The Department of Health Care Services has announced its intent to amend the Assisted Living Waiver (ALW) to include a new “Tier 5″ level of care. The current ALW provides a Medi-Cal benefit for residents of Residential Care Facilities for the Elderly in ten counties: Sacramento, San Joaquin, Los Angeles, Sonoma, Fresno, San Bernardino, Contra Costa, Alameda, San Diego and Riverside. The current system includes four tiers raging in a daily reimbursement of $52 to $82/per patient/per day.
The new Tier 5, as proposed, would provide “for the maximum amount of waiver and protective supervision services. Tier five is designed to provide a community residential alternative for beneficiaries whose physical, mental and cognitive disabilities make placement inappropriate or unmanageable in other facilities, such as skilled nursing facilities, Institutions for the Mental Diseases, Intermediate Care Facilities for persons with intellectual disabilities, or in tiers one through four of the ALW. Beneficiaries eligible for tier five will need to have demonstrated one or more failed placements in the past, but has demonstrated that they can successfully reside in a supervised community setting. Tier five is being designed to provide extensive physical, behavioral, cognitive, communicative, social and psychosocial treatments and supervision for those ALW-eligible beneficiaries such as those with severe traumatic brain injury.”
A public review and comment period via teleconference will be scheduled for later this summer. To download the Fact Sheet, click here. For more information on the Assisted Living Waiver, visit the DHCS website.
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