Assisted Living Waiver Pilot Project (ALWPP)
UPDATE: ALWPP has reached its enrollment capacity for the pilot project. Potential providers are still welcome to apply. Beneficiary enrollment will begin again in January, 2009.
Project Description
What is Assisted Living?
Services
Participant Information
Provider Information
Reimbursement Rates
Contact Us
Project Description
The Assisted Living Waiver Pilot Project (ALWPP) 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 Project’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.
ALWPP-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 ALWPP as an alternative to receiving nursing home care. To begin the process of enrolling in the ALWPP, 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 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 is 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 Department of Health Care Services will both 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 Pilot Project (ALWPP) defines assisted living based on the standards set by the national Assisted Living Workgroup (ALW). 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 ALW 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 Pilot Project will have access to seven 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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Translation and Interpretation Services help facilitate the assessment and re-assessment process for limited and non English-speaking clients.
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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.
- Environmental Accessibility Adaptations are physical adaptations to the home required by the client’s Individual Service Plan that are necessary to ensure the health, welfare and/or safety of the client, or enable the client to function with greater independence in the home. Without these services the client would require institutionalization. Such adaptations may include the installation of ramps and grab-bars, widening of doorways, modifications of bathroom facilities, or installation of specialized electric and plumbing systems. This service is only available to residents of publicly-funded housing. Community Transition Services
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The Community Transition Services benefit is available only to individuals who are transitioning from a nursing facility to an Assisted Living setting. The benefit provides assistance with one-time costs associated with establishing a residence.
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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 ALWPP, 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 ALWPP 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 ALWPP 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 ALWPP will have access to seven 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
- Translation and Interpretation Services
- Consumer Education
- Environmental Accessibility Adaptations
- Community Transition Services
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PROVIDER INFORMATION
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Interested In Becoming A Provider?
Residential Care Facilities for the Elderly, Home Health Agencies and Care Coordination Agencies interested in becoming ALWPP providers should click on the appropriate link below to download information on eligibility and expected services.
Interested providers may also want to download and review the that were developed to help potential providers understand the tier structure on which reimbursement for the assisted living and assisted care services are based. The ALWPP includes four service tiers, each with different Reimbursement Rates. The Participant Profiles provide a brief summary of the background and care needs of two randomly selected participants at each tier.
Interested providers should also download and review the )To become an ALWPP provider, you must first complete the Provider Application. If your application is accepted, you will be invited to attend an ALWPP training workshop. After you attend the workshop, you will be required to complete the Medi-Cal Provider Application. These steps are outlined below.
Steps in Becoming a Provider
Step 1: Complete the following ALWPP Application Forms
Step 2: Return completed application forms to the following Address
- Mark Mimnaugh, R.N., CCRN, MPA
Nurse Consultant III
Home and Community-Based Services Branch
1501 Capitol Avenue, MS 4503
PO Box 997419
Sacramento, CA 95899-741
Step 3: Complete a Medi-Cal Provider Application:
All provider applicants are required to complete the forms below. A complete application package includes the application, provider agreement, disclosure statement and all required attachments as stated on the forms. Please read and follow all instructions on each form carefully. Incomplete application packages will be returned and will delay your enrollment in the Medi-Cal program. Only current forms will be accepted as part of the complete application package. Previous versions will not be accepted. The application forms listed below have been recently revised are are available on the Medi-Cal website:http://files.medi-cal.ca.gov/pubsdoco/forms.asp (under "Provider Enrollment")
- Medi-Cal Provider Application (DHS 6204)
- Medi-Cal; Provider Agreement (DHS 6208)
- Medi-Cal Disclosure Statement (DHS 6207)
Step 4: Attend a Provider Training Workshop.
- DHCS will send you notice of the next workshop date
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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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Community Transition: $2,500/participant (only for participants transferring from nursing facility to the community)
- Environmental Accessibility Adaptations: $1,500/participant
- Consumer Education: $22/hour (consumers are limited to 10 hours in their initial year of enrollment)
- Interpretation and Translation: $59/hour (consumers are limited to 4 hours/year)
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Room and Board: ALWPP providers receive room or rent payments from ALWPP waiver participants. The current room and board rate is $936 per month (based on $1055 for Supplemental Security Income (SSI)/State Supplemental Payment (SSP) payments less $119 for the personal needs allowance). RCFEs receive service payment at the assessed tier plus the $936 room and board payment. Public housing providers receive the payment in ALWPP settings where participants receive assisted living services from a home health agency and live in a public housing residenc
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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