7 AAC 47.472. Augmented rates; restricted

(a) Except for a resident who also receives financial assistance under 7 AAC 47.471, or from another agency, organization, or program for the cost of services provided in an assisted living home, the department may augment the minimum daily reimbursement rate set in 7 AAC 47.470 for a resident of an assisted living home who

(1) is receiving community support services from the local community mental health center or another local service provider;

(2) has a primary diagnosis of severe and persistent mental illness; and

(3) qualifies for one or more of the categories in (d) of this section.

(b) An augmented rate approved under this section will not exceed $35 per day. Augmented funding is restricted to very limited periods of time.

(1) whether a resident of an assisted living home is eligible for an augmented rate under this section;

(2) the category of need under (d) of this section for which the resident is qualified; and

(3) the number of days that augmented funding should be provided.

(d) The department may approve an augmented rate for one or more of the following categories for a person described in (a) of this section, not to exceed $35 a day for that person:

(1) Category I: $7 a day, for each resident of an assisted living home with 16 or fewer beds that provides 24-hour a day awake staff supervision in the home; for a provider that operates more than one assisted living home in a community, financial assistance under this category is limited to no more than 16 residents, unless the department finds that exceptional circumstances exist;

(2) Category II: only one Category II rate may be applied to a resident who qualifies for Category II, as follows:

(A) emergency placement: $15 a day, for a resident who must be placed in an assisted living home within 24 hours of referral; an augmented rate under this subparagraph may be approved for no more than 31 days, unless the department determines that payment for additional days is necessary to protect the resident;

(B) temporary placement: $10 a day, for a resident who needs to be placed in an assisted living home for a short time until arrangements can be made for permanent placement elsewhere; an augmented rate under this subparagraph may be approved for up to 31 days unless the local community mental health center recommends an extension; any extension under this subparagraph may not exceed 90 days, unless the department determines that payment for additional days is necessary to protect the resident; or

(C) transitional services: $10 a day, for a resident who is being placed in an assisted living home for the first time or after an absence from the home of six months or more; the local community mental health center may recommend the augmented rate under this subparagraph if the resident has been away from the home less than six months for a resident who is very unstable and needs significantly more staff attention or services than other residents in the home; an augmented rate under this subparagraph may be approved for up to 31 days unless the local community mental health center recommends an extension; any extension under this subparagraph may not exceed 90 days, unless the department determines that payment for additional days is necessary to protect the resident; and

(3) Category III: up to $35 a day, for a resident who is without access to other sources of financial assistance and who has specific unusual circumstances or extremely special needs that require a significant increase in the level of services for continued community placement in the community; this category will be used only in the most extreme cases and is expected to be used very rarely; no more than four residents statewide will receive financial assistance under this category at the same time, unless the department finds that exceptional circumstances exist.

(e) If the local community mental health center finds that a resident is eligible for an augmented rate, the local community mental health center shall make a recommendation for an augmented rate to the department for its approval.

(f) If the department finds that a resident is eligible for an augmented rate and approves the local community mental health center's recommendation, at least once every three months the local community mental health center shall re-evaluate each resident receiving financial assistance under Category III to determine whether there is a need to adjust, reduce, extend, or discontinue the resident's augmented rate. The local community mental health center shall discuss each resident's ongoing needs with staff of the assisted living home.

(g) An augmented rate paid on behalf of a resident is discontinued for any day that the resident is not living in the assisted living home.

History: Eff. 6/28/2002, Register 162; am 6/24/2004, Register 170

Authority: AS 47.05.010

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