Assistive Care Services and Assisted Living for the Elderly Waiver

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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
Assistive Care Services and Assisted Living for the Elderly Waiver Services Coverage and Limitations Handbook Reimbursement Information, continued Billing for ACS and Assisted Living Waiver Services Facilities participating in the ALE Waiver are required to bill Medicaid for both the ACS state plan service and the ALE waiver services for some recipients. Waiver Daily Rate Calculation Worksheet Instructions for Worksheet 1. Insert the number of days in the month on Line A 2. Calculate the Maximum Waiver and ACS for the Month (Lines C and D) 3. Perform the calculations from Line F through Line L to obtain the daily waiver payment (L) to bill for the days the recipient received services in the facility. 4. If Line I is “0” (Zero), do not bill for ACS. A. Number of Days in the Month B. Maximum Daily Waiver Rate $28.00 C. Maximum Waiver for the Month: A times B D. Assistive Care Service Daily Rate $9.28 E. ACS for the Month: A times D F. Is Resident Income Greater than $716.00 and less than $770.00 If YES, add C plus G and Subtract $54.00 IF NO, add C plus $716.00 G. Method I Recipient Income: Insert Income Social Security: _________ OSS (State Subsidy): _________ Other (Income, if any)_________ Total Income: __________ H Subtract G from F I. Is recipient Income (G) more than $716.00 If Yes, Insert “0” (Zero). If No, Insert ACS for the month (E) J. Subtract I from H K Add J plus $54.00 L. Daily Waiver Rate: Divide K by A Method II (From Notice of Case Action) Needs Allowance: ________ Pat. Resp.: ________ Total Income _________ July 2001 6-4
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Assistive Care Services and Assisted Living for the Elderly Waiver

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