Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 1020. Recipient disenrollment

7 AAC 43.1020. Recipient disenrollment

(a) The department will disenroll a recipient for one or more of the following reasons:

(1) the recipient is no longer eligible for Medicaid coverage under 7 AAC 43.020;

(2) the recipient no longer meets the eligibility requirements of 7 AAC 43.1010(d);

(3) the recipient or the recipient's representative chooses to end use of home and community-based waiver services;

(4) the department terminates its participation in the waiver program under 42 U.S.C. 1396n(c);

(5) the recipient fails to take an action or submit documentation as required in 7 AAC 43.1030;

(6) the recipient's care coordinator, on the behalf of the recipient, fails to take an action or submit documentation as required in 7 AAC 43.1030, if the department has provided the recipient with written notice

(A) identifying the action the care coordinator did not take or the documentation the care coordinator did not provide;

(B) indicating that the recipient has 30 days to take the action or submit the documentation required;

(C) informing the recipient that the recipient may choose a new care coordinator; and

(D) indicating whether the department is not willing to assume the duties of care coordination under 7 AAC 43.1030(i);

(7) the recipient has a documented history of failing to cooperate with the delivery of services identified in the plan of care prepared under 7 AAC 43.1030(c), or of placing caregivers at risk of physical injury; for purposes of this paragraph, a documented history exists if service providers

(A) report that they cannot obtain cooperation with service delivery or eliminate the risk of physical injury to caregivers through reasonable accommodation to a person's disability; and

(B) maintain records to support that report; those records must be available to the department for inspection; the department will review those records before making a decision on disenrollment under this paragraph.

(b) A recipient who is disenrolled from the home and community-based waiver services program, as documented by the department for reasons described in (a) of this section may appeal that decision under 7 AAC 49.

History: Eff. 12/19/93, Register 128; am 5/15/2004, Register 170

Authority: AS 47.05.010

AS 47.07.030