reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.050 - Personal care services; place of service

Current through May 31, 2024
(a) The department
				  will pay for 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 property 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 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.060 - Personal care services agency certification and enrollment

Current through May 31, 2024
(a) To receive
				  payment for personal care services, an agency must be certified by the
				  department as a provider of personal care services. To be certified by the
				  department, an agency must
(1) submit an
				  application, in a format provided by the department; before submitting the
				  application for certification or application to renew certification, the
				  personal care services program administrator for that agency must attend the
				  personal care services agency training course provided by the
				  department;
(2) meet and comply
				  with the applicable standards of certification criteria, including provider
				  qualifications and program standards, set out in the department's
Personal Care Services and Community First Choice Personal Care
				  Services Provider Conditions of Participation
, adopted by reference in
				  7 AAC 160.900;
(3) demonstrate to the department's
				  satisfaction that the program administrator, supervisors of personal care
				  assistants, and personal care assistants possess the requisite skills and
				  competencies necessary to meet the needs of the recipient population;
				  and
(4) comply with 7 AAC 105 - 7
				  AAC 160 (Medicaid coverage and payment), including enrolling in the Medicaid
				  program in accordance with 7 AAC 105.210.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.070 - Electronic visit verification

Current through May 31, 2024
(a) A provider of
				  personal care services shall use an electronic visit verification (EW) system
				  that is either provided or approved by the department. If a provider decides to
				  use its own EVV system or vendor, that system must include at the time of
				  service delivery, and report to the state's EVV system, the following data:
(1) the name of the agency;
(2) the identity of the rendering
				  provider;
(3) the identity of the
				  recipient;
(4) the location of the
				  service;
(5) the date of the
				  service;
(6) the start and stop
				  times of the service; and
(7) the
				  type of service provided.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.080 - Personal care services agency decertification and disenrollment

Current through May 31, 2024
(a) The department will deny an application
				  to renew certification of, will suspend certification of, or will decertify and
				  disenroll a personal care services agency as a provider for the
				  consumer-directed or agency-based program
(1)
				  if the agency does not submit an application for renewal in accordance with or
				  meet the requirements of
				  7 AAC 125.060(a);
(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
				  7 AAC 125.010 -
				  7 AAC 125.199;
(4) for grounds and under procedures set out
				  in
				  7 AAC 105.400 - 7 AAC 105.490;
(5) if the agency no longer qualifies for
				  certification under 7 AAC 105 - 7 AAC 160;
(6) if the department determines under
				  7 AAC 10.900 - 7 AAC 10.990 (barrier crimes and conditions;
				  background checks) that a barrier crime or condition exists with respect to a
				  personal care assistant or revokes a background check under
				  7 AAC 10.945, and the personal care services agency does
				  not terminate association with the individual 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 and
				  7 AAC 10.935;
(7) for a reason stated in
				  7 AAC 125.060(e); or
(8) if the department determines a personal
				  care services agency misrepresented the recipient's physical condition, or need
				  for personal care services, for the purpose of obtaining personal care services
				  for activities the recipient is able to perform or for which the recipient does
				  not qualify.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.090 - Employment of personal care assistants; qualifications

Current through May 31, 2024
(a) To be employed as a personal care
				  assistant in either the consumer-directed program or the agency-based program,
				  a personal care assistant
(1) must be at
				  least 18 years of age;
(2) must
				  comply with the requirements of
				  7 AAC 125.010 - 7AAC 125.199;
(3) must be associated with a personal care
				  services agency certified in accordance with
				  7 AAC 125.060;
(4) must be individually enrolled with the
				  department under 7 AAC 105.205(b) and
				  7 AAC 105.210;
(5) may not be determined as described in (c)
				  of this section to be subject to a barrier crime or condition, unless the
				  department grants a redetermination under
				  7 AAC 10.927 or a variance under
				  7 AAC 10.930 and
				  7 AAC 10.935;
(6) may not have a health care provider
				  license or certification currently denied or revoked; and
(7) must be able independently to physically
				  assist the recipient with the ADLs and to perform the IADLs and other covered
				  services identified in the recipient's service level authorization under
				  7 AAC 125.024.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.100 - Safety of recipients; recipient representatives

Current through May 31, 2024
(a) An
				  agency certified in accordance with
				  7 AAC 125.060 as a provider of 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;
				  and
(B) the critical incident
				  reporting requirements of 7 AAC 125.102; and
(3) submit reports in compliance with
				  AS
				  47.17.020,
				  AS
				  47.24.010, and this section.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.102 - Critical incident reporting

Current through May 31, 2024
(a) A provider of
				  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 of personal care services
				  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 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.104 - Use of restrictive intervention

Current through May 31, 2024
(a) A 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 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.110 - Consumer-directed and agency-based personal care services programs; safety of employees; termination of service

Current through May 31, 2024
(a) Notwithstanding
				  (c) of this section, and not later than 30 days before a personal care services
				  agency terminates personal care services to a recipient, the agency shall send
				  written notice of the termination to the department and the
				  recipient.
(b) An agency may
				  terminate services to a recipient without the notice required in (a) of this
				  section if the agency
(1) has evidence that
				  continuing services to the recipient will
(A)
				  jeopardize the safety of a personal care assistant providing services for that
				  recipient;
(B) endanger the health,
				  safety, and welfare of the recipient because the recipient rejects or docs not
				  cooperate in the provision of personal care services; or
(C) create a financial risk for the agency
				  because the agency suspects recipient misrepresentation or fraud; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.120 - Responsibilities of personal care assistant in a personal care services agency

Current through May 31, 2024
(a) A personal care assistant employed by a
				  personal care services agency shall maintain for Medicaid billing purposes a
				  contemporaneous record of services provided for each recipient that must
				  include
(1) a copy of the service level
				  authorization that the department has approved under
				  7 AAC 125.024 and that is signed by or bears the legal
				  mark of the recipient, the recipient's representative, or the representative's
				  designee;
(2) a copy of any
				  amendments to the recipient's service level authorization prepared under
				  7 AAC 125.026 and approved by the department;
(3) documentation, in the form of case notes,
				  of services provided in accordance with the service level authorization;
				  and
(4) timesheets that indicate
(A) the date, time, and length of each visit,
				  and the services provided during each visit; and
(B) for each visit, the signature or legal
				  mark of the recipient, the recipient's representative, or the representative's
				  designee verifying that the services were provided as reported by the personal
				  care assistant.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.130 - Consumer-directed personal care services program; consumer directed personal care agencies

Current through May 31, 2024
(a) In addition to meeting the requirements
				  under 7 AAC 125.010 - 7 AAC 125.199, a personal care services agency that
				  administers a 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 are sufficient to meet the recipient's continuing
				  needs;
(B) interviewing the
				  recipient's personal care assistant to evaluate the service records and
				  timesheets 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 service level authorization under 7 AAC 125.024; and
(D) submitting to the department an amendment
				  to the recipient's service level authorization under 7 AAC 125.024 and 7 AAC 125.026 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 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.140 - Consumer-directed personal care services program; recipient requirements

Current through May 31, 2024
(a) To qualify for personal care services
				  through a consumer-directed program, a recipient or a recipient's
				  representative 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
				  personal care assistants;
(3)
				  designate a personal care services agency that administers a consumer-directed
				  program to fulfill the responsibilities of
				  7 AAC 125.130 on behalf of the recipient;
(4) cooperate with the department in reviews
				  of the recipient's 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 personal care services with the
				  personal care services 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 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.150 - Agency-based personal care services program; personal care services before authorization

Current through May 31, 2024
(a) A personal care services agency that
				  manages an agency - based personal care services program may provide personal
				  care services for a recipient that has submitted an application under
				  7 AAC 125.012 and a request for expedited consideration
				  under 7 AAC 125.020(b),
				  but does not have a service level authorization approved by the department
				  under 7 AAC 125.024, if the recipient
(1) is in the process of being, or has been,
				  discharged from a general acute care hospital or a nursing facility, and has a
				  discharge plan that documents a need, immediately upon the recipient's
				  discharge, for assistance with specific ADLs and IADLs identified in
				  7 AAC 125.030; or
(2) would be at risk of immediate
				  hospitalization or placement in a nursing facility because the recipient's
				  primary caregiver is not available due to
(A)
				  an unplanned absence because of a medical or family emergency, death, or
				  hospitalization; or
(B) declining
				  health that makes that caregiver unable to continue to provide care for the
				  recipient.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.160 - Agency-based personal care services program; personal care assistant education and training requirements

Current through May 31, 2024
(a) A personal care
				  assistant must
(1) be a licensed registered
				  nurse that is qualified to practice under AS 08.68 or
				  7 AAC 105.200(c);
(2) be a licensed certified nurse aide that
				  is qualified to practice under AS 08,68 or
				  7 AAC 105.200(c);
(3) hold an active certification as a
				  community health aide or community health practitioner from the Community
				  Health Aide Program Certification Board;
(4) have satisfactorily completed training as
				  specified in (b) of this section and have passed a standardized competency test
				  approved by the department; or
(5)
				  have had training or experience, equivalent to the training specified in (b) of
				  this section, during the two-year period immediately preceding application to
				  work as a personal care assistant, and have passed a standardized competency
				  test approved by the department.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.170 - Agency-based personal care services program; supervising registered nurse

Current through May 31, 2024
(a) A
				  personal care services agency that manages an agency-based personal care
				  services program shall retain a supervising licensed registered nurse that is
				  qualified to practice under AS 08.68 or
				  7 AAC 105.200(c) to perform the
				  following duties:
(1) monitor the delivery of
				  services by personal care assistants to ensure services are provided in
				  accordance with the service level authorization for each recipient;
(2) at least once every six months perform a
				  review of each 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 are sufficient to meet the recipient's continuing
				  needs;
(B) interviewing the
				  recipient's personal care assistant to evaluate the service records and
				  timesheets prepared by the recipient's personal care assistant;
(C) documenting in the recipient's record the
				  supervising registered nurse's conclusion whether the services were provided as
				  stated and were consistent with the recipient's service level authorization
				  under 7 AAC 125.024; and
(D) submitting to the department amendments
				  to the service level authorization under
				  7 AAC 125.024 and
				  7 AAC 125.026 when the recipient's needs change
				  sufficiently to warrant an amendment;
(3) place in the recipient's file written
				  instructions regarding emergency situations that the personal care assistant
				  might encounter;
(4) maintain
				  communications with the recipient, the recipient's health care providers as
				  appropriate, and the personal care assistant;
(5) maintain a service record for each
				  recipient that includes
(A) a copy of each
				  service level authorization, assessment, and documentation of reviews under
				  (a)(2) of this section, including amendments made under
				  7 AAC 125.026;
(B) a copy of all personal care assistant
				  timesheets signed by the recipient, the recipient's representative, or the
				  representative's designee; and
(C)
				  records of all contacts with the recipient, die recipient's health care
				  providers, and the personal care assistant.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.180 - Review and appeal rights

Current through May 31, 2024
(a) A recipient
				  that is terminated from an agency-based personal care services program may
				  appeal that termination through the complaint process established by the
				  personal care services agency.
(b)
				  If the assessment under
				  7 AAC 125.020 indicates that an individual is not
				  capable of managing consumer-directed 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 personal care services covered activity on the recipient's
				  current service level authorization;
(B) deny time on a service level
				  reauthorization for a personal care services activity that was included in a
				  previous service level authorization if that activity is listed in
				  7 AAC 125.030;
(C) terminate the recipient's authorization
				  to receive personal care services in accordance with
				  7 AAC 125.026(d); or
(D) deny personal care services, alter review
				  of an initial application under
				  7 AAC 125.012, 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 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.190 - Consumer-directed and agency-based personal care services programs; compliance reviews

Current through May 31, 2024
The department, with recipient participation, will conduct
					 compliance reviews of the personal care services agencies at least once every
					 two years and at other times determined to be necessary by the department. In
					 the reviews, the department will include evaluation of
(1) service delivery;
(2) service authorization;
(3) records maintenance;
(4) financial accountability; and
(5) recipient satisfaction.
Authority:
AS
						47.05.010
AS
						47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.195 - Payment for personal care services

Current through May 31, 2024
(a) The department
				  will pay for personal care services that are performed in accordance with
				  7 AAC 125.010 -
				  7 AAC 125.199 and applicable federal and state
				  law.
(b) The department will base
				  payment on the documented and verified total time during which the personal
				  care assistant performed services in accordance with the recipient's approved
				  service level authorization under
				  7 AAC 125.024.
(c) Repealed 1/26/2012.
(d) The department will pay a personal care
				  services agency for providing personal care services at the rate identified in
				  7 AAC 145.500. At least 50 percent of the annual total
				  payment made by the department to a personal care services agency for personal
				  care services must be disbursed to personal care assistants as payment for work
				  performed.
(e) A personal care
				  assistant's rendering provider identification number must be associated with
				  each claim that the personal care services agency submits to the department for
				  Medicaid payment.
Authority:
AS
						47.05.010
AS
						47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.199 - Definitions

Current through May 31, 2024
In
					 7 AAC 125.010 -
					 7 AAC 125.199, unless the context requires
					 otherwise,
(1) "ADL" means activity of
				  daily living;
(2) "agency-based
				  program" means a program that provides personal care services to a qualified
				  recipient who is Unable to manage those services because of cognitive capacity
				  or a documented history of self-neglect or who chooses not to take
				  responsibility for managing those services;
(3) "assessment" means an evaluation of a
				  recipient's capacity to perform ADLs and IADLs over a consecutive seven-day
				  period, before and including the date of the assessment, taking into
				  consideration other health, medical, or functional needs identified during the
				  previous 12 months or since the recipient's last assessment;
(4) "business day" means a day other than
				  Saturday, Sunday, or a legal holiday under
				  AS
				  44.12.010;
(5) "consumer-directed program" means a
				  program that provides personal care services to a recipient, and that recipient
				  or either the recipient's representative or the representative's designee is
				  responsible for managing those services;
(6) "CPR" means cardiopulmonary
				  resuscitation;
(7) "lADL" means
				  instrumental activity of daily living;
(8) "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 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 2 - Home Health Care Services › 7 AAC 125.300 - Home health care provider enrollment

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160, a home health agency must be
(1) certified as a home health agency for the
				  purposes of Medicare in the jurisdiction where home health care services are
				  provided;
(2) enrolled as a home
				  health care provider in accordance with
				  7 AAC 105.210; and
(3) enrolled in the jurisdiction where home
				  health care services are provided if providing home health care services out of
				  state.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 2 - Home Health Care Services › 7 AAC 125.310 - Home health care services

Current through May 31, 2024
(a) The department
				  will pay a public or private home health agency for the following home health
				  care services, if recommended by a licensed physician, advanced practice
				  registered nurse, or physician assistant as part of a plan of care developed in
				  accordance with
				  7 AAC 125.320:
(1) the
				  following services if they are provided to a recipient in the recipient's place
				  of residence by a public or private organization that the department has
				  certified as a home health agency for purposes of Medicare:
(A) intermittent or part-time skilled nursing
				  services that are provided by a registered nurse or a licensed practical nurse,
				  under the continued direction of the recipient's physician, advanced practice
				  registered nurse, or physician assistant, and within the scope of the nurse's
				  license;
(B) home health aide
				  services that are prescribed by and under the continued direction of a
				  physician, advanced practice registered nurse, or physician assistant and
				  supervised by a registered nurse;
(C) supplies suitable for use in the
				  home;
(D) physical therapy,
				  occupational therapy, speech-language pathology services, and audiology
				  services that are prescribed by a physician, advanced practice registered
				  nurse, or physician assistant and provided to a recipient by or under the
				  supervision of a qualified practitioner;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 2 - Home Health Care Services › 7 AAC 125.320 - Requirements for home health care services

Current through May 31, 2024
(a) The department
				  will not pay for a home health care service, other than an initial visit for
				  evaluation purposes, unless the provider has received prior authorization from
				  the department. The department will accept a request for a home health
				  evaluation received from any person concerned with the care of the
				  recipient.
(b) A home health agency
				  must submit a request for prior authorization on a form provided by the
				  department, and must include a written statement from the attending physician
				  advanced practice registered nurse, or physician assistant that
(1) explains the need for home health care
				  services, including the reason services cannot be performed in a clinic,
				  outpatient setting, or physician's office; and
(2) includes medical recommendations for a
				  plan of care developed under (d) of this section for services provided
(A) on an ongoing basis; or
(B) after acute care; for services provided
				  under this subparagraph, the written statement must include the expected
				  decrease in need for skilled nursing services and home health aide
				  visits.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 2 - Home Health Care Services › 7 AAC 125.350 - Electronic visit verification

Current through May 31, 2024
(a) A provider of
				  home health services under
				  7 AAC 125.310 shall use an electronic visit verification
				  (EVV) system that is either provided or approved by the department. If a
				  provider decides to use its own EVV system or vendor, that system must include
				  at the time of service delivery, and report to the state's EVV system, the
				  following data:
(1) the name of the
				  agency;
(2) the identity of the
				  rendering provider;
(3) the
				  identity of the recipient;
(4) the
				  location of the service;
(5) the
				  date of the service;
(6) the start
				  and stop times of the service; and
(7) the type of service provided.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 2 - Home Health Care Services › 7 AAC 125.399 - Definitions

Current through May 31, 2024
In
					 7 AAC 125.300 -
					 7 AAC 125.399, unless the context requires
					 otherwise,
(1) "intermittent or
				  part-time" means no more than eight hours of care, not necessarily consecutive,
				  in a 24-hour period;
(2) "skilled
				  nursing services" means the curative, restorative, or preventive aspects of
				  patient care services
(A) performed by a
				  registered nurse or by a licensed practical nurse under the supervision of a
				  registered nurse; and
(B)
				  emphasizing a high level of nursing direction, observation, and
				  skill.
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 127.010 - Purpose

Current through May 31, 2024
The purpose of this chapter is to offer to individuals that
				  meet the eligibility criteria in 7 AAC 127.025 the opportunity to choose to
				  receive Community First Choice services as an alternative to institutional
				  care.
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 127.015 - Services provided by family members

Current through May 31, 2024
(a) Community First
				Choice 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,
				an individual with a legal duty to support the recipient under state law, the
				recipient's representative, or the representative's designee that was appointed
				in accordance with 7 AAC 127.125. For purposes of this section, a foster parent
				is not an individual with a legal duly 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 Community First Choice services to a
				recipient if
(1) the court authorizes the
				guardian to provide those services under AS 13.26.167(2) or 13.26.311(c);
				and
(2) the guardian is qualified
				to provide those services and employed by a provider certified under 7 AAC 127.050.
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 127.025 - Eligibility and enrollment for Community First Choice services; level of care determination

Current through May 31, 2024
(a) The department
				will pay a provider for Community First Choice services authorized in a
				recipient's support plan developed under
				7 AAC 127.039, and provided in accordance with the
				applicable requirements of this chapter, for an individual that is
(1) a current Medicaid recipient;
(2) eligible for coverage under (d) of this
				section; and
(3) enrolled under (f)
				of this section.
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 127.027 - Disenrollment

Current through May 31, 2024
(a) The department
				will disenroll a recipient for any of the following reasons:
(1) the department terminates its
				participation in the Community First Choice program under
				42 U.S.C.
				1396n(k);
(2) the department is unable to determine
				eligibility for Community First Choice services because the recipient,
				recipient's representative, or recipient's care coordinator did not submit the
				documentation required for assessment or interim level-of-care review under
				7 AAC 127.030(c) at least 90 days
				before expiration of the current support plan;
(3) the recipient is no longer eligible for
				Medicaid coverage under
				AS
				47.07.020 or
				7 AAC 100.002;
(4) the recipient or the recipient's
				representative chooses to end the recipient's participation in the Community
				First Choice program;
(5) the
				recipient or the recipient's representative misrepresents the recipient's
				physical, intellectual, developmental, or medical condition in an effort to
				obtain services that are not medically necessary or for which the recipient
				does not qualify;
(6) the recipient
				has a documented history of failing to cooperate with the delivery of services
				identified in the support plan prepared under
				7 AAC 127.039, or of placing caregivers or other
				recipients at risk of physical injury, and no other providers are willing to
				provide services to the recipient; for the purposes of this paragraph, a
				documented history exists if a provider
(A)
				reports that the provider has been unable to obtain cooperation with service
				delivery or to mitigate the risk of physical injury to a caregiver or other
				recipients through reasonable accommodation of the recipient's disability;
				and
(B) maintains records to
				support that report, and makes those records available to the department for
				inspection; the department will review those records before making a decision
				on disenrollment under this paragraph;
(7) the recipient or the recipient's
				representative fails to take an action or to submit documentation required
				under 7 AAC 127.025 -
				7 AAC 127.165.
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 127.030 - Application for Community First Choice services; authorization; reapplication and reauthorization

Current through May 31, 2024
(a) The department
				will pay for and review, in any 365-day period, one initial application for
				Community First Choice services to determine whether there is a reasonable
				indication that the individual might need services at a level of care under
				7 AAC 127.025(d)
(b) To apply for Community First Choice
				services under this chapter, an individual must
(1) participate in the person-centered intake
				process;
(2) select a care
				coordinator to provide services under
				7 AAC 128.010 and participate in pre-enrollment options
				counseling; and
(3) with the
				assistance of the care coordinator, complete an application in a format
				provided 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 127.039 - 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 127.030, and the level-of-care determination made
				in accordance with
				7 AAC 127.025. After an assessment or interim
				level-of-care-review under
				7 AAC 127.030, and after receiving the department's
				notice that the recipient meets the level-of-care requirement under
				7 AAC 127.025, 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 127.050 or
				7 AAC 130.220 and of any close familial relationship or
				close business relationship with a home and community-based waiver services
				provider, personal care services provider, or Community First Choice services
				provider;
(B) the Community First
				Choice services and other long-term services and supports available to the
				recipient and the names of all providers that offer those services;
				and
(C) the recipient's right to
				free choice of providers, including the right 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 127 - Community First Choice Personal Care Services › 7 AAC 127.040 - Community First Choice covered services

Current through May 31, 2024
(a) The
				department will pay a Community First Choice provider agency for the following
				services for individuals eligible under
				7 AAC 127.025, if those services are provided in
				accordance with this chapter:
(1) personal
				emergency response services under
				7 AAC 127.085;
(2) Community First Choice personal care
				services, including
(A) physical assistance
				with services as specified in
				7 AAC 125.030(b) - (d);
(B) supervision and cueing assistance with
				the ADLs and lADLs specified in
				7 AAC 125.030(b) and (c) for a recipient
				who requires assistance based on behavior or cognitive scoring on the CAT
				assessment as indicated in the
Community First Choice Personal Care
				Services: Service Level Computation,
adopted by reference in
				7 AAC 160.900(d); and
(C) acquisition, maintenance, and enhancement
				of skills necessary for the recipient to accomplish the activities in
				7 AAC 125.030(b) - (d); the recipient may
				request time for training to enable the recipient to perform independently the
				ADLs, I ADLs, and other services identified in the recipient's Community First
				Choice service level authorization; and.
(3) chore services under 7 AAC 127.087.
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 127.045 - Community First Choice excluded services

Current through May 31, 2024
(a) Community
				First Choice personal care services do not include
(1) application of dressings involving
				prescription medication and aseptic techniques, except as allowed under
				7 AAC 125.030(d)(3);
(2) invasive body procedures, including
(A) tracheostomy care, deep suctioning, and
				care and maintenance of intravenous equipment;
(B) tube feedings, except as allowed under
				7 AAC 125.030(b)(5)(B);
(C) insertion or removal of catheters or the
				administration of enemas;
(D)
				injection of medication and administration of medication, except as provided
				under
				7 AAC 125.030(d)(1);
(3) cleaning an area not used directly by the
				recipient, home maintenance, or pet care, except care for a certified service
				animal under
				7 AAC 125.030(c)(3)(F);
(4) an activity that the department
				determines could be performed by the recipient except as provided under
				7 AAC 127.040(a)(2)(B) and (C);
(5) respite care to relieve a member of the
				recipient's household, a family member, or a caregiver from the responsibility
				of caring for the recipient;
(6) an
				activity that is not included in the recipient's service level authorization
				approved under
				7 AAC 127.090;
(7) care of other members of the recipient's
				household, baby sitting, or social visitation;
(8) services provided under 7 AAC
				130;
(9) monitoring of
				equipment;
(10) an activity that
				supplants or duplicates assistance offered by an individual organization
				without charge;
(11) an activity
				for which payment for performance of that activity is the responsibility of a
				third party;
(12) assistance with
				an lADL under
				7 AAC 125.030(c) that
(A) is the responsibility of an immediate
				family member; or
(B) duplicates
				services that other recipients living in the same residence receive as
				assistance with IADLs under this section, 7 AAC 125, or similar services under
				7 AAC 127.087, and those services are sufficient to maintain a clean, sanitary,
				and safe environment for all recipients in that residence; however, the
				department may authorize assistance with an IADL that duplicates services if it
				is justified as necessary for the health, safety, and welfare of a
				recipient;
(13)
				assistance with an activity that is a parental responsibility for a minor
				recipient, and that, if not provided, would be considered neglect of a child
				under
				AS
				47.10.014;
(14) range-of-motion exercise, walking
				exercise, or other types of exercise, except for passive range-of-motion as
				specified in
				7 AAC 125.030(d)(5); or
(15) any activity not specified in
				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 127.050 - Community First Choice services agency certification and enrollment

Current through May 31, 2024
(a) Except as specified in (j) of this
				section, to receive payment for Community First Choice services under 7 AAC 127.040, a provider must enroll in the Medicaid program under
				7 AAC 105.210 and must be certified under this section. To
				be certified by the department, a provider must
(1) submit an application and meet and comply
				with the applicable standards of certification criteria, including
(A) the provider qualifications and program
				standards set out in the department's
Personal Care Services and
				Community First Choice Personal Care Services Provider Conditions of
				Participation,
adopted by reference in
				7 AAC 160.900, if the provider seeks certification to
				provide personal care services; or
(B) the provider qualifications and program
				standards applicable to chore services under 7 AAC 127.087 and set out in the
				department's
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, if the provider seeks certification to
				provide chore services; 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 127.053 - Electronic visit verification

Current through May 31, 2024
(a) A provider of
				Community First Choice personal care services under
				7 AAC 127.040(a)(2) shall use an
				electronic visit verification (EW) system that is either provided or approved
				by the department. If a provider decides to use its own EW system or vendor,
				that system must include at the time of service delivery, and report to the
				state's EVV system, the following data:
(1)
				the name of the agency;
(2) the
				identity of the rendering provider;
(3) the identity of the recipient;
(4) the location of the service;
(5) the date of the service;
(6) the start and stop times of the service;
				and
(7) the type of service
				provided.