Assistive Care Services and Assisted Living for the Elderly Waiver

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Assistive Care Services and Assisted Living for the Elderly Waiver Services Coverage and Limitations Handbook Description and Purpose, continued Medicaid Fraud and Abuse Consult Chapter 5 of the Medicaid Provider Reimbursement Handbook HCFA 1500 and Child Health Check-Up 221, for information regarding Medicaid policy on provider abuse and fraud and Medicaid’s recoupment policies. Administrative Responsibility The assistive care service program is jointly administered by the Agency for Health Care Administration (AHCA), and the Department of Children and Families (DCF). • AHCA is responsible for assuring compliance with federal program requirements, developing Medicaid policy, program operations, and for reimbursing Medicaid providers. • DCF is responsible for determining the recipient’s OSS and Medicaid eligibility. Area Medicaid Offices Area Medicaid offices are located throughout Florida to assist Medicaid service providers with questions and problems. Note: See Appendix C of the Medicaid Provider Reimbursement Handbook, HCFA-1500 and Child Health Check-Up 221, for a list of area Medicaid office addresses and telephone numbers. July 2001 1-3
Assistive Care Services and Assisted Living for the Elderly Waiver Services Coverage and Limitations Handbook Provider Qualifications and Responsibilities General Assistive Care Service Provider Qualifications Three types of residences may qualify as Medicaid Assistive Care Service providers: • Assisted living facilities (ALFs) licensed pursuant to Chapter 400, Part III, FS; • Adult family care homes (AFCHs) licensed pursuant to Chapter 400, Part VII, FS; and • Mental Health Residential treatment (RTFs) facilities licensed pursuant to Section 394.875 FS. In addition, an ACS provider must meet the following qualifications: • Is not an institution for mental diseases (IMD) as defined in 42 CFR § 435.1009(2); • Provide on-site care to residents seven days a week; • Does not have a contract with a state agency that provides reimbursement for assistive care services as defined in this handbook; • Will not claim reimbursement for assistive care services for any recipient receiving a payment for personal care through the Optional State Supplementation (OSS) Program under Chapter 409.212, FS. Special Assistive Care Provider Requirements for RTFs Along with their Medicaid Provider application, RTFs must submit two additional forms: • Provider Self-Certification Form (AHCA From 5000-3200) and • Roster of OSS recipients. July 2001 1-4
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