Medicaid Waiver for Assisted Living
The
Medicaid Waiver for Assisted Living Pilot Program (MWALPP) is up and
running in Sacramento, San Joaquin and Los Angeles counties. A
handful of RCFEs are serving Medi-Cal recipients who would otherwise
be in a skilled nursing facility. The program is not yet
operational in publicly funded senior housing. For all the details
of this Department of Health Services program, please go to
www.californiaassistedliving.org
Medi-Cal Waiver for Assisted
Living Delayed Again
Implementation of the Assisted
Living Medicaid Waiver Pilot Program has been delayed until March
2006.
Five years ago, legislation (Chapter
557, Statutes of 2000) was
enacted requiring the Department of Health Services to apply for a
Medicaid waiver to pilot a program that would provide Medi-Cal
benefits to residents in RCFEs and publicly funded low-income senior
housing. The Centers for Medicare and Medicaid Services (CMS)
approved California’s request in June 2005 and DHS had hoped to
begin the program in January 2006.
Once the pilot program is
operational, it will serve beneficiaries in Sacramento, San Joaquin
and Los Angeles counties. If you are interested in becoming a
Medi-Cal provider as part of this program, go to
www.californiaassistedliving.org
for more information.
Medi-Cal
Waiver for Assisted Living to Begin in January ‘06
California now has an approved Medicaid waiver for assisted living
(effective 1/1/06) -- more than five years after legislation required
the state to develop such a program. The Assisted Living Waiver Pilot
Project (ALWPP) will operate in three counties, Sacramento, San Joaquin
and Los Angeles. The Assisted Living Bundle of Services, which is a
Medi-Cal Assisted Living Waiver benefit, will be provided by Residential
Care Facilities for the Elderly (RCFEs) to ALWPP participants residing
in the RCFE. These services are provided to individuals over the age of
21 who are Medi-Cal eligible, require nursing facility level of
care, and are enrolled as participants. The services included
in the Assisted Living Waiver bundle provided by the RCFE are as
follows:
-
Provide personal care and assistance
with ADLs sufficient to meet both the scheduled and unscheduled
needs of the residents;
-
Wash, dry and fold all laundry;
-
Perform all necessary housekeeping
tasks;
-
Provide three meals per day plus
snacks. Food must meet minimum daily nutritional requirements;
-
Provide intermittent skilled nursing
services as required by residents;
-
In accordance with State law, provide
assistance with the self-administration of medications or, as
necessary, administer medications;
-
Provide or coordinate transportation;
-
Provide or coordinate daily
recreational activities;
-
Provide social services.
Each
participant will be assessed by an R.N. Care Coordinator from a Care
Coordination entity. The assessment will determine the participants’
Tier of Care. The reimbursement rate for the Assisted Living Waiver
bundle depends on the Tier of care assigned to the participant. The
rates by tier are:
-
Tier 1
$52/participant/day
-
Tier 2
$62/participant/day
-
Tier 3
$71/participant/day
-
Tier 4
$82/participant/day
Medi-Cal
waiver reimbursement is for waiver services only and not room and
board. Residents must cover room and board charges (SSI/SSP).
RCFE
providers must have a hospice waiver and be capable of caring for
participants through “Tier 4”. In addition, RCFE participants must
become Medi-Cal providers, comply with HIPPA, and meet all quality
assurance and data reporting requirements as outlined by DHS. The
program specifics, however, have not yet been released.
Applications are being accepted through August 12, 2005 to qualify
providers for the fall training. Applications will be accepted after
August 12 as well.
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