Transcript MEDICAID WAIVER-WHAT IS IT?

Medicaid Waiver Programs:
Aged and Disabled Adult Waiver (ADA)
&
Assisted Living Waiver (ALW)
1
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
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
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
 Less
Assets
 Less
 Less
than $2022 for an individual
than $4044 per couple
than $2000 for an individual
than $3000 per couple
4
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
Medicaid Waiver:
Case Manager Responsibilities



Intake, screening & assessment
Develop and implement a care plan based upon the
recipient’s needs
Monthly Contact


Every 6 months






Face to face visit
Review care plan
Satisfaction of services and functional status
Yearly


Satisfaction of services
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
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
Medicaid Waiver:
File Requirements

Handwritten
Assessment


Notice of Fair Hearing

Physicians Referral
Form 701B
Turnaround
Assessment


CIRTS printout



Care Plan

Care Plan Review
Protocol Form


CDC+ consent Form


Hospice Agreement
Level of Care

Form 603
Informed Consent

Form 2040
DCF -HCBS services


Form 3008
Form 2515
Medicaid Application

Form 2066
8
Medicaid Waiver:
File Requirements Continued

Financial/Medical Release


DCF Notice of Case Action









Form 2266
Medicaid Eligibility Documentation


Form 2613
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
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
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
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
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


Each Month

Visit each recipient




Ensure that waiver services are still needed
Document status
Satisfaction with services
Additional service needs
Advise clients of their fair hearing rights and
grievance process
13
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
Assisted Living Waiver:
File Requirements

Handwritten Assessment


Turnaround Assessment





Calculate daily rate for waiver
Hospice Agreement
Notice of Fair Hearing
Physicians Referral


CIRTS printout
Care Plan
ALE worksheet


Form 701B
Form 3008
Level of Care

Form 603
15
Assisted Living Waiver:
File Requirements

Informed Consent


DCF -HCBS services


Form 1823
DCF Notice of Case Action


Form 2613
ALF Resident Health Assessment


Form 2066
Financial/Medical Release


Form 2515
Medicaid Application


Form 2040
Form 2266
Medicaid Eligibility Documentation


If there’s no Notice of Case Action
Ex: FMMIS printout
16
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
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