Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services
Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care
7 AAC 130.280 - Respite care services

Universal Citation: 7 AK Admin Code 130.280

Current through November 28, 2024

(a) The department will pay for respite care services that

(1) are provided in accordance with the department's Respite Care Services Conditions of Participation, adopted by reference in 7 AAC 160.900;

(2) are approved under 7 AAC 130.217 and 7 AAC 130.218 as part of the recipient's support plan;

(3) receive prior authorization; and

(4) do not exceed the maximum number of hours and days specified in (c) of this section.

(b) The department will consider services to be respite care services if the services are provided

(1) in one or more of the following locations, for hourly respite care services:

(A) the recipient's home;

(B) the private residence of the respite care provider;

(D) another community setting if that setting is appropriate for the needs of the recipient and the recipient's health, safety, and welfare will not be placed at risk;

(2) in one or more of the following locations, for daily respite care services;

(A) the recipient's home;

(B) a licensed facility specified in (d)(1) of this section;

(3) because of the absence or need for relief of the following caregivers only:

(A) a primary unpaid caregiver;

(B) a provider of family home habilitation services under 7 AAC 130.265(b), except that the department will not pay claims for daily respite care services under (c)(2) of this section and family home habilitation services for the same time period; and

(4) to replace the caregiver's oversight, care, and support needed by the recipient to remain in the recipient's community and to prevent risk of institutionalization; in this paragraph, "institutionalization" does not mean the temporary arrangement for respite care services in a facility specified in (d)(1) of this section.

(1) 520 hours of hourly respite care services per year, unless the department approves more hours because the lack of additional care or support would result in risk of institutionalization, and except that under this paragraph the department will not pay more than the daily rate established in 7 AAC 145.520 for respite care services provided to a recipient in the adults with physical disabilities category;

(2) 14 days of daily respite care services per year; for purposes of this paragraph, daily respite care services for the time that includes the recipient's usual nightly sleep period must be provided in the recipient's home or in the types of facilities specified in (d)(1) of this section.

(d) The department will pay under this section for respite care services subject to the following limitations:

(1) the department will pay for room and board expenses incurred during the provision of respite care services only when the room and board arc provided in

(A) a nursing facility;

(B) a general acule care hospital;

(D) an assisted living home licensed under AS 47.32, if that home is not the recipient's residence; or

(E) a foster home licensed under AS 47.32, if that home is not the recipient's residence;

(2) the department will not pay for daily respite care services provided in a facility specified in (1) of this subsection at a rate in excess of the rate established for Medicaid providers under 7 AAC 105-7 AAC 160;

(3) the department will not pay for respite care services to

(A) relieve paid providers of Medicaid services, except providers of family home habilitation services under 7 AAC 130.265(b); or

(B) provide oversight for minor children, other than a recipient of home and community-based waiver services, in the home; for purposes of this subparagraph, "minor children" means unemancipated individuals under 18 years of age;

(4) the department will not pay for respite care services that are provided at the same time as

(A) other home and community-based waiver services that include care and supervision of the recipient; or

(B) personal care services under 7 AAC 125.010 - 7 AAC 125.199;

(5) the department will pay for hourly respite care services provided at the same time as one or more of the following services, except that an individual may not provide another service identified in this paragraph while rendering respite care services:

(A) chore services under 7 AAC 127.087;

(B) transportation services under 7 AAC 120.290;

(6) the department will not pay for hourly respite care services provided to recipients receiving residential supported-living services under 7 AAC 130.255.

(e) The department will pay for family-directed respite care services if the services are

(1) provided for a recipient in one of the following recipient categories:

(A) children with complex medical conditions;

(B) individuals with intellectual or developmental disabilities;

(2) provided through a home and community-based waiver services provider that

(A) is certified under 7 AAC 130.220 to provide respite care services;

(B) has on file with the department a current letter of agreement acknowledging responsibility for

(i) complying with the requirements of AS 47.05.017 with respect to an individual retained and directed by a family to provide respite care services under this subsection; and

(ii) ensuring that the retention and direction of an individual by a family to provide respite care services under this subsection is in accordance with municipal, state, and federal law pertaining to employment of that individual, including applicable provisions of 26 U.S.C. (Internal Revenue Code), and to protection of the health, safety, and welfare of the recipient;

(D) pays the individuals retained by the family to provide family-directed respite care services;

(3) directed by a primary unpaid caregiver that

(A) in regard to the individuals selected to provide family-directed respite care services

(i) identifies and trains the individuals that meet the requirements for respite care services direct care workers specified in the department'sRespite Care Services Conditions of Participation, adopted by reference in 7 AAC 160.900; and

(ii) completes and signs timesheets for individuals;

(B) provides, to the home and community-based waiver services provider that has prior authorization for the family-directed respite care services, written assurance that the primary unpaid caregiver understands the risk that the primary unpaid caregiver assumes for family-directed respite care services; and

(C) does not identify, train, or sign timesheets for individuals that provide family-directed respite care services for other recipients; and

(4) consistent with the following limitations:

(A) daily respite care services in a facility specified in (d)(1) of this section may not be provided as family-directed respite care services;

(B) family-directed respite care services may not be provided to relieve providers of family home habilitation services under 7 AAC 130.265(b).

(f) In this section,

(1) "daily respite care services" means respite care services not less than 12 hours and not more than 24 hours in duration;

(2) "family-directed respite care services" means respite care services provided by an individual that is

(A) retained by the family of the recipient; and

(B) paid by a home and community-based waiver services provider.

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040

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