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
Case Manager
Responsibilities
The case manager is responsible to:
• Assist ALE applicants with making application for Medicaid waiver
services;
• Advise the ALE applicant and recipient of their fair hearing rights and the
grievance process;
• Develop and implement an assessment-based plan of care for each
recipient;
• Review plans of care every three months to assure the continued need
for waiver services;
• Visit each recipient at least once every 30 days and document the
recipient’s status, satisfaction with services and additional service needs
in the recipient’s case record;
• Maintain up-to-date recipient case records;
• Coordinate other services provided to the consumer, including hospice
and Medicare with the ALE service provider for waiver recipients
electing to receive those services;
• Contact the service provider when there is indication that needed
services are not being rendered in order to have those services reinstated
immediately;
• Contact the Agency for Health Care Administration, Health Quality
Assurance (MC/HQA) simultaneously with the Medicaid waiver
specialist within 24 hours of a site visit if a recipient is not receiving
needed services; and
• Notify the Florida Abuse Hotline immediately in cases where lack of
service provision endangers the recipient’s health, safety, or welfare.
Medicaid Fraud and
Abuse
See Chapter 5 of the Medicaid Provider Reimbursement Handbook,
Non-Institutional 081, for information regarding Medicaid policy on
provider abuse and fraud and Medicaid’s recoupment policies.
July 2001 4-9