department of health and social services

Division of Medicaid and Medical Assistance

PROPOSED

PUBLIC NOTICE

Assisted Living Medicaid Waiver Program

In compliance with the State's Administrative Procedures Act (APA - Title 29, Chapter 101 of the Delaware Code) and under the authority of Title 31 of the Delaware Code, Chapter 5, Section 512, Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) is proposing to amend a rule in the Division of Social Services Manual (DSSM) related to the Assisted Living Medicaid Waiver Program.

Any person who wishes to make written suggestions, compilations of data, testimony, briefs or other written materials concerning the proposed new regulations must submit same to Sharon L. Summers, Policy and Program Development Unit, Division of Medicaid and Medical Assistance, 1901 North DuPont Highway, P.O. Box 906, New Castle, Delaware 19720-0906 by October 31, 2005.

The action concerning the determination of whether to adopt the proposed regulation will be based upon the results of Department and Division staff analysis and the consideration of the comments and written materials filed by other interested persons.

Summary of Proposed Change

Statutory Authority

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 Changes

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.

DSS PROPOSED REGULATION #05-49

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.