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 ACS and
Waiver Services,
continued
ALE waiver recipients with incomes up to $716.00 per month are eligible for
ACS and ALE waiver payments.
The ALE waiver facility reimbursement under the waiver program is $1,500.00
for a 28 day month, $1,556.00 for a 30 day month, and $1,584.00 for a 31
day month.
Daily Billing for
Assisted Living
Waiver and State
Plan Service
Components
ALE waiver recipients must be present in the ALF for some period each day
that is billed for assisted living services. However, no billing is permitted for
partial days of service.
When the ALE resident is transferring between two ALE assisted living
facilities, the discharging facility may not bill for the day of discharge and the
admitting facility may bill for the day of admission.
When the ALE recipient is transferring to either a hospital or nursing home, the
ALE facility cannot bill for the date of discharge.
When the ALE resident is returning from a hospital, nursing home stay, or other
temporary absence, the ALE facility can bill for the date of return.
Recipient
Responsibility
As part of the eligibility process, DCF applies a standard formula to calculate a
financial responsibility, if any, for recipients who receive ALE waiver services.
The ALF, recipient, and the case manager are notified by DCF using a Notice
of Case Action form of the recipient’s financial responsibility. This monthly
amount must be deducted from the total charges for assisted living services
prior to submitting a claim for reimbursement to Medicaid.
The ALF is responsible for collecting the financial responsibility from the
recipient and may establish individual collection methodologies to fit the
circumstances of each recipient.
July 2001 6-5