Assisted Living Waiver (ALW)
UPDATE: ALW is now enrolling only beneficiaries currently residing in Skilled Nursing Facilitities. Until further notice, the ALW is no longer enrolling new Providers.
Project Description
What is Assisted Living?
Services
Participant Information
Reimbursement Rates
Contact Us
Project Description
The Assisted Living Waiver (ALW) is the Medi-Cal program that pays for Assisted Living, care coordination and other specified benefits provided to eligible seniors and persons with disabilities who reside in one of the Program's three target counties: Sacramento, San Joaquin and Los Angeles.
- 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 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 three 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. 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. The program is in the process of being converted to a five year federal waiver program. Upon waiver renewal in 2009, the ALWPP will be tiltled 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 consumers.
What is Assisted Living?
The Assisted Living Waiver (ALW) defines assisted living based on the standards set by the national Assisted Living Workgroup. The Assisted Living Workgroup was formed at the request of the U.S. Senate Special Committee on Aging and was comprised of nearly 50 organizations representing providers, consumers, long-term care and health care professionals, regulators and accrediting bodies. The Assisted Living Workgroup created guidelines for federal and state policy, state regulation, and operations for assisted living. Its final was submitted to the Committee on Aging in April of 2003. The report defined assisted living as follows: 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.
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SERVICES
Services that are required by state law 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
- Provision and oversight personnel and supportive services (assistance with activities of daily living and instrumental activities of daily living)
- Health related services (e.g., medication management services)
- 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 Bundle 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 includes identifying, organizing, coordinating and monitoring services needed by a participant. Care Coordinators enroll clients, conduct assessments, develop Individualized Service Plans, arrange for services, maintain contact with participants, and monitor service delivery.
- Nursing Facility Transition Care Coordination helps transition clients from nursing facilities to the community.
Translation and Interpretation Services
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Consumer Education services are intended to promote clients’ independence, help them exercise their rights, and assist them to acquire the skills needed to exercise control and responsibility over the services they receive.
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Assisted Living Services Include:
- Developing a Service Plan for each resident that details, at a minimum, the frequency and timing of assistance. 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 three counties: Sacramento, San Joaquin and Los Angeles. The following is a general description of participants by tier:
Participants in the ALW will have access to four waiver benefits:
- Assisted Living Services (these services are called the Assisted Living Bundle 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 (XLS)
Nursing Facility Transition Care Coordination
- Consumer Education
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PROVIDER INFORMATION
**UNTIL FURTHER NOTICE THERE IS NO NEW PROVIDER ENROLLMENT FOR THE ALW**
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Interested In Becoming A Provider?
New Provider Enrollment for the ALW is closed until further notice.
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
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Assisted Living Bundle:
Tier 1 -- $52/participant/day
Tier 2 -- $62/participant/day
Tier 3 -- $71/participant/day
Tier 4 -- $82/participant/day
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Assisted Care:
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:
ALWPP
Home and Community-Based Services Branch
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