Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Service Criteria

12/01/2003

To be eligible for Assistive Care Services individuals must need an integrated set of services on a 24-hour basis and must have a health assessment establishing the medical necessity of at least two of the program's four service components, which are described below.8

  • Health Support Component--defined as requiring the provider to observe the recipient's whereabouts and well-being on a daily basis; remind the recipient of any important tasks on a daily basis; and record and report any significant changes in the recipient's appearance, behavior, or state of health to the recipient's health care provider, designated representative, or case manager.

  • Assistance with Activities of Daily Living (ADLs) Component--defined as providing individual assistance with ambulating, transferring, bathing, dressing, eating, grooming, and toileting. At least one service component must be required daily.

  • Assistance with Instrumental Acts of Daily Living (IADLs) Component--defined as providing intensive assistance with shopping for personal items, making telephone calls, and managing money.

  • Assistance with Self-Administration of Medication Component--defined as assistance with or supervision of self-administration of medication at least daily in accordance with licensure requirements applicable to the facility type.


8. Chapter 59G-1.010, Florida Administrative Code, defines medical necessity as medical or allied care, or services furnished or ordered that must be necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.

View full report

Preview
Download

"med4rcs.pdf" (pdf, 3.73Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®