDS/HIV waiver services shall not be provided when the person is an inpatient in a medical institution.
	  c.   	 Be eligible for medical assistance under SSI, SSI-related, FMAP, or FMAP-related coverage groups; medically needy at hospital level of care; or a special income level (300 percent group); or become eligible through application of the institutional deeming rules.
	  d.   	 Require, and use at least quarterly, one service available under the waiver as determined through an evaluation of need described in subrule 83.42(2).
	  e.   	 Have service needs such that the costs of the waiver services are not likely to exceed the costs of care that would otherwise be provided in a medical institution.
	  f.   	 Have income which does not exceed 300 percent of the maximum monthly payment for one person under supplemental security income.
	  g.   	 For the consumer choices option as set forth in 441—subrule 78.38(9), not be living in a residential care facility.
	 83.42(2) Need for services.
	  a.   	 The county social worker shall perform an assessment of the person’s need for waiver services and determine the availability and appropriateness of services. This assessment shall be based, in part, on information in the completed Home- and Community-Based Services Assessment or Reassessment, Form 470-0659. Form 470-0659 shall be completed annually.
	  b.   	 The total monthly cost of the AIDS/HIV waiver services shall not exceed the established aggregate monthly cost for level of care. The monthly cost of AIDS/HIV waiver services cannot exceed the established limit of $1,751.