Section 7 AAC 125.026 - Amendments to service level authorization(a) The department will modify the time authorized for personal care services if the department determines that a recipient has experienced a change that alters the recipient's need for physical assistance with ADLs, IADLs, or other covered services.(b) To request an amendment to a service level authorization before the end of the recipient's current authorization period, a personal care services agency must (1) complete and submit the request in the format provided by the department for that purpose; and(2) submit all current medical or other relevant documentation that supports the claim that the change alters the recipient's need for physical assistance with ADLs, IADLs, or other covered services.(c) The department will amend a recipient's service level authorization before the end of the recipient's current authorization period if (1) the recipient's physical condition changed after the recipient's last assessment or amendment to the service level authorization;(2) the recipient's living environment, support services, or informal supports or caregivers changed after the recipient's last assessment; or(3) the recipient received personal care services(A) under a time-limited amendment to the recipient's service level authorization, and that amendment has expired; or(B) that are no longer authorized under 7 AAC 105-7 AAC 160.(d) The department will terminate a recipient's authorization to receive personal care services approved under 7 AAC 125.024 if the recipient (1) fails to use the personal care services in the service level authorization within 90 consecutive days after approval by the department or during any 90-consecutive-day period authorized under 7 AAC 125.024(d); or(2) has a documented history of failing to cooperate with the delivery of services identified in the service level authorization, or of placing a personal care assistant at risk of physical injury, and no other provider is willing to provide services for the recipient; for the purposes of this paragraph a documented history exists if a provider (A) reports that a personal care assistant was unable to obtain cooperation with service delivery or to mitigate the risk of physical injury despite reasonable attempts; and(B) maintains records to support that report, and makes those records available to the department for inspection; the department will review those records and interview the recipient or the recipient's representative before making a decision to terminate the recipient's authorization to receive personal care services.(e) The department may reduce time authorized for, or terminate, personal care services if the department determines that the recipient, the recipient's representative, the representative's designee, or the recipient's personal care services agency misrepresented the recipient's physical condition, or need for personal care services, for the purpose of obtaining personal care services for activities the recipient is able to perform or for which the recipient does not qualify.(f) The department will not reduce time authorized for personal care services if a reduction would create a risk of institutionalization for a recipient eligible to receive home and community-based waiver services under 7 AAC 130. To determine whether a reduction in personal care services would create a risk of institutionalization, the department will consider (1) the documents specified in 7 AAC 125.012(a)(4) that are current and submitted by the recipient in response to the department's notification requiring a new assessment;(2) the findings on the recipient's Consumer Assessment Tool, adopted by reference in 7 AAC 160.900, that are the result of a new assessment;(3) the impact of a reduction in time measured over a 24-hour period, taking into consideration the total time that the recipient receives assistance from any source;(4) whether the recipient's representative, family members, or other natural supports provide assistance to the recipient;(5) whether other individuals living in the same residence as the recipient receive services that benefit the recipient; and(6) the recipient's history of utilization of the time authorized on the recipient's current service level authorization.(g) In (f) of this section, "risk of institutionalization" means it is likely that as a result of the recipient's current condition as identified in assessments and medical records, the recipient would require relocation from the recipient's current residence to a hospital or nursing facility in 30 days.Eff. 1/26/2012, Register 201; am 7/22/2017,Register 223, October 2017Authority:AS 47.05.010
AS 47.07.030