1 / 18

Medicaid Waiver Programs: Aged and Disabled Adult Waiver (ADA) & Assisted Living Waiver (ALW)

Medicaid Waiver Programs: Aged and Disabled Adult Waiver (ADA) & Assisted Living Waiver (ALW). 1. Aged & Disabled Adult Medicaid Waiver ADA Waiver In-home Services Assisted Living for the Elderly Medicaid Waiver ALE or ALW Services in an Assisted Living Facility. Programs: Two types.

onan
Download Presentation

Medicaid Waiver Programs: Aged and Disabled Adult Waiver (ADA) & Assisted Living Waiver (ALW)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Medicaid Waiver Programs:Aged and Disabled Adult Waiver (ADA) & Assisted Living Waiver (ALW) 1

  2. Aged & Disabled Adult Medicaid Waiver ADA Waiver In-home Services Assisted Living for the Elderly Medicaid Waiver ALE or ALW Services in an Assisted Living Facility Programs: Two types 2

  3. Medicaid Waiver Program (ADA)Overview • Program is jointly administered by AHCA, DOEA, DCF, and AAA • ProvidesHome & Communitybasedservices • To those in need of nursing home care who could remain at home if they had special services • Recipients choose these services instead of going into a nursing facility 3

  4. Medicaid Waiver: Eligibility • 60 and older • Living in the community • Not an institution • Level of Care Criteria (LOC) from DOEA/CARES • Financial Eligibility from DCF • Qualify for Medicaid • Income • Less than $2022 for an individual • Less than $4044 per couple • Assets • Less than $2000 for an individual • Less than $3000 per couple 4

  5. Medicaid Waiver: Services • Case Management • Case Aide • Companionship • Caregiver Training • Home Delivered Meals • Respite • Pest control • Homemaker • Consumable Supplies • Incontinence • Emergency Alert Response • Personal Care • Home Modifications • Adult Day Care • Specialized Medical Equipment 5

  6. Medicaid Waiver: Case Manager Responsibilities • Intake, screening & assessment • Develop and implement a care plan based upon the recipient’s needs • Monthly Contact • Satisfaction of services • Every 6 months • Face to face visit • Review care plan • Satisfaction of services and functional status • Yearly • Reassess • Develop new care plan • Identify providers for the needed services • Monitor services received by the recipient & make sure it matches the care plan 6

  7. Medicaid Waiver: Case Manager Responsibilities • Ensure all assessment & care plan forms are complete and signed • Maintain monitoring reports and corrective actions • Maintain current Choice of Providers List • Make referrals to appropriate community resources • Inform client of the Fair hearing & Grievance process • Document the recipient’s satisfaction with all services regardless of the funding source • Ensure that Medicaid State Plan services are utilized before authorizing Medicaid Waiver services • Notify the Florida Abuse Hotline if lack of service provision endangers the recipient’s health, safety or welfare 7

  8. Medicaid Waiver: File Requirements • Handwritten Assessment • Form 701B • Turnaround Assessment • CIRTS printout • Care Plan • Care Plan Review Protocol Form • CDC+ consent Form • Hospice Agreement • Notice of Fair Hearing • Physicians Referral • Form 3008 • Level of Care • Form 603 • Informed Consent • Form 2040 • DCF -HCBS services • Form 2515 • Medicaid Application • Form 2066 8

  9. Medicaid Waiver:File Requirements Continued • Financial/Medical Release • Form 2613 • DCF Notice of Case Action • Form 2266 • Medicaid Eligibility Documentation • If no Notice of Case Action • Ex: FMMIS printout, MediFax or Medline • Notice of Privacy Practices • Authorization for Release of Information • Voter Registration Preference Form • Grievance Procedures • Authorization to collect Social Security Number • Choice of Providers Form for Medicaid Waiver • Case Notes 9

  10. Assisted Living Waiver:Program Overview • Jointly administered by AHCA, DOEA, DCF, and AAA • Provides Home & Community based services • To clients who reside in qualified Assisted Living Facilities (ALF’s) with an LNS or ECC license • Clients choose these services instead of going to a nursing facility • Pays for the services; not the room & board charges • Amount Paid by ALW • Up to $32.20 per day for services • Up to $125.00 per month for incontinent supplies 10

  11. Assisted Living Waiver:Eligibility • Eligibility • 60 years of age and older • Reside in an assisted living facility (ALF) • Extended Congregate Care (ECC) License • Limited Nursing Services (LNS) License • Level of Care (LOC) from DOEA/CARES • Financial eligibility from DCF • Qualify for Medicaid • Income • Less than$2022 for an individual • Less than $4044 per couple • Assets • Less than $2000 for an individual • Less than $3000 per couple 11

  12. Assisted Living Waiver: Services • Case Management • Specialized Medical Equipment • Therapeutic Social & Recreational Services • Incontinent Supplies • Attendant Call System • Attendant Care • Behavior Management • Personal Care • Medication Administration • Homemaker • Intermittent Nursing Care • Speech Therapy • Occupational Therapy • Physical Therapy 12

  13. Assisted Living Waiver:Case Manager Responsibilities • Assist ALE clients with making an application for Medicaid waiver services • Develop and implement an assessment based care plan • Every 3 months (Quarterly) • Review the care plan • Ensure that waiver services are still needed • Each Month • Visit each recipient • Document status • Satisfaction with services • Additional service needs • Advise clients of their fair hearing rights and grievance process 13

  14. Assisted Living Waiver:Case Manager Responsibilities • Maintain up to date clients’ case records • Coordinate other services with the ALE service provider including Hospice and Medicare • Contact the service provider to ensure proper services are being provided • Contact the Medicaid Waiver Specialist and AHCA/Health Quality Assurance if needed services aren’t being provided • Notify the Florida Abuse Hotline if lack of service provision endangers the recipient’s health, safety or welfare 14

  15. Assisted Living Waiver:File Requirements • Handwritten Assessment • Form 701B • Turnaround Assessment • CIRTS printout • Care Plan • ALE worksheet • Calculate daily rate for waiver • Hospice Agreement • Notice of Fair Hearing • Physicians Referral • Form 3008 • Level of Care • Form 603 15

  16. Assisted Living Waiver:File Requirements • Informed Consent • Form 2040 • DCF -HCBS services • Form 2515 • Medicaid Application • Form 2066 • Financial/Medical Release • Form 2613 • ALF Resident Health Assessment • Form 1823 • DCF Notice of Case Action • Form 2266 • Medicaid Eligibility Documentation • If there’s no Notice of Case Action • Ex: FMMIS printout 16

  17. Assisted Living Waiver:File Requirements • Authorization to Collect Social Security Number Form • Release of Information • Voter Registration Preference Form • Grievance Procedures • Choice of Provider Form for Assisted Living Facilities • Notice of Privacy Practices • Case Notes • Documentation of Review of Medication management sheet 17

  18. Additional Contacts and Resources FL Dept. of Children & Families (DCF): www.dcf.state.fl.us FL Dept. of Elder Affairs (DOEA): www.elderaffairs.state.fl.us Agency for Health Care Administration (AHCA): www.ahca.myflorida.com Area Agency on Aging for North Florida (AAANF): www.aaanf.com Abuse Hotline: 1-800-96-ABUSE 18

More Related