Section 7 AAC 130.218 - Person-centered practice(a) Based on capacity and interest in participation, the recipient of home and community-based waiver services shall lead the planning process that results in a support plan under 7 AAC 130.217 and this section.(b) The planning process must (1) recognize and support the recipient as central to the process with the authority to specify goals and needs, to request meetings at times and locations convenient to the recipient, including distance delivery if the recipient request it, and to revise the support plan when necessary;(2) include the recipient, the recipient's representative, individuals chosen by the recipient to participate in the planning process, and the providers selected by the recipient to render home and community-based waiver services other than providers of (A) transportation services under 7 AAC 130.290; (B) environmental modification services under 7 AAC 130.300; or(C) specialized medical equipment under 7 AAC 130.305;(3) respond to recipient requests in a timely manner;(4) reflect cultural considerations;(5) provide information the recipient needs to make informed choices regarding services and supports; the information must be in plain language, and presented in a manner accessible to a recipient with disabilities or limited English proficiency; and(6) include strategies for solving conflicts or disagreements that might arise during the process, including conflict-of-interest guidelines for all planning participants.(c) The providers, selected in accordance with (d) of this section, must collaborate with the recipient, and with the individuals chosen by the recipient to participate in the planning process, to develop for the recipient a written, person-centered support plan . The support plan must (1) address the clinical and support needs identified through a functional assessment conducted in accordance with 7 AAC 130.213;(2) reflect the recipient's strengths and the recipient's preferences for delivery of services and supports;(3) identify the elements important to the recipient to achieve the quality of life the recipient wishes, including the recipient's goals and desired outcomes;(4) identify (A) the services and supports, paid and unpaid, that will assist the recipient to achieve the recipient's goals and desired outcomes;(B) the providers of those services and supports, including natural supports; and(C) for each service (i) the number of units, the frequency, and the projected duration of that service; and(ii) an analysis of whether the service and amount of that service is consistent with the assessment or interim-level-of-care-review conducted under 7 AAC 130.213, the level-of-care-determination made in accordance with 7 AAC 130.215, and the treatment plans, if any, developed for the recipient;(5) document the options for services and supports that were offered to the recipient under (b)(5) of this section;(6) reflect that the setting in which the recipient resides is chosen by the recipient;(7) document any modification of the requirements for provider-owned or operated residential settings in accordance with 7 AAC 130.220(p);(8) reflect the risk factors and measures in place to minimize risks, including an individualized backup plan;(9) identify the individuals responsible for monitoring the plan;(10) use plain language, and be written in a manner that is both accessible to a recipient with disabilities or limited English proficiency and makes the support plan understandable by the recipient and the individuals important in supporting the recipient;(11) be finalized and agreed to in accordance with 7 AAC 130.217(a)(4); any disagreement among planning team members about outcomes or service levels, or any suggestion by a team member that an outcome or service level should be different than the one established in the support plan, must be documented and attached to the support plan submitted to the department for consideration and approval; and(12) be distributed to the recipient and all others involved in developing the support plan.(d) The providers, recipient, and individuals chosen by the recipient to participate in the planning process must ensure that (1) unnecessary or inappropriate services and supports are not included in the support plan developed in accordance with (c) of this section; and(2) the settings in which home and community-based services are rendered are integrated in and support access to the greater community, including distance delivery when requested and authorized.Eff. 11/5/2017, Register 224, January 2018; am 3/3/2021, Register 238, July 2021; am 9/18/2022, Register 243, October 2022; am 1/22/2023, Register 245, April 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.045