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 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
Assistive Care Services and Assisted Living for the Elderly Waiver Services Coverage and Limitations Handbook PART II APPENDIX F ASSISTED LIVING FOR THE ELDERLY WAIVER SERVICES PROCEDURE CODE TABLE AND FEES CODE DESCRIPTION OF SERVICE UNIT MAXIMUM FEE W9655 Case Management Monthly $100 W9654 Assisted Living Daily $28 W9656 Incontinence Supplies Monthly $125 Note: ALE waiver providers can bill for ACS state plan services using Pocedure Code W9657 for residents with incomes up to $716.00 per month. The daily reimbursement rate for ACS is $9.28. This procedure code can only be used by ALE waiver providers billing on the 081 billing form. July 2001 F-1
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Assistive Care Services and Assisted Living for the Elderly Waiver

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