Assisted Living Waiver (ALW)
The ALW was renewed for five years effective March 1, 2009 by the Centers for Medicaid & Medicare Services (CMS). ALW Provider enrollment is currently open to interested, potential providers in the following counties: Sacramento, San Joaquin, Los Angeles, Sonoma, Fresno, San Bernardino and Riverside. The ALW is currently enrolling beneficiaries residing in skilled nursing facilities and in the community into licensed Residential Care Facilities (RCFEs) in Los Angeles, Sacramento, San Joaquin, Riverside, Fresno and San Bernardino Counties. The ALW anticipates enrolling beneficiaries in Sonoma County, beginning in winter 2012.
Project Description
The Assisted Living Waiver (ALW) is the Medi-Cal program that provides for assisted living, care coordination and other specified benefits provided to eligible seniors and persons with disabilities who currently reside in Sacramento, San Joaquin, Los Angeles Counties. It is anticipated that eligible beneficiaries in Sonoma, Fresno, San Bernardino and Riverside Counties will begin enrollment in late Spring 2010.
- In the first model, Assisted Living services are provided to participants who reside in Residential Care Facilities for the Elderly (RCFEs). In this model, services are delivered by the RCFE staff.
- In the second model, Assisted Living Care services are provided to participants who reside in publicly subsidized housing. In this model, services are delivered by Home Health Agency staff.
ALW-eligible individuals are those who are enrolled in Medi-Cal and need the level of care provided in a nursing facility. If the individual meets both the financial and health/functional requirements of the project, then she or he can choose to enroll in the ALW, as an alternative to receiving nursing home care. To begin the process of enrolling in the ALW, interested individuals should contact a Care Coordinator in one of the participating counties. The Care Coordinator determines if the individual is eligible for the program.
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History of the Assisted Living Waiver Pilot Project (ALWPP)
The ALWPP was created by legislation that directed the California Department of Health Care Services (DHCS) to develop and implement the project to test the efficacy of assisted living as a Medi-Cal benefit. A key goal of the pilot project was to enable low-income, Medi-Cal eligible seniors and persons with disabilities, who would otherwise require nursing facility services, to remain in or relocate to the community. The pilot project was successful during the past three years in a limited trial in three counties. In March 2009, CMS approved waiver renewal for an additional five years and expansion of the program into additional counties. The AWLPP is now titled the ALW. The Department of Health Care Services will continue to oversee the delivery of assisted living services and determine whether those service are being provided cost-effectively and in a manner that assures the safety and well-being of participants.
What is assisted living?
The Assisted Living Waiver (ALW) defines assisted living based on the standards set by the National Assisted Living Workgroup. Assisted living is a state regulated and monitored residential long-term care option. Assisted living provides or coordinates oversight and services to meet the residents’ individualized scheduled needs, based on the residents’ assessments and service plans and their unscheduled needs as they arise. Assisted living residents have the option of a private room and the ability to prepare simple meals.
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SERVICES
Services that are required by state statutes and regulations to be provided or coordinated must include, but are not limited to:
- 24-hour awake staff to provide oversight and meet the scheduled and unscheduled needs of residents
- Provision and oversight personnel and supportive services (assistance with activities of daily living and instrumental activities of daily living)
- Health related services including skilled nursing (e.g., medication management services, treatments, wound care, etc.)
- Social services
- Recreational activities
- Meals
- Housekeeping and laundry
- Transportation
A resident has the right to make choices and receive services in a way that will promote the resident’s dignity, autonomy, independence, and quality of life. These services are disclosed and agreed to in the contract between the provider and resident. Assisted living does not generally provide ongoing, 24-hour skilled nursing. Assisted living units are private occupancy and shared only by the choice of residents (e.g., by spouses, partners or friends).
Participants in the Assisted Living Waiver will have access to four waiver benefits:
- Assisted Living Services - These services are called the Assisted Living Services when they’re provided in an RCFE and Assisted Care when they’re provided by a licensed Home Health Agency and delivered to residents of publicly-funded housing.
- Care Coordination - These services include identifying, organizing, coordinating and monitoring services needed by a participant. Care Coordinators enroll clients, conduct assessments, develop Individualized Service Plans (ISPs), arrange for services, maintain contact with participants, and monitor service delivery.
- Environmental Accessibility Adaptations - This benefit provides for physical adaptations to the residence in a publicly-funded setting, as identified by the residents’ ISPs.
- Nursing Facility Transition Care Coordination - This benefit helps transition residents from nursing facilities to the community.
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Assisted Living Services Include:
- Developing a Service Plan for each resident that details the needs of the resident, the provider of the service and, the frequency and timing of a. Residents must be a part of the development process and must sign the Service Plan;
- Providing personal care and assistance with ADLs sufficient to meet both the scheduled and unscheduled needs of the residents;
- Washing, drying and folding all laundry;
- Performing all necessary housekeeping tasks;
- Maintaining the facility;
- Providing three meals per day plus snacks. Food must meet minimum daily nutritional requirements;
- Providing intermittent skilled nursing services as required by residents;
- In accordance with State law, providing assistance with the self-administration of medications or, as necessary, administering medications;
- Providing or coordinating transportation;
- Providing daily recreational activities;
- Providing social services;
- Providing a response system that enables waiver beneficiaries to summon assistance from personal care providers.
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PARTICIPANT INFORMATION
To be eligible to participate in the ALW, you must be enrolled in the Medi-Cal program and be in need of the care provided by a nursing facility. If you meet these requirements, you may be eligible to choose to enroll in the ALW and receive services as an alternative to long-term placement in a nursing facility. To determine if you are eligible to participate, contact a Care Coordinator in your county. The ALW will be implemented in Spring 2011 in Sonoma, Fresno, San Bernardino and Riverside. The following is a general description of participants by tier:
Participants can obtain more information regarding the ALW and the participating providers through the following documents:
Listed below are the current Residential Care Facilities for the Elderly (RCFEs)
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PROVIDER information
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Provider Enrollment
The ALW is accepting applications from interested RCFEs providers in only the following counties: Sacramento, San Joaquin, Los Angles, Fresno, Sonoma, Riverside and San Bernadino. Please note that applications from interested RCFE providers will only be accepted by the ALW Office for those RCFE's that have undergone a comprehensive review from Community Care Licensing (CCL), within the previous 18 months of submitting the ALW application. The comprehensive review must have been conducted with at least two current residents, who resided at the RCFE for at least 6 consecutive months, prior to the CCL review. The ALW Office cannot consider any RCFE that has not meet these criteria.
Applications from interested, qualified and potential RCFE providers in Fresno, Los Angeles, Riverside, Sacramento, San Bernardino, San Joaquin and Sonoma Counties are the only applications being considered.
The RCFE application packet initially consists of the two page application at the following link. This is only the first step in a multi-part process of becoming an ALW/Medi-Cal provider. Before completing any of the following forms, please contact the ALW Program Manager at (916) 552-9322.
Residential Care Facility for the Elderly (RCFE) Provider Application (PDF)
For Home Health Agencies interested in providing assisted care in public subsidized housing and providers interested in Care Coordination please see the following links;
The final steps in becoming a ALW Provider is the completion of the NPI number and the three part Medi-Cal application package. The following links provide the needed forms;
Bernie Finneran, Health Program Manager I
Assisted Living Waiver
Long-Term Care Division
Department of Health Care Services
1501 Capitol Avenue, MS 4502
P.O. Box 997419
Sacramento, CA 95899-7419
(916) 552-9322
Email to: Bernard.Finneran@dhcs.ca.gov
REIMBURSEMENT RATES
A listing of reimbursement rates appears below. Note, providers can only bill for Medi-Cal services provided to enrolled clients.
- Care Coordination: $200/participant/month
- Nursing Facility Transition Care Coordination: $1,000/participant
-
Assisted Living Services:
Tier 1 -- $52/participant/day
Tier 2 -- $62/participant/day
Tier 3 -- $71/participant/day
Tier 4 -- $82/participant/day
-
Assisted Care in Publicly Funded Housing:
Tier 1 -- $52/participant/day
Tier 2 -- $62/participant/day
Tier 3 -- $71/participant/day
Tier 4 -- $82/participant/day
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CONTACT US
You may reach us directly:
ALW
Long-Term Care Division
1501 Capitol Avenue, MS 4503
PO Box 997419
Sacramento, CA 95899-7419
Phone: 916-552-9105
For further information about this Waiver refer to the following page: