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 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
Overview Assistive Care Services and Assisted Living for the Elderly Wavier Services Coverage and Limitations Handbook PART II CHAPTER 5 ASSISTED LIVING FOR THE ELDERLY WAIVER SERVICES COVERED SERVICES, LIMITATIONS, AND EXCLUSIONS Introduction This chapter describes the services covered under the Florida Medicaid Assisted Living for the Elderly (ALE) waiver. It also describes the requirements for service provision, service limitations, and exclusions. In This Chapter This chapter contains: TOPIC PAGE Requirements To Receive Services 5-1 Case Management Requirements 5-4 Case Management Documentation 5-5 Plan of Care 5-6 Plan of Care Review and Reassessment 5-9 ALE Waiver and Assistive Care Covered Services 5-9 Placement and Discharge 5-17 Termination of Services 5-18 Requirements to Receive Services Introduction Medicaid can reimburse for services provided in assisted living facilities (ALFs) to eligible Medicaid recipients who are enrolled in the ALE waiver program. July 2001 5-1
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Assistive Care Services and Assisted Living for the Elderly Waiver

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