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 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
Assistive Care Services and Assisted Living for the Elderly Wavier Services Coverage and Limitations Handbook ALE Waiver and Assistive Care Covered Services, continued Assisted Living W9654, continued • Occupational therapy; • Personal care; • Physical therapy; • Specialized medical equipment and supplies; • Speech therapy; and • Therapeutic social and recreational services. The criteria for provision of each component are explained below. Attendant Call System Component The attendant call system is an emergency response system for recipients who are at high risk of falling, becoming disoriented or experiencing some disorder that puts them in physical, mental, or emotional jeopardy requiring immediate assistance. The recipient either wears an electronic device (e.g., a medallion or a bracelet) or is in proximity to a button that enables him or her to summon emergency help from an ALF attendant. This component also includes alerting the attendant if the recipient wanders from the facility. Attendant Care Component Attendant care is hands-on care, of both a medical and non-medical supportive nature, specific to the needs of a medically stable, physically disabled recipient. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. Light housekeeping activities that are incidental to the performance of care may also be furnished as part of this component. Behavior Modification Component Behavior modification consists of specialized approaches to manage the behavior of recipients with dementia. These approaches are remedial measures aimed at preventing or ameliorating disruptive behaviors. They may include supervision of recipients with behavior problems due to dementia and educational activities for training caregivers to respond to recipients’ behavior. July 2001 5-11
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