1. (a) The department will pay for residential supported-living 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 Residential Supported-Living 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;
   4. (4) receive prior authorization; and
   5. (5) are provided in an assisted living home licensed under AS 47.32.

2. (b) The department will consider services to be residential supported-living services if the services

   1. (1) are provided in a residential setting staffed 24 hours a day by on-site personnel capable of

      1. (A) meeting both scheduled and unpredictable resident needs; and
      2. (B) providing supervision, safety, and security;

   2. (2) assist a recipient in the assisted living home with

      1. (A) activities of daily living described in 7 AAC 125.030(b); and
      2. (B) supportive services, including social and recreational activities; and

   3. (3) are designed for a recipient that

      1. (A) can no longer live alone, but whose need for institutional level of care can be met though the support provided in the 24-hour residential supported-living setting; and
      2. (B) without the services, would require placement in a nursing facility for lack of alternate placements.

3. (c) If a recipient is eligible for residential supported-living services, the department will not make separate payment for

   1. (1) chore services under 7 AAC 127.087;
   2. (2) meal services under 7 AAC 130.295, unless the meals are provided in a congregate setting other than an assisted living home licensed under AS 47.32;
   3. (3) respite care services payable under 7 AAC 130.280;
   4. (4) the recipient's room and board;
   5. (5) the cost of facility maintenance, upkeep, or improvement; or
   6. (6) activities or supervision for which a source other than Medicaid makes payment.
4. (d) A provider of residential supported-living services under this section may not compel a recipient to be absent from the assisted living home for the convenience of the provider.

(Eff. 2/1/2010, Register 193; am 7/1/2013, Register 206; am 11/5/2017, Register 224; am 1/1/2021, Register 236; am 3/31/2021, Register 238)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040