Alaska Admin. Code tit. 7, § 130.240 – Care coordination services

(a) The department will pay for care coordination services that are
1. (1) provided in accordance with 7 AAC 130.217 and 7 AAC 130.218 and the department's Care Coordination Services and Long Term Services and Supports Targeted Case Management Conditions of Participation, adopted by reference in 7 AAC 160.900; and
2. (2) approved in the recipient's support plan
  1. (A) developed under 7 AAC 128.010, for long term services and supports targeted case management; or
  2. (B) developed under the provisions of 7 AAC 130.217 and 7 AAC 130.218 for a support plan.
(b) The department will pay a monthly care coordination service rate, established in accordance with 7 AAC 145.520, if the care coordinator,
1. (1) for a recipient of services under the individualized supports waiver described in 7 AAC 130.206, makes one in-person contact with the recipient or the recipient's representative at least once every six months, and one telephone contact or distance delivery contact in each of the subsequent five months;
2. (2) for a recipient enrolled in other home and community-based waivers, including the individuals with intellectual and developmental disabilities waiver described in 7 AAC 130.206, remains in contact with the recipient or the recipient's representative in a manner and with a frequency appropriate to the needs and the communication abilities of the recipient, but at a minimum makes two contacts each month with the recipient or the recipient's representative; every six months one of the monthly contacts must be in person; the remainder may be done by telephone or distance delivery;
3. (3) monitors service delivery by
  1. (A) meeting in person with the recipient in at least two service environments, including the recipient's home, at least once during the plan year; and
  2. (B) arranging for the in-person contacts required in (1) or (2) of this subsection to occur in one of the settings where home and community-based waiver services are provided; and
4. (4) after each visit with the recipient, completes and retains as documentation of each visit, a recipient contact report in accordance with the department's Care Coordination Services and Long Term Services and Supports Targeted Case Management Conditions of Participation, adopted by reference in 7 AAC 160.900.
(c) The department will pay the monthly care coordination service rate beginning the first of the month that the recipient is enrolled under 7 AAC 130.219(b) and has a support plan approved in accordance with the provisions of 7 AAC 130.217 and 7 AAC 130.218 for a support plan, for the following ongoing activities provided in accordance with (b) of this section:
1. (1) routine monitoring and support;
2. (2) monitoring quality of care;
3. (3) evaluating the need for specific home and community-based waiver services;
4. (4) reviewing the support plan and amending the support plan as needed;
5. (5) coordinating multiple services and providers;
6. (6) assisting the recipient to apply for reassessment under 7 AAC 130.213;
7. (7) assisting the recipient in case terminations.
(d) Repealed 9/18/2022.
(e) A care coordinator must disclose, to the department in a format provided by the department, any close familial relationship or close business relationship with a home and community-based waiver services provider.
(f) The department will not pay for care coordination services provided by
1. (1) the recipient, a member of the recipient's immediate family, the recipient's representative, an individual with a duty to support the recipient under state law, a holder of power of attorney for the recipient, the recipient's personal care assistant; or
2. (2) a care coordinator, if any home and community-based service included in the recipient's support plan is determined by the department to result in a conflict of interest involving that care coordinator.
(g) The department will recoup under 7 AAC 105.260 any payment for other home and community-based waiver services provided to a recipient by a care coordinator while that care coordinator provided ongoing care coordination under this section.
(h) The care coordinator shall notify the department not later than seven days after the date of a recipient's
1. (1) planned admission to a hospital or to a nursing facility; and
2. (2) discharge from a hospital or from a nursing facility.
(i) Notwithstanding (b) of this section, the department will pay for additional support plans that have received a prior authorization.
(j) In this section,
1. (1) "close business relationship" means
  1. (A) a five percent or greater ownership, partnership, or equity interest in another home and community-based waiver services provider or its owner; or
  2. (B) a five percent or greater ownership, partnership, or equity interest in any other business or commercial activity in which another home and community-based waiver services provider or its owner or administrator also has a five percent or greater ownership, partnership, or equity interest;
2. (2) "close familial relationship" means a relationship in which the care coordinator is
  1. (A) the spouse, parent, sibling, or child of
    1. (i) a home and community-based waiver services provider who is a natural person; or
    2. (ii) an owner, administrator, or employee of a home and community-based waiver services provider agency;
3. (3) "owner" means a person having a five percent or greater ownership, partnership, or equity interest;
4. (4) Repealed 9/18/2022.

(Eff. 2/1/2010, Register 193; am 7/1/2013, Register 206; am 7/1/2015, Register 214; am 11/5/2017, Register 224; am 10/1/2018, Register 227; am 3/31/2021, Register 238; am 9/18/2022, Register 243)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040