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
Universal Citation: 7 AK Admin Code 125.050
Current through November 28, 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;
(2) during a temporary absence under (c) of
this section; or
(3) at the
recipient's workplace, if the recipient needs physical assistance with ADLs to
prevent job loss; the department will not assess the recipient at the
recipient's workplace or allow time for personal care services at that location
in addition to the total time authorized in accordance with
7
AAC 125.024.
(b) The department will not pay for personal care services for a recipient in
(1) a
licensed skilled or intermediate care facility or hospital;
(2) a licensed intermediate care facility for
individuals with an intellectual or developmental disability or a related
condition;
(3) a foster home
licensed under AS 47.32, except for a recipient that is residing in the foster
home and is eligible for home and community-based waiver services under the
recipient category of
(A) children with
complex medical conditions under
7
AAC 130.205(d)(1); or
(B) individuals with intellectual and
developmental disabilities under
7
AAC 130.205(d)(3);
(4) an assisted living home
licensed under AS 47.32;
(5) an
unlicensed residential setting that the department determines to fall within
the definition of an assisted living home under
AS
47.32.900;
(6) a residence where personal care services
are provided under a contractual agreement; or
(7) a general acute care hospital.
(c) The department will pay for personal care services for a recipient during a recipient's temporary absence from the recipient's community when the recipient travels to another location within the state or to a destination in another state if
(1) the services are requested before travel
and are approved by the department in the service level
authorization;
(2) the services are
necessary to maintain the recipient's current level of functioning, and the
temporary absence is justified as
(A)
medically necessary, as documented by a licensed physician that is qualified to
practice under AS 08.64 or
7
AAC 105.200(c);
(B) an educational opportunity of limited
duration that is not available in the recipient's community or in the state,
and that will further the recipient's capacity for vocational or professional
employment; or
(C) a
vacation;
(3) the
recipient's need for assistance with ADLs, IADLs, and other covered services
during the travel period can be met only by a personal care
assistant;
(4) the services to be
provided during the recipient's temporary absence are the same as those
provided when the recipient is in the recipient's community;
(5) the temporary absence will be for at
least 24 hours, but not longer than 30 days; the department will authorize
personal care services under this subsection for not longer than 30 days in a
365-day period unless approved under (d) of this section;
(6) the recipient meets the requirements of
7
AAC 100.064, if travel is to be out-of-state;
and
(7) the personal care services
provider certified and enrolled under
7
AAC 125.060 maintains an employer relationship with
the personal care assistant traveling with and providing services to a
recipient during the temporary absence.
(d) Notwithstanding (c)(5) of this section, the department may approve a temporary absence of longer than 30 days in a 365-day period if
(1) a licensed physician
that is qualified to practice under AS 08.64 or
7
AAC 105.200(c) documents that a
longer temporary absence is medically necessary; or
(2) the department determines that the
benefits to the recipient of an educational opportunity under (c)(2)(B) of this
section justify a longer temporary absence.
(e) The department will not pay for
(1) transportation, room and board, or other
expenses for a personal care assistant or other individual providing services
under this section; or
(2) services
provided in any location other than those where Medicaid services may be
provided.
Authority:AS 47.05.010
AS 47.07.030
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