7 AAC 43.1080. Restrictions on residential supported living services reimbursement

(a) Unless waived in writing by the department under (b) of this section, the department will not reimburse for residential supported living services provided under 7 AAC 43.1044 to a recipient if that recipient's approved plan of care was prepared by a care coordination agency provider that has a close familial or business relationship with the residential supported living services provider.

(b) The limitation on reimbursement of certain residential supported living services providers under (a) of this section may be waived by the department for the benefit of the recipient, subject to any conditions that the department may impose, based on one of the following considerations:

(1) another care coordination agency provider is not reasonably available to serve the recipient;

(2) the person rendering the care coordination service is not subject to supervision or control by the owner, administrator, or staff of the residential supported living services provider and does not have a close familial or business relationship with the residential supported living services provider or its owner or administrator.

(1) "close business relationship" means

(A) having a 15 percent or greater ownership, partnership, or equity interest in the other provider or its owner; or

(B) having a 15 percent or greater ownership, partnership, or equity interest in any other business or commercial activity in which the other provider or its owner or administrator also has a 15 percent or greater ownership, partnership, or equity interest;

(2) "close familial relationship" includes the person's spouse, a parent, sibling, or child of the person, and the spouse of the person's parent, sibling, or child;

(3) "owner" means a person having a 15 percent or greater ownership, partnership, or equity interest.

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

Authority: AS 47.05.010

AS 47.07.030

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