Assistive Care Services and Assisted Living for the Elderly Waiver

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Assistive Care Service and Assisted Living for the Elderly Wavier Services Coverage and Limitations Handbook Covered Service, continued Assistance with Instrumental Acts of Daily Living (IADLs) Component Assistance with instrumental activities of daily living (IADLs) is defined as providing intensive assistance with one or more of the following activities: individual assistance with shopping for personal items, making telephone calls, and managing money Assistance with Self-Administration of Medication Component Assistance with self-administration of medication is defined assistance with or supervision of self-administration of medication at least daily in accordance with licensure requirements applicable to the facility type. Implementation of Assistive Care Services Assistive care services for an eligible recipient may be provided and billed from the first day of need for services as long as service planning is under way and completed as required. Assessments for ALF and AFCH Residents Initial Health Assessment If the need and eligibility for ACS commence with admission to the ALF and AFCH, the initial assessment requirement is the same as for the facility type. • ALF Residents • AFCH Residents Chapter 58A-5.0181 (2), F.A.C. Chapter 58A-14.0061, F.A.C. If the need and eligibility for ACS commence after admission to the ALF and AFCH, an assessment following the same procedure as for re-assessment must be completed prior to billing for ACS. However, if the admission does not document the need for at least two of the four ACS components, additional documentation must be obtained from the health care provider. The optional Certification of Medical Necessity form may be used for this purpose. Note: See Part I, Appendix C for a copy of the form and instructions. July 2001 2-6
Assistive Care Services and Assisted Living for the Elderly Wavier Services Coverage and Limitations Handbook Assessments for ALF and AFCH Residents, continued Re-Assessment Recipients receiving Assistive Care Services must have a complete assessment at least annually or sooner if a significant change in the recipient’s condition occurs. An annual assessment must be completed no more than one-year plus fifteen days after the last assessment. An assessment triggered by a significant change must be completed no more than fifteen days after the significant change. The assessment must be completed by physician or physician assistant or advanced registered practitioner. The assessment must document the need for at least two of the four Assistive Care Service components. Note: Either the DOEA Form 1823 for ALF residents, the DOEA Form 1110 for AFCH residents or the optional Certification of Medical Necessity form in Appendix C must be used for this purpose. Significant Change Chapter 58A-5.0131, F.A.C., defines significant change as a sudden or major shift in behavior or mood, or deterioration in health status such as unplanned weight change, stroke, heart condition, or stage 2, 3, or 4 pressure sore. Ordinary day-to day fluctuations in functioning and behavior, a shortterm illness such as a cold, or the gradual deterioration in the ability to carry out the activities of daily living that accompanies the aging process are not considered significant changes. Service Plans for ALF and AFCH Residents Service Plans Every ACS recipient must have a service plan completed by the ACS service provider. The ALF or AFCH is responsible for insuring the service plan is developed and implemented. July 2001 2-7
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Assistive Care Services and Assisted Living for the Elderly Waiver

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