1. (a) The department will authorize an individual for nursing facility services as a new admission, transfer, or continuing placement. Authorization may be given even if an individual is currently receiving services in a general acute care hospital or in an inpatient psychiatric hospital, or nonacute care services in a skilled nursing facility, an intermediate care facility, a home, or other nonacute setting. The department will determine the appropriate level of care by considering

   1. (1) the type of care required;
   2. (2) the qualifications of the person necessary to provide direct care; and
   3. (3) whether the recipient's overall condition is relatively stable or unstable.

2. (b) To receive payment under 7 AAC 105 - 7 AAC 160, a nursing facility, on a form provided by the department, must request

   1. (1) the authorization for admission of the recipient:
   2. (2) a level-of-care determination; and
   3. (3) a length-of-stay determination.

3. (c) When requesting authorization or reauthorization for admission and a level-of-care determination, a provider shall provide the following information:

   1. (1) the medical reason for the stay or continued stay;
   2. (2) information supporting the level-of-care decision of the facility's utilization review committee;
   3. (3) the plan of care established for the recipient by the attending physician;
   4. (4) the recipient's diagnosis, symptoms, complaints, and any complication indicating the need for admission or continued stay;
   5. (5) a description of the functional level of the recipient;
   6. (6) written objectives;
   7. (7) an order for medications, treatments, restorative and habilitative services, therapies, diet, activities, social services, and special procedures to meet these objectives;
   8. (8) the plans for continuing care, including provision for review and necessary modification of the plan;
   9. (9) the reasons why alternative placement is not feasible or appropriate;
   10. (10) the plan for discharge.

(Eff. 2/1/2010, Register 193)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040