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

Universal Citation: 7 AK Admin Code 125.130

Current through November 28, 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;

(2) maintain communication with the recipient, the recipient's health care providers, and the personal care assistant as appropriate; and

(3) maintain a service record for each recipient that includes
(A) a copy of each service level authorization, assessment, and documentation of reviews under (a)(1) 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 between the agency and the recipient, the recipient's health care providers, and the personal care assistant.

(b) The department may waive the requirement that the review under (a)(1) of this section occur every six months if

(1) the recipient's residence is in a remote community or location;

(2) the agency performs in accordance with (a)(1) of this section a review of the recipient's services at least once in a 12-month period;

(3) instead of the omitted six-month review the agency conducts, at the time the six-month review would occur, a telephonic or electronic meeting with the recipient and the recipient's personal care assistant for the review of services; and

(4) the agency requests a waiver in a format provided by the department, and documents to the department's satisfaction that waiving one of the six-month reviews will not compromise the health, safety, or welfare of the recipient.

(c) A personal care services agency that administers a consumer-directed program shall collect and verify consumer-directed personal care assistants' timesheets, and submit claims based on those timesheets to the department.

(d) A personal care services agency that administers a consumer-directed program shall work with either the recipient or the recipient's representative to

(1) identify possible risks to the health, safety, and welfare of the recipient if the recipient's regularly scheduled personal care assistant is unable to provide services; and

(2) develop a backup plan that identifies the responsibilities of the agency and the recipient for obtaining the personal care services or other backup services if the recipient's regularly scheduled personal care assistant is unable to provide those services.

Authority:AS 47.05.010

AS 47.07.030

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