7 AAC 43.1049. Respite care services

(a) The department will reimburse for respite care services that

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

(2) receive prior authorization; and

(3) do not exceed the maximum number of hours and days in (c) of this section.

(b) The department will consider services to be respite care services if they provide alternative caregivers, regardless of whether the services are provided in the recipient's home or at another location, to relieve

(1) primary unpaid caregivers, including family members and court-appointed guardians;

(2) providers of family habilitation home services under 7 AAC 43.1046(b)(1), except as provided in (e)(4) of this section; or

(3) foster parents licensed under AS 47.35.

(1) 520 hours of hourly respite care services per year, unless the lack of additional care or support would result in risk of institutionalization because

(A) the recipient has inadequate supports from unpaid caregivers; or

(B) appropriate out-of-home daily respite care services are unavailable;

(2) 14 days of daily respite care services per year.

(d) The department will reimburse under this section for respite care services subject to the following limitations:

(1) the department will reimburse for room and board expenses incurred during the provision of respite care services only if the room and board are provided in

(A) a nursing facility;

(B) an acute care hospital;

(D) an assisted living home licensed under AS 47.33, and that home is not the recipient's residence; or

(E) a foster home licensed under AS 47.35, and that home is not the recipient's residence;

(2) the department will not reimburse more than $250 per day for respite care services, whether provided singly or in combination, other than out-of-home daily respite care services;

(3) the department will not reimburse for out-of-home daily respite care services at a rate in excess of the rate established for Medicaid providers under this chapter; or

(4) the department will not reimburse for respite care services to

(A) allow a primary caregiver to work;

(B) relieve other paid providers of Medicaid services, except providers of family habilitation home services under 7 AAC 43.1046(b)(1); or

(C) provide oversight for additional minor children in the home; for purposes of this subparagraph, "additional minor children" means unemancipated individuals under 18 years of age other than recipients;

(5) the department will reimburse for respite care services provided at the same time as personal care assistants under 7 AAC 43.750 - 7 AAC 43.795 or habilitation services provided under 7 AAC 43.1045 - 7 AAC 43.1046 only if the lack of additional care or support would result in risk of institutionalization because

(A) the recipient has inadequate supports from unpaid caregivers; or

(B) appropriate out-of-home daily respite care services are unavailable;

(6) the department will not reimburse for hourly respite care services provided to recipients receiving residential supported living services under 7 AAC 43.1044.

(e) The department will reimburse under this section for family-directed respite care services subject to the following additional limitations:

(1) family-directed respite care services will be reimbursed only for a recipient in one of the following recipient categories:

(A) children with complex medical conditions;

(B) individuals with mental retardation or developmental disabilities;

(2) family-directed respite care services must be provided through a home and community-based services provider that is certified and enrolled under 7 AAC 43.1090 to provide respite care services; prior authorization will not be given unless the department has on file a current letter of agreement, in which the home and community-based services provider acknowledges responsibility to

(A) comply with the requirements of AS 47.05.017 with respect to an individual retained and directed by a family to provide respite care services under this subsection; and

(B) ensure that the retention and direction of an individual by a family to provide respite care services under this subsection is in accordance with municipal, state, and federal law

(i) applicable to employment of that individual, including applicable provisions of 26 U.S.C. (Internal Revenue Code); or

(ii) to protect the health and safety of the recipient;

(3) out-of-home daily respite care services may not be provided as family-directed respite care services;

(4) family-directed respite care services may not be provided to relieve providers of family habilitation home services under 7 AAC 43.1046(b)(1);

(5) primary unpaid caregivers of a recipient receiving family-directed respite care services may not provide the service for other recipients of family-directed respite care services;

(6) a primary unpaid caregiver

(A) may identify and train individuals who meet the minimum requirements listed in the "Respite Provider Standards" text on page 27 of the department's Home and Community Based Waiver Services Certification Application Packet, adopted by reference in 7 AAC 43.1090(a);

(B) may complete and sign timesheets for individuals providing family-directed respite care services; and

(C) shall provide, to the home and community-based services provider that has received prior authorization for the family-directed respite care services, written assurance that the primary unpaid caregiver understands the additional risk that the primary unpaid caregiver assumes in the provision of family-directed respite care services;

(7) individuals providing family-directed respite care services shall be reimbursed directly by the home and community-based services provider that received prior authorization for those services.

(f) In this section,

(1) "daily respite care services" means respite care services between 12 and 24 hours in duration;

(2) "family-directed respite care services" means respite care services provided by an individual whom

(A) the family of the recipient retains; and

(B) a home and community-based services provider reimburses;

(3) "out-of-home daily respite care services" means daily respite care services provided in

(A) a nursing facility;

(B) an acute care hospital;

(D) an assisted living home licensed under AS 47.33; or

(E) a foster home licensed under AS 47.35.

History: Eff. 5/15/2004, Register 170

Authority: AS 47.05.010

AS 47.07.030

The Alaska Administrative Code was automatically converted to HTML from a plain text format. Every effort has been made to ensure its accuracy, but neither Touch N' Go Systems nor the Law Offices of James B. Gottstein can be held responsible for any possible errors. This version of the Alaska Administrative Code is current through June, 2006.

If it is critical that the precise terms of the Alaska Administrative Code be known, it is recommended that more formal sources be consulted. Recent editions of the Alaska Administrative Journal may be obtained from the Alaska Lieutenant Governor's Office on the world wide web. If any errors are found, please e-mail Touch N' Go systems at E-mail. We hope you find this information useful. Copyright 2006. Touch N' Go Systems, Inc. All Rights Reserved.