State Residential Care and Assisted Living Policy: 2004. TABLE 2-6. Comparison of State Reimbursement Policy
State
Coverage
Payment
Method
Rates
Rates
Include
R&B
R&B
Limits
Family
Supplement ...
State Residential Care and Assisted Living Policy: 2004. TABLE 2-5. Staff Training Requirements (see note)
State
Initial
Annual
State
Initial
Annual
State
Initial
Anaual
AL
Topics
Topics...
State Residential Care and Assisted Living Policy: 2004. TABLE 2-4. Requirements for Resident Agreements
TABLE 2-4. Requirements for Resident Agreements
AL
AK
AZ ...
State Residential Care and Assisted Living Policy: 2004. TABLE 2-3. Requirement for Facilities Serving Residents with Dementia
TABLE 2-3. Requirement for Facilities Serving Residents with Dementia
AL
AK
AZ ...
State Residential Care and Assisted Living Policy: 2004. TABLE 2-2. Comparison of State Residential and Assisted Living Regulations: Characteristics
State
Category
Size
Definition 1
Apt
Required
Sharing
by
Choice? 2
Max #
Occupants
Size-
Single
Size...
State Residential Care and Assisted Living Policy: 2004. TABLE 2-1. Comparison of State Residential and Assisted Living Regulations: Supply
State
Category
2004
2002
2000
CoN
Facilities
Units/Beds
Facilities ...
State Residential Care and Assisted Living Policy: 2004. Notes
The data were reported by state licensing agencies. Partial information was reported for some categories in Delaware, Kentucky, Minnesota, New Jersey, New York, New Mexico and West Virginia. (See Table 2-1 in Section 2 for each state's information.) While these numbers do not include facilities licensed by state Mental Retardation/Developmental...
State Residential Care and Assisted Living Policy: 2004. Expanding the Supply of Assisted Living for Low-Income Individuals
Both federal and state governments recognize that, in order to reduce costly institutionalization, a range of supportive housing and service options is needed. An increasing number of persons 65 and older who can no longer live independently view assisted living as a preferred alternative to nursing home care, or as a means to forestall admission...
State Residential Care and Assisted Living Policy: 2004. Adequacy of Rates
At first glance, it appears that states are paying markedly different rates for services, suggesting that some states may not be paying rates that are adequate to meet residents' service needs. However, it is not possible to compare service rates across states due to significant differences in their admission and retention criteria for residential...
State Residential Care and Assisted Living Policy: 2004. Cost-Based Reimbursement and Fee-for-Service Rates
Cost-based reimbursement pays the facility for aggregate costs incurred for Medicaid eligible residents for allowable services....
State Residential Care and Assisted Living Policy: 2004. Rates Based on Case-Mix Systems
Several states have adopted payment systems based on their nursing home case-mix methodology. Like tiered rate approaches, the case-mix approach creates incentives to serve more impaired residents by linking reimbursement to the level of care needed. Case-mix approaches typically have more categories that tiered rates. The case-mix approach requir...
State Residential Care and Assisted Living Policy: 2004. Flat Rates that Vary by Setting
States may vary its flat rates for different types of residential care settings. Texas pays a higher rate for apartment and other private occupancy settings, reflecting the states' preference for these settings. Varying rates by setting may reflect differences in the average level of resident service needs in each setting. For example, a state may...
State Residential Care and Assisted Living Policy: 2004. Flat Rates
Under a flat rate system, providers receive the same monthly payment regardless of the amount of services and staff assistance a resident requires. As in the health care system, flat rates for residential care create incentives for facilities to admit residents with lighter care needs, not those with multiple impairments in ADLs, cognitive impairm...
State Residential Care and Assisted Living Policy: 2004. State Approaches to Reimbursing Services
The extent to which low-income older people have access to residential care settings as an alternative to nursing homes depends in large part on the extent to which states use Medicaid to cover services in these settings and providers' views on the adequacy of Medicaid's service reimbursement rates. In addition to the amount of the payment, the re...
State Residential Care and Assisted Living Policy: 2004. Time Frame for Determining Medicaid Eligibility
Some states may not determine eligibility for services until financial eligibility has been determined, a process that can take up to 45 days. An extended time frame for determining Medicaid eligibility can be a major deterrent to participation in the Medicaid program, because providers will generally not want to admit someone if they are unsure a...
State Residential Care and Assisted Living Policy: 2004. State Policy Regarding Room and Board Payments
About half of the states limit the amount that facilities can charge Medicaid beneficiaries for room and board--usually to an amount equal to the federal SSI payment plus a state supplement (if offered). Others do not restrict the amount that can be charged, but providers need to understand their states' income eligibility rules and cost sharing r...
State Residential Care and Assisted Living Policy: 2004. Waiting Lists
Some states have long waiting lists for waiver services, which can present a significant obstacle to serving Medicaid beneficiaries in assisted living. If waiver slots are not available, Medicaid-eligible persons who cannot be served at home will need to enter a nursing home (if they meet the state's nursing home level of care criteria) and the as...
State Residential Care and Assisted Living Policy: 2004. Types of Waivers
As discussed earlier, states can cover services in residential care settings through a waiver program that provides services in the full range of home and community settings, or through a waiver that covers services only in residential care settings. The type of waiver can affect the pattern of referrals. States that include assisted living as one...
