Assistive Care Services and Assisted Living for the Elderly Waiver

Assistive Care Services and Assisted Living for the Elderly Wavier Services
Coverage and Limitations Handbook
Plan Of Care, continued
Plan of Care
Contents, continued
All waiver services or service components must be specified in the
recipient’s plan of care. Services or service components not specified in the
plan of care are not considered approved or authorized. Reimbursement for
services furnished, but not specified in the plan of care for that specific time
period, are subject to recoupment.
Assistive Care
Services
Assistive Care Services are described in Part I of this handbook. These
services are not covered services under the ALE waiver, but must be
included in the waiver plan of care. The ACS components are health
support, assistance with activities of daily living, assistance with instrumental
activities of daily living, and medication assistance. ACS service provision is
expected to take an average of about one hour per day. Recipients eligible
for both ACS and ALE waiver assistance must have a service plan in which
services that are considered ACS are shown and identified separately from
those provided under the waiver. The same information should be shown for
each ACS component as for each waiver service.
Approval and
Authorization
The recipient, the recipient’s family or guardian, as appropriate, case
manager and the facility administrator must meet to discuss and agree on the
plan of care.
The plan of care must be signed and dated by the recipient or, the recipient’s
guardian or designated representative when the recipient is not competent to
give his or her consent.
When signing the plan of care, the recipient and the recipient’s family or
guardian are informed that signing the plan of care indicates the recipient
accepts ALE waiver services in lieu of nursing facility placement. The
recipient and the recipient’s family or guardian are also notified in writing of
the right to a fair hearing if services are denied, suspended, reduced, or
terminated. The notice of rights must be sent by certified mail or hand
delivered with a signed acknowledgement of receipt.
The plan of care is considered authorized when it is signed and dated by the
case manager.
July 2001 5-8