1. (a) The department will pay for adult day services that

   1. (1) are provided to a recipient in one of the following recipient categories:

      1. (A) older adults or adults with physical disabilities;
      2. (B) adults with physical and developmental disabilities;
   2. (2) are provided in accordance with the department's Adult Day Services Conditions of Participation, adopted by reference in 7 AAC 160.900;
   3. (3) are approved under 7 AAC 130.217 and 7 AAC 130.218 as part of the recipient's support plan; and
   4. (4) receive prior authorization.

2. (b) The department will consider health, social, and related support services to be adult day services if the services are

   1. (1) provided in a non-institutional community setting on a regular basis for not more than 10 hours per day, not including transportation to and from the setting; however, the department will allow more than 10 hours per day if the department determines that the recipient is unable to benefit from

      1. (A) other home and community-based waiver services; or
      2. (B) services provided by family members or community supports; and
   2. (2) planned to promote the optimal functioning of the recipient by meeting both health and social service needs.

3. (c) The department will not pay for adult day services that duplicate

   1. (1) services performed by personal care assistants under 7 AAC 125.010 - 7 AAC 125.199; or
   2. (2) other home and community-based waiver services.
4. (d) In this section, "non-institutional community setting" means a setting other than a hospital, nursing facility, or ICF/IID.

(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 3/31/2021, Register 238)