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 125.020 - Assessment; levels of assistance

Universal Citation: 7 AK Admin Code 125.020

Current through November 28, 2024

(a) Except as specified in 7 AAC 125.010(c), the department, using the Consumer Assessment Tool adopted by reference in 7 AAC 160.900,

(1) will conduct an assessment of a recipient
(A) for an initial application for services unless an assessment is denied under (d) of this section;

(B) after receiving an application for reauthorization under 7 AAC 125.012(b), an amendment of the recipient's service level authorization under 7 AAC 125.026, or a report under 7 AAC 125.028, if a review of materials submitted indicates that another assessment is necessary to evaluate the need to continue the recipient's level of assistance with the activities specified in the recipient's current service level authorization or to alter the service level authorization as requested by an amendment; or

(C) for quality assurance purposes, if the recipient is
(i) selected at random for a quality assurance review; or

(ii) receiving services through a personal care services agency that is the subject of an audit, a program review, or an investigation;

(2) may conduct an assessment of a recipient if
(A) the recipient failed to notify the department, in accordance with 7 AAC 125.028, of a change that could affect the recipient's service level authorization;

(B) the department suspects that the recipient, the recipient's representative, the representative's designee, or the recipient's personal care services agency misrepresented the recipient's physical condition or need for personal care services; or

(C) the department determines that an assessment is necessary to maintain the integrity and fiscal viability of the personal care services program under 7 AAC 125.010- 7AAC 125.199,

(b) The department will conduct an expedited review of an application if

(1) the request is submitted, in a format provided by the department, with a complete application as specified in 7 AAC 125.012 or with a request for amendment of the recipient's service plan in accordance with 7 AAC 125.026; and

(2) the department determines, on the basis of the request and the application or amendment, that the applicant has no natural supports to meet the applicant's needs and the applicant qualifies because of
(A) a diagnosis of terminal illness with a life expectancy of six months or less;

(B) imminent or recent discharge from a general acute care hospital or nursing facility; the recipient must submit the application not later than seven days after the date of discharge;

(C) an unplanned absence of the primary caregiver due to a medical or family emergency or to hospitalization;

(D) the declining health of the primary caregiver that makes that caregiver unable to continue to provide care for the applicant;

(E) the death of the primary caregiver 30 or fewer days before the date of the application;

(F) a referral from the departmental office responsible for adult protective services or children's services; or

(G) a request by the personal care services agency for a time-limited increase in personal care services, not to exceed six consecutive weeks, to address a recipient's immediate need if that need is related to the recipient's functional capacity to perform ADLs, IADLs, or other services covered under 7 AAC 125.030.

(c) The department will authorize personal care services for a recipient if, after an assessment conducted in accordance with this section, the department determines that

(1) the recipient needs one or more of the following levels of assistance described in the Consumer Assessment Tool, adopted by reference in 7 AAC 160.900:
(A) at least limited assistance with one ADL;

(B) supervision, if the recipient's need is established in accordance with 7 AAC 125.030(b)(5)(C);

(C) at least physical assistance with one IADL; and

(2) those needs cannot be met by the recipient's representative, immediate family members, or natural supports.

(d) The department will not authorize personal care services for a recipient if the assessment, performed in accordance with this section, establishes that the recipient

(1) docs not need a level of assistance described in (c) of this section; or

(2) needs only cueing or supervision as described in the Consumer Assessment Tool, adopted by reference in 7 AAC 160.900, except for supervised eating under 7 AAC 125.030(b)(5)(C), in order to perform an ADL, IADL, or other covered service specified in 7 AAC 125.030.

Authority:AS 47.05.010

AS 47.07.030

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