Section 7 AAC 127.075 - Community First Choice personal care services; place of service(a) The department will pay for Community First Choice personal care services for a recipient only if provided (1) in the recipient's residence if that residence is(A) the dwelling that the recipient considers to be the recipient's established or principal home and to which, when absent, the recipient intends to return; and(B) real or personal property that is fixed or mobile and that is located on land or water, if the living conditions are appropriate for the needs of the recipient, including adequate arrangements for handwashing and waste disposal;(2) during a temporary absence under (c) of this section; or(3) at the recipient's workplace, if the recipient needs physical assistance with ADLs to prevent Job loss; the department will not assess the recipient at the recipient's workplace or allow time for Community First Choice personal care services at that location in addition to the total time authorized in accordance with 7 AAC 127.090.(b) The department will not pay for Community First Choice personal care services in the following locations: (1) a licensed skilled nursing or intermediate care facility or hospital;(2) a licensed intermediate care facility for individuals with an intellectual disability or related condition (ICF/IDD);(3) an assisted living home licensed under AS 47.32;(4) an unlicensed residential setting that the department determines to fall within the definition of an assisted living home under AS 47.32.900;(5) a residence where Community First Choice personal care services are provided under a contractual agreement;(6) a general acute care hospital;(7) an institution providing psychiatric services for individuals under 21 years of age, under 7 AAC 127,025(e);(8) an institution for mental diseases for individuals 65 years of age and over, under 7 AAC 127.025(e)(c) The department will pay for Community First Choice personal care services for a recipient during a recipient's temporary absence from the recipient's community when the recipient travels to another location within the slate or to a destination in another state if (1) the services are requested before travel and are approved by the department in the service level authorization;(2) the services are necessary to maintain the recipient's current level of functioning, and the temporary absence is justified as (A) medically necessary, as documented by a licensed physician that is qualified to practice under AS 08.64 or 7 AAC 105.200(c);(B) an educational opportunity of limited duration that is not available in the recipient's community or in the state, and that will further the recipient's capacity for vocational or professional employment; or(3) the recipient's need for assistance with ADLs, lADLs, and other covered services during the travel period can be met only by a Community First Choice personal care assistant;(4) the services to be provided during the recipient's temporary absence are the same as those provided when the recipient is in the recipient's community;(5) the temporary absence will be for at least 24 hours, but not longer than 30 days; the department will authorize Community First Choice personal care services under this subsection for not longer than 30 days in a 365-day period unless approved under (d) of this section;(6) the recipient meets the requirements of 7 AAC 100.064, if travel is to be out-of-state; and(7) the Community First Choice persona! care services provider certified and enrolled under 7 AAC 127.050 maintains an employer relationship with the Community First Choice personal care assistant traveling with and providing services to a recipient during the temporary absence.(d) Notwithstanding (c)(5) of this section, the department may approve a temporary absence of longer than 30 days in a 365-day period if (1) a licensed physician that is qualified to practice under AS 08.64 or 7 AAC 105.200(c) documents that a longer temporary absence is medically necessary; or(2) the department determines that the benefits to the recipient of an educational opportunity under (c)(2)(B) of this section justify a longer temporary absence.(e) The department will not pay for (1) transportation, room and board, or other expenses for a Community First Choice personal care assistant or other individual providing services under this section; or(2) services provided in any location other than those where Medicaid services may be provided. Eff. 10/1/2018, Register 227, October 2018Authority:AS 47.05.010
AS 47.07.030
AS 47.07.036
AS 47.07.040