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 Assessments for RTF 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 licensed mental health professional. The assessment must document the need for at least two of the four Assistive Care Service components. Note: See Part I, Appendix C for the optional Certification of Medical Necessity form that may 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. July 2001 2-12
Assistive Care Services and Assisted Living for the Elderly Wavier Services Coverage and Limitations Handbook Treatment Plans for RTF Residents Treatment Plans for RTF residents Every ACS recipient must have a treatment plan completed, implemented and reviewed according to the requirements of Chapter 65E-4.016(11), F.A.C. Assistive care services for an eligible recipient may be provided and billed from the first day of need for services as long as treatment planning is under way and completed as required. Service Documentation for RTF Residents The RTF must document that residents received ACS on the day billed. There is no required format for such documentation. ACS Records In addition to the records required by Chapter 65E-4.016 (11), F.A.C., ACS records must be kept for every recipient receiving ACS. ACS records must include copies of all eligibility documents, i.e., OSS Notice of Case Action or a copy of the Medifax strip. Documentation applicable to ACS must be kept for at least five years and be made available to Medicaid staff or its designated representatives 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 2-13
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