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 130.319 - Definitions

Universal Citation: 7 AK Admin Code 130.319

Current through November 28, 2024

In this chapter, unless the context requires otherwise,

(1) "active teaching or training" means the use of appropriate measures or interventions that are evidence-informed, address objectives described in a recipient's approved support plan, lead to positive outcomes, and engage a recipient during each unit of service;

(2) "applicant's representative" means a person who serves, for an applicant, the functions of a recipient's representative;

(3) "assessment" means the process by which the department, using an assessment tool specified by recipient category in 7 AAC 130.215, determines if an applicant meets a level of care necessary to qualify for home and community-based waiver services;

(4) "business day" means a day other than Saturday, Sunday, or a legal holiday under AS 44.12.010;

(5) "care coordination" means those services provided in accordance with 7 AAC 130.240 by a care coordinator;

(6) "care coordination agency provider" means a provider that the department has certified under 7 AAC 130.220 to provide care coordination services under 7 AAC 130.240;

(7) "care coordinator" means an individual that the department has enrolled under 7 AAC 105.210 and certified under 7 AAC 130.238;

(8) "habilitation" means active teaching or training that

(A) assists a recipient to acquire, retain, or improve the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings; and

(B) is planned to help a recipient reach the level of physical, mental, and social functioning that the recipient has the capacity to engage in and benefit from;

(9) "home and community-based waiver services provider" has the meaning given in 7 AAC 160.990(b);

(10) "immediate family" means the spouse of the recipient, and the parent of a minor child that is the recipient;

(11) "interim level-of-care review" means an evaluation of a recipient's most recent documents related to receiving home and community-based waiver services, including the contents of the most recent application, the results of the recipient's most recent assessment, medical records, and other relevant documents or observations, in order to determine if an applicant meets a level of care necessary to continue to qualify for home and community-based waiver services;

(12) "natural supports" means

(A) individuals that, voluntarily and without payment, provide care and supports that enhance quality of life and foster community access and integration for the recipient; and

(B) the care and supports that are
(i) provided voluntarily and without pay for a recipient; and

(ii) similar to and supplemented by home and community-based waiver services;

(13) "primary caregiver" means an individual

(A) that lives in the same licensed residence as a recipient and provides care for a recipient; and

(B) provides the oversight, care, and support needed by the recipient to prevent risk of institutionalization of that recipient;

(14) "primary unpaid caregiver" means an individual that

(A) lives
(i) with a recipient in the same unlicensed residence; or

(ii) in a different residence and assists a recipient in the recipient's unlicensed residence;

(B) provides the oversight, care, and support needed by the recipient to prevent risk of institutionalization of that recipient, by assisting with the recipient's basic personal activities or with activities related to independent living; and

(C) does not receive payment for providing any other services for the recipient;

(15) "private residence" means a home that a recipient owns or rents, or a home where the recipient resides with other family members or friends;

(16) "recipient category" means a category listed in 7 AAC 130.205(d);

(17) "recipient's representative" has the meaning given in 7 AAC 160.990(b);

(18) "residential habilitation" means habilitation provided in a location that is

(A) a recipient's private residence; or

(B) a facility licensed under AS 47.32 that provides
(i) a structured setting with supervision and care;

(ii) shelter, food, household maintenance, and transportation;

(iii) encouragement, assistance, and guidance as necessary with activities of daily living described in 7 AAC 125.030(b);

(iv) social and recreational activities and opportunities both in the home and in the community; and

(v) arrangements for medical services if the need is indicated in the recipient's medical records;

(19) "residential supported-living services provider" means a provider that the department has certified under 7 AAC 130.220 to provide residential supported-living services under 7 AAC 130.255;

(20) "risk of institutionalization" means it is likely that the recipient's current condition would require the recipient to be relocated, within the support plan year, from the recipient's current residence to an acute care hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities;

(21) "teleassessment" means the use of audio, visual, or data communication methods to complete an assessment.

(22) "distance delivery"

(A) means a face-to-face interaction between a recipient and a provider, using a secure web-based platform that is compliant with P.L. 104-191 (Health Insurance Portability and Accountability Act of 1996 (HIPAA));

(B) does not include the use of a telephone without a video component.

(23) "material change in condition" means an alteration in the applicant's health, behavior, or functional capacity of sufficient significance that the department is likely to reach a different decision regarding the applicant's need for home and community-based waiver services.

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040

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