Assistive Care Services and Assisted Living for the Elderly Waiver

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