Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 127 - Community First Choice Personal Care Services
7 AAC 127.039 - Support plan development and amendment

Universal Citation: 7 AK Admin Code 7 AAC 127.039

Current through November 28, 2024

(a) Not less than once every 12 months, the care coordinator shall submit a support plan, based on the current needs of the recipient, the most recent assessment or interim level-of-care review conducted under 7 AAC 127.030, and the level-of-care determination made in accordance with 7 AAC 127.025. After an assessment or interim level-of-care-review under 7 AAC 127.030, and after receiving the department's notice that the recipient meets the level-of-care requirement under 7 AAC 127.025, the care coordinator shall

(1) inform the recipient regarding
(A) the care coordinator's relationship as an employee of any provider certified under 7 AAC 127.050 or 7 AAC 130.220 and of any close familial relationship or close business relationship with a home and community-based waiver services provider, personal care services provider, or Community First Choice services provider;

(B) the Community First Choice services and other long-term services and supports available to the recipient and the names of all providers that offer those services; and

(C) the recipient's right to free choice of providers, including the right to choose another care coordinator to develop the recipient's support plan; the care coordinator shall support the recipient in the recipient's exercising the right to free choice of providers;

(2) consult, in person or by electronic mail, telephone, or video conference, with each member of a planning team that
(A) at a minimum, includes
(i) the recipient;

(ii) the recipient's representative;

(iii) members chosen by the recipient; and

(iv) a representative of each provider certified under 7 AAC 127.050 or 7 AAC 130.220 that is expected to provide services to the recipient, except that a provider of specialized medical equipment under 7 AAC 130.305, transportation services under 7 AAC 130.290, or environmental modification services under 7 AAC 130.300 is not required to be represented on the planning team; and

(B) includes the recipient's family members or other persons that provide natural supports for the recipient, at the request of the recipient or the recipient's representative;

(3) prepare in writing, in a format provided by the department, a support plan that
(A) identifies the needs of the recipient for specific services;

(B) identifies the providers certified under 7 AAC 127.050 or 7 AAC 130.220 that are available to render services to the recipient;

(C) identifies a recipient backup plan in the event that Community First Choice services are not available;

(D) identifies, for each Community First Choice service and other long-term services and supports,
(i) the provider certified under 7 AAC 127.050 or 7 AAC 130.220 that has agreed to provide that service;

(ii) the number of units of that service;

(iii) the frequency of that service; and

(iv) the projected duration of that service; and

(E) includes an analysis of whether each service and amount of that service is consistent with
(i) the assessment or interim level-of-care-review conducted under 7 AAC 127.030 and the level-of-care determination made in accordance with 7 AAC 127.025; and

(ii) any treatment plans developed for the recipient;

(4) secure the signature, either in person or electronically, of
(A) the recipient or the recipient's representative to indicate that the recipient or the recipient's representative
(i) agrees to the support plan;

(ii) has been informed of any relationship between the care coordinator and any provider certified under 7 AAC 127.050 or 7 AAC 130.220 and of any relationship described in (1)(A) of this subsection; and

(iii) has been informed of the recipient's right to free choice of providers;

(B) each provider representative indicating the provider agrees to render the services as specified in the support plan; and

(C) each individual on the planning team to verily participation in the development of the recipient's support plan; any disagreement among planning team members about outcomes or service levels, or any suggestion by a team member that an outcome or service level should be different than one established in the support plan, must be documented and attached to the support plan; and

(5) submit the support plan and supporting documentation to the department; unless the care coordinator has submitted to the department written documentation of unusual circumstances that prevent timely completion of the support plan, and the department has approved a later submission date, the care coordinator shall submit the support plan not later than
(A) 60 days after the date of the department's notice to the recipient and the recipient's care coordinator that the recipient meets the level-of-care requirement in 7 AAC 127.025;

(B) 30 days before expiration of the current support plan year.

(b) The department will approve a support plan if the department determines that

(1) the services specified in the support plan meet the needs of the recipient;

(2) each service listed on the support plan
(A) is of sufficient amount, duration, and scope to meet the needs of the recipient;

(B) is supported by the documentation required in this section; and

(C) cannot be provided under 7 AAC 105 - 7 AAC 160, except as Community First Choice services under this chapter or home and community-based waiver services under 7 AAC 130.

(c) The department will provide notice to the recipient, the recipient's representative, and the recipient's care coordinator that includes the department's approval or disapproval of specific services not later than 30 business days after the department receives the recipient's complete support plan.

(d) At the request of the recipient for a change in the recipient's Community First Choice services, the recipient's care coordinator shall

(1) prepare an amendment to the recipient's support plan if
(A) a modification is required to meet the recipient's needs because of a change of circumstances related to the health, safety, and welfare of the recipient; or

(B) the recipient needs an increase or decrease in the number of service units approved under (a) - (c) of this section or in a prior amendment to the support plan;

(2) secure the signature, other in person or electronically, of
(A) the recipient or the recipient's representative to indicate that the recipient or the recipient's representative agrees to the support plan amendment; and

(B) ii representative of each provider of services that arc modified by the amendment indicating the provider agrees to render the services as specified in the support plan amendment; and

(3) submit the support plan amendment to the department not later than 10 business days after the dale of a change in circumstances or a change in the number of service units needed, unless the care coordinator has submitted to the department written documentation of unusual circumstances that prevent timely completion of a support plan amendment, and the department has approved a later submission date,

(e) The department will provide notification to the recipient, the recipient's representative, and the recipient's care coordinator that includes the department's approval or disapproval of specific services not later than 30 business days after the department receives a complete support plan amendment.

(f) In this section,

(1) "close business relationship" means
(A) a five percent or greater ownership, partnership, or equity interest in another provider described in (a)(1)(A) of this section or its owner; or

(B) a five percent or greater ownership, partnership, or equity interest in any other business or commercial activity in which another provider described in (a) (1)(A) of this section or its owner or administrator also has a five percent or greater ownership, partnership, or equity interest;

(2) "close familial relationship" means a relationship in which the care coordinator is
(A) the spouse, parent, sibling, or child of
(i) a provider described in (a)(1)(A) of this section who is a natural person; or

(ii) an owner, administrator, or employee of a personal care services provider agency, Community First Choice services provider agency, or home and community-based waiver services provider agency;

(3) "owner" means a person having a five percent or greater ownership, partnership, or equity interest.

Authority: AS 47.05.010

AS 47.07.030

AS 47.07.036

AS 47.07.040

AS 47.07.045

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