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that the change alters the recipient’s need for physical assistance with ADLs, IADLs, or other covered services. (c) Before reducing the time authorized for a recipient for Community First Choice personal care services, the department will first consider whether a reduction in the time authorized for the recipient’s Community First Choice personal care services would create a risk of institutionalization. The department will consider the following to make this determination:

(1) the documents specified in 7 AAC 127.030 that are current and submitted by the recipient in response to the department’s notification requiring a new assessment;

(2) the findings on the recipient’s Consumer Assessment Tool that are the result of a new assessment under 7 AAC 127.030;

(3) the impact of a reduction in time measured over a 24-hour period, taking into consideration the total time that the recipient receives physical assistance from any source;

(4) whether the recipient’s representative, family members, or other natural supports provide assistance to the recipient;

(5) whether other individuals living in the same residence as the recipient receive services that benefit the recipient; and

(6) the recipient’s history of utilization of the time authorized on the recipient’s current service level authorization. (d) In this section, “risk of institutionalization” means a likelihood that, as a result of the recipient’s current condition as identified in assessments and medical records, the recipient would require relocation from the recipient’s current residence to a hospital or nursing facility in 30 days. (e) The department will terminate a recipient’s authorization to receive personal care services approved under 7 AAC 127.090 if the recipient

(1) fails to use the personal care services in the service level authorization within 90 consecutive days after approval by the department or during any 90 consecutive-day period authorized under 7 AAC 127.090(e); or

(2) has a documented history of failing to cooperate with the delivery of services identified in the service level authorization, or of placing a personal care assistant at risk of physical injury, and no other provider is willing to provide services for the recipient; for the purposes of this paragraph a documented history exists if a provider

(A) reports that a personal care assistant was unable to obtain cooperation with service delivery or to mitigate the risk of physical injury despite reasonable attempts; and

(B) maintains records to support that report and makes those records available to the department for inspection; the department will review those records and interview the recipient or the recipient’s representative before making a decision to terminate the recipient’s