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(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. (Eff. 2/1/2010, Register 193) Statutory Authority: Authority: AS 47.05.010 AS 47.07.030 AS 47.07.040