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. For all the details
of this Department of Health Services program, please go to
http://www.dhcs.ca.gov/services/ltc/pages/alwpp.aspx
Medi-Cal
Waiver for Assisted Living
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. Go
to
http://www.dhcs.ca.gov/services/ltc/pages/alwpp.aspx
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