Home care billing · AL
Home care billing in Alabama
Short answer
Home care billing in Alabama is fee-for-service to the Medicaid fiscal agent, with the operating agency's plan behind every waiver claim.
There is no Medicaid MCO for home care: the Department of Senior Services runs the Elderly and Disabled and ACT waivers through case managers' Plans of Care, and the Department of Mental Health runs the intellectual disability waivers through support coordinators and Person-Centered Plans. A clean claim must reach the fiscal agent within one year of the date of service, and a returned claim does not count. A dedicated Remitwright biller bills against each plan and keeps claims clean and inside the year, serving Alabama agencies remotely. Rules for other states are on the home care billing by state page.
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Key facts for Alabama home care billing
| Fact | In Alabama | Source |
|---|---|---|
| Programs that pay | Elderly and Disabled Waiver (0068.R08.00); Alabama Community Transition Waiver (ACT, 0878.R02.00); State of Alabama Independent Living Waiver (SAIL, 0241.R06.00); Technology Assisted Waiver (TA, 0407.R04.00); Intellectual Disabilities Waiver (0001.R10.00) and Living at Home Waiver (LAH, 0391.R05.00); Community Waiver Program (CWP, 1746.R00.00) | 1 |
| How it is delivered | Fee-for-service, with care coordination layered on top | 2 |
| Medicare home health and hospice | Palmetto GBA, Jurisdiction M | 10 |
Programs that pay for home care in Alabama1
Elderly and Disabled Waiver (0068.R08.00)
Personal care, homemaker, skilled nursing, skilled and unskilled respite, adult companion service, adult day health with or without transportation, case management, home delivered meals, home modification, medical supplies, assistive technology and durable medical equipment, personal emergency response system installation and monthly monitoring, pest control and supervisory visits, for people 65 and older and people with physical or other disabilities of any age who meet a nursing facility level of care.
The 2024 CMS tables place people on this waiver who meet nursing home level of care in the Integrated Care Network, a primary care case management entity run by Alabama Select Network that provides case management only.
Alabama Community Transition Waiver (ACT, 0878.R02.00)
Personal care, personal assistant service, homemaker, skilled nursing, skilled and unskilled respite, adult companion service, adult day health, case management, home delivered meals, home modifications, medical supplies, assistive technology, personal emergency response system installation and monthly fee, pest control and transitional assistance, for people 65 and older and people with physical or other disabilities of any age who meet a nursing facility level of care.
Chapter 560-X-44 of the Alabama Medicaid Administrative Code calls the ACT Waiver a cooperative effort between the Alabama Medicaid Agency and the Alabama Department of Senior Services, for people moving out of a nursing facility or whose current HCBS program no longer meets their needs. Its case managers develop the Plan of Care, and ADSS or its designee enrolls waiver providers.
State of Alabama Independent Living Waiver (SAIL, 0241.R06.00)
Personal care, personal assistance service, unskilled respite, case management, medical supplies, assistive technology with evaluation, repairs and minor items, environmental accessibility adaptations, personal emergency response system installation and monthly fee, and pest control, for people with physical disabilities ages 18 to 63 who meet a nursing facility level of care.
Technology Assisted Waiver (TA, 0407.R04.00)
Personal care and attendant services, private duty nursing, assistive technology, individual directed goods and services, medical supplies and pest control, for technology dependent adults 21 and older who meet a nursing facility level of care.
Intellectual Disabilities Waiver (0001.R10.00) and Living at Home Waiver (LAH, 0391.R05.00)
Personal care, respite, adult companion services, skilled nursing, day habilitation, prevocational services, employment support and supported employment transportation, benefits and career counseling, community experience and assistance in community integration, crisis intervention, positive behavior support, remote supports, occupational, physical and speech and language therapy, specialized medical supplies, assistive technology, environmental accessibility adaptations, housing stabilization, individual directed goods and services and a personal emergency response system, with residential habilitation and supported living in the Intellectual Disabilities Waiver, for people with intellectual disabilities ages 3 and older who meet an ICF/IID level of care.
Operated through the Alabama Department of Mental Health's Division of Developmental Disabilities, whose Office of Support Coordination guides the 310 Boards that coordinate waiver services from each person's level of care and assessed needs; the DMH Call Center is the point of contact for screening and the waiting list.
Community Waiver Program (CWP, 1746.R00.00)
Personal assistance at home and in the community, skilled nursing, breaks and opportunities (respite), community-based residential services, adult family home, supported living, independent living skills training, community integration connections and skills training, integrated employment path services, individual and small group supported employment, co-worker supports, remote supports, positive behavior supports, peer specialist services, occupational, physical and speech and language therapy, natural support or caregiver education, financial literacy and work incentives benefits counseling, housing counseling and start-up assistance, minor home modifications, assistive technology and adaptive aids, community transportation, individual directed goods and services and support coordination, for people with intellectual disabilities ages 3 and older who meet an ICF/IID level of care.
Chapter 560-X-43 requires each service to be justified and documented in the Person-Centered Plan, confirmed by the Support Coordinator, and repeats the 12-month claim filing rule for CWP services.
How the program is delivered
Fee-for-service, with care coordination layered on top. Alabama has no Medicaid MCO: the 2024 CMS state tables list two statewide primary care case management entity programs, the Alabama Coordinated Health Network (since October 1, 2019, under 1915(b), seven network entities each serving one region, with mandatory enrollment for most groups) and the Integrated Care Network (since October 1, 2018, under 1915(b) and 1915(c), run by Alabama Select Network for people at nursing home level of care in skilled nursing facilities and on the Elderly and Disabled and Alabama Community Transition waivers), plus PACE through Mercy Life of Alabama. Neither PCCM program's benefit grid includes HCBS waiver services, home health or personal care, so those claims bill the Medicaid fiscal agent.2 PACE is the one program in the tables whose grid includes home health, personal care, private duty nursing and hospice, for voluntary enrollees who are aged, blind or disabled or full duals. Waiver providers are enrolled and overseen through the operating agency: the Department of Senior Services for the ACT Waiver under Chapter 560-X-44, and the Department of Mental Health for the intellectual disability waivers.
Electronic visit verification
Alabama attested to CMS that EVV covers personal care services in its 1915(c) home and community-based services waivers and its 1915(j) self-directed personal attendant care, and CMS accepted that attestation on January 7, 2021, so federal match reductions do not apply to those services; Medicaid.gov lists the state compliant for personal care EVV by January 1, 2021 and for home health EVV as of January 1, 2024.6 The same letter records that Alabama was then using its 1915(c) waivers to meet the EPSDT personal care mandate for children under 21 and was preparing to move those services to the 1905(a)(24) state plan benefit in 2021, with CMS asking the state to update its survey once it did. Confirm your system's connection and the visit data it must send with the Alabama Medicaid Agency and the operating agency before the first claim, and keep the six data points the Cures Act requires, as Medicaid.gov's EVV page lists them (type of service, recipient, date, location, caregiver, and start and end time), on every visit.
Services under EVV6
- Personal care services under the 1915(c) home and community-based services waivers
- Self-directed personal attendant care under section 1915(j)
- Home health care services, which Medicaid.gov lists Alabama as compliant for as of January 1, 2024
Authorizations
Through the operating agency's case manager or support coordinator. Under Chapter 560-X-44 the ACT Waiver is a cooperative effort between the Alabama Medicaid Agency and the Alabama Department of Senior Services, case managers employed by or under contract with the operating agency develop the Plan of Care and monitor the waiver and non-waiver services in it, personal care is delivered by a certified home health agency or another agency the Medicaid Commissioner approves under the case manager's supervision, and services depend on individual need as set out in the Plan of Care.3 In the Community Waiver Program (Chapter 560-X-43) each service must be justified and documented in the Person-Centered Plan and confirmed by the Support Coordinator, support coordination is itself the case management service, and ADMH's Office of Support Coordination guides the 310 Boards that coordinate waiver services from each person's level of care and assessed needs. The CMS tables add that the Integrated Care Network provides case management for people at nursing home level of care on the Elderly and Disabled and ACT waivers. The plan the case manager or support coordinator writes is what an agency bills against.
Where the claims go
Electronically to the Medicaid fiscal agent, as clean claims received within one year of the date of service under rule 560-X-1-.17. A claim without enough information to enter the claims processing system is returned to the provider and does not count as timely, and a clean claim received late is denied as outdated unless an exception applies: 120 days from the notice date of a Medicare or other third-party disposition with the denial attached, one year from the award notice when eligibility is retroactive, or 120 days from a recoupment date with the explanation of payment attached, except recoupments from medical record reviews or investigations, which are final.9 A provider denied as outdated may request an administrative review in writing within 60 days of the claim becoming outdated, with documentation of its good-faith attempts to be paid and an error-free claim ready to process, and may request a fair hearing within 60 days of an adverse review decision; a claim that fails every remedy cannot be collected from the recipient or the family. The fiscal agent must process clean claims within 12 months of receipt, and Chapter 560-X-43 repeats the 12-month filing rule for Community Waiver Program services. PACE enrollees are the PACE organization's members for every covered service.
Medicare home health and hospice in Alabama
Palmetto GBA, the A/B MAC for Jurisdiction M, processes Medicare home health and hospice claims for Alabama along with Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Texas, while its Part A and Part B work covers North Carolina, South Carolina, Virginia and West Virginia.10 On the Medicaid side, CMS lists Alabama compliant with the Cures Act home health EVV requirement as of January 1, 2024, a year after the federal deadline. The ACT Waiver rule has personal care delivered by certified home health agencies or other agencies the Medicaid Commissioner approves, and PACE is the only coordinated program in the CMS tables whose benefit grid carries home health and hospice.
Common rejections in Alabama, and the fix
Claim returned to provider instead of adjudicated
The fixRule 560-X-1-.17 says a claim without enough information to enter the claims system is returned and never counts as a timely clean claim, so the filing clock keeps running. The biller scrubs every required field before release and treats a return as an urgent rework, not a pending item.
Clean claim received more than one year after the date of service
The fixThe fiscal agent denies it as outdated. The biller files as soon as the plan confirms the service, keeps the three exceptions (120 days from a third-party notice with the denial attached, one year from a retroactive award notice, 120 days from a recoupment with the EOP attached) for the cases they cover, and requests administrative review within 60 days when the claim was first filed in time.
Waiver service billed before the Plan of Care or Person-Centered Plan allowed it
The fixIn the ACT and Elderly and Disabled waivers services depend on individual need as set out in the case manager's Plan of Care, and in the Community Waiver Program each service must be justified and documented in the Person-Centered Plan. The biller reconciles delivered units to the plan before each claim and asks the case manager or support coordinator for a revision first.
Personal care or waiver claim sent to the ACHN or the Integrated Care Network
The fixBoth are primary care case management entities whose benefit grid in the CMS tables holds case management only, so neither pays a home care claim. The biller bills the Medicaid fiscal agent fee-for-service and keeps the network's care coordinator in the loop on the account.
Recouped claim resubmitted too late or after a program integrity review
The fixA resubmitted clean claim has 120 days from the recoupment date with the EOP attached, and recoupments from medical record reviews or investigations are final and cannot be resubmitted. The biller dates each recoupment on the account and files the corrected claim inside that window.
Provider not enrolled with the operating agency for the waiver
The fixADSS or its designee enrolls ACT Waiver providers that meet the waiver's licensure or certification requirements, and the intellectual disability waivers run through ADMH and the 310 Boards. The biller confirms enrollment with the operating agency for each waiver before the first visit is scheduled.
Remitwright serves Alabama home care and home health agencies remotely, inside the agency software you already use, with a dedicated biller.
FAQ
Questions from Alabama agencies
Who authorizes our Elderly and Disabled or ACT Waiver hours in Alabama?
How long do we have to file an Alabama Medicaid claim?
Our claim was returned, not denied. Does that count as filed?
Which Alabama waivers pay for personal care and in-home supports for people with intellectual disabilities?
Does Alabama Medicaid run managed care for home care?
Which of our services are under EVV in Alabama?
Which EVV system does Alabama require for home care visits?
Which Medicare contractor pays home health and hospice claims in Alabama?
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