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 127.075 - Community First Choice personal care services; place of service
Universal Citation: 7 AK Admin Code 7 AAC 127.075
Current through November 28, 2024
(a) The department will pay for Community First Choice 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 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 Community First Choice personal care
services at that location in addition to the total time authorized in
accordance with
7
AAC 127.090.
(b) The department will not pay for Community First Choice personal care services in the following locations:
(1) a licensed skilled nursing or
intermediate care facility or hospital;
(2) a licensed intermediate care facility for
individuals with an intellectual disability or related condition
(ICF/IDD);
(3) an assisted living
home licensed under AS 47.32;
(4)
an unlicensed residential setting that the department determines to fall within
the definition of an assisted living home under
AS
47.32.900;
(5) a residence where Community First Choice
personal care services are provided under a contractual agreement;
(6) a general acute care hospital;
(7) an institution providing psychiatric
services for individuals under 21 years of age, under 7 AAC
127,025(e);
(8) an institution for
mental diseases for individuals 65 years of age and over, under
7
AAC 127.025(e)
(c) The department will pay for Community First Choice 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 slate 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, lADLs, and other covered services
during the travel period can be met only by a Community First Choice 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
Community First Choice 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 Community First Choice
persona! care services provider certified and enrolled under
7
AAC 127.050 maintains an employer relationship with
the Community First Choice 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 Community First Choice 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
AS 47.07.036
AS 47.07.040
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