reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.055 - Community First Choice services agency decertification and disenrollment

Current through May 31, 2024
(a) The department may deny an application to
				renew certification of, will suspend certification of, or will decertify and
				disenroll a Community First Choice services agency as a provider
(1) if the agency does not submit an
				application for renewal in accordance with or meet the requirements of
				7 AAC 127.050;
(2) if the agency does not meet the
				requirements in the
Personal Care Services and Community First Choice
				Personal Care Services Provider Conditions of Participation,
adopted
				by reference in
				7 AAC 160.900;
(3) if the agency does not meet the
				requirements of this chapter;
(4)
				for grounds and under procedures set out in
				7 AAC 105.400 -
				7 AAC 105.490;
(5) if the agency is no longer qualified for
				certification under 7 AAC 105 -7 AAC 160;
(6) if the department determines under
				7 AAC 10.900 - 7 AAC 10.990 that a barrier crime or
				condition exists with respect to an employee of a provider agency or revokes a
				background check under
				7 AAC 10.945, and the provider agency does not terminate
				association with the employee in accordance with
				7 AAC 10.960, unless the department grants a redetermination
				under
				7 AAC 10.927 or grants a variance under 7 AAC 10.930 or 7
				AAC 10,935;
(7) for a reason stated
				in
				7 AAC 127.050(e); or
(8) if the department determines a Community
				First Choice services agency misrepresented the recipient's physical condition,
				or need for Community First Choice services, for the purpose of obtaining
				services for which the recipient is able to perform or for which the recipient
				does not quality.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.060 - Responsibilities of personal care assistants providing Community First Choice personal care services

Current through May 31, 2024
(a) A personal care
				assistant employed by an agency providing Community First Choice personal care
				services shall maintain, for Medicaid billing purposes, a contemporaneous
				record of services provided to each recipient. The record must include
(1) a copy of the service level authorization
(A) signed by, or bearing the legal mark of,
				the recipient, the recipient's representative, or the representative's designee
				appointed in accordance with 7 AAC 127.115(c); and
(B) signed by the department;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.070 - Provider termination of services to a recipient

Current through May 31, 2024
(a) Not later than
				30 days before a provider of Community First Choice services terminates
				services to a recipient, the provider agency shall send written notice of
				service termination to the department, the recipient, and the recipient's care
				coordinator.
(b) A provider agency
				may terminate services to a recipient without the notice required in (a) of
				this section if the provider agency has evidence that
(1) continuing services to the recipient will
(A) jeopardize the safety of the provider, an
				employee of the provider, or an individual receiving services from the
				provider: or
(B) endanger the
				health, safety, and welfare of the recipient; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.075 - Community First Choice personal care services; place of service

Current through May 31, 2024
(a) The department
				will pay for Community First Choice personal care services for a recipient only
				if provided
(1) in the recipient's residence
				if that residence is
(A) the dwelling that the
				recipient considers to be the recipient's established or principal home and to
				which, when absent, the recipient intends to return; and
(B) real or personal property that is fixed
				or mobile and that is located on land or water, if the living conditions are
				appropriate for the needs of the recipient, including adequate arrangements for
				handwashing and waste disposal;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.085 - Personal emergency response system services

Current through May 31, 2024
(a) The
				department will pay for a personal emergency response system that
(1) is supported by a prescription or other
				written documentation required by the department's
Specialized Medical
				Equipment Fee Schedule,
adopted by reference in 7 AAC 160.900,
(A) from an individual qualified to practice
				under AS 08 or 7 A AC 105.200(c) as
(i) a
				physician, including an osteopath;
(ii) a physician assistant;
(iii) an advanced practice registered
				nurse;
(iv) an occupational
				therapist; or
(v) a physical
				therapist; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.087 - Chore services

Current through May 31, 2024
(a) The department
				will pay for chore services that
(1) comply
				with the department's
(A)
Provider
				Conditions of Participation for Home and Community-Based Waiver Services and
				Community First Choice Chore Services,
adopted by reference in
				7 AAC 160.900; and
(B)
Community First Choice Chore
				Services Conditions of Participation,
adopted by reference in
				7 AAC 160.900;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.090 - Service level authorization and reauthorization for Community First Choice personal care services

Current through May 31, 2024
(a) For each
				recipient, based upon that recipient's assessment conducted under 7 A AC
				127.030, the department will
(1) determine
				the level of assistance necessary for and the amount, duration, and frequency
				of the specific Community First Choice personal care services for which the
				department will pay using the
Community First Choice Personal Care
				Services: Service Level Computation,
adopted by reference in 7 AAC
				160,900; and
(2) develop a
				Community First Choice personal care service level authorization that
				identifies the specific ADLs, lADLs, and other services covered for the
				recipient under 7 AAC 127.040.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.095 - Amendments to service level authorization for Community First Choice personal care services

Current through May 31, 2024
(a) The department will increase or reduce
				the time authorized for Community First Choice personal care services before
				the end of a recipient's current authorization period if the department
				determines that
(1) a recipient has
				experienced a change that alters the recipient's need for assistance with ADLs,
				lADLs, or other covered services after the recipient's last assessment or
				amendment to the service level authorization;
(2) the recipient's living environment,
				support services, or informal supports or caregivers changed after the
				recipient's last assessment: or
(3)
				the recipient received Community First Choice services that are no longer
				authorized under 7 AAC 105-7 AAC 160.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.105 - Employment of Community First Choice personal care services personal care assistants; qualifications

Current through May 31, 2024
(a) To receive payment for Community First
				Choice personal care services, a personal care assistant must be employed in
				either a consumer-directed program or an agency-based program, and must
(1) be at least !8 years of age;
(2) comply with the requirements of this
				chapter; and
(3) have on file
				documentation of successful completion of training to assist a recipient to
				learn the skills necessary to perform independently the persona! care services
				specified in a recipient's service level authorization, in addition to training
				requirements in 7 AAC 125.090.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.115 - Consumer-directed and agency-based Community First Choice personal care services; safety of recipients; safety of employees

Current through May 31, 2024
(a) An agency
				certified, in accordance will 7 AAC 127.050, as a provider of Community First
				Choice personal care services shall
(1)
				protect a recipient's health, safety, and welfare while rendering services
				under this chapter; and
(2) provide
				training for all employees regarding
(A) the
				mandatory reporting requirements of AS 47.17.020 for children and AS 47.24.010
				for vulnerable adults;
(B) the
				critical incident reporting requirements of 7 AAC 127.155.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.125 - Consumer-directed Community First Choice personal care services; recipient requirements

Current through May 31, 2024
(a) To qualify for Community First Choice
				personal care services through a consumer-directed program, a recipient,
				recipient's representative, or representative's designee, identified in
				accordance with (e)(2) of this section, must
(1) demonstrate cognitive capacity for
				decision-making;
(2) understand the
				impact of, and assume responsibility for, managing and training the recipient's
				persona! care assistants;
(3)
				designate a provider agency that administers a consumer-directed Community
				First Choice personal care services program to fulfill the responsibilities of
				7 AAC 127.130 on behalf of the recipient;
(4) cooperate with or the department in
				reviews of the recipient's level-of-care assessment, support plan, and service
				level authorization;
(5) cooperate
				with the department and with other state and federal oversight agencies during
				compliance reviews, investigations, or audits; and
(6) negotiate a contract for the recipient's
				Community First Choice personal care services with the personal care services
				provider agency that will administer those services through a consumer-directed
				program.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.130 - Consumer-directed Community First Choice personal care services; provider agencies

Current through May 31, 2024
(a) In addition lo meeting the requirements
				under this chapter, a personal care services agency that administers a
				Community First Choice consumer-directed program shall
(1) perform, at least once every six months,
				a review of the recipient's services, including
(A) interviewing the recipient at the
				recipient's residence to evaluate whether services were provided as authorized,
				and that those services meet the recipient's continuing needs;
(B) interviewing the recipient's personal
				care assistant to evaluate the service records, including timesheets and case
				notes prepared by the recipient's personal care assistant;
(C) documenting in the recipient's record if
				the review concludes that the services provided are consistent with the
				recipient's Community First Choice support plan; and
(D) submitting to the department an amendment
				to the recipient's Community First Choice support plan when the recipient's
				needs change sufficiently to warrant an amendment;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.135 - Agency-based Community First Choice personal care services; personal care assistant education and training requirements; supervising registered nurse

Current through May 31, 2024
An agency that manages an agency-based Community First Choice
				  personal care services program shall
(1) employ personal care assistants that meet
				the requirements of 7 AAC 125.160; and
(2) retain a supervising licensed registered
				nurse and meet the requirements under 7 AAC 125.170.
Authority:
AS 47.05.010
AS 47.07.030
AS 47.07.036
AS 47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.145 - Reporting recipient changes

Current through May 31, 2024
(a) A recipient
				shall report to each of the recipient's Community First Choice services
				providers and the recipient's care coordinator any of the following changes by
				telephone, by facsimile transmission, by electronic mail, in writing, or in
				person not later than 15 days after the recipient knows of the change:
(1) a change in the recipient's
(A) place of residence or living
				an-arrangement;
(B) personal
				contact information;
(C)
				representative;
(D) medical
				provider; or
(E) marital
				status;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.155 - Critical incident reporting

Current through May 31, 2024
(a) A provider of
				Community First Choice personal care services shall report to the department,
				in a format provided by the department, a critical incident involving a
				recipient not later than one business day after observing or learning of the
				critical incident.
(b) A provider
				agency shall develop and implement a system to manage and report critical
				incidents that includes
(1) methods for
				identifying a critical incident;
(2) a protocol for emergency response to a
				critical incident;
(3) procedures
				for investigating and analyzing a critical incident to determine its
				cause;
(4) a plan to ensure that
				each member of the provider's staff is trained in critical incident management
				and reporting; and
(5) a process
				that ensures timely reporting of a critical incident
(A) to the department and the recipient's
				representative; and
(B) to other
				service providers when necessary to protect recipient health, safety, and
				welfare; the provider shall maintain a record of names of the providers that
				are sent incident reports and the date sent.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.160 - Use of restrictive intervention

Current through May 31, 2024
(a) A Community
				First Choice personal care assistant may use restrictive intervention only
(1) as a response when a recipient presents
				an imminent danger to the recipient's safety or to the safety of
				others;
(2) when other types of
				interventions have been tried, and documented as ineffective for safe
				management of the recipient's behavior that requires intervention;
				and
(3) if the type of intervention
				is safe, proportionate to the recipient's behavior, and appropriate to the
				recipient's chronological and developmental age, size, gender, and physical,
				medical, and psychological condition,
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.165 - Community First Choice personal care services review and appeal rights

Current through May 31, 2024
(a) A
				recipient that is terminated From an agency-based Community First Choice
				personal care services program may appeal that termination through the
				complaint process established by the Community First Choice personal care
				services agency.
(b) If the
				assessment under 7 AAC 127.030 indicates that an individual is not capable of
				managing consumer-directed personal care services because of a lack of
				cognitive capacity, or if a recipient is terminated from a consumer-directed
				personal care services program because the recipient lacks cognitive capacity
				to manage personal care services, the recipient may request a hearing under 7
				AAC 49.
(c) A recipient may request
				a hearing under 7 AAC 49
(1) for a decision by
				the department to
(A) reduce or end the time
				allowed for a Community First Choice personal care services covered activity on
				the recipient's current service level authorization in accordance with 7 AAC 127.095;
(B) deny time on a service
				level reauthorization for a Community First Choice personal care services
				activity that was included in a previous service level authorization if that
				activity is listed in 7 AAC 127.040;
(C) terminate the recipient's authorization
				to receive Community First Choice personal care services in accordance with 7 AAC 127.095; or
(D) deny Community
				First Choice personal care services, after review of an initial application
				under 7 AAC 127.030, because the recipient does not qualify for those services;
				or
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 127 - Community First Choice Personal Care Services › 7 AAC 127.990 - Definitions

Current through May 31, 2024
In this chapter, unless the context requires
				  otherwise
(1) "ADL" means activity of
				daily living;
(2) "agency-based
				program" means a program that provides Community First Choice personal care
				services to a qualified recipient who is unable Lo manage those services
				because or cognitive capacity or a documented hi story or self-neglect or who
				chooses not to take responsibility for managing those services;
(3) "assessment" means the process by which
				the department, using an assessment tool specified by recipient category in
				7 AAC 130.215, determines if an applicant meets a level
				of care necessary to qualify for home and community-based waiver
				services;
(4) "business day" means
				a day other than Saturday, Sunday, or a legal holiday under
				AS
				44.12.010;
(5) "Community First Choice personal care
				service level authorization" or 'service level authorization" means the
				authorization to provide personal care services for a recipient that was
				developed under
				7 AAC 127.090, with any amendment Linder
				7 AAC 127.095. and approved by the department;
(6) "consumer-directed program" means a
				program that provides Community First Choice personal care services to a
				qualified recipient, and that recipient or either the recipient's
				representative or the representative's designee is responsible for managing
				those services;
(7) "cueing" means
				verbal or physical guidance, provided at the time an activity is to be
				performed, that services as a signal to a recipient to perform the
				activity;
(8) "lADL" means
				instrumental activity of daily living;
(9) "natural supports" means
(A) individuals that voluntarily and without
				payment provide care and supports for the recipient; and
(B) the care and supports that are
(i) provided voluntarily and without pay for
				a recipient; and
(ii) similar to
				and supplemented by personal care services;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 128 - Long-Term Services and Supports Targeted Case Management › 7 AAC 128.010 - Long-term services and supports targeted case management

Current through May 31, 2024
(a) The services
				provided under this section must assist and enable an individual eligible under
				7 AAC 125.010 - 7 AAC 125.199, 7 AAC 127, or 7 AAC 130 to access necessary
				medical, social, educational, developmental, and related services,
(b) The department will pay for the long-term
				services and supports targeted case management services as specified in 7 AAC 145.290 for
(1) the following, prepared and
				submitted in a format provided by the department:
(A) one initial application for home and
				community-based waiver services or Community First Choice services; the
				department may approve one additional application for an individual who does
				not qualify for services based on the individual's first application;
(B) one initial support plan for home and
				community-based waiver services and Community First Choice services;
(C) annual renewal support plans for home and
				community-based waiver services and Community First Choice services;
				and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.105 - Recipient eligibility (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.110 - Recipient enrollment and disenrollment for FASD/SED waiver services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.115 - FASD/SED waiver services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.120 - FASD/SED waiver plan-of-care standards (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.130 - Plan-of-care development and coordination services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.135 - Professional and paraprofessional training and consultation services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.140 - Treatment and intervention mentor services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.145 - FASD/SED day habilitation services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.150 - FASD/SED residential habilitation services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.160 - Supported-employment development services; supported-employment ongoing services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 1 - Home and Community-Based Waiver Services; Residential Psychiatric Treatment Center Level of Care › 7 AAC 130.165 - FASD/SED respite care services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.200 - Purpose

Current through May 31, 2024
The purpose of this chapter is to offer to individuals that
					 meet the eligibility criteria in 7 AAC 130.205 the opportunity to choose to
					 receive home and community-based waiver services as an alternative to
					 institutional care. Those services, when implemented through a person-centered
					 support plan, provide opportunities for eligible individuals to receive
					 services in the community and to maximize engagement in community life. The
					 individual, those individuals chosen by the individual to participate in
					 service planning, and the providers selected by the individual to render
					 services, work in collaboration to align services and supports in a
					 person-centered practice that provides the full benefits of community living,
					 and contributes to the achievement of the individual's goals.
Authority:
AS
						47.05.010
AS
						47.07.030
AS
						47.07.040
AS
						47.07.045
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.202 - Services provided by family members

Current through May 31, 2024
Home and community-based waiver services covered under this
					 chapter do not include services provided by the spouse of the recipient, the
					 parent of a minor child that is the recipient, au individual with a legal duty
					 to support the recipient under state law, or the recipient's legal
					 representative. For purposes of this section, a foster parent is not an
					 individual with a legal duty to support a recipient placed in the care of that
					 foster parent by the department.
(b)
				  Notwithstanding (a) of this section, a court-appointed guardian may provide
				  home and community-based services to a recipient if
(1) the court authorizes the guardian to
				  provide those services under
				  AS
				  13.26.167(2) or
				  AS
				  13.26.311(c); and
(2) the guardian is qualified to provide
				  those services and employed by a provider certified under
				  7 AAC 130.220(a)(l) or (3).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.205 - Eligibility for home and community-based waiver services

Current through May 31, 2024
(a) The
				  department will pay for home and community-based waiver services provided in
				  accordance with the applicable requirements of this chapter to an individual
				  that is
(1) eligible for coverage under AS
				  47.07.020, 7 AAC 100.002, and (d) of this section; and
(2) enrolled in accordance with 7 AAC 130.219.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.206 - Waiver options for the recipient category of individuals with intellectual and developmental disabilities

Current through May 31, 2024
(a) An individual
				  who submitted an application under
				  7 AAC 130.207(a)(2), and determined by
				  the department to be a person with a developmental disability under AS
				  47.80.900, may request placement on a waiting list established under AS
				  47.80.130(d) for the individualized supports waiver, the individuals with
				  intellectual and developmental disabilities waiver, or both waivers. If funding
				  for waiver services is available, and if the applicant meets all eligibility
				  requirements under
				  7 AAC 130.205 for the recipient category of individuals
				  with intellectual and developmental disabilities, the applicant may be eligible
				  for one of the following:
(1) individualized
				  supports waiver benefits up to an individual cost limit of 517,500 annually,
				  adjusted for inflation using the CMS from Health Agency Market Basket in the
				  most recent quarterly publication of Global Insight's
Healthcare Cost
				  Review
available 60 days before July 1, for the following services:
(A) day habilitation services under
				  7 AAC 130.260;
(B) residential habilitation services for
				  recipients of either supported-living habilitation services under
				  7 AAC 130.265(d) and (e) or in-home support habilitation
				  services under
				  7 AAC 130.265(h) and (i);
(C)employment services under
				  7 AAC 130.270;
(D) intensive active treatment services for
				  recipients 21 years of age and older under
				  7 AAC 130.275;
(E) respite care services under
				  7 AAC 130.280;
(F) transportation services under
				  7 AAC 130.290; or
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.207 - Application for home and community-based waiver services

Current through May 31, 2024
(a) To apply
				  for home and community-based waiver services under this chapter
(1) for the recipient categories of children
				  with complex medical conditions, adults with physical and developmental
				  disabilities, and older adults or adults with physical disabilities,
(A) an individual must participate in the
				  person-centered intake process approved by the department; in this
				  subparagraph, "person-centered intake process" means the process undertaken to
				  help an individual understand the individual's unmet needs and to explore the
				  resources available to meet those needs; and
(B) if the person-centered intake process
				  results in a recommendation for the services available under this chapter and
				  the individual desires them, the individual must submit to the department a
				  completed application in a format provided by the department with relevant
				  supporting documents;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.209 - Expedited application, assessment, level-of-care determination, and support plan

Current through May 31, 2024
(a) The department will conduct an expedited
				  review of a complete application that is submitted in accordance with 7 AAC 130.207 if the applicant has no natural supports to meet the applicant's needs
				  and the applicant qualifies because of
(1) a
				  diagnosis of a terminal illness with a life expectancy of six months or less:
(2) imminent or recent discharge
				  from a general acute care hospital or nursing facility; the applicant must
				  submit the application not later than seven days after the date of discharge;
(3) an unplanned absence of a
				  primary unpaid caregiver due to a medical or family emergency or
				  hospitalization;
(4) the declining
				  health of a primary unpaid caregiver that makes the caregiver unable to
				  continue to provide care for the applicant;
(5) the death of a primary unpaid caregiver
				  30 or fewer days before the date of the application; or
(6) a referral from the office of the
				  department responsible for adult protective services or the office of the
				  department responsible for children's services.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.210 - Recipient disenrollment (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.211 - Screening of applications

Current through May 31, 2024
(a) The department
				  will pay for and review, in any 365-day period, one application for home and
				  community-based waiver services to determine whether there is a reasonable
				  indication that the applicant might need services at a level of care provided
				  in a hospital, nursing facility, or ICF/MR in 30 or fewer days unless the
				  applicant receives home and community-based waiver services under this
				  chapter.
(b) The care coordinator
				  selected by the applicant to assist with the application shall
(1) inform the applicant regarding the care
				  coordinator's relationship as an employee of any provider certified under 7 AAC 130.220 and of any relationship described in 7 AAC 130.240(e); and
(2) provide to the department a complete
				  application in accordance with 7 AAC 130.207, and relevant and contemporaneous
				  documentation that
(A) addresses each medical
				  and functional condition that places the applicant into a recipient category
				  listed in 7 AAC 130.205(d); and
(B) indicates the applicant's need for home
				  and community-based waiver services.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.213 - Assessment and interim level-of-care-review

Current through May 31, 2024
(a) If an
				  application under
				  7 AAC 130.211 and supportive diagnostic documentation
				  reasonably indicate the need for services described in
				  7 AAC 130.211(a), the department will
				  conduct an assessment of the applicant's physical, emotional, and cognitive
				  functioning to determine the
(1) recipient
				  category under
				  7 AAC 130.205(d) for which the
				  applicant is eligible; and
(2)
				  level of care under
				  7 AAC 130.215 that the applicant requires.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.215 - Level-of-care determination

Current through May 31, 2024
The department will determine an applicant's level of care
					 as follows, and will provide notice to the applicant, the applicant's
					 representative, and the applicant's care coordinator of the department's
					 determination:
(1) for the recipient
				  category of children with complex medical conditions, the department will
				  determine, based on the results of the department's
Nursing Facility
				  Level of Care Assessment Form for Children
, adopted by reference in
				  7 AAC 160.900,or an interim Ievel-of-care review,
				  whether
(A) under
				  7 AAC 140.515 the applicant requires a level of care
				  provided in a skilled nursing facility; or
(B) under
				  7 AAC 140.510 the applicant requires a level of care
				  provided in an intermediate care facility;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.217 - Support plan development and amendment

Current through May 31, 2024
(a) Not less than
				  once every 12 months, the care coordinator shall submit a support plan, based
				  on the current needs of the recipient, the most recent assessment or interim
				  level-of-care review conducted under
				  7 AAC 130.213, and the level-of-care determination made in
				  accordance with
				  7 AAC 130.215. After an assessment, or interim level-of-care
				  review under
				  7 AAC 130.213, and after receiving the department's notice
				  that the recipient meets the level-of-care requirement under
				  7 AAC 130.215, the care coordinator shall
(1) inform the recipient regarding
(A) the care coordinator's relationship as an
				  employee of any provider certified under
				  7 AAC 130.220 and of any relationship described in
				  7 AAC 130.240(e);
(B) the full range of home and
				  community-based waiver services and the names of all providers that offer those
				  services; and
(C) the recipient's
				  right to free choice of providers, including the option to choose another care
				  coordinator to develop the recipient's support plan; the care coordinator shall
				  support the recipient in the recipient's exercising the right to free choice of
				  providers;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.218 - Person-centered practice

Current through May 31, 2024
(a) Based on
				  capacity and interest in participation, the recipient of home and
				  community-based waiver services shall lead the planning process that results in
				  a support plan under
				  7 AAC 130.217 and this section.
(b) The planning process must
(1) recognize and support the recipient as
				  central to the process with the authority to specify goals and needs, to
				  request meetings at times and locations convenient to the recipient, including
				  distance delivery if the recipient request it, and to revise the support plan
				  when necessary;
(2) include the
				  recipient, the recipient's representative, individuals chosen by the recipient
				  to participate in the planning process, and the providers selected by the
				  recipient to render home and community-based waiver services other than
				  providers of
(A) transportation services
				  under 7 AAC 130.290;
(B) environmental modification services under
				  7 AAC 130.300; or
(C) specialized medical equipment under
				  7 AAC 130.305;
(3) respond to recipient requests in a timely
				  manner;
(4) reflect cultural
				  considerations;
(5) provide
				  information the recipient needs to make informed choices regarding services and
				  supports; the information must be in plain language, and presented in a manner
				  accessible to a recipient with disabilities or limited English proficiency;
				  and
(6) include strategies for
				  solving conflicts or disagreements that might arise during the process,
				  including conflict-of-interest guidelines for all planning
				  participants.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.219 - Enrollment in home and community-based waiver services; disenrollment

Current through May 31, 2024
(a) The department
				  will enroll an applicant, determined eligible under
				  7 AAC 130.205, in the recipient category for which the
				  recipient is qualified if the department determines that enrolling the
				  applicant will not bring the department out of compliance with the terms of the
				  waiver approved under 42
				  U.S.C. 1396 n(c) by exceeding the
(1) number of recipients approved for
				  participation in the waiver program for the applicable recipient category;
				  or
(2) average per capita
				  expenditure limit on home and community-based waiver services for the
				  applicable recipient category.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.220 - Provider certification

Current through May 31, 2024
(a) Unless the
				  department grants an exception under (j) of this section, the department will
				  certify a provider agency as either a provider of one or more home and
				  community-based waiver services under (1) or (3) of this subsection or a
				  provider of care coordination services under (2) of this subsection, as
				  follows:
(1) the department will certify a
				  provider agency as a home and community-based waiver services provider, for
(A) nursing oversight and care management
				  services provided under
				  7 AAC 130.235;
(B) chore services provided under 7 AAC 127.087;
(C) adult day services
				  provided under
				  7 AAC 130.250;
(D) day habilitation services provided under
				  7 AAC 130.260;
(E) residential
				  habilitation services provided under
				  7 AAC 130.265;
(F) employment services under 7 AAC 130.270;
(G) intensive active
				  treatment services provided under
				  7 AAC 130.275;
(H) respite care services provided under 7 AAC 130.280;
(I) transportation
				  services provided under
				  7 AAC 130.290;
(J) meal services provided under 7 AAC 130.295;
(K) environmental
				  modification services provided under
				  7 AAC 130.300;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.222 - Recipient safeguards

Current through May 31, 2024
A home and community-based waiver services provider
					 certified under
					 7 AAC 130.220 shall
(1) protect a recipient's health, safety, and
				  welfare while rendering a service under this chapter; and
(2) provide training for all employees
				  regarding the reporting requirements of
				  7 AAC 130.224 and the mandatory reporting requirements
				  of AS
				  47.17.020 for children and
				  AS
				  47.24.010 for vulnerable adults.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.224 - Critical incident reporting

Current through May 31, 2024
(a) A provider
				  shall report to the department, in a format provided by the department, a
				  critical incident involving a recipient not later than one business day after
				  observing or learning of the critical incident.
(b) A provider shall develop and implement a
				  system to manage and report critical incidents that includes
(1) methods for identifying a critical
				  incident;
(2) a protocol for
				  emergency response to a critical incident;
(3) procedures for investigating and
				  analyzing a critical incident to determine its cause;
(4) a plan to ensure that each member of the
				  provider's staff is trained in critical incident management and reporting;
				  and
(5) a process that ensures
				  timely reporting of a critical incident to
(A) the department and the recipient's
				  representative; and
(B) other
				  service providers when necessary to protect the recipient's health, safety, and
				  welfare; the provider shall maintain a record of names of the providers that
				  are sent incident reports and the date sent.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.225 - Provider disenrollment and decertification (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.227 - Administration of medication and assistance with self-administration of medication

Current through May 31, 2024
(a) Except as provided in (i) of this
				  section, a provider shall offer administration of medication and assistance
				  with self-administration of medication as integral parts of the following home
				  and community-based waiver services:
(1)
				  adult day services under
				  7 AAC 130.250;
(2) day habilitation services under
				  7 AAC 130.260;
(3) residential habilitation services under
				  7 AAC 130.265;
(4) employment services under
				  7 AAC 130.270;
(5) intensive active treatment services under
				  7 AAC 130.275;
(6) respite care services under 7 AAC 130.280.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.229 - Use of restrictive intervention

Current through May 31, 2024
(a) A home and
				  community-based waiver services provider may use restrictive intervention as a
				  response
(1) when a recipient's behavior is
				  unanticipated and presents an imminent danger to the recipient's safety or to
				  the safety of others; or
(2) if
				  justified for safe management of the recipient's behavior that requires
				  intervention as described in the support plan developed in accordance with
				  7 AAC 130.217 and
				  7 AAC 130.218
(A) when
				  other types of intervention have been tried and documented as ineffective for
				  behavior management; and
(B) if the
				  type of intervention is safe, proportionate to the recipient's behavior, and
				  appropriate to the recipient's chronological and developmental age, size,
				  gender, and physical, medical, and psychological
				  condition.