Section 7 AAC 130.213 - Assessment and interim level-of-care-review(a) If an application under 7 AAC 130.211 and supportive diagnostic documentation reasonably indicate the need for services described in 7 AAC 130.211(a), the department will conduct an assessment of the applicant's physical, emotional, and cognitive functioning to determine the(1) recipient category under 7 AAC 130.205(d) for which the applicant is eligible; and(2) level of care under 7 AAC 130.215 that the applicant requires.(b) If the department determines that an applicant meets the level-of-care requirement under 7 AAC 130.215, the department will send notice to the care coordinator for development of a support plan in accordance with 7 AAC 130.217 and 7 AAC 130.218. (c) To request an evaluation to determine whether a recipient has a continuing need for home and community-based waiver services, the recipient must submit a new application with current information in accordance with 7 AAC 130.207 not later than 90 days before the expiration of the period covered by the preceding level-of-care approval. The recipient must submit a new application in order to continue receiving home and community-based services after the expiration of the previous period.(d) For recipients enrolled in the recipient categories specified in 7 AAC 130.205(d)(1), (2), and (4), the department will (1) evaluate the recipient to determine if the recipient continues to meet the eligibility requirements of 7 AAC 130.205(d) and level-of-care requirement under 7 AAC 130.215 by conducting (A) an assessment for (i) a recipient's second year of enrollment; and (ii) every third year after the recipient's second year of enrollment, if there has been no change in the recipient's condition; and(B) an interim level-of-care review for each year an assessment does not occur; if the interim level-of-care review indicates that the recipient has experienced a material change in condition, the department will conduct an assessment; and(2) after each assessment or interim level-of-care review, notify the recipient, the recipient's representative, and the recipient's care coordinator of the department's determination.(e) For recipients enrolled in the recipient category specified in 7 AAC 130.205(d)(3), if the new application indicates a need for continuing services, the department will(1) either (A) assess the recipient to determine if the recipient continues to meet the eligibility requirements of 7 AAC 130.205(d)(3) and the level-of-care requirement under 7 AAC 130.215(3); the department will schedule an assessment based on the age of the recipient or earlier if the department determines it necessary, as follows: (i) annually for recipients at least three years of age and under seven years of age; (ii) as necessary for recipients seven years of age or older; or (B) conduct an interim level-of-care review for each year an assessment is not conducted and confer with the care coordinator for the recipient, to confirm that the recipient continues to meet the level-of-care requirement; if the interim level-of-care review indicates that there has been a material change in the recipient's condition, the department will conduct an assessment; and (2) after an assessment or interim level-of-care review under this subsection, notify the recipient, the recipient's representative, and the recipient's care coordinator of the department's determination.(f) If the department finds, based on an assessment under this section, that the recipient no longer requires the level of care described in 7 AAC 130.215, the department will (1) forward the assessment for review by an independent qualified health care professional in accordance with AS 47.07.045(b) and 7 AAC 130.219(e)(4); and(2) notify the recipient and the recipient's care coordinator of the referral and extension of the notification timeframe under 7 AAC 130.207(c)(3).(g) If the department determines that translation and interpretation services for a non-English speaking applicant or for a deaf applicant are necessary for an assessment under this section, the department will secure and pay for those services.(h) The department may schedule and conduct an assessment by teleassessment for an applicant or recipient who submits to the department an application in accordance with 7 AAC 130.207. If the department selects an applicant or recipient for a teleassessment, the department may request that the applicant or recipient provide information to the department about the residential setting of the applicant or recipient before the teleassessment is scheduled.Eff. 7/1/2013, Register 206; am 7/1/2015, Register 214, July 2015; am 11/5/2017, Register 224, January 2018; am 3/3/2021, Register 238, July 2021; am 1/22/2023, Register 245, April 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.045