Assistive Care Services and Assisted Living for the Elderly Waiver

Assistive Care Service and Assisted Living for the Elderly Wavier Services
Coverage and Limitations Handbook
Requirements to Receive Services, continued
Medicaid
Application
Responsibilities
If an individual has not applied for and been determined eligible for Medicaid
at the time Assistive Care Services (ACS) are needed, the individual must
submit a Request for Assistance (RFA) to the local service center of the
Department of Children and Families. Providers should assist individuals with
this process.
Note: See Appendix C of the Medicaid Provider Reimbursement
Handbook, HCFA-1500 and Child Health Check-Up 221 for a list of the
DCF district offices. A map of district offices is available on the Internet at
www.MyFlorida.com. Click on Directory, and then click on Children and
Families, then click on Economic Services, and then click on Service Center
of desired county.
Who Can Receive
ACS Services
To receive assistive care services, recipients in this program must be at least
18 years of age or older and meet the following requirements:
1. Be Medicaid eligible;
2. Have a health assessment completed by a physician or other licensed
practitioner of the healing arts acting within the scope of their practice
under state law which indicates the medical necessity of assistive care
services;
3. Be determined to need at least two service components of the
assistive care service;
4. Reside in an ACS-enrolled ALF, RTF, or AFCH; and
5. Not participate in any Medicaid managed care program such as the
Eldercare HMO, or the Long-Term Care Community Pilot Project
where the capitated payment is designed to cover all Medicaid
services.
Assisted Living for the Elderly (ALE) waiver recipients can receive ASC
services provided the waiver and ACS component services are not
duplicative and appear on the ALE service plans.
Note: See Part II of this handbook for information on the ALE waiver
program requirements.
July 2001 2-2