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
Billing for Case
Management
ALE case management services are billed once a month. The date of service
(DOS) is always the last day of the month for which reimbursement is
requested. However, if the recipient is admitted to a hospital or a nursing
facility, the DOS must be the day before the recipient’s admission in order for
case management to be reimbursed.
Incontinence
Supplies Service
This service is billed once a month using the last day of the month for which
reimbursement is being requested. The total billing should represent the value
of those incontinence supplies used by the waiver consumer. Individual waiver
consumer supplies must be maintained in separate locations and ALE providers
must keep accurate monthly records of supplies used by individual waiver
consumers. However, if the recipient is admitted to a hospital or a nursing
facility, the date of service (DOS) must be the day before the recipient’s
admission in order for incontinence supplies to be reimbursed.
Assisted Living
Service Component
Reimbursement
The assisted living service components are reimbursed at a single per diem rate.
Reimbursement will not be made for any continuous 24-hour period that the
recipient is temporarily absent from the facility.
Billing for Assisted
Living Service and
ACS Components
Assisted living service components and assistive care service components are
reimbursed by the number of days (i.e., units) the recipient resides in the facility
while enrolled in the ALE waiver. The total number of units is billed once a
month using the last day of the month for which reimbursement is requested as
the date of service (DOS). The billing method should be consistent, preferably
once per month. However, if the recipient is admitted to a hospital or a nursing
facility, the last DOS must be the day before the recipient’s admission.
July 2001 6-3