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> <strong>Services</strong> <strong>and</strong> <strong>Assisted</strong> <strong>Living</strong> <strong>for</strong> <strong>the</strong> <strong>Elderly</strong> <strong>Waiver</strong> <strong>Services</strong><br />
Coverage <strong>and</strong> Limitations H<strong>and</strong>book<br />
Reimbursement In<strong>for</strong>mation, continued<br />
Medicaid<br />
Reimbursement<br />
Claim Form<br />
<strong>Assistive</strong> care services are billed on <strong>the</strong> HCFA-1500 <strong>and</strong> <strong>the</strong> 081 Non-<br />
Institutional claim <strong>for</strong>ms. ALFs that do not participate in <strong>the</strong> ALE <strong>Waiver</strong><br />
program will use <strong>the</strong> HCFA-1500 claim <strong>for</strong>m. ALE ALFs will bill <strong>for</strong> ACS on<br />
<strong>the</strong> 081 Non-Institutional claim <strong>for</strong>m.<br />
Note: See <strong>the</strong> Medicaid Provider Reimbursement H<strong>and</strong>book, HCFA-1500<br />
<strong>and</strong> Child Health Check-Up 221 <strong>and</strong> <strong>the</strong> Medicaid Provider<br />
Reimbursement H<strong>and</strong>book, 081-Non-Institutional, <strong>for</strong> specific procedures<br />
<strong>for</strong> submitting claims <strong>for</strong> payment.<br />
Procedure Code<br />
Table<br />
There is one reimbursable service in <strong>the</strong> assistive care service program. The<br />
procedure code is found in Appendix A of this chapter. The service <strong>and</strong> its<br />
components have been explained in Chapter 2 of this h<strong>and</strong>book. The table<br />
gives:<br />
• The procedure code associated with <strong>the</strong> service;<br />
• The name of <strong>the</strong> service; <strong>and</strong><br />
• The fee that Medicaid will reimburse <strong>for</strong> <strong>the</strong> service.<br />
Billing <strong>for</strong> <strong>Assistive</strong><br />
<strong>Care</strong> <strong>Services</strong> (ACS)<br />
<strong>Assistive</strong> care service components are reimbursed at a single per diem rate.<br />
<strong>Assistive</strong> care services providers are encouraged to bill at <strong>the</strong> end of each<br />
calendar month. Claims <strong>for</strong> less than one calendar month will be paid as billed.<br />
However, if a claim encompasses more than one calendar month, <strong>the</strong> claim will<br />
be paid based only on <strong>the</strong> number of days billed <strong>for</strong> <strong>the</strong> first month.<br />
If <strong>the</strong> recipient is admitted to a hospital or a nursing facility from <strong>the</strong> ACS<br />
facility, <strong>the</strong> last date of service (DOS) <strong>for</strong> ACS must be <strong>the</strong> day be<strong>for</strong>e <strong>the</strong><br />
recipient’s admission to <strong>the</strong> o<strong>the</strong>r facility.<br />
July 2001 3-2