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
Provider Qualifications and Responsibilities, continued
Vendor
Qualifications
If an ALF purchases services from a vendor, the vendor and staff must meet
all mandatory educational, licensing, and certification requirements for the
specific area of service furnished.
Referral Agreement
To be reimbursed by Medicaid for ALE waiver services, and prior to the
provision of services, each ALF and case management agency must have on
file with the AAA, a completed, signed and dated Assisted Living Medicaid
Waiver Referral Agreement. Referral agreements are available from the
Medicaid Waiver Specialists in each DOEA Planning and Services Area
(PSA).
Case Management
Case managers begin the assessment process for applicants for entry into the
ALE waiver program and provide ongoing case management oversight of
recipient’s care in ALFs.
There can only be one case manager for an ALE recipient. If a recipient has
a Department of Children and Families placement worker, the ALE case
manager must be designated as the sole case manager when the recipient
becomes an ALE waiver recipient. However, the DCF placement worker
will continue to process Optional State Supplementation (OSS), reviews,
placement, and other associated OSS responsibilities.
July 2001 4-5