Section 7 AAC 127.025 - Eligibility and enrollment for Community First Choice services; level of care determination(a) The department will pay a provider for Community First Choice services authorized in a recipient's support plan developed under 7 AAC 127.039, and provided in accordance with the applicable requirements of this chapter, for an individual that is (1) a current Medicaid recipient;(2) eligible for coverage under (d) of this section; and(3) enrolled under (f) of this section.(b) A recipient is not eligible to receive Community First Choice services while (1) in a location identified in 7 AAC 127.075(b); or(2) receiving services under 7 AAC 125.010 - 7 AAC 125.199.(c) A recipient enrolled in the Community First Choice services program is eligible to receive other medicaid services for which the recipient is other wise eligible.(d) For the department to determine whether an individual is eligible for Community First Choice services under this section, the individual must require a level of care provided in one of the following: (1) a nursing facility, as determined under 7 AAC 130.215;(2) an intermediate care facility for individuals with intellectual disabilities, as determined under 7 AAC 130.215;(3) an institution providing psychiatric services for individuals under 21 years of age, as determined under (e) of this section; or(4) an institution for mental diseases for individuals 65 years of age and over, as determined under (e) of this section.(e) For the purposes of eligibility under (d)(3) and (4) of this section, an individual must (1) require a level of care in an institution providing psychiatric services for individuals under 21 years of age or an institution for mental diseases for individuals 65 years of age and over;(2) have a mental illness or severe emotional disturbance that(A) has been diagnosed by a psychiatrist or mental health professional;(B) is likely to cause serious harm to self and others or is gravely disabled; and(C) has persisted six months and is expected to persist for a total of 12 months or longer; and(3) absent appropriate intervention in the home and community, requires psychiatric hospitalization as documented by a mental health professional.(f) The department will consider the recipient to be enrolled under this section after the recipient has (1) applied under 7 AAC 127.030 or 7 AAC 130.207;(2) been assessed or received an interim level-of-care review under 7 AAC 127.030(f) or 7 AAC 130.213;(3) met the level-of-care requirement under (d) of this section or 7 AAC 130.215; and(4) received approval of the recipient's support plan under 7 AAC 127.039 or 7 AAC 130.217.(g) The earliest date that an individual is eligible to receive Community First Choice services is the date when all of the requirements in (1) of this section have been met.(h) In this section, (1) "gravely di-sabled" has the meaning given in AS 47.30,915;(2) "likely to cause serious harm" has the meaning given in AS 47.30.915;(3) "mental health professional" has the meaning given in AS 47.30.915;(4) "mental illness" has the meaning given in AS 47.30.915. Eff. 10/1/2018, Register 227, October 2018; am 1/1/2021, Register 236, January 2021; am 1/22/2023, Register 245, April 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040