7 AAC 43.1046. Residential habilitation services

(a) The department will reimburse for residential habilitation services that

(1) are provided to a recipient in one of the following recipient categories:

(A) children with complex medical conditions;

(B) adults with physical disabilities; however, the department will reimburse only if a recipient in that recipient category is also diagnosed as experiencing a developmental disability;

(2) are approved under 7 AAC 43.1030 as part of the recipient's plan of care; and

(3) receive prior authorization.

(b) Reimbursement for residential habilitation services will be limited to the following habilitation services, and is subject to the following limitations:

(1) family habilitation home services; the department will consider habilitation services to be family habilitation home services if they are provided to a recipient who spends more than 50 percent of the time in an assisted living home licensed under AS 47.33 or a foster home licensed under AS 47.35, and if the home has a paid primary caregiver in residence who is not a member of the recipient's immediate family; reimbursement under this paragraph is subject to the following limitations:

(A) the total number of individuals receiving care in the home, regardless of whether they receive home and community-based waiver services, may not exceed

(i) two, for a recipient in the recipient category of children with complex medical conditions; however, the total number may be exceeded to allow the placement of siblings with the same primary caregiver in residence;

(ii) three, for a recipient in the recipient category of adults with physical disabilities; or

(iii) three, for a recipient in the recipient category of individuals with mental retardation or developmental disabilities; however, the total number may be exceeded to allow the placement of siblings with the same primary caregiver in residence;

(B) the department will not make separate payment for

(i) chore services under 7 AAC 43.1042;

(ii) transportation services under 7 AAC 43.1052; or

(iii) meals services under 7 AAC 43.1053;

(2) shared care services; the department will consider habilitation services to be shared care services if they are provided to a recipient who spends more than 50 percent of the time in the home of an unpaid primary caregiver and the remainder in an assisted living home licensed under AS 47.33 or a foster home licensed under AS 47.35;

(3) supported living services; the department will consider habilitation services to be supported living services if they are provided to a recipient 18 years of age or older and in the recipient's private residence, subject to the following limitations:

(A) the department will not reimburse for more than 18 hours per day of supported living services, unless the department determines that the recipient is unable to benefit from other home and community-based waiver services;

(B) other persons also may furnish direct care services after providing written assurance to the department that those services do not supplant services provided by informal community supports; for purposes of this subparagraph, "direct care services" includes

(i) personal care assistants under 7 AAC 43.750 - 7 AAC 43.795;

(ii) chore services under 7 AAC 43.1042;

(iii) transportation services under 7 AAC 43.1052; and

(iv) meals services under 7 AAC 43.1053;

(4) group home habilitation services; the department will consider habilitation services to be group home habilitation services if they are provided to a recipient 18 years of age or older living full-time in an assisted living home licensed under AS 47.33;

(5) in-home support services; the department will consider habilitation services to be in-home support services if they are provided in the recipient's private residence where an unpaid primary caregiver resides; if a recipient receives in-home support services, the department will not make separate payment for

(A) personal care assistants under 7 AAC 43.750 - 7 AAC 43.795;

(B) chore services under 7 AAC 43.1042;

(D) meals services under 7 AAC 43.1053.

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

Authority: AS 47.05.010

AS 47.07.030

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