Section 7 AAC 130.267 - Acuity payments for qualified recipients(a) The department will pay for additional services under this section that (1) are provided for a recipient who is qualified under (b) of this section and is receiving (A) residential supported-living services under 7 AAC 130.255 that are assigned the procedure code described in 7 AAC 145.520(h); or(B) group-home habilitation services under 7 AAC 130.265(t) that are assigned the procedure code described in 7 AAC 145.520(h);(2) are requested in accordance with (c) of this section;(3) the department determines to be necessary, based upon evaluation of the supporting documentation submitted in accordance with (d) or (e) of this section; and(4) receive prior authorization.(b) For purposes of this section, a qualified recipient is one that (1) needs services that exceed those authorized in the recipient's current support plan under 7 AAC 130.217 and 7 AAC 130.218; and(2) because of the recipient's physical condition or behavior, needs direct one-to one support from direct care workers whose time is dedicated solely to providing services under (a)(1) of this section to that one recipient 24 hours per day, seven days per week, in all environments in which the recipient functions.(c) To request additional services under this section, the care coordinator responsible under 7 AAC 130.217 and 7 AAC 130.218 for the recipient's support plan must submit (1) written documentation that (A) describes how the recipient's physical condition or behavior justifies the support described in (b) of this section;(B) lists each intervention tried or in use to address the recipient's physical condition or behavior, and whether the intervention was successful or unsuccessful;(C) indicates how additional services under this section would be consistent with services approved as part of the recipient's support plan under 7 AAC 130.217 and 7 AAC 130.218; and(D) addresses how the acuity payment under this section would be used to improve management of the recipient's physical condition or behavior; and(2) the supporting evidence required under (d) or (e) of this section, as appropriate.(d) If the recipient needs the support described in (b)(2) of this section because of the recipient's physical condition, in whole or in part, the request for additional services must include, in addition to the information required under (c) of this section, (1) a copy of the recipient's most recent medical evaluation conducted as part of an assessment under 7 AAC 130.213 specific to the recipient's support plan under 7 AAC 130.217 and 7 AAC 130.218;(2) a record of the recipient's dates of hospital admission and discharge or of other medical interventions during the 30 days immediately preceding the date of the request; (3) a copy of the recipient's clinical record under 7 AAC 105.230(d)(6) documenting 24 hours of activity for each of the 30 days immediately preceding the date of the request; and(4) a description of how administration of medication is managed, and how other recurring medical treatments are managed. (e) If the recipient needs the support described in (b )(2) of this section because of the recipient's behavior, in whole or in part, the request for prior authorization must include, in addition to the information required under (c) of this section, a copy of the recipient's (1) most recent medical and psychological evaluations conducted as part of an assessment under 7 AAC 130.213 specific to the recipient's support plan under 7 AAC 130.217 and 7 AAC 130.218; and(2) clinical record under 7 AAC 105.230(d)(6) documenting 24 hours of activity for each of the 30 days immediately preceding the date of the request.(f) The department will not approve additional services under this section for more than 12 consecutive months.(g) The department may terminate authorization for services under this section at any time if the department verifies that the recipient's physical condition or behavior no longer requires additional services under this section.(h) A provider who receives an acuity payment under this section shall (1) provide workers to provide the services described in (b )(2) of this section; and(2) ensure that at least one worker is awake at all times to provide those services.Eff. 4/1/2012, Register 201; am 7/1/2013, Register 206; am 7/1/2015, Register 214, July 2015; am 11/5/2017, Register 224, January 2018; am 3/1/2018, Register 225, April 2018; am 3/3/2021, Register 238, July 2021 Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040