7 AAC 140.505 - Authorization for admission and determination of level of care

(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) the type of care required;

(2) the qualifications of the person necessary to provide direct care; and

(3) whether the recipient's overall condition is relatively stable or unstable.

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

(1) the authorization for admission of the recipient:

(2) a level-of-care determination; and

(3) a length-of-stay determination.

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

(1) the medical reason for the stay or continued stay;

(2) information supporting the level-of-care decision of the facility's utilization review committee;

(3) the plan of care established for the recipient by the attending physician;

(4) the recipient's diagnosis, symptoms, complaints, and any complication indicating the need for admission or continued stay;

(5) a description of the functional level of the recipient;

(6) written objectives;

(7) an order for medications, treatments, restorative and habilitative services, therapies, diet, activities, social services, and special procedures to meet these objectives;

(8) the plans for continuing care, including provision for review and necessary modification of the plan;

(9) the reasons why alternative placement is not feasible or appropriate;

(10) the plan for discharge.

Notes

7 AAC 140.505

Eff. 2/1/2010, Register 193

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040