1. (a) The department will pay an in-state hospice at the Medicaid rates established under 42 C.F.R. 418.306, adopted by reference in 7 AAC 160.900, for routine home care, continuous home care, inpatient respite care, and general inpatient care. The hospice shall pay a participating facility for general inpatient and inpatient respite care.
2. (b) The department will pay an in-state hospice for the cost of room and board for care provided to a recipient in a nursing facility or intermediate care facility for individuals with an intellectual disability or related condition if the hospice has a written agreement under which the hospice takes full responsibility for the professional management of the recipient's hospice care and the nursing facility or facility agrees to provide room and board to the recipient. The room and board provided by the facility must, at a minimum, include personal care services, administration of medication, maintenance of the recipient's room, and supervision and assistance in the use of durable medical equipment and prescribed therapies.

3. (c) In addition to the payment described in (a) of this section, the department will pay for

   1. (1) room and board, as described under (b) of this section, at the rate of 95 percent of the daily rate established under 7 AAC 150; and
   2. (2) physician services rendered by the hospice medical director as a licensed physician or by the licensed physician member of the interdisciplinary group, at the rate determined under 7 AAC 145.200(a) - (c).
4. (d) The department will not pay a hospice for inpatient days, including respite care, that exceeds 20 percent of the aggregate number of days of hospice care provided to all recipients during the immediately preceding 12-month period that began after October 31 and ended before November 1, excluding from the total number of recipient any recipient who has acquired immunodeficiency syndrome (AIDS). The hospice must refund to the department the excess payments less the routine home care rate for each day over the 20 percent of the total hospice days billed.
5. (e) In this section, "continuous home care,""general inpatient care," "inpatient respite care," "interdisciplinary group," and "routine home care" have the meanings given in 7 AAC 140.289.

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

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040