Current through November 28, 2024
(a) The department
will pay for care coordination services that are
(1) provided in accordance with
7
AAC 130.217 and
7
AAC 130.218 and the department's
Care
Coordination Services and Long Term Services and Supports Targeted Case
Management Conditions of Participation, adopted by reference in
7
AAC 160.900; and
(2) approved in the recipient's support plan
(A) developed under
7
AAC 128.010, for long term services and supports
targeted case management; or
(B)
developed under the provisions of
7
AAC 130.217 and
7
AAC 130.218 for a support plan.
(b) The department will pay a
monthly care coordination service rate, established in accordance with
7
AAC 145.520, if the care coordinator,
(1) for a recipient of services under the
individualized supports waiver described in
7
AAC 130.206, makes one in-person contact with the
recipient or the recipient's representative at least once every six months, and
one telephone contact or distance delivery contact in each of the subsequent
five months;
(2) for a recipient
enrolled in other home and community-based waivers, including the individuals
with intellectual and developmental disabilities waiver described in
7
AAC 130.206, remains in contact with the recipient or
the recipient's representative in a manner and with a frequency appropriate to
the needs and the communication abilitie s of the recipient, but at a minimum
makes two contacts each month with the recipient or the recipient's
representative; eveiy six months one of the monthly contacts must be in person;
the remainder may be done by telephone or distance delivery;
(3) monitors service delivery by
(A) meeting in person with the recipient in
at least two service environments, including the recipient's home, at least
once during the plan year; and
(B)
arranging for the in-person contacts required in (1) or (2) of this subsection
to occur in one of the settings where home and community-based waiver services
are provided; and
(4)
after each visit with the recipient, completes and retains as documentation of
each visit, a recipient contact report in accordance with the department's
Care Coordination Services and Long Term Services and Supports Targeted
Case Management Conditions of Participation, adopted by reference in
7
AAC 160.900.
(c) The department will pay the monthly care
coordination service rate beginning the first of the month that the recipient
is enrolled under
7
AAC 130.219(b) and has a support plan
approved in accordance with the provisions of
7
AAC 130.217 and
7
AAC 130.218 for a support plan, for the following
ongoing activities provided in accordance with (b) of this section:
(1) routine monitoring and support;
(2) monitoring quality of care;
(3) evaluating the need for specific home and
community-based waiver services;
(4) reviewing the support plan and amending
the support plan as needed;
(5)
coordinating multiple services and providers;
(6) assisting the recipient to apply for
reassessment under
7
AAC 130.213;
(7) assisting the recipient in case
terminations.
(e) A care
coordinator must disclose, to the department in a format provided by the
department, any close familial relationship or close business relationship with
a home and community-based waiver services provider.
(f) The department will not pay for care
coordination services provided by
(1) the
recipient, a member of the recipient's immediate family, the recipient's
representative, an individual with a duty to support the recipient under state
law, a holder of power of attorney for the recipient, the recipient's personal
care assistant; or
(2) a care
coordinator, if any home and community-based service included in the
recipient's support plan is determined by the department to result in a
conflict of interest involving that care coordinator.
(g) The department will recoup under
7
AAC 105.260 any payment for other home and
community-based waiver services provided to a recipient by a care coordinator
while that care coordinator provided ongoing care coordination under this
section.
(h) The care coordinator
shall notify the department not later than seven days after the date of a
recipient's
(1) planned admission to a
hospital or to a nursing facility; and
(2) discharge from a hospital or from a
nursing facility.
(i)
Notwithstanding (b) of this section, the department will pay for additional
support plans that have received prior authorization.
(j) In this section,
(1) "close business relationship" means
(A) a five percent or greater ownership,
partnership, or equity interest in another home and community-based waiver
services provider 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 home and community-based waiver services provider 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 home and
community-based waiver services provider who is a natural person; or
(ii) an owner, administrator, or employee of
a 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
47.07.040
