0. Agency for Health Care Administration Assisted Living Facilities
September 23, 2011

1. State & Local Government Roles & Responsibilities
Agency for Health Care Administration
Licensure and Regulation
Medicaid – Assisted Care Services, Various Waivers
Department of Children and Families
Adult Protective Services
Mental Health Clients in ALFs
Specific Medicaid Waiver
Agency for Persons with Disabilities
Developmentally Disabled Clients in ALFs
Attorney General
Medicaid Fraud Control
Patient Abuse, Neglect and Exploitation (PANE)
Operation Spot Check
Health Department
Health & Sanitation Inspections

2. State & Local Government Roles & Responsibilities
Department of Elder Affairs
Rule Development for Assisted Living, Adult Family Care Home, Adult Day Care, Hospice
Comprehensive Assessment and Review of Long-Term Care Services (CARES)
Long-Term Care Ombudsman Program
Statewide Public Guardianship Office
Assisted Living Trainer Certification
Specific Medicaid Waivers
Local Authorities (ALF)
Fire Authority – Fire & Life Safety Approval
Zoning / Building Code Approval &Enforcement

3. Assisted Living Growth
30% Increase in Assisted Living Facilities (ALF) 2, 2,
80% Increase in ALFs with Limited Mental Health
30% Increase in Indigent Beds (Optional State Supplementation – OSS
Over Half of ALF beds have Six or Fewer Beds

4. AHCA Inspections Re-Licensure Surveys - Every Two Years Monitor Visits
Limited Nursing Services License - Twice/Year
Extended Congregate Care License - Quarterly
Complaint Investigations
Prioritize Allegations
Investigate Based on Severity
Priority One – Investigate in Two Days
All Investigated on Average in 27 Days
40% Find Deficiencies
Fee for Complaint Investigations with Deficiencies

5. Regulatory Oversight Revisions
Statewide Complaint Training of Survey Staff
Revised ALF Inspection Process
Focus on Consistency

6. Revised Assisted Living Survey
Enhanced Focus on Residents
Concentration on Interviews, Observations, and Record Review
Improve Consistency/ Revised Regulation (Tags)
Abbreviated Review as Authorized by Law
Two Survey Periods (Four Years)
Consistent Ownership
Survey History
Licensure Complaint History
Ombudsman Complaint History
Largely Based on Wisconsin Model

7. Abbreviated Survey Focus on Resident and Family Feedback
Observations by the Surveyor
Record Reviews Based on Observations and Interviews
Concerns Identified Result in Expanded Sample Selection up to Standard Survey

8. Regulatory Violations / Deficiencies
Class I – Immediate danger or substantial probability that death or serious physician or emotional harm would result. Fine $5,000 to $10,000.
Class II – Directly threaten the physical or emotional health, safety, or security of clients. Fine $1,000 to $5,000.
Class III – Indirectly or potentially threaten physical or emotional health, safety or security of clients. Fine
Class IV – related to maintenance of provider or required reports, forms, or documents that do not negatively affect clients

9. Regulatory Sanctions
Emergency Actions – Limited to Serious Ongoing Issues
(Imposed Before Due Process)
Moratorium
Suspension
Sanctions for Violations
Fines / Conditional Licenses
Denial of License Renewal or Initial Application
Revocation of License
Closure During Litigation
Due Process for Sanctions
Opportunity to Challenge
Agency Has Clear and Convincing Burden of Proof
Actions Pend During Litigation
Imposed by Final Order
May Also Be Challenged
Court Can Enjoin Agency Imposition

10. Consumer Information and Outreach
Florida Health Finder
Consumer Awareness Brochures
Outreach to Partners and Providers
Regulators
Managed Care Plans
Health Care Providers

11. Outreach Activities Interagency Staffing Meetings
Joint Training Activities Include Other Departments
Provider Training
Staff Training
Access to Systems and Data Used by Partners
Joint Visits With Partner Agencies

12. Medicaid Reimbursements in Assisted Living Facilities
Presented by
Darcy Abbott
AHC Administrator
Bureau of Medicaid Services
September 23, 2011

13. Assistive Care Services
Medicaid state plan service provided in assisted living facilities (ALF), adult family-care homes (AFCH), and residential treatment facilities (RTF)
Population – Age 18+
Eligibility – Services medically necessary as determined by a physician or licensed health practitioner; require two of the four service components of Assistive Care Services; and reside in a Medicaid enrolled ALF, RTF, or AFCH
Service Area – Statewide
FY enrollment – 12,130
FY expenditures – $27,240,926
Medicaid maintains the administrative rule for this state plan program.

14. Assistive Care Services
Assistive Care services include:
assistance with activities of daily living,
assistance with instrumental activities of daily living, and
assistance with self administration of medications.
Medicaid reimburses enrolled providers $9.28 per day for assistive care services provided to Medicaid eligible recipients.

15. Assisted Living Waiver
Population – Age 60+
Eligibility – Medicaid Institutional Care Program, and meet additional clinical impairment criteria
Services – case management, assisted living, and incontinence supplies
Service Area – Statewide
FY enrollment – 3,941
FY expenditures – $30,039,071
Managed by the Department of Elder Affairs in cooperation with the Agency for Health Care Administration

16. Assisted Living Waiver Reimbursement
The waiver reimburses for assisted living services and if necessary, incontinence supplies.
Medicaid reimburses up to $32.20 per day for the assisted living facility (ALF) assisted services provided to waiver residents.
Medicaid also reimburses for Incontinence supplies up to $ per month.
Room and board costs detailed in the ALF resident contract are paid by the resident.

17. Nursing Home Diversion Waiver
Population – Age 65+
Eligibility – Medicaid Institutional Care Program, Medicare parts A & B, and meet additional clinical impairment criteria
Services – Case management, and 20 other home and community-based services including assisted living services, 11 acute care services, Medicare co-payments and co-insurance, and unlimited nursing facility care in enrolled facilities
Service Area – 41 counties
17 managed care plans provide services
FY enrollment – 23,158
FY expenditures – $312,771,163
Managed by the Department of Elder Affairs in cooperation with the Agency for Health Care Administration

18. Nursing Home Diversion Reimbursements in ALFs
The Nursing Home Diversion waiver serves eligible aged adults who can be safely served in standard licensed assisted Living facilities (ALFs).
Assisting Living services under this waiver include personal care, homemaker, escort, medication administration, adult companion, and other medically necessary long term cares services
Plan members select ALFs available in each Nursing Home Division provider’s network.
ALFs negotiate daily or monthly rates for services provided in the facility with each Nursing Home Diversion plan.
Room and board costs detailed in the ALF resident contract are paid by the resident.

19. Questions ??