DEPARTMENT OF HEALTH AND SOCIAL SERVICES

Division of Medicaid and Medical Assistance

Statutory Authority: 31 Delaware Code,

Section 512 (31 Del.C. §512)

ORDER

Assisted Living Medicaid Waiver Program

Nature of the Proceedings

Delaware Health and Social Services (“Department”) / Division of Medicaid and Medical Assistance initiated proceedings to amend a rule in the Division of Social Services Manual (DSSM) related to the Assisted Living Medicaid Waiver Program. The Department’s proceedings to amend its regulations were initiated pursuant to 29 Delaware Code Section 10114 and its authority as prescribed by 31 Delaware Code Section 512.

The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the October 2005 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by October 31, 2005 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.

Summary of Proposed Change

Statutory Authority

• 42 CFR Subpart G – Home and Community-Based Services: Waiver Requirements

Background

The Assisted Living Medicaid Waiver Program (ALMWP) is a community based residential services program administered by the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD). The ALMWP pays for services for eligible clients living in assisted living facilities who would otherwise need nursing home placement. To be eligible, a client must meet financial and functional criteria.

Summary of Proposed Change

DSSM 20700.4.5: This change provides clarification of an existing policy regarding Medicaid bed hold days for the Assisted Living Medicaid Waiver Program. There are no Medicaid bed hold days for hospitalization.

Summary of Comments Received with Agency Response and Explanation of Changes

The Governor’s Advisory Council for Exceptional Citizens (GACEC) and the State Council for Persons with Disabilities (SCPD) offered the following observations summarized below. DSS has considered the comment and responds as follows:

Historically, DHSS has not paid for “bed hold” days for persons in assisted living facilities participating in the Medicaid assisted living waiver. The reference to a 14-day nursing home bed-hold policy is inaccurate since it was reduced to 7 days a few years ago.

The Councils prefer that the Division maintain a bed hold policy since the short-term continuation of compensation for assisted living services due to resident hospitalization would ostensibly deter loss of the “placement”. However, we endorse the technical amendment which deletes an incorrect reference to a 14-day nursing home bed hold policy.

Agency Response: DMMA thanks the Councils for their endorsement.

Findings of Fact

The Department finds that the proposed changes as set forth in the October 2005 Register of Regulations should be adopted.

THEREFORE, IT IS ORDERED, that the proposed regulation to amend the Division of Social Services Manual regarding the Assisted Living Medicaid Waiver Program is adopted and shall be final effective December 10, 2005.

Vincent P. Meconi, Secretary, DHSS, November 17, 2005

DSS FINAL ORDER REGULATION #05-66

REVISION:

20700.4.5 Illness Or Hospitalization

The assisted living provider shall NOT provide services for an individual that has been bedridden for 14 consecutive days unless a physician certifies that the consumer’s needs may be safely met by the service agreement.

There is no 14 day bed hold day Medicaid payment for hospitalization (20650) as available for nursing facility residents. There are no Medicaid bed hold days for hospitalization.

9 DE Reg. 998 (12/01/05)(Final)