ASSISTED LIVING WAIVER PROGRAM (ALWP)
The ALWP was renewed for five years effective March 1, 2009 by the Centers for Medicaid & Medicare Services (CMS). ALWP Provider enrollment is currently open to potential providers in the following counties: Sacramento, San Joaquin, Los Angeles, Sonoma, Fresno, San Bernardino, Contra Costa, Alameda, San Diego and Riverside. The ALWP is currently enrolling beneficiaries residing in skilled nursing facilities and in the community into licensed Residential Care Facilities for the Elderly (RCFEs) and Public Subsidized Housing (PSH).
Project Description
The ALWP is designed to assist Medi-Cal beneficiaries to remain in their community as an alternative to receiving care in a licensed health care facility. The program provides specified benefits to eligible seniors and persons with disabilities. Eligible beneficiaries will participate in one of two care provider models:
- 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.
ALWP-eligible individuals are those who are enrolled in Medi-Cal and need the level of care provided in a nursing facility due to their medical needs. If the individual meets both the financial and health/functional requirements of the program, then she or he can choose to enroll in the ALWP. To begin the process of enrolling in the ALWP, interested individuals should first contact a Care Coordinator Agency in one of the participating counties. The Care Coordinator will help determine if the individual is eligible for the program.
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History of the Assisted Living Waiver Program (ALWP)
The ALWP was created by legislation that directed the California Department of Health Care Services (DHCS) to develop and implement the projectto test the efficacy of assisted living as a Medi-Cal benefit. A key goal of the program 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 program was successful during 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 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 ALWP 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 (24-hour awake staff is not required in RCFEs with 6 beds or less))
- 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
- Provide or arrange 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 Program will have access to three 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 conduct assessments to assist in determining eligibility, develop Individualized Service Plans (ISPs), arrange for services, maintain contact with participants, and monitor service delivery on a monthly basis.
- Nursing Facility Transition Care Coordination - This benefit helps to transition residents from nursing facilities to the community.
Assisted Living Services Include:
- Assistance in developing and updating ALWP participant's Individualized Service Plans (ISP) which details in part, the frequency and timing of assistance. Participants play active roles in the development process and must sign their ISP;
- Providing personal care and assistance with ADLs and IADLs sufficient to meet both the scheduled and unscheduled needs of the residents;
- Washing, drying and folding laundry;
- Performing all necessary housekeeping tasks;
- Maintaining the facility;
- Providing three meals per day plus snacks. Food must meet minimum daily nutritional requirements and meet the resident's special dietary needs as prescribed by their PCP;
- Providing intermittent skilled nursing services as required by residents;
- In accordance with State law, providing assistance with the self-administration of medications, or administering medications by an RN or LVN;
- 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 ALWP, 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 ALWP 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 Agency in your county.
PROVIDER INFORMATION
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CCA PARTICIPANT ENROLLMENT FORMS
PROVIDER ENROLLMENT
The ALWP is accepting applications from interested RCFE providers in all participating counites. Please note that applications from interested RCFE providers will only be accepted by the ALWP Office for those RCFEs that have undergone a comprehensive review from Community Care Licensing (CCL) and are in substantial compliance with all licensing regulations.
The initial RCFE and CCA applications consist of two pages and are reviewed by ALWP staff to ensure providers meet the initial criteria for participation in the ALWP. Once the two page application has been reviewed and approved, the RCFE or CCA applicant must then complete Medi-Cal Provider Enrollment application which consists of three documents: DHCS 6204, DHCS 6207, and DHCS 6208.
Before completion of the provider enrollment forms, the CCA and RCFE applicant must have a National Provider Identifier (NPI) number.
Please Note: As of January 1, 2013 there is an application fee of $532.00. The fee must be submitted with your application in a cashier's check only, made payable to the State of California, Department of Health Care Services. For more information regarding the current fee amount please visit the following website:
The following is the link to access the ALWP Provider Agreement form. Please fill out and send along with the initial RCFE or CCA application.
For RCFEs interested in providing assisted living care, please access the following link below:
For Home Health Agencies/CCAs interested in providing care coordination services, please access the following link below:
For Medi-Cal Provider Enrollment forms, please access the following links below:
PLEASE NOTE: DO NOT SEND THESE FORMS IN TO PROVIDER ENROLLMENT
When all documents have been completed please submit them along with a copy of the NPI application receipt showing your NPI number, and the application fee to the address below:
Carol Hausler, Chief
Assisted Living Waiver Unit
Long-Term Care Division
Department of Health Care Services
1501 Capitol Avenue, MS 4503
P.O. Box 997437
Sacramento, CA 95899-7437
REIMBURSEMENT RATES
A listing of services and rates appears below. Please 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, a one time fee only.
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$993 per month based on income of $1,122.00 from Social Security (SS) or Supplemental Security Income (SSI), less $129.00 for the personal needs allowance).
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$1,013 per month based on income of $1,142.00 or greater, less $129.00 for the personal needs allowance.
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CONTACT US
You may reach us directly:
ALWP
Long-Term Care Division
1501 Capitol Avenue, MS 4503
P O Box 997437
Sacramento, CA 95899-7437
Phone: 916-552-9105
For further information about this Waiver refer to the following page: Centers for Medicare and Medicaid Services.