(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 130.213, and the level-of-care determination made
in accordance with
7
AAC 130.215. After an assessment, or interim
level-of-care review under
7
AAC 130.213, and after receiving the department's
notice that the recipient meets the level-of-care requirement under
7
AAC 130.215, 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 130.220 and of any relationship described in
7
AAC 130.240(e);
(B) the full range of home and
community-based waiver services and the names of all providers that offer those
services; and
(C) the recipient's
right to free choice of providers, including the option 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 meets the requirements of
7
AAC 130.218(b);
(3) prepare in writing, in a format provided
by the department, a support plan developed in accordance with this section and
7
AAC 130.218;
(4) secure the handwritten or electronic
signature of
(A) the recipient or recipient's
representative indicating that the recipient or recipient's representative
(i) agrees to the support plan;
(ii) is aware of any relationship between the
care coordinator and any provider certified under
7
AAC 130.220 and of any relationship described in
7
AAC 130.240(e);
(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 verify participation in the development of the recipient's
support plan; and
(5)
submit the support plan and supporting documentation to the department for
approval; 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 130.215;
(B) 30 days before expiration of the current
plan year.
(b) The department will approve a plan of
care if the department determines that
(1)
the services specified in the support plan are sufficient to prevent
institutionalization and to maintain the recipient in the community;
(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 a home and
community-based waiver service under this chapter; and
(3) if nursing oversight and care management
services are to be provided, a nursing plan in accordance with
7
AAC 130.235 is included.
(c) Not later than 30 business days after the
department receives the complete support plan of care, the department will
notify the recipient, the recipient's representative, and the recipient's care
coordinator of the department's approval or disapproval of specific
services.
(d) A 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, either in person or
electronically, of
(A) the recipient or
recipient's representative indicating that the recipient or recipient's
representative agrees to the plan of care amendment; and
(B) a representative of each provider of
services that are modified by the amendment indicating the provider agrees to
render the services as specified in the plan of care amendment; and
(3) submit the support plan
amendment to the department not later than 10 business days after the date of a
change in circumstances or a change in the number of service units, 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) Not later than 30 business
days after the department receives a complete support plan amendment, the
department will notify the recipient, the recipient's representative, and the
recipient's care coordinator of the department's approval or disapproval of
specific services.
