Section 7 AAC 130.235 - Nursing oversight and care management services(a) The department may authorize nursing oversight and care management services for a recipient that is eligible under the recipient category of (1) children with complex medical conditions; or(2) individuals with intellectual and developmental disabilities if the recipient meets, except for the age requirement in 7 AAC 130.205(d)(1)(A), the criteria for the recipient category for children with complex medical conditions under 7 AAC 130.205(d)(1).(b) The department will pay for nursing oversight and care management services that (1) are approved under 7 AAC 130.217 and 7 AAC 130.218 as part of the recipient's support plan ;(2) receive prior authorization; (3) are provided by a registered nurse that is(A) qualified to practice under AS 08.68 or 7 AAC 105.200; and(B) employed by a home and community-based waiver services provider ; and.(4) are provided in compliance with the department's Nursing Oversight and Cave Managenient Services Conditions of Participation, adopted by reference in 7 AAC 160.900.(c) For a home and community-based waiver services provider to qualify for payment for nursing oversight and care management services, a registered nurse must (1) conduct a nursing assessment of the recipient's medical care needs;(2) develop, for inclusion in the recipient's support plan, in a format provided by the department, (A) a nursing plan that addresses the(i) recipient's health and safety; and(ii) needs that require the recipient or the recipient's paid and unpaid caregivers to perform medical care tasks; and(B) a training plan that specifics the training required for the recipient and the recipient's paid and unpaid caregivers to perform the medical care tasks necessary to meet the recipient's needs;(3) participate in planning the recipient's care in accordance with 7 AAC 130.217;(4) provide oversight by evaluating whether (A) services are delivered in accordance with the nursing plan and in a manner that promotes the health, safety, and welfare of the recipient;(B) services are reasonable and necessary for the recipient's medical condition and the complexity of the care required to treat that condition; and(C) additional training is necessary for the recipient or recipient's paid and unpaid care givers; and(5) remain in contact with the recipient in a manner and with a frequency appropriate to the medical condition of the recipient and to the complexity of the care to be delivered; at a minimum, the contact must include at least one on-site evaluation every 90 days during which the recipient and any individual to which nursing duties were delegated shall be in attendance.(d) The department will not pay separately for services under this section that duplicate (1) specialized private-duty nursing services under 7 AAC 110.525 or 7 AAC 130.285;(2) private-duty nursing services under 7 AAC 110.525; or(3) intensive active treatment services under 7 AAC 130.275.Eff. 2/1/2010, Register 193; am 7/1/2013, Register 206; am 11/5/2017,Register 224, January 2018; am 6/13/2019,Register 230, May 2019Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040