Section 7 AAC 127.027 - [Effective until 10/19/2024] Disenrollment(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 eligibility for Community First Choice services because the recipient, recipient's representative, or recipient's care coordinator did not submit the documentation required for assessment or interim level-of-care review under 7 AAC 127.030(c) at least 90 days before expiration of the current support plan;(3) the recipient is no longer eligible for Medicaid coverage under AS 47.07.020 or 7 AAC 100.002;(4) the recipient or the recipient's representative chooses to end the recipient's participation in the Community First Choice program;(5) the recipient or the recipient's representative misrepresents the recipient's physical, intellectual, developmental, or medical condition in an effort to obtain services that are not medically necessary or for which the recipient does not qualify;(6) the recipient has a documented history of failing to cooperate with the delivery of services identified in the support plan prepared under 7 AAC 127.039, or of placing caregivers or other recipients at risk of physical injury, and no other providers are willing to provide services to the recipient; for the purposes of this paragraph, a documented history exists if a provider (A) reports that the provider has been unable to obtain cooperation with service delivery or to mitigate the risk of physical injury to a caregiver or other recipients through reasonable accommodation of the recipient's disability; and(B) maintains records to support that report, and makes those records available to the department for inspection; the department will review those records before making a decision on disenrollment under this paragraph;(7) the recipient or the recipient's representative fails to take an action or to submit documentation required under 7 AAC 127.025 - 7 AAC 127.165.(b) An applicant or recipient that is denied enrollment for Community First Choice services or a recipient that is disenrolled for reasons described in (a) of this section, may appeal that decision under 7 AAC 49.Eff. 10/1/2018, Register 227, October 2018; am 1/22/2023, Register 245, April 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.036
AS 47.07.040
AS 47.07.045