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 2 - Home Health Care Services
7 AAC 125.320 - Requirements for home health care services

Universal Citation: 7 AK Admin Code 125.320

Current through November 28, 2024

(a) The department will not pay for a home health care service, other than an initial visit for evaluation purposes, unless the provider has received prior authorization from the department. The department will accept a request for a home health evaluation received from any person concerned with the care of the recipient.

(b) A home health agency must submit a request for prior authorization on a form provided by the department, and must include a written statement from the attending physician advanced practice registered nurse, or physician assistant that

(1) explains the need for home health care services, including the reason services cannot be performed in a clinic, outpatient setting, or physician's office; and

(2) includes medical recommendations for a plan of care developed under (d) of this section for services provided
(A) on an ongoing basis; or

(B) after acute care; for services provided under this subparagraph, the written statement must include the expected decrease in need for skilled nursing services and home health aide visits.

(c) The department will not determine eligibility to receive home health care services based upon the recipient's

(1) need for institutional care;

(2) discharge from institutional care;

(3) homebound status; or

(4) need for skilled nursing services.

(d) A physician. advanced practice registered nurse, or physician assistant shall develop a plan of care for a recipient of home health care services. The plan of care must include

(1) pertinent diagnoses, including mental status;

(2) types of services and equipment required; orders for therapy services must include the specific procedures and modalities to be used and the amount, frequency, and duration of those services;

(3) the frequency of visits;

(4) the prognosis for the recipient;

(5) an analysis of the recipient's rehabilitation potential;

(6) a description of the recipient's functional limitations;

(7) activities permitted to the recipient;

(8) the recipient's nutritional requirements;

(9) the recipient's medications and treatments;

(10) any safety measures to protect the recipient against injury; and

(11) instructions for a timely discharge and referral.

(e) If a physician. advanced practice registered nurse, or phvsician assistant refers a recipient under a plan of care that cannot be completed until after an evaluation visit, the phvsician, advanced practice registered nurse, or phvsician assistant shall make additions or modifications to the original plan of care as necessary to reflect the outcome of the evaluation.

(f) To determine the immediate care and support needs of the recipient, and except as provided in (h) of this section, a registered nurse shall complete an initial assessment of the recipient no more than 48 hours after the referral, no more than 48 hours after the recipient's return to the recipient's place of residence, or on the start-of-care date that the physician, advanced practice registered nurse, or physician assistant ordered.

(g) Consistent with the recipient's immediate care and support needs, and except as provided in (h) of this section, a registered nurse shall complete a comprehensive assessment of the recipient no later than five days after the date care starts. The comprehensive assessment must include a review of each medication that the recipient currently uses in order to identify

(1) significant side effects, significant drug interactions, and potential adverse effects and drug reactions;

(2) ineffective drug therapy;

(3) duplicate drug therapy; and

(4) noncompliance by the recipient with drug therapy.

(h) If speech-language pathology, physical therapy, or occupational therapy is the only service ordered by the physician, advanced practice registered nurse, or physician assistant,

(1) a speech-language pathologist, physical therapist, or occupational therapist, as appropriate, may complete the initial and comprehensive assessments within the scope of the professional's license; and

(2) the department will not require a medication review as part of the comprehensive assessment under (g) of this section.

(i) The attending physician advanced practice registered nurse, or physician assistant shall review the plan of care, initial assessment, and comprehensive assessment

(1) at least once during the prior authorization period established under 7 AAC 125.310(c);

(2) more frequently if a significant change occurs in the recipient's condition; and

(3) if a discharge of the recipient and return to the same home health agency occurs during a prior authorization period established under 7 AAC 125.310(c).

(j) At least annually, a physician, advanced practice registered nurse, or physician assistant shall review a recipient's need for supplies. The department may require more frequent physician, advanced practice registered nurse, or physician assistant reviews for particular prescribed items.

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040

Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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