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
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