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

2 Programs: Two types  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 2

3 Medicaid Waiver Program (ADA) Overview  Program is jointly administered by AHCA, DOEA, DCF, and AAA  Provides Home & Community based services 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

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 $ 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

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): FL Dept. of Elder Affairs (DOEA): Agency for Health Care Administration (AHCA): Area Agency on Aging for North Florida (AAANF): Abuse Hotline: ABUSE 18