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.
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