Section 7 AAC 130.240 - Care coordination services(a) The department will pay for care coordination services that are (1) provided in accordance with 7 AAC 130.217 and 7 AAC 130.218 and the department's Care Coordination Services and Long Term Services and Supports Targeted Case Management Conditions of Participation, adopted by reference in 7 AAC 160.900; and(2) approved in the recipient's support plan (A) developed under 7 AAC 128.010, for long term services and supports targeted case management; or(B) developed under the provisions of 7 AAC 130.217 and 7 AAC 130.218 for a support plan.(b) The department will pay a monthly care coordination service rate, established in accordance with 7 AAC 145.520, if the care coordinator,(1) for a recipient of services under the individualized supports waiver described in 7 AAC 130.206, makes one in-person contact with the recipient or the recipient's representative at least once every six months, and one telephone contact or distance delivery contact in each of the subsequent five months; (2) for a recipient enrolled in other home and community-based waivers, including the individuals with intellectual and developmental disabilities waiver described in 7 AAC 130.206, remains in contact with the recipient or the recipient's representative in a manner and with a frequency appropriate to the needs and the communication abilitie s of the recipient, but at a minimum makes two contacts each month with the recipient or the recipient's representative; eveiy six months one of the monthly contacts must be in person; the remainder may be done by telephone or distance delivery; (3) monitors service delivery by (A) meeting in person with the recipient in at least two service environments, including the recipient's home, at least once during the plan year; and(B) arranging for the in-person contacts required in (1) or (2) of this subsection to occur in one of the settings where home and community-based waiver services are provided; and(4) after each visit with the recipient, completes and retains as documentation of each visit, a recipient contact report in accordance with the department's Care Coordination Services and Long Term Services and Supports Targeted Case Management Conditions of Participation, adopted by reference in 7 AAC 160.900.(c) The department will pay the monthly care coordination service rate beginning the first of the month that the recipient is enrolled under 7 AAC 130.219(b) and has a support plan approved in accordance with the provisions of 7 AAC 130.217 and 7 AAC 130.218 for a support plan, for the following ongoing activities provided in accordance with (b) of this section: (1) routine monitoring and support;(2) monitoring quality of care;(3) evaluating the need for specific home and community-based waiver services;(4) reviewing the support plan and amending the support plan as needed;(5) coordinating multiple services and providers;(6) assisting the recipient to apply for reassessment under 7 AAC 130.213;(7) assisting the recipient in case terminations.(e) A care coordinator must disclose, to the department in a format provided by the department, any close familial relationship or close business relationship with a home and community-based waiver services provider. (f) The department will not pay for care coordination services provided by (1) the recipient, a member of the recipient's immediate family, the recipient's representative, an individual with a duty to support the recipient under state law, a holder of power of attorney for the recipient, the recipient's personal care assistant; or(2) a care coordinator, if any home and community-based service included in the recipient's support plan is determined by the department to result in a conflict of interest involving that care coordinator.(g) The department will recoup under 7 AAC 105.260 any payment for other home and community-based waiver services provided to a recipient by a care coordinator while that care coordinator provided ongoing care coordination under this section.(h) The care coordinator shall notify the department not later than seven days after the date of a recipient's (1) planned admission to a hospital or to a nursing facility; and(2) discharge from a hospital or from a nursing facility.(i) Notwithstanding (b) of this section, the department will pay for additional support plans that have received prior authorization.(j) In this section, (1) "close business relationship" means (A) a five percent or greater ownership, partnership, or equity interest in another home and community-based waiver services provider or its owner; or(B) a five percent or greater ownership, partnership, or equity interest in any other business or commercial activity in which another home and community-based waiver services provider or its owner or administrator also has a five percent or greater ownership, partnership, or equity interest; (2) "close familial relationship" means a relationship in which the care coordinator is(A) the spouse, parent, sibling, or child of (i) a home and community-based waiver services provider who is a natural person; or(ii) an owner, administrator, or employee of a home and community-based waiver services provider agency; (3) "owner" means a person having a five percent or greater ownership, partnership, or equity interest;Eff. 2/1/2010, Register 193; am 7/1/2013, Register 206; am 7/1/2015, Register 214, July 2015; am 11/5/2017, Register 224, January 2018; am 10/1/2018, Register 227, October 2018; am 3/3/2021, Register 238, July 2021; am 9/18/2022, Register 243, October 2022Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040