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
ALE Waiver and Assistive Care Covered Services, continued
Assistive Care
Services
Assistive Care Services is a Medicaid state plan service the ALE waiver
providers may provide to their waiver recipients. This is not an ALE waiver
service.
Case
Management
W9655
Case management is a service that provides the ALE waiver recipient with a
case manager who will identify, organize, coordinate, and monitor the
services needed by the recipient. The case manager also assists the recipient
to access needed services.
Assisted Living
W9654
Assisted living is a service that is comprised of an array of components
provided by or through the ALF in which the recipient resides. These
components will be provided only when the recipient is not capable of
performing them and where no relative, caretaker, landlord, community
volunteer or agency, or third party payor is capable or responsible for their
provision.
Each recipient must have a resident contract with the ALF that specifies
services to be provided by the facility. Prior to including a service component
into a recipient’s plan of care, the case manager must examine the recipient’s
resident contract to determine if any needed service component is already
covered by the facility’s basic charges and would be considered duplicative.
Duplicative service components must not be included or authorized in the plan
of care.
The following components may be included in the assisted living service:
• Attendant call system;
• Attendant care;
• Behavior management;
• Chore services;
• Companion services;
• Homemaker services;
• Intermittent nursing;
• Medication administration;
July 2001 5-10