Who is Medicaid's fiscal agent?
Consultec, Inc., became the Medicaid fiscal agent in July 1999. Since that time, Consultec was acquired by Affiliated Computer Services, Incorporated (ACS). The Medicaid fiscal agent is in the process of changing its name to ACS State Healthcare. Only the name is changing. All addresses and phone numbers will remain the same. You will hear the Medicaid fiscal agent referred to as ACS State Healthcare, ACS, and Consultec as this transition takes place.

Are there any special qualifications for providers?
An ALF and AFCHs must have a current license. In addition to a current license, an RTF must certify that meets certain size and licensure criteria, it provides on-site care seven days a week, and it does not receive funding from other sources for ACS-type services.

How can facilities enroll?
Providers must complete a Medicaid Provider Enrollment Application and submit it to the respective area Medicaid office for pre-review. The area office will forward it to Medicaid Contract Management and on to Medicaid's fiscal agent for enrollment. The area Medicaid office can provide the appropriate forms, as well as training and assistance with the enrollment process.

What are the responsibilities of the ACS provider?
The assistive care provider has the responsibility to:

• Assist prospective ACS recipients with applications for Medicaid services, if necessary;
• Advise the ACS applicant and recipient of their fair hearing rights and the grievance process;
• Provide an integrated set of services on a 24-hour basis;
• Arrange for health assessments annually or when significant changes occur in an ACS resident's condition;
• Develop and implement a service plan for each recipient;
• Document that the recipient is receiving services from the facility staff on each day for which ACS is billed;
• Maintain up-to-date recipient case records in accordance with the provider handbook and applicable licensure requirements;
• Coordinate other services provided to the consumer, such as hospice, waiver, and Medicare, and avoid duplication of services;
• Provide all ACS recipients with a personal needs allowance in an amount equal to that set by the OSS rule;
• Comply with all provisions of the Medicaid Provider Agreement and the provider handbook; and
• Comply with all licensure requirements applicable to the facility.

How will providers meet the resident assessment requirements?
The assessment requirement for ACS at admission is the same as that required under the applicable licensing rules, with one exception. If the initial assessment does not document the need for at least two of the four ACS service components, the optional Certification of Medicaid Necessity form must also be completed. Subsequently, an assessment must be completed on an annual basis or sooner if the resident has experienced a significant change. The annual assessment must be completed no more than one year plus 15 days after the last assessment. An assessment triggered by a significant change must be completed no more than 15 days after the significant change. The assessment for an ALF or AFCH resident must be completed by a physician or physician assistant or advanced registered nurse practitioner. The assessment for an RTF resident must be completed by a physician or licensed mental health professional. The assessment must document the need for at least two of the four ACS components on a daily basis. Either the DOEA Form 1823 for ALF residents, the DOEA Form 1110 for AFCH residents, or the optional Certification of Medical Necessity form must be used must be used for this purpose.

For residents in qualifying ALFs as of September 1 who have not had an assessment during the previous year, the first annual assessment must be completed by December 31, 2001.

For residents in qualifying AFCHs as of January 1 who have not had an assessment during the previous year, the first annual assessment must be completed by June 30, 2002.

For residents in qualifying RTFs at the time of enrollment whom have not had an assessment during the previous year, the first annual assessment must be completed by March 31, 2002.

How will providers meet the resident service planning requirements?
Every ACS recipient must have a service plan. For RTF residents the requirements are the same as those for treatment and service planning in Rules 64E-4.014 and 64E-4.016, FAC. The information that follows pertains to ALF and AFCH residents. The ALF or AFCH is responsible for developing and implementing the service plan. The service plan must be in writing and be based on the information contained in the assessment. The following components must be included:

• Identifying information (facility name, resident's name and Medicaid identification number, and date);
• Services that addressed all needs identified in the health assessment;
• Level of functioning and assistance needed;
• Service provider;
• Expected outcome of service;
• Signed and dated by facility representative and resident or resident's guardian or designated representative; and
• Updated to reflect current conditions, as necessary.

Providers may use Medicaid's optional AHCA Form 2900 (July 2001), the Resident Service Plan for Assistive Care Services , or other formats provided they include the required components such as a community living support plan, Medicaid Waiver service plan, extended congregate care service plan, or provider's own service plan format.

The service plan must be completed no more than 15 days after the initial health assessment, and a new service plan is required on an annual basis or sooner if a significant change in the recipient's condition occurs, in which case the service plan must be completed no more than 15 days after the required re-assessment.

For residents in ALFs as of September 1 who do not already have a service plan in place, the service plan must be completed by September 30, 2001.

For residents in AFCHs as of January 1 who do not already have a service plan in place, the service plan must be completed by January 31, 2002.

Are there any other new facility requirements?
Finally, the facility must document that the resident was receiving services in the facility on each day billed. The optional Resident Service Log form may be used for this purpose.

What is the ACS payment rate?
The payment rate is $9.28 for each day the recipient was receiving services in the facility. All payments are made by electronic funds transfer.

How will providers be paid?
The provider will submit a claim to the Medicaid fiscal agent for assistive care services provided to the resident. Claims may be submitted at any time after services are provided, but monthly billing is recommended. Claims may be submitted electronically, on paper by mail, or through a billing agent. Enrolled ACS providers who wish to bill electronically should contact their Medicaid fiscal agent field representative to arrange installation and training for the software.

Visit the Medicaid fiscal agent's web site for more information and a listing of field representatives who can assist with billing.

What will this mean for the facility operators?
Medicaid hopes to increase the overall payment operators receive for the services they give to state-supported residents to about $847 per month, a 16 percent increase overall. Medicaid will make direct payments to facilities. OSS payments to individual residents will go down, but the total rate of reimbursement to the provider will be significantly higher.

What will happen if the facility does not enroll in Medicaid?
The reimbursement for OSS residents in ALFs, AFCHs, and qualified RTFs drops to $569.40 per month as of January 2002. If the facility is not enrolled, the new Medicaid funds to enhance the OSS payment cannot be accessed.

What if an enrolled facility closes or changes ownership?
Medicaid provider numbers are not transferable. The provider must notify Medicaid at least 60 days in advance of the change. Contact your Medicaid area office for information about these requirements.

How will residents receiving Medicaid Assisted Living waiver services be affected?
The overall reimbursement for the care of OSS-waiver recipients (currently $1556 per month) residents will be the same. These residents will be eligible for both ACS and ALE waiver payments, but the amount of the waiver payment will be reduced to keep the overall provider reimbursement level the same. Waiver providers will bill for these residents on the same claim form used for the waiver (081) and will use separate billing codes for ACS and waiver services. Billing for non-OSS waiver recipients will not change. The Provider Handbook for the ALE Waiver has been revised and incorporated into a combined Handbook with Assistive Care Services. The new Handbook section for the ALE Waiver may be downloaded from the introductory page of this web site.

ALFs that participate in the Medicaid Assisted Living for the Elderly Waiver do not need to enroll in ACS unless they currently have OSS recipients that are not on the waiver or if they intend to serve low-income residents who do not qualify for the waiver.