Alaska Administrative Code

(a) The department will pay a public or private home health agency for the following home health care services, if recommended by a licensed physician, advanced practice registered nurse, or physician assistant as part of a plan of care developed in accordance with 7 AAC 125.320:…

(a) The department will not pay for a home health care service, other than an initial visit for evaluation purposes, unless the provider has received prior authorization from the department. The department will accept a request for a home health evaluation received from any perso…

(a) A provider of home health services under 7 AAC 125.310 shall use an electronic visit verification (EVV) system that is either provided or approved by the department. If a provider decides to use its own EVV system or vendor, that system must include at the time of service del…

In 7 AAC 125.300 - 7 AAC 125.399, unless the context requires otherwise, (1) "intermittent or part-time" means no more than eight hours of care, not necessarily consecutive, in a 24-hour period; (2) "skilled nursing services" means the curative, restorative, or preventive aspects…

The purpose of this chapter is to offer to individuals that meet the eligibility criteria in 7 AAC 127.025 the opportunity to choose to receive Community First Choice services as an alternative to institutional care. Notes 7 AAC 127.010 Eff. 10/1/2018, Register 227, October 2018 …

(a) Community First Choice personal care services may be provided by a recipient's legally responsible individual under AS 47.07.045(d), including the recipient's spouse, the recipient's parent if the recipient is a minor child, or the recipient's court-appointed legal guardian, …

(a) The department will pay a provider for Community First Choice services authorized in a recipient's support plan developed under 7 AAC 127.039, and provided in accordance with the applicable requirements of this chapter, for an individual that is (1) a current Medicaid recipie…

(a) The department will disenroll a recipient for any of the following reasons: (1) the department terminates its participation in the Community First Choice program under 42 U.S.C. 1396n(k); (2) the department is unable to determine the recipient's continued eligibility for Comm…

(a) The department will pay for and review, in any 365-day period, one initial application for Community First Choice services to determine whether there is a reasonable indication that the individual might need services at a level of care under 7 AAC 127.025(d) (b) To apply for …

(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 127.030, and the level-of-care determination made in accordance …

(a) The department will pay a Community First Choice provider agency for the following services for individuals eligible under 7 AAC 127.025, if those services are provided in accordance with this chapter: (1) personal emergency response services under 7 AAC 127.085; (2) Communit…

(a) Community First Choice personal care services do not include (1) application of dressings involving prescription medication and aseptic techniques, except as allowed under 7 AAC 125.030(d)(3); (2) invasive body procedures, including (A) tracheostomy care, deep suctioning, and…

(a) Except as specified in (j) of this section, to receive payment for Community First Choice services under 7 AAC 127.040, a provider must enroll in the Medicaid program under 7 AAC 105.210 and must be certified under this section. To be certified by the department, a provider m…

(a) A provider of Community First Choice personal care services under 7 AAC 127.040(a)(2) shall use an electronic visit verification (EW) system that is either provided or approved by the department. If a provider decides to use its own EW system or vendor, that system must inclu…

(a) The department may deny an application to renew certification of, will suspend certification of, or will decertify and disenroll a Community First Choice services agency as a provider (1) if the agency does not submit an application for renewal in accordance with or meet the …

(a) A personal care assistant employed by an agency providing Community First Choice personal care services shall maintain, for Medicaid billing purposes, a contemporaneous record of services provided to each recipient. The record must include (1) a copy of the service level auth…

(a) Not later than 30 days before a provider of Community First Choice services terminates services to a recipient, the provider agency shall send written notice of service termination to the department, the recipient, and the recipient's care coordinator. (b) A provider agency m…

(a) The department will pay for Community First Choice personal care services for a recipient only if provided (1) in the recipient's residence if that residence is(A) the dwelling that the recipient considers to be the recipient's established or principal home and to which, when…

(a) The department will pay for a personal emergency response system that (1) is supported by a prescription or other written documentation required by the department's Specialized Medical Equipment Fee Schedule, adopted by reference in 7 AAC 160.900, (A) from an individual quali…

(a) The department will pay for chore services that (1) comply with the department's (A)Provider Conditions of Participation for Home and Community-Based Waiver Services and Community First Choice Chore Services, adopted by reference in 7 AAC 160.900; and (B)Community First Choic…

(a) For each recipient, based upon that recipient's assessment conducted under 7 A AC 127.030, the department will (1) determine the level of assistance necessary for and the amount, duration, and frequency of the specific Community First Choice personal care services for which t…

(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 nee…

(a) To receive payment for Community First Choice personal care services, a personal care assistant must be employed in either a consumer-directed program or an agency-based program, and must (1) be at least !8 years of age; (2) comply with the requirements of this chapter; and (…

(a) An agency certified, in accordance will 7 AAC 127.050, as a provider of Community First Choice personal care services shall (1) protect a recipient's health, safety, and welfare while rendering services under this chapter; and (2) provide training for all employees regarding …

(a) To qualify for Community First Choice personal care services through a consumer-directed program, a recipient, the recipient's representative, or the representative's designee, identified in accordance with (e)(2) of this section, must (1) demonstrate cognitive capacity for d…

(a) In addition lo meeting the requirements under this chapter, a personal care services agency that administers a Community First Choice consumer-directed program shall (1) perform, at least once every six months, a review of the recipient's services, including (A) interviewing …

An agency that manages an agency-based Community First Choice personal care services program shall (1) employ personal care assistants that meet the requirements of 7 AAC 125.160; and (2) retain a supervising licensed registered nurse and meet the requirements under 7 AAC 125.170…

(a) A recipient or the recipient's representative shall report any of the following changes by telephone, by facsimile transmission, by electronic mail, in writing, or in person to each of the recipient's Community First Choice services providers and the recipient's care coordina…

(a) A provider of Community First Choice personal care services shall report to the department, in a format provided by the department, a critical incident involving a recipient not later than one business day after observing or learning of the critical incident. (b) A provider a…

(a) A Community First Choice personal care assistant may use restrictive intervention only (1) as a response when a recipient presents an imminent danger to the recipient's safety or to the safety of others; (2) when other types of interventions have been tried, and documented as…

(a) A recipient that is terminated From an agency-based Community First Choice personal care services program may appeal that termination through the complaint process established by the Community First Choice personal care services agency. (b) If the assessment under 7 AAC 127.0…

In this chapter, unless the context requires otherwise (1) "ADL" means activity of daily living; (2) "agency-based program" means a program that provides Community First Choice personal care services to a qualified recipient who is unable Lo manage those services because or cogni…

(a) The services provided under this section must assist and enable an individual eligible under 7 AAC 125.010 - 7 AAC 125.199, 7 AAC 127, or 7 AAC 130 to access necessary medical, social, educational, developmental, and related services, (b) The department will pay for the long-…

Subject to legislative appropriation and the provisions of AS 18.25.070-18.25.110, the department will award grants under this chapter to assist in the operation of community health facilities in case of operational deficits. Notes 7 AAC 13.010 Eff. 3/17/85, Register 93 Authority…

(a) Applicants for financial assistance under AS 18.25.070-18.25.110 must apply on forms provided by the division. (b) The division will, in its discretion, assist an applicant in preparing the application and in complying with the requirements of this chapter. Notes 7 AAC 13.020…

(a) A facility may serve one or more communities in a geographically contiguous area in which a mid-level practitioner or physician is not readily accessible. (b) When an applicant proposes to serve two or more communities through a single facility, the applicant shall (1) provid…

(a) To be eligible to receive financial assistance under AS 18.25.070-18.25.110, a facility must be either governed or advised by a board selected in accordance with the following criteria:(1) A governing or advisory board must be composed of at least five members who reside in t…

(a) A facility shall establish a schedule of fees that it will charge for services. These fees must be sufficient to minimize the need for assistance from the department, but may not be unreasonable when compared to fees charged for similar services by other health care providers…

In its grant application, a facility shall include a five-year plan for increasing self-sufficiency. A five-year plan for self-sufficiency must include (1) a summary, by source and amount of revenues and expenses, that the facility expects during each of the five years starting w…

A facility receiving financial assistance under AS 18.25.070-18.25.110 shall work with other programs in its service area providing the same kinds of services to assure that delivery of services is coordinated with the other programs, to minimize duplication of services, and to b…

A facility may not use financial assistance provided under AS 18.25.070-18.25.110 to pay any capital cost without express advance approval by the department. Notes 7 AAC 13.050 Eff. 3/17/85, Register 93 Authority:AS 18.25.100 State regulations are updated quarterly; we currently …

A facility may use money granted under 7 AAC 13 to meet requirements for matching money funds to obtain or retain federal grants for operation of health facilities. Notes 7 AAC 13.055 Eff. 3/17/85, Register 93 Authority:AS 18.25.100 State regulations are updated quarterly; we cur…

A facility may use money granted under 7 AAC 13 to pay costs of salaries and other costs of mid-level practitioners if the division finds the salaries to be reasonable in light of salaries paid to other individuals in the region that perform comparable work. A facility may also u…

(a) The governing board of a facility shall provide the division with a table of organization that(1) identifies all operating units of the program; (2) defines the roles and responsibilities of all facility staff; and (3) delineates the interrelationship of the governing board, …

(a) A facility must have a policy and procedures manual that is approved by the governing board. The governing board shall review the manual annually and revise the manual as necessary. If a facility has an advisory body as defined in 7 AAC 13.030(b), adoption, review, and revisi…

To maximize revenues and to ensure proper fiscal management, the governing board or the program director of a facility shall (1) prepare and maintain a formal budget; (2) maintain fiscal records and provide fiscal reports to the department on forms provided by the department; (3)…

(a) A facility must have written and functioning policies and procedures to ensure consistency in personnel administration and staff competency in carrying out assigned tasks. These policies and procedures must include (1) job descriptions for paid and volunteer staff members, in…