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> Service <strong>and</strong> <strong>Assisted</strong> <strong>Living</strong> <strong>for</strong> <strong>the</strong> <strong>Elderly</strong> Wavier <strong>Services</strong><br />
Coverage <strong>and</strong> Limitations H<strong>and</strong>book<br />
Service Plans <strong>for</strong> ALF <strong>and</strong> AFCH Residents, continued<br />
Service<br />
Documentation<br />
The ALF or AFCH must document that recipients received services in <strong>the</strong><br />
facility on each day <strong>for</strong> which ACS is billed. There is no required <strong>for</strong>mat <strong>for</strong><br />
such documentation.<br />
Note: See Part I, Appendix E <strong>for</strong> <strong>the</strong> Optional Service Plan Log Form that<br />
can be used <strong>for</strong> this purpose.<br />
Service Plan Review<br />
The service plan must be reviewed <strong>and</strong> updated to reflect <strong>the</strong> current needs<br />
of <strong>the</strong> recipient. The service provider must monitor <strong>the</strong> service plan <strong>for</strong><br />
continuity of services <strong>and</strong> determine if changes in <strong>the</strong> recipient’s status<br />
warrant changes in <strong>the</strong> service plan.<br />
New Service Plan<br />
A new service plan is required on an annual basis or sooner if a significant<br />
change in <strong>the</strong> recipient’s condition occurs. The new service plan must be<br />
completed no more than 15 days after <strong>the</strong> re-assessment required above.<br />
ACS Records<br />
In addition to records required by <strong>the</strong> applicable licensure st<strong>and</strong>ards, ACS<br />
records that must be kept include:<br />
• Copies of all eligibility documents, ( i.e., DCF OSS Notice of Case<br />
Action, or Medifax strip)<br />
• Health Assessment Forms (DOEA Form 1823 or 1110) <strong>and</strong><br />
reassessments <strong>for</strong>ms;<br />
• <strong>Assistive</strong> care service plan with updates, if any; <strong>and</strong><br />
• Copy of daily roster or o<strong>the</strong>r daily service documentation.<br />
This documentation must be maintained at <strong>the</strong> facility, kept <strong>for</strong> at least five<br />
years <strong>and</strong> be made available to Medicaid staff or its designated representative<br />
upon request.<br />
Note: See Chapter 2 of <strong>the</strong> Medicaid Provider Reimbursement<br />
H<strong>and</strong>book, HCFA 1500 <strong>and</strong> Child Health Check-Up 221, <strong>for</strong> additional<br />
in<strong>for</strong>mation about documentation requirements.<br />
July 2001 2-10