Assistive Care Services and Assisted Living for the Elderly Waiver

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Overview Assistive Care Services and Assisted Living for the Elderly Waiver Services Coverage and Limitations Handbook PART II CHAPTER 4 ASSISTED LIVING FOR THE ELDERLY WAIVER SERVICES PURPOSE, BACKGROUND, AND PROGRAM SPECIFIC INFORMATION Introduction This chapter describes Florida Medicaid’s Assisted Living for the Elderly (ALE) waiver services program, specifies the authority regulating ALE waiver services, the purpose of the program, and provider qualifications and responsibilities. Legal Authority Medicaid waiver programs, also called home and community-based services (HCBS), are authorized under Section 1915(c) of the Social Security Act and governed by Title 42, Code of Federal Regulations (C.F.R.), Part 441.300. The Florida Medicaid ALE waiver is authorized by Chapter 409, Florida Statutes (F.S.) and the Florida Administrative Code (F.A.C.), Chapter 59G- 8.200. In This Chapter This chapter contains: TOPIC PAGE Description and Purpose 4-1 Provider Qualifications and Responsibilities 4-2 Description and Purpose ALE Waiver Description The ALE waiver is a Medicaid program that provides extra support and supervision through provision of home and community based services to eligible recipients living in assisted living facilities (ALFs) licensed for extended congregate care (ECC) or limited nursing services (LNS). July 2001 4-1
Assistive Care Services and Assisted Living for the Elderly Waiver Services Coverage and Limitations Handbook Description and Purpose, continued ALE Waiver Description, continued ALE waiver recipients must demonstrate functional deterioration that would result in placement in a nursing facility were it not for the provision of ALE waiver services. Purpose The purpose of the ALE waiver program is to promote, maintain, and restore the health of eligible recipients, and to minimize the effects of illness and disability in order to delay or prevent institutionalization. The program provides assisted living services, incontinent supplies, and case management services to eligible recipients living in ALFs, to enable them to live in the home-like setting of an ALF as long as possible. Medicaid Reimbursement This portion of the handbook is intended for use by ALFs and case management agencies that provide ALE waiver services to eligible recipients in assisted living facilities. It must be used in conjunction with the Medicaid Provider Reimbursement Handbook, Non-Institutional 081, which contains information about the Medicaid program in general, as well as specific procedures for submitting claims for payment. Provider Qualifications and Responsibilities Introduction The ALE waiver program is jointly administered by the Agency for Health Care Administration (AHCA), the Department of Elder Affairs (DOEA) and the Department of Children and Families (DCF). • AHCA is responsible for assuring compliance with federal program requirements, developing Medicaid policy, and for reimbursing Medicaid providers. July 2001 4-2
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Assistive Care Services and Assisted Living for the Elderly Waiver

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