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AS 47.07.030 AS 47.07.040 7 AAC 130.267. Acuity payments for qualified recipients. (a) The department will pay for additional services under this section that

(1) are provided for a recipient who is qualified under (b) of this section and is receiving

(A) residential supported-living services under 7 AAC 130.255 that are assigned the procedure code described in 7 AAC 145.520(h); or

(B) group-home habilitation services under 7 AAC 130.265(f) that are assigned the procedure code described in 7 AAC 145.520(h);

(2) are requested in accordance with (c) of this section;

(3) the department determines to be necessary, based upon evaluation of the supporting documentation submitted in accordance with (d) or (e) of this section; and

(4) receive prior authorization. (b) For purposes of this section, a qualified recipient is one that

(1) needs services that exceed those authorized in the recipient’s current support plan under 7 AAC 130.217 and 7 AAC 130.218; and

(2) because of the recipient’s physical condition or behavior, needs direct one-to-one support from direct care workers whose time is dedicated solely to providing services under (a)(1) of this section to that one recipient 24 hours per day, seven days per week, in all environments in which the recipient functions. (c) To request additional services under this section, the care coordinator responsible under 7 AAC 130.217 and 7 AAC 130.218 for the recipient’s support plan must submit

(1) written documentation that

(A) describes how the recipient’s physical condition or behavior justifies the support described in (b) of this section;

(B) lists each intervention tried or in use to address the recipient’s physical condition or behavior, and whether the intervention was successful or unsuccessful;

(C) indicates how additional services under this section would be consistent with services approved as part of the recipient’s support plan under 7 AAC 130.217 and 7 AAC 130.218; and