Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 1041. Care coordination services

7 AAC 43.1041. Care coordination services

(a) An employee of a care coordination agency rendering care coordination services must be separately enrolled under this subsection as a care coordinator with the department. Before an employee of a care coordination agency can provide care coordination services, the care coordination agency must

(1) be certified and enrolled with the department in accordance with 7 AAC 43.1090;

(2) certify, in writing, to the department that the employee

(A) meets the minimum requirements listed in the "Care Coordinator Provider Standards" text on pages 14 - 15 of the department's Home and Community Based Waiver Services Certification Application Packet, adopted by reference in 7 AAC 43.1090(a);

(B) is employed by the care coordination agency; and

(C) meets the agency's employment and certification standards to provide care coordination services; and

(3) provide documentation as listed for the employee in the "Required Attachments" text on page 15 of the department's Home and Community Based Waiver Services Certification Application Packet, adopted by reference in 7 AAC 43.1090(a);

(b) The department will reimburse for the following services:

(1) for an applicant, one screening per calendar year under 7 AAC 43.1030(a), except that the department will reimburse for a second screening if the applicant was determined, based on the first screening, ineligible for home and community-based waiver services;

(2) for an applicant or recipient, one initial assessment under 7 AAC 43.1030(b) per calendar year;

(3) for a recipient, one development of a plan of care per calendar year, if that plan of care is accompanied by the form required under 7 AAC 43.1002 documenting the recipient's choice of home and community-based services; the plan of care must be developed in accordance with 7 AAC 43.1030, except that the department will reimburse for a plan of care

(A) for which agreement of the recipient or the recipient's representative was not obtained under 7 AAC 43.1030(e), if the department would have approved the plan of care had agreement been obtained; or

(B) that was developed in reliance on the form required under 7 AAC 43.1002, but that the department cannot approve because home and community-based waiver services were subsequently determined not to be available under 7 AAC 43.1010(b).

(c) The department will reimburse a care coordinator for ongoing care coordination services provided to each recipient, beginning with the first month that the recipient is enrolled under 7 AAC 43.1010(e) and has a plan of care approved under 7 AAC 43.1010(f)(1). Ongoing care coordination services include

(1) routine monitoring and support;

(2) review and revision of a plan of care under 7 AAC 43.1030(g);

(3) case terminations;

(4) two contacts each month with the recipient, one of which must be face-to-face; however, the department will waive the monthly face-to-face requirement if the plan of care documents, to the department's satisfaction, that the recipient lives in a rural community as defined in 7 AAC 43.1054(c)(5)(B); if the department waives the monthly face-to-face requirement, the care coordinator must document a minimum of one face-to-face visit per calendar quarter with each recipient whom the care coordinator serves, to monitor service delivery; notwithstanding a waiver under this paragraph, if the purpose of a contact is to develop the annual plan of care for the recipient, that contact must be face-to-face;

(5) evaluation of the need for specific home and community-based waiver services;

(6) coordination of multiple services and providers; and

(7) monitoring of the quality of care.

(d) The department will reimburse a care coordinator for one new assessment under 7 AAC 43.1030(g) during the 12-month period following the month that the recipient is enrolled under 7 AAC 43.1010(e), and for no more than two new assessments during each subsequent 12-month period.

(e) The department will not reimburse for care coordination services provided by the recipient, a member of the recipient's immediate family, the recipient's guardian, a holder of power of attorney for the recipient, or the recipient's personal care assistant.

(f) Within seven days after a recipient's admission to or subsequent discharge from an acute care hospital, the recipient's care coordinator shall notify the department of the date of the admission or discharge, to assist the department in determining the correct reimbursement amount payable to providers of home and community-based waiver services to that recipient.

(g) Notwithstanding (b) and (d) of this section, the department will reimburse for additional screenings, assessments, or plans of care that have received prior authorization.

History: Eff. 5/15/2004, Register 170; am 8/21/2005, Register 175

Authority: AS 47.05.010

AS 47.07.030