Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 751. Personal care assessment tool (PCAT)

7 AAC 43.751. Personal care assessment tool (PCAT)

(a) All personal care services must be performed in accordance with a recipient's PCAT that is approved by the department under this section. The recipient's PCAT will be prepared using the department's document entitled Personal Care Assessment Tool (PCAT) 2005, adopted by reference, including the

(1) consumer assessment tool;

(2) personal care services supplement tool; and

(3) service plan, including changes made under (e) of this section.

(b) The department or its designee will develop the recipient's PCAT, which must include

(1) supporting documentation

(A) on a form provided by the department;

(B) that identifies the recipient's diagnosis; and

(C) that is completed by a physician, a physician assistant, or an advanced nurse practitioner, who is licensed in this state or practicing or employed in a federally or tribally owned or leased health facility in this state;

(2) an assessment of the recipient's personal care needs, prepared in accordance with (d) of this section;

(3) specific instructions regarding the type and frequency of tasks the personal care assistant is expected to perform;

(4) a statement of the expected outcome of the recipient's PCAT service plan;

(5) for the consumer-directed program only, identification of any legal representative of the recipient and specification of the requirements of 7 AAC 43, 768 for which the legal representative will be responsible; and

(6) for the agency-based program only, a backup plan that defines the agency's responsibility to

(A) provide services if the recipient's regularly scheduled personal care assistant is unable to provide those services;

(B) develop a contingency plan to ensure the health and welfare of the recipient if the recipient is unable to receive personal care services from either the regularly scheduled personal care assistant or from another personal care assistant provided through the backup plan; and

(C) educate the recipient about the contingency plan.

(c) For the consumer-directed program only, the agency and either the recipient or the legal representative shall develop a backup plan that

(1) identifies the extent to which the agency or recipient is responsible for obtaining personal care services if the recipient's regularly scheduled personal care assistant is unable to provide those services; and

(2) includes a contingency plan that

(A) defines the agency's and the recipient's responsibilities to work with and educate a recipient about a plan of action to ensure the health and welfare of the recipient if the recipient's regularly scheduled personal care assistant is unable to provide personal care services and other personal care services are not available through the backup plan; and

(B) informs the recipient of the risks involved.

(d) An assessment of a recipient's need for personal care services will be

(1) recorded on the recipient's PCAT;

(2) based upon personal observation of the recipient; and

(3) performed by the department staff or designee and conducted in the recipient's residence.

(e) Any change in a recipient's PCAT before the end of the 12-month authorization period

(1) must be developed by the department or its designee and approved as provided in (g)(1) of this section;

(2) must include medical or other relevant documentation of the recipient's condition;

(3) must be recorded in the recipient's PCAT service plan records; and

(4) may be made outside the recipient's residence and without personal observation of the recipient by the department or its designee.

(f) The department will establish a renewal date for a recipient's PCAT that coincides with the renewal of a plan of care under 7 AAC 43.1030 so that services are coordinated and payments are not duplicated. A copy of a recipient's PCAT will be made part of the recipient's service record under 7 AAC 43.1000 - 7 AAC 43.1110 (Home and Community-Based Waiver Services Program), if applicable.

(g) A recipient's PCAT developed under (a) of this section does not take effect unless approved by the department. The department will approve a recipient's PCAT if the department determines that each service listed in the PCAT

(1) is of sufficient duration, amount, and scope to prevent

(A) placement in acute care hospital or nursing facility; or

(B) loss of employment; and

(2) is supported by documentation required under (b) of this section.

(h) Reimbursement is not available under 7 AAC 43.750 - 7 AAC 43.795 for any service provided that is not identified in a recipient's PCAT.

History: Eff 4/1/2006, Register 177

Authority: AS 47.05.010

AS 47.07.030

Editor's note: The Personal Care Assessment Tool (PCAT) 2005, adopted by reference in 7 AAC 43.751, may be obtained from the Department of Health and Social Services, Division of Senior and Disabilities Services, 3601 C Street, Suite 310, Anchorage, Alaska 99503.

The form provided under 7 AAC 43.751(b) (1) may be obtained from the Department of Health and Social Services, Division of Senior and Disabilities Services, 3601 C Street, Suite 310, Anchorage, Alaska 99503.