7 AAC 43.755. Excluded services

(a) Except as provided in (b) of this section, personal care services reimbursable under Medicaid, in both the consumer-directed and agency-based programs, do not include the following:

(1) application of dressings involving prescription medication and aseptic techniques;

(2) invasive body procedures; for purposes of this paragraph, invasive body procedures include injections of medications, insertion or removal of catheters, tracheostomy care, enemas, deep suctioning, tube or other enteral feedings, medication administration, and care and maintenance of intravenous equipment;

(3) chore services in the home, except for those tasks identified in 7 AAC 43.752(a) (2); for purposes of this paragraph, chore services in the home include cleaning of floors and furniture not used directly by the recipient, laundry not incidental to the recipient's care, and cutting firewood;

(4) a task that the department determines could reasonably be performed by the recipient;

(5) respite care intended primarily to relieve a member of the recipient's household, a family member, or a caregiver other than a personal care assistant from the responsibility of caring for the recipient;

(6) a task that is not on the recipient's PCAT service plan that has been approved under 7 AAC 43.751;

(7) a task that requires a sterile technique or procedure, except for sterilizing or autoclaving needed supplies and equipment that, if not for the presence of a personal care assistant, a recipient would have to perform independently;

(8) care that requires a technical or professional skill that a state statute or regulation mandates must be performed by a health care professional licensed or certified by the state;

(9) care of other members of the recipient's household;

(10) cleaning an area not used directly by the recipient;

(11) supervision, monitoring, cueing, transportation provided under 7 AAC 43.502, babysitting, social visitation, general monitoring for equipment failure, services provided under 7 AAC 43.1000 - 7 AAC 43.1110 (Home and Community-Based Waiver Services Program), home maintenance, or pet care, except for a service animal;

(12) repealed 4/1/2006;

(13) tasks that supplant or duplicate assistance offered by an individual or organization without charge or that is paid for by a third party;

(14) IADL under 7 AAC 43.752 if

(A) the recipient or anyone else in the household is capable to perform or financially provide the IADL for the recipient;

(B) another relative, caregiver of the recipient, community or volunteer agency, or third-party payer is capable of or responsible for the provision of the IADL services;

(C) IADL services, other than shopping, are greater than one-third of the total time authorized per week for personal care services;

(D) other recipients living in the same residence receive IADL services under 7 AAC 43.750 - 7 AAC 43.795 or under 7 AAC 43.1000 - 7 AAC 43.1110 (Home and Community-Based Waiver Services Program); or

(E) the IADL services are not specifically related to a qualifying ADL listed in 7 AAC 43.752(a) (1);

(15) tasks to provide necessary food, clothing, shelter, or medical attention for a minor recipient that are a parental responsibility and are considered neglect under AS 47.10.014 if not performed.

(b) In the case of a consumer-directed personal care agency, (a)(1), (7), and (8) of this section do not apply, and notwithstanding (a)(2) of this section, insertion and removal of catheters, tube or other enteral feedings, and medication administration are reimbursable under Medicaid.

(c) The department will not make separate payment for personal care assistants under 7 AAC 43.750 - 7 AAC 43.795 if the recipient receives in-home support services under 7 AAC 43.1046(b)(5).

History: Eff. 11/6/86, Register 100; am 6/27/92, Register 122; am 10/21/98, Register 148; am 10/1/2001, Register 159; am 1/1/2002, Register 160; am 6/19/2004, Register 170; am 4/1/2006, Register 177

Authority: AS 47.05.010

AS 47.07.030

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