Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 752. Covered services

7 AAC 43.752. Covered services

(a) If the requirements of 7 AAC 43.750 - 7 AAC 43.795 are met, the department will reimburse a personal care agency, whether it is enrolled in the consumer-directed or agency-based program, for services provided to a recipient in accordance with the recipient's PCAT for

(1) assistance with the recipient's activities of daily living (ADL), including

(A) physical assistance with basic personal hygiene and grooming, including

(i) bathing;

(ii) dressing

(iii) care of the mouth, hair, and skin; and

(iv) filing of toenails and both cutting and filing of fingernails, excluding nail care for recipients who are diabetic or have poor circulation;

(B) physical assistance with bladder and bowel routines, including

(i) helping the recipient to and from the bathroom;

(ii) assisting the recipient with a bedpan or other toileting procedures;

(iii) providing general hygiene care of a colostomy, an ileostomy, or an external catheter;

(iv) giving suppositories that do not contain medication;

(v) providing digital stimulation; and

(vi) providing routine care of an incontinent recipient;

(C) assistance with eating;

(D) physical assistance with transferring the recipient in and out of a bed, chair, or wheelchair and helping the recipient walk with support of a walker, cane, gait belt, braces, or crutches; and

(E) physical assistance with positioning or turning a nonambulatory recipient in a bed or chair;

(2) assistance with a recipient's instrumental activities of daily living (IADL) essential to the recipient's health and specifically related to approved task for an ADL need, including

(A) light housekeeping tasks;

(B) changing and laundering the recipient's bed linens;

(C) laundering the recipient's clothing;

(D) meal planning and preparation; and

(E) shopping; and

(3) additional covered services, including

(A) physical assistance taking and documenting the recipient's temperature, pulse, blood pressure, and respiration when medically necessary;

(B) physical assistance with setup for diabetic testing and documentation;

(C) physical assistance with

(i) care of nonsterile dressings for uninfected post-operative or chronic conditions;

(ii) prescribed foot care, excluding nail care for recipients who are diabetic or have poor circulation; and

(iii) the application of elastic bandages and support hose;

(D) physical assistance with the use and minor maintenance of respiratory equipment and prescribed oxygen;

(E) physical assistance with putting on and removing a prosthetic device;

(F) assistance with self-administered routine or medication, eye drops, and skin ointments; that assistance may include reminding the recipient and placing a medication within the recipient's reach;

(G) physical assistance with walking and simple exercises prescribed 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; and

(H) assistance with

(i) travel to and from routine medical and dental appointments; and

(ii) conferring with medical or dental staff for routine medical or dental appointments.

(b) The department will reimburse only a personal care agency enrolled in the agency-based program for physical assistance with range-of-motion and stretching exercises, if

(1) the physical assistance is provided to a recipient in accordance with the recipient's PCAT; and

(2) the exercises are prescribed 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.

(c) The department will reimburse only a personal care agency enrolled in the consumer-directed program for physical assistance for services provided to a recipient in accordance with the recipient's PCAT, including health maintenance activities, urinary system management, bowel treatments, administration of medications, tube feeding, and wound care.

(d) The department will reimburse for IADL services that are

(1) provided to a recipient 18 years of age or older; and

(2) approved under 7 AAC 43.751 as part of a recipient's PCAT service plan.

(e) The department will reimburse under this section for meal preparation essential to meeting a recipient's health needs, if the meal preparation service is

(1) not duplicated by another meal service approved under 7 AAC 43.1053 or 42 U.S.C. 3001 - 3058ee (Older Americans Act);

(2) provided in the recipient's home; and

(3) provided in accordance with 42 U.S.C. 3030e(1).

(f) The department will reimburse under this section for up to four hours a month of assistance with shopping in the vicinity of a recipient's residence for prescribed drugs, medical supplies, groceries, and other household items required specifically for the health and maintenance of the recipient, including items required by the recipient but also used by other occupants of the recipient's residence.

(g) If there is a second recipient in a residence, the department may authorize a personal care assistant to perform an IADL for both recipients residing in the same residence.

(h) The department will authorize limited assistance, in conjunction with another service listed in this section essential to a recipient's health and specifically related to an approved task for an ADL listed in (a)(1) of this section, if

(1) the recipient's PCAT service plan supports an ADL self-performance of two or three for the respective ADL, as scored in Section E of the PCAT; and

(2) the recipient has a medical history of falls with injury, documented 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.

History: Eff. 4/1/2006, Register 177

Authority: AS 47.05.010

AS 47.07.030