Current through November 28, 2024
(a) The department
will modify the time authorized for personal care services if the department
determines that a recipient has experienced a change that alters the
recipient's need for physical assistance with ADLs, IADLs, or other covered
services.
(b) To request an
amendment to a service level authorization before the end of the recipient's
current authorization period, a personal care services agency must
(1) complete and submit the request in the
format provided by the department for that purpose; and
(2) submit all current medical or other
relevant documentation that supports the claim that the change alters the
recipient's need for physical assistance with ADLs, IADLs, or other covered
services.
(c) The
department will amend a recipient's service level authorization before the end
of the recipient's current authorization period if
(1) the recipient's physical condition
changed 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 personal care
services
(A) under a time-limited amendment to
the recipient's service level authorization, and that amendment has expired;
or
(B) that are no longer
authorized under 7 AAC 105-7 AAC 160.
(d) The department will terminate a
recipient's authorization to receive personal care services approved under
7
AAC 125.024 if the recipient
(1) fails to use the personal care services
in the service level authorization within 90 consecutive days after approval by
the department or during any 90-consecutive-day period authorized under
7
AAC 125.024(d); or
(2) has a documented history of failing to
cooperate with the delivery of services identified in the service level
authorization, or of placing a personal care assistant at risk of physical
injury, and no other provider is willing to provide services for the recipient;
for the purposes of this paragraph a documented history exists if a provider
(A) reports that a personal care assistant
was unable to obtain cooperation with service delivery or to mitigate the risk
of physical injury despite reasonable attempts; and
(B) maintains records to support that report,
and makes those records available to the department for inspection; the
department will review those records and interview the recipient or the
recipient's representative before making a decision to terminate the
recipient's authorization to receive personal care services.
(e) The department may
reduce time authorized for, or terminate, personal care services if the
department determines 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, for the purpose of obtaining personal care services for activities
the recipient is able to perform or for which the recipient does not
qualify.
(f) The department will
not reduce time authorized for personal care services if a reduction would
create a risk of institutionalization for a recipient eligible to receive home
and community-based waiver services under 7 AAC 130. To determine whether a
reduction in personal care services would create a risk of
institutionalization, the department will consider
(1) the documents specified in
7
AAC 125.012(a)(4) that are current
and submitted by the recipient in response to the department's notification
requiring a new assessment;
(2) the
findings on the recipient's
Consumer Assessment Tool, adopted
by reference in
7
AAC 160.900, that are the result of a new
assessment;
(3) the impact of a
reduction in time measured over a 24-hour period, taking into consideration the
total time that the recipient receives assistance from any source;
(4) whether the recipient's representative,
family members, or other natural supports provide assistance to the
recipient;
(5) whether other
individuals living in the same residence as the recipient receive services that
benefit the recipient; and
(6) the
recipient's history of utilization of the time authorized on the recipient's
current service level authorization.
(g) In (f) of this section, "risk of
institutionalization" means it is likely that as a result of the recipient's
current condition as identified in assessments and medical records, the
recipient would require relocation from the recipient's current residence to a
hospital or nursing facility in 30 days.
Authority:AS
47.05.010
AS
47.07.030
