Assistive Care Services and Assisted Living for the Elderly Waiver

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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
Assistive Care Services and Assisted Living for the Elderly Waiver Services Coverage and Limitations Handbook Reimbursement Information, continued Billable Days for ACS Reimbursement will be made only for days the resident is eligible for and is receiving services in the facility. ACS providers cannot bill for those days a resident is not eligible for Medicaid. In case of a resident who is not initially Medicaid-eligible, but who applies for and is determined eligible for Medicaid, the provider can bill for services from the effective date of Medicaid eligibility as shown on the Notice of Case Action. If the resident’s need and eligibility for ACS commence with admission to the facility, reimbursement will be made from the day of admission. Reimbursement will not be made for the day of discharge from the facility. Reimbursement will not be made when the recipient is absent for 24 hours or more. In such cases, reimbursement will be made for the day the resident returns, but not the day the resident leaves. Note: See Chapter 3 of the Medicaid Provider Reimbursement Handbook, HCFA-1500 and Child Health Check-Up 221 and the Medicaid Provider Reimbursement Handbook, 081-Non-Institutional, for more information regarding Medicaid recipient eligibility Personal Responsibility ACS providers agree to accept Medicaid payment as payment in full for assistive care services. ACS providers cannot accept or solicit payments from recipients or others for assistive care services. Facilities may accept contributions from recipients and others for the cost of room, board, and for services other than ACS. July 2001 3-3
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