Assistive Care Services and Assisted Living for the Elderly Waiver

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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
Assistive Care Services and Assisted Living for the Elderly Wavier Services Coverage and Limitations Handbook Plan of Care Review and Reassessment Review The plan of care must be reviewed and updated to reflect the current needs of the recipient. For the purposes of case review, case managers must conduct a face-to-face visit at least quarterly, or more frequently depending on changes in the recipient’s condition. The case manager must monitor the plan of care for continuity of services and ensure that changes in the recipient’s status warrant service increases, service reductions, or other changes in the plan of care. This review is not a complete reassessment. The case manager must initial and date the plan of care at each review to certify that authorized services are appropriate and continue to be needed. Case reviews must be documented in the case narrative. Reassessment ALE waiver recipients must receive a quarterly review and updates. A complete reassessment must be performed annually. Complete reassessments are conducted by using the comprehensive client assessment instrument. If changes in the recipient’s condition warrant complete reassessment, one should be done more frequently than once a year. Reassessment results will be used to develop a new plan of care. Reassessments must be maintained in the recipient’s case record and all contacts and visits made in completing a reassessment must be noted in the case narrative. ALE Waiver and Assistive Care Covered Services Introduction ALE waiver services are based on individual recipient needs and must be documented in the plan of care. Recipients enrolled in the ALE waiver must receive: • Case management, and • Assisted living. The receipt of incontinence supplies is based on need. July 2001 5-9
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Assistive Care Services and Assisted Living for the Elderly Waiver

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