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Authority: AS 47.05.010 AS 47.07.030 AS 47.07.040 7 AAC 125.320. Requirements for home health care services. (a) The department will not pay for a home health care service, other than an initial visit for evaluation purposes, unless the provider has received prior authorization from the department. The department will accept a request for a home health evaluation received from any person concerned with the care of the recipient. (b) A home health agency must submit a request for prior authorization on a form provided by the department, and must include a written statement from the attending physician, advanced practice registered nurse, or physician assistant that

(1) explains the need for home health care services, including the reason services cannot be performed in a clinic, outpatient setting, or physician’s office; and

(2) includes medical recommendations for a plan of care developed under (d) of this section for services provided

(A) on an ongoing basis; or

(B) after acute care; for services provided under this subparagraph, the written statement must include the expected decrease in need for skilled nursing services and home health aide visits. (c) The department will not determine eligibility to receive home health care services based upon the recipient’s

(1) need for institutional care;

(2) discharge from institutional care;

(3) homebound status; or

(4) need for skilled nursing services. (d) A physician, advanced practice registered nurse, or physician assistant shall develop a plan of care for a recipient of home health care services. The plan of care must include

(1) pertinent diagnoses, including mental status;

(2) types of services and equipment required; orders for therapy services must include the specific procedures and modalities to be used and the amount, frequency, and duration of those services;