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 125.030 - Personal care services; covered services

Universal Citation: 7 AK Admin Code 125.030

Current through November 28, 2024

(a) A personal care services provider may only bill for the personal care services identified in this section for a recipient, if those services are

(1) included in the recipient's service level authorization;

(2) provided through either an agency-based or a consumer-directed personal care services program in accordance with 7 AAC 125.010 - 7 AAC 125.199; and

(3) documented in case notes and verified as received by the recipient on time sheets that must be signed by the recipient, the recipient's representative, or the representative's designee appointed in accordance with 7 AAC 125.100(c).

(b) Based on the assessment and level of assistance determination under 7 AAC 125.020, the department may authorize personal care services for one or more of the following types of physical assistance to enable a recipient to complete an ADL:

(1) for the ADL of bed mobility, for a recipient who is non-ambulatory, moving a recipient to and from a lying position, turning a recipient from side to side in a bed, or positioning a recipient in a bed; the department will not authorize time for the ADL of bed mobility if moving, turning, or positioning a recipient is necessary for the performance of the ADL of transferring, locomotion, toileting, or bathing;

(2) for the ADL of transferring, moving a recipient between one surface and another, including to and from a bed, chair, or wheelchair; the department will not authorize time for the ADL of transferring if the moving of a recipient is necessary for the performance of the ADLs of toileting or bathing;

(3) for the ADL of locomotion, if the physical assistance of a personal care assistant is necessary for a recipient to walk
(A) between locations in the recipient's residence; or

(B) to and from a location in the recipient's residence to a vehicle used by the recipient to access a routine medical or dental appointment; the department will not authorize time for the ADL of locomotion for
(i) a recipient who is self-sufficient with an assistive device; or

(ii) locomotion that is necessary for the performance of the ADLs of toileting and bathing;

(4) for the ADL of dressing, the putting on, fastening, unfastening, and removal of the recipient's clothing, support hose, or prosthesis;

(5) for the ADL of eating,
(A) eating, drinking, or other oral intake, except that, regardless of the number of times the recipient eats and drinks each day, the department will not approve more time than that allowed in Personal Care Services: Service Level of Computation, adopted by reference in 7 AAC 160.900, for the consumption of three meals a day;

(B) for a recipient in a consumer-directed personal care services program only, tube feeding, manual or with a mechanical device, if the recipient has a written plan for feeding from the recipient's licensed physician, physician assistant, or advanced practice registered nurse that is qualified to practice under AS 08 or 7 AAC 105.200(c); the written plan must
(i) specify the method for administration of the enteral nutrition product and fluids; and

(ii) provide instructions for the recipient's personal care assistant to follow regarding the method of administration, the enteral nutrition product and fluids to be used and the amount for each feeding, the rate of flow and duration of each feeding, and the feeding schedule; the personal care services agency must ensure that the recipient's personal care assistant has the training necessary to implement the written plan safely; or

(C) supervising the eating and drinking of a recipient who has swallowing or aspiration difficulties if
(i) the need for supervision has been confirmed by a swallow study that was conducted not earlier than one year before the date of application under 7 AAC 125.012; and

(ii) the report of that study is submitted to the department with the recipient's initial application under 7 AAC 125.012 or request for amendment under 7 AAC 125.026, or as requested by the department;

(6) for the ADL of toileting,
(A) moving a recipient to and from a location in the recipient's home and the location of the toilet or commode, including all transfers and locomotion necessary to complete the ADL of toileting;

(B) assisting the recipient with the use of a bedpan or urinal;

(C) colostomy, ileostomy, or external catheter care; or

(D) for a recipient in a consumer-directed program only, inserting a non-medicated suppository, digital stimulation, or other routine incontinence care;

(7) for the ADL of personal hygiene,
(A) washing and drying face, hands, or feet, when done separately from bathing;

(B) nail care for non-diabetic recipients;

(C) skin care;

(D) mouth and teeth care;

(E) brushing and combing hair;

(F) shaving, when done separately from bathing; or

(G) washing hair, when done separately from bathing;

(8) for the ADL of bathing, the washing of a recipient's entire body, including the recipient's hair, in a bathtub or shower, or by means of a sponge bath, and all transfers and locomotion necessary to complete the ADL of bathing.

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(c) Subject to the limitations in 7 AAC 125.040(a)(12), the department may authorize personal care services for one or more of the following types of physical assistance to enable a recipient to complete an IADL;

(1) for the IADL of light meal preparation in the recipient's home, the preparation, serving, and cleanup of a meal that is essential to meet the health needs of the recipient, is not the main meal of the day, and meets the requirements of (e) of this section;

(2) for the IADL of main meal preparation in the recipient's home, the preparation, serving, and cleanup of one main meal a day that is essential to meet the health needs of the recipient and meets the requirements of (e) of this section;

(3) for the IADL of housework in the recipient's home,
(A) making living spaces used by the recipient neat and orderly, including dusting and floor cleaning;

(B) cleaning the kitchen and dishes used for preparation of the recipient's meals only if the recipient prepares the recipient's meals;

(C) cleaning any bathroom used by the recipient;

(D) making the recipient's bed;

(E) trash removal; or

(F) providing food and water, and clean-up and disposal of animal waste, for one service animal; in this subparagraph, "service animal" means a dog that has been individually trained to perform work or tasks directly related to the recipient's functional limitations experienced as a result of the recipient's physical condition;

(4) for the IADL of laundering,
(A) changing a recipient's bed linens; or

(B) laundering a recipient's linens and clothing;

(5) for the IADL of shopping, shopping for items required for the health and maintenance of the recipient, including groceries, household items, prescribed drugs, and medical supplies.

(d) In addition to the types of physical assistance set out in (b) and (c) of this section, personal care services may include one or more of the following activities if physical assistance is necessary for a recipient to complete the activity:

(1) assisting a recipient with self-administration of prescribed oral medication, eye drops, and skin ointments;

(2) minor maintenance of respiratory equipment;

(3) dressing changes and wound care, except that dressing changes and wound care involving prescription medication and aseptic techniques may be performed only by a personal care assistant working for a consumer-directed personal care services agency;

(4) escorting a recipient to and from a routine medical or dental appointment, if that recipient is authorized to receive assistance with the ADL of locomotion;

(5) passive range-of-motion, if provided for a recipient that has
(A) a documented physical condition associated with contractures that results in a need for passive range-of-motion for the extremities affected by that condition; and

(B) a written plan for passive range-of-motion for those extremities, to be performed in the home of the recipient, that
(i) has been provided by a licensed physician, physician assistant, advanced practice registered nurse, physical therapist, or occupational therapist that is qualified to practice under AS 08 or 7 AAC 105.200(c);

(ii) provides detailed guidance for the movements of the recipient's extremities that is to be followed by the recipient's personal care assistant when performing passive range-of-motion as a personal care service;

(iii) is reviewed and revised, annually or as necessary, for a change in the recipient's condition that requires an alteration of the written plan; and

(iv) is submitted to the department with the recipient's application under 7 AAC 125.012 or request for amendment under 7 AAC 125.026, or as requested by the department.

(e) The department will pay for light meal preparation and main meal preparation under (c) of this section, if the meal preparation service is

(1) not duplicated by another meal service approved under 7 AAC 130.295 or 42 U.S.C. 3001- 3058ff (Older Americans Act);

(2) provided in the recipient's home; and

(3) provided in accordance with 42 U.S.C. 3030g.

(f) If two or more recipients reside in the same residence, the department may require that one personal care assistant provide assistance with specified IADLs when those activities benefit all recipients in that residence,

(g) In this section,

(1) "assisting a recipient with self-administration of prescribed oral medication, eye drops, and skin ointments" means
(A) reminding the recipient to take or use medication;

(B) opening a medication container or prepackaged medication for the recipient;

(C) reading a medication label to the recipient;

(D) providing food or liquids if the medication label instructs the recipient to take the medication with food or liquids; for purposes of this subparagraph, providing food or liquids does not include time to prepare food or meals;

(E) observing the recipient while the recipient takes or uses medication;

(F) checking the recipient's dosage to be self-administered against the label of the medication container;

(G) reassuring the recipient that the recipient is taking the dosage or using a medication as prescribed; or

(H) directing or guiding the hand of the recipient, at the recipient's request, while the recipient administers medication;

(2) "medication" means a drug or product, including an over-the-counter product, that is intended to be taken or used by the recipient at a scheduled time or as needed, and that is prescribed for the recipient by a licensed physician, physician assistant, advanced practice registered nurse, or dentist that is qualified to practice under AS 08 or 7 AAC 105.200(c);

(3) "passive range-of-motion" means moving a joint through the range of motion by another individual with no effort from the recipient.

Authority:AS 47.05.010

AS 47.07.030

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