Assistive Care Services and Assisted Living for the Elderly Waiver

More documents

Recommendations

Info

Overview Assistive Care Services and Assisted Living for the Elderly Waiver Services Coverage and Limitations Handbook PART II CHAPTER 6 ASSISTED LIVING FOR THE ELDERLY WAIVER SERVICES PROCEDURE CODES AND FEES Introduction This chapter provides and describes the procedure codes and approved fees for assisted living for the elderly (ALE) waiver services. In this Chapter This chapter contains: TOPIC PAGE Reimbursement Information 6-1 Appendix F: Procedure Code Table and Fees F-1 Appendix G: Appeal Rights and Fair Hearing Process G-1 Reimbursement Information Introduction Medicaid reimburses for home and community based waiver procedure codes based on the Centers for Medicare and Medicaid Services (CMS) Common Procedure Coding System (HCPCS), Level III procedure codes and locally assigned codes that have been approved by HCFA. Locally assigned codes are identified by a “W” prefix. Medicaid Reimbursement Claim Form ALE waiver services are billed on the Non-Institutional 081 claim form. Note: See the Medicaid Provider Reimbursement Handbook, Non- Institutional 081, for specific procedures for submitting claims for payment. July 2001 6-1
Assistive Care Services and Assisted Living for the Elderly Waiver Services Coverage and Limitations Handbook Reimbursement Information, continued Procedure Code Table ALE waiver providers may bill for three waiver services and one state plan service provided in their facilities. The procedure code for each service is found in Appendix F of this chapter. Each service and its components have been explained in Chapter 5 of this handbook. The table gives: • The procedure code associated with the service; • The name of the service; and • The maximum fee that Medicaid will reimburse for the service. Case Management Reimbursement Case management activities are paid on a fixed monthly rate. Reimbursement will be made if case management activities were provided for a recipient for any portion of the month. Any of the following activities constitute case management: • Assisting with a recipient’s facility placement or enrollment into the ALE waiver; • Conducting an assessment or reassessment of service needs; • Developing or reviewing a care plan, including arrangements for service delivery and referral activities; • Conducting a monitoring visit for provision of services or to assess the quality of services being rendered; • Advocacy or legal related tasks such as working with adult protective services, court officials or other investigators on behalf of an eligible recipient; • Time spent recording activities in the recipient’s case record, telephone time or travel time associated with any of the above case management activities; and • Coordinating hospice, Medicaid state plan and Medicare services with the hospice coordinator for ALE consumers electing to receive those services. July 2001 6-2
Page 1 and 2:
ASSISTIVE CARE SERVICES AND ASSISTE
Page 3 and 4:
ASSISTIVE CARE SERVICES AND ASSISTE
Page 5 and 6:
Part II - Assisted Living for the E
Page 7 and 8:
Assistive Care Services and Assiste
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32: Assistive Care Services and Assiste
Page 45 and 46: TRANSFERRING Assistive Care Service
Page 47 and 48: RESIDENT SERVICE PLAN FOR ASSISTIVE
Page 49 and 50: USING AVAILABLE TRANSPORTATION o In
Page 51 and 52: RESIDENT SERVICE LOG (Optional Form
Page 53 and 54: RESIDENT SERVICE LOG (Optional Form
Page 63 and 64: Overview Assistive Care Services an
Page 81: Assistive Care Services and Assiste
Page 89: Assistive Care Services and Assiste
show all

Assistive Care Services and Assisted Living for the Elderly Waiver

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?