Assistive Care Services and Assisted Living for the Elderly Waiver

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