Assistive Care Services and Assisted Living for the Elderly Waiver
Assistive Care Services and Assisted Living for the Elderly Waiver
Assistive Care Services and Assisted Living for the Elderly Waiver
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<strong>Assistive</strong> <strong>Care</strong> <strong>Services</strong> <strong>and</strong> <strong>Assisted</strong> <strong>Living</strong> <strong>for</strong> <strong>the</strong> <strong>Elderly</strong> <strong>Waiver</strong> <strong>Services</strong><br />
Coverage <strong>and</strong> Limitations H<strong>and</strong>book<br />
Description <strong>and</strong> Purpose<br />
<strong>Assistive</strong> <strong>Care</strong><br />
Service Description<br />
The <strong>Assistive</strong> <strong>Care</strong> <strong>Services</strong> program is a Medicaid state plan service that<br />
provides care to eligible recipients requiring an integrated set of services on a<br />
24-hour per day basis. Eligible residents must reside in a qualified assisted<br />
living facility (ALF), adult family care home (AFCH) or residential treatment<br />
facility (RTF) <strong>and</strong> be provided scheduled <strong>and</strong> unscheduled care on a 24-<br />
hour per day basis when needed by <strong>the</strong> resident.<br />
<strong>Assistive</strong> care service recipients must demonstrate functional limitations that<br />
make it medically necessary <strong>for</strong> <strong>the</strong>m to live in congregate living facilities <strong>and</strong><br />
have access to integrated assistive care services on a 24-hour per day basis.<br />
Purpose<br />
The purpose of <strong>the</strong> <strong>Assistive</strong> <strong>Care</strong> Service program is to promote <strong>and</strong><br />
maintain <strong>the</strong> health of eligible recipients <strong>and</strong> to minimize <strong>the</strong> effects of illness<br />
<strong>and</strong> disability in order to delay or prevent institutionalization.<br />
Medicaid<br />
Reimbursement<br />
This h<strong>and</strong>book is intended <strong>for</strong> use by ALFs, AFCHs <strong>and</strong> RTFs who provide<br />
assistive care services to eligible recipients. It must be used in conjunction<br />
with <strong>the</strong> Medicaid Provider Reimbursement H<strong>and</strong>book, HCFA-1500 <strong>and</strong><br />
Child Health Check-Up 221, which contains in<strong>for</strong>mation about <strong>the</strong><br />
Medicaid program in general, as well as specific procedures <strong>for</strong> submitting<br />
claims <strong>for</strong> payment.<br />
Personal Needs<br />
Allowance (PNA)<br />
All recipients of <strong>Assistive</strong> <strong>Care</strong> <strong>Services</strong> must be allowed to keep from <strong>the</strong>ir<br />
personal income an amount equal to <strong>the</strong> personal needs allowance under <strong>the</strong><br />
Optional State Supplementation (OSS) Program. (Chapter 65A-2.036,<br />
F.A.C.) Currently <strong>the</strong> PNA is $54.00 per month. The PNA must be<br />
available to <strong>the</strong> resident by <strong>the</strong> tenth day of each month. The facility may<br />
assist <strong>the</strong> resident in managing <strong>the</strong>se personal funds, but may not restrict how<br />
<strong>the</strong> resident chooses to spend <strong>the</strong> PNA funds.<br />
July 2001 1-2