Providers of Assistive Care Services
Who should enroll as an ACS provider?
All qualified ALFs and RTFs who provide ACS services and who serve or intend to serve Medicaid-eligible residents should enroll as ACS providers as soon as possible. Over 1,400 facilities have submitted applications to enroll in Medicaid.
- If you have submitted an application that is complete and correct, you will receive an enrollment package from the Medicaid fiscal agent. If your application was submitted more than a month ago and you have not heard anything, you should contact your Medicaid area office.
- If you have submitted an application and were requested to submit additions or corrections, you should submit those as soon as possible because your application cannot be processed until it is complete.
Who is Medicaid's fiscal agent?
Please visit our Medicaid Fiscal Agent page for up-to-date information on our fiscal agent.
Are there any special qualifications for providers?
An ALF and AFCHs must have a current license. In addition to a current license, an RTF must certify that it meets certain size and licensure criteria, it provides on-site care seven days a week, and it does not receive funding from other sources for ACS-type services.
How can facilities enroll?
Providers must complete a Medicaid Provider Enrollment Application and submit it to the respective area Medicaid office for pre-review. The area office will forward it to Medicaid Contract Management and on to Medicaid's fiscal agent for enrollment. The Medicaid area office can provide the appropriate forms, as well as training and assistance with the enrollment process.
What are the responsibilities of the ACS provider?
The assistive care provider has the responsibility to:
- Assist prospective ACS recipients with applications for Medicaid services, if necessary;
- Advise the ACS applicant and recipient of their fair hearing rights and the grievance process;
- Provide an integrated set of services on a 24-hour basis;
- Arrange for health assessments annually or when significant changes occur in an ACS resident's condition;
- Develop and implement a service plan for each recipient;
- Document that the recipient is receiving services from the facility staff on each day for which ACS is billed;
- Maintain up-to-date recipient case records in accordance with the provider handbook and applicable licensure requirements;
- Coordinate other services provided to the consumer, such as hospice, waiver, and Medicare, and avoid duplication of services;
- Provide all ACS recipients with a personal needs allowance in an amount equal to that set by the OSS rule;
- Comply with all provisions of the Medicaid Provider Agreement and the provider handbook; and
- Comply with all licensure requirements applicable to the facility.
How will providers meet the resident assessment requirements?
The assessment requirement for ACS at admission is the same as that required under the applicable licensing rules. The initial assessment must document the need for at least two of the four ACS service components, and be documented on the required Certification of Medicaid Necessity [6KB] (AHCA-Med Serv Form 035, July 2009) form. Subsequently, an assessment must be completed on an annual basis or sooner if the resident has experienced a significant change. The annual assessment must be completed no more than one year plus 15 days after the last assessment. An assessment triggered by a significant change must be completed no more than 15 days after the significant change. The assessment for an ALF or AFCH resident must be completed by a physician or physician assistant or advanced registered nurse practitioner. The assessment for an RTF resident must be completed by a physician or licensed mental health professional. The assessment must document the need for at least two of the four ACS components on a daily basis. Either the DOEA Form 1823 for ALF residents, the DOEA Form 1110 for AFCH residents, and the required Certification of Medical Necessity [6KB] form must be used for this purpose.
How will providers meet the resident service planning requirements?
Every ACS recipient must have a service plan. For RTF residents the requirements are the same as those for treatment and service planning in Rules 64E-4.014 and 64E-4.016, FAC. The information that follows pertains to ALF and AFCH residents. The ALF or AFCH is responsible for developing and implementing the service plan. The service plan must be in writing and be based on the information contained in the assessment. The following components must be included:
- Identifying information (facility name, resident's name and Medicaid identification number, and date);
- Services that addressed all needs identified in the health assessment;
- Level of functioning and assistance needed;
- Service provider;
- Expected outcome of service;
- Signed and dated by facility representative and resident or resident's guardian or designated representative; and
- Updated to reflect current conditions, as necessary.
Providers must use Medicaid's Resident Service Plan for Assistive Care Services [28KB] (AHCA-Med Serv Form 036, July 2009 need document). The Resident Service Plan must be included in the resident’s case file.
The service plan must be completed no more than 15 days after the initial health assessment, and a new service plan is required on an annual basis or sooner if a significant change in the recipient's condition occurs, in which case the service plan must be completed no more than 15 days after the required re-assessment.
Are there any other new facility requirements?
Finally, the facility must document that the resident was receiving services in the facility on each day billed. The required Resident Service Log [200KB] (AHCA-Med Serv Form 037, July 2009 need document) must be used for this purpose.
What is the ACS payment rate?
The payment rate is $9.28 for each day the recipient was receiving services in the facility. All payments are made by electronic funds transfer.
How will providers be paid?
The provider will submit a claim to the Medicaid fiscal agent for Assistive Care Services provided to the resident. Claims may be submitted at any time after services are provided, but monthly billing is recommended. Claims may be submitted electronically, on paper by mail, or through a billing agent. Enrolled ACS providers who wish to bill electronically should contact their Medicaid fiscal agent field representative to arrange installation and training for the software.
Visit the Medicaid fiscal agent's Provider Web Portal for more information.
How will residents receiving Medicaid Assisted Living waiver services be affected?
The overall reimbursement for the care of OSS-waiver recipients will remain the same. These residents will be eligible for both ACS and ALE waiver payments. Waiver providers will bill for these residents on the same claim form used for the waiver (CMS-1500) and will use separate billing codes for ACS and waiver services. Billing for non-OSS waiver recipients will not change.
ALFs that participate in the Medicaid Assisted Living for the Elderly Waiver do not need to enroll in ACS unless they currently have OSS recipients that are not on the waiver or if they intend to serve low-income residents who do not qualify for the waiver.
