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