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

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