(a) The department
will increase or reduce the time authorized for Community First Choice personal
care services before the end of a recipient's current authorization period if
the department determines that
(1) a
recipient has experienced a change that alters the recipient's need for
assistance with ADLs, lADLs, or other covered services after the recipient's
last assessment or amendment to the service level authorization;
(2) the recipient's living environment,
support services, or informal supports or caregivers changed after the
recipient's last assessment: or
(3)
the recipient received Community First Choice services that are no longer
authorized under 7 AAC 105-7 AAC 160.
(b) To request an amendment to a service
level authorization before the end of the recipient's current authorization
period, the recipient's personal care services agency shall
(1) complete and submit the request in the
format provided by the department for that purpose; and
(2) submit all current medical or other
relevant documentation that supports the claim that the change alters the
recipient's need for physical assistance with ADLs, lADLs, or other covered
services.
(c) Before
reducing the time authorized for a recipient for Community First Choice
personal care services, the department will first consider whether a reduction
in the time authorized for the recipient's Community First Choice personal care
services would create a risk of institutionalization. The department will
consider the following to make this determination:
(1) the documents specified in
7
AAC 127.030 that are current and submitted by the
recipient in response to the department's notification requiring a new
assessment;
(2) the findings on the
recipient's
Consumer Assessment Tool that are the result of a
new assessment under
7
AAC 127.030;
(3) the impact of a reduction in time
measured over a 24-hour period, taking into consideration the total time that
the recipient receives physical assistance from any source;
(4) whether the recipient's representative,
family members, or other natural supports provide assistance to the
recipient;
(5) whether other
individuals living in the same residence as the recipient receive services that
benefit the recipient; and
(6) the
recipient's history of utilization of the time authorized on the recipient's
current service level authorization.
(d) In this section, "risk, of
institutionalization" means a likelihood that, as a result of the recipient's
current condition as identified in assessments and medical records, the
recipient would require relocation from the recipient's current residence to a
hospital or nursing facility in 30 days.
(e) The department will terminate a
recipient's authorization to receive personal care services approved under
7
AAC 127.090 if the recipient
(1) fails to use the personal care services in the service level
authorization within 90 consecutive days after approval by the department or
during any 90 consecutive-day period authorized under
7
AAC 127.090(e); or
(2) has a documented history of failing to
cooperate with the delivery of services identified in the service level
authorization, or of placing a personal care assistant at risk of physical
injury, and no other provider is willing to provide services for the recipient;
for the purposes of this paragraph a documented history exists if a provider
(A) reports that a personal care assistant
was unable to obtain cooperation with service delivery or to mitigate the risk
of physical injury despite reasonable attempts; and
(B) maintains records to support that report
and makes those records available to the department for inspection; the
department will review those records and interview the recipient or the
recipient's representative before making a decision to terminate the
recipient's authorization to receive personal care
services.
