AAU Provider Update: Member Choice Regarding Medicare Services in AL

To: All ADvantage Assisted Living Facilities and Case Management Providers with an Assisted Living case

While residing in the Assisted living, it may become necessary for the Member to receive skilled nursing services that may be outside the scope of what the "Assisted Living" can provider. Some Assisted Living facilities have a preferred list of Medicare agencies to choose from, while others do not. Many Assisted Living facilities choose to limit the amount of providers doing business in the assisted living, due to OAC Policy 317:30-5-763(17)(A) stating they are responsible for coordinating services provided by third parties to ADvantage members in the assisted living. It should be noted that while this is a preferred list, from the assisted living facility; it is not a mandatory list for an ADvantage Member. ADvantage Members always have freedom of choice of any service provider and they may choose their services from any Medicare agency of their choice.

If you have any questions or concerns regarding the information provided above, please feel free to contact us via email at Provider Questions.