This Alaska regulation governs the designation, application, operation, and oversight of facilities authorized to conduct civil commitment evaluations and treatment under AS 47.30.660–47.30.915. Eligible facilities include licensed hospitals and certain tribally operated facilities exempt from state licensure. Operators must maintain written policies and procedures covering personnel, patient rights, pharmaceuticals, and discharge planning, and must submit annual compliance reports to the department. The regulation also addresses revocation of designation, waiver requests, and coordination agreements with community mental health centers for continuity of care after inpatient psychiatric discharge.
View official source7 AAC 72.010. Scope of chapter. Repealed. 7 AAC 72.012. Adoption by reference. Repealed. 7 AAC 72.015. Facilities eligible for designation; exemption from designation. (a) The department will only approve the following facilities under this chapter and AS 47.30.660 - 47.30.915 to operate as a designated treatment facility: (1) a hospital that is licensed under AS 47.32.010 and 7 AAC 12.610 ; or (2) a facility that (A) is exempt from state licensure but is accredited by a nationally recognized accreditation organization; and (B) is operated under 25 U.S.C. 5301 - 5423 (Indian Self-Determination and Education Assistance Act), as amended. (b) For the purposes of this chapter, a facility designated as a treatment facility is also a designated evaluation facility. (c) The department will approve the following facilities under this chapter and AS 47.30.660 - 47.30.915 to operate as a designated evaluation facility: (1) a hospital that is licensed under AS 47.32.010 and 7 AAC 12.610 ; (2) a crisis residential center licensed under AS 47.32.010 as a subacute mental health facility; and (3) a facility that (A) is exempt from state licensure; (B) is operated under 25 U.S.C. 5301 - 5423 (Indian Self-Determination and Education Assistance Act), as amended; and (C) complies with the requirements for an evaluation facility under AS 47.30.660 - 47.30.915. (d) An evaluation facility or treatment facility that is operated by the department is exempt from the facility designation requirements of this chapter. 7 AAC 72.017. Function of a designated facility. Repealed. 7 AAC 72.020. Application for facility designation. (a) The administrator of a facility described in 7 AAC 72.015 may apply for designation as an evaluation facility or treatment facility by submitting an application to the department on a form and in a manner prescribed by the department that includes: (1) a copy of the facility's current license; if the facility is a hospital is operating under a provisional license issued under 7 AAC 12.610 , the administrator shall also submit a written report that describes each violation and the facility's efforts to achieve compliance; (2) certification, on a form provided by the department, that the facility is in compliance with AS 47.30.660 - 47.30.915 and this chapter; (3) a copy of the table of contents for the facility's policies and procedures, prepared as described in (b) of this section; the complete policies and procedures must be available for department review, and a copy of any specific procedure must be provided if requested by the department; and (4) for an accredited facility described in 7 AAC 72.015 (a)(2), a copy of the facility's current accreditation; if the report describes a deficiency, the administrator shall submit a written report that describes each deficiency and the facility's efforts to achieve compliance. (b) The administrator of a designated facility shall develop, and amend as necessary, written policies and procedures that cover (1) personnel administration; (2) fiscal administration; (3) patient records; (4) patient rights under AS 47.30.817 - 47.30.865; (5) language and cultural relevance of services; (6) coordination and continuity of services; (7) services for patients with physical disabilities; (8) management of pharmaceuticals; (9) quality assurance procedures; (10) program evaluation procedures; (11) ongoing inservice training; and (12) interdisciplinary services for patients with an alcohol or drug problem or a developmental disability, including planning for treatment before and after discharge. (c) Repealed 4/25/2025. (d) Repealed 4/25/2025. (e) Repealed 4/25/2025. 7 AAC 72.030. Waiver of requirements. (a) Upon request by a facility administrator, the commissioner or the commissioner's designee will waive a provision of this chapter if the administrator (1) provides an alternative method that reasonably assures, to the satisfaction of the commissioner or the commissioner's designee, the same level of protection and treatment that the provision sought to be waived affords the patient; and (2) demonstrates, to the satisfaction of the commissioner or the commissioner's designee, that the waiver does not result in a violation of a requirement of AS 47.30.660 - 47.30.915 or 7 AAC 12 . (b) A request for a waiver from a provision of this chapter must be in writing and must (1) identify the provision for which a waiver is sought; (2) explain the reasons why the facility cannot comply with the provision; (3) describe the alternative method proposed to satisfy the requirement in (a)(1) of this section; and (4) describe the facility's plan for complying with the provision, including a time schedule for compliance. (c) The department will rescind a waiver granted under this section if the department determines that the facility in not in compliance with (a)(1) and (2) of this section. 7 AAC 72.040. Decision on application for designation. (a) Within 60 days after receipt of a written application for designation under 7 AAC 72.020 (a), after review of any additional information requested under (b) of this section, and based on the department's determination as to whether the facility complies with 7 AAC 72.015 (a) or 7 AAC 72.015 (c), as applicable, the department will, in writing, either (1) approve the application, with modifications or conditions as necessary, make a decision on any request for a waiver submitted under 7 AAC 72.030 , and designate the facility as an evaluation facility or as a treatment facility; or (2) deny the application and specify the reasons for denial. (b) If the department requires additional information to make a decision under this section, the department will request that information in writing and advise the applicant that the 60-day review period will be suspended until the information is received. (c) If the department denies an application under this section, the administrator may request reconsideration of that decision under 7 AAC 72.060 . 7 AAC 72.050. Annual report regarding facility designation. (a) On or before June 30 of each year, the administrator of a designated facility shall submit to the department, on a form supplied by the department, the following: (1) for a hospital described in 7 AAC 72.015 (a)(1), (A) a copy of the facility's current license; if the facility is operating under a provisional license issued under 7 AAC 12.610 , the administrator shall also submit a written report that describes each violation and the facility's efforts to achieve compliance; (B) certification, on a form supplied by the department, that the facility is in compliance with AS 47.30.660 - 47.30.915 and this chapter; if a waiver has been granted under 7 AAC 72.030 , the administrator shall also submit a report setting out the status of the facility's compliance plan and schedule; (C) a list of policies and procedures described in 7 AAC 72.020 (b) that have been updated during the previous year and a copy of the current table of contents for the policies and procedures; and (D) a copy of each written agreement prepared under 7 AAC 72.110 , or a certification attesting that each written agreement already submitted to the department is still in effect; (2) for a facility described in 7 AAC 72.015 (a)(2), (A) a copy of the facility's current accreditation; (B) certification, on a form supplied by the department, that the facility is in compliance with AS 47.30.660 - 47.30.915 and this chapter; if a waiver has been granted under 7 AAC 72.030 , the administrator shall also submit a report setting out the status of the facility's compliance plan and schedule; (C) a copy of the facility's most recent accreditation report; if the report describes a deficiency, the administrator shall provide a written report of the nature of each deficiency and of the efforts to achieve compliance; (D) a list of policies and procedures described in 7 AAC 72.020 (b) that have been updated during the previous year and a copy of the current table of contents for the policies and procedures; and (E) a copy of each written agreement prepared under 7 AAC 72.110 , or a certification attesting that each written agreement already submitted to the department is still in effect. (b) The department will review the information submitted under this section and will advise the administrator in writing that the department finds the facility to be in compliance with this chapter, unless the department finds that the facility no longer meets the requirements for designation set out in 7 AAC 72.015 (a) or 7 AAC 72.015 (c), as applicable. If the department finds that the facility no longer (1) meets the requirements for designation, the department will notify the administrator in writing under 7 AAC 72.070 ; or (2) complies with the conditions of any waiver issued under 7 AAC 72.030 , the department will rescind the waiver under 7 AAC 72.030 (c). 7 AAC 72.060. Reconsideration. The administrator may, within 30 days after receiving the department's decision under 7 AAC 72.040 , request reconsideration of the decision. In the request for reconsideration, the administrator may include any additional materials and information that support facility designation and that are relevant to the department's decision. Within 30 days after receipt of a request for reconsideration, after review of any additional material and information submitted, and based on the department's determination as to whether the facility complies with 7 AAC 72.015 , the department will (1) approve the application, with modifications or conditions as necessary; or (2) reaffirm the decision made under 7 AAC 72.040 . 7 AAC 72.070. Revocation of designation. (a) Based on the department's review of a facility's performance under this chapter, including a review of information provided by the facility or by an interested person under (e) of this section, the department will revoke the facility's designation if the department determines that the facility does not substantially comply with (1) the applicable requirements of AS 47.30.660 - 47.30.915; or (2) the applicable requirements of this chapter. (b) Except as provided in (c) of this section, and at least 30 days before the effective date of the revocation, the department will notify the administrator of the department's determination and of the department's intent to revoke the facility's designation. (c) If the department determines that immediate revocation of a facility's designation is necessary to protect the public from a substantial and immediate threat to health or safety, the department will notify the administrator of the department's determination and that the facility's designation has been immediately revoked. (d) The department will issue a notice under this section in writing, will specify the basis for revocation in the notice, and will state in the notice that the administrator may appeal the decision under 7 AAC 72.410 - 7 AAC 72.440 . The department will hand-deliver the notice to an authorized agent of the facility or will mail the notice to the last known address of the facility's authorized agent. For the purpose of starting the 30-day period in (b) of this section, or triggering immediate revocation under (c) of this section, notice is effective upon personal delivery of the notice or on the third day after the department mails the notice, whichever occurs first. For the purposes of this subsection, the department mails a notice if the department sends that notice through the United States mail, a courier-type delivery service, a facsimile, or a telegram. (e) An interested person may submit a request to the department, asking that the department revoke a facility's designation, and clearly stating how the facility has failed to comply with an applicable provision of AS 47.30.660 - 47.30.915 or this chapter. Within 14 days after receiving a request under this subsection, the department will send the interested person and the administrator of the facility written notification as to whether the department will perform a review under (a) of this section. 7 AAC 72.080. General requirements for a designated facility. The administrator of a designated evaluation facility or designated treatment facility shall ensure that (1) staff members receive training to develop appropriate interactions with patients; (2) properly trained and qualified staff handle the protection, security, and observation of patients; (3) children under 18 years of age do not share a room with adults; (4) discharge plans are initiated early in the evaluation or treatment process and that the facility provides stabilization, establishes diagnoses, and initiates care with the goal of permitting the patient's early return to the community for followup care; discharge planning at an evaluation facility includes determining whether a patient should be released or transferred to a treatment facility, and whether the patient needs medication; (5) treatment is individualized; as necessary, the administrator shall hire or contract with staff to deliver necessary specialized care; and (6) subject to the disclosure restrictions of 42 C.F.R. Part 2, for a patient who is also receiving treatment for alcohol or drug abuse at a facility that receives federal financial assistance as described in 42 C.F.R. Part 2, the local community mental health center or other after-care agency is notified within 48 hours if a client from that center or agency, or an unassigned patient, is admitted for care, after obtaining a release for this notification from the patient. 7 AAC 72.085. Determination regarding declarations for mental health treatment. The staff at a designated facility shall make a reasonable effort to determine whether a patient committed under AS 47.30 has made a declaration of preferences or instructions regarding mental health treatment under AS 47.30.950 - 47.30.980 by consulting the patient, the patient's health care provider, the patient's spouse or parent, a person in the patient's household, or a person designated by the patient. 7 AAC 72.090. Qualified personnel. Repealed. 7 AAC 72.100. Personnel administration. Repealed. 7 AAC 72.110. Written agreements. (a) The administrator shall enter into a written agreement with each community mental health center served by the facility to provide for coordination and continuity of services related to the admission and discharge of patients receiving inpatient psychiatric care. (b) An agreement under (a) of this section must state that the center, after being notified by the facility of a patient's discharge from the facility, will schedule an appointment at the center with the patient for (1) clinical services within one week after a patient's discharge from the facility; and (2) medication management services before depletion of any psychotropic medication dispensed or prescribed for a patient upon discharge, and that, whenever possible, medication management services are to include a psychiatric evaluation. (c) If a single-point-of-entry psychiatric emergency facility is located in the area served by a designated facility, the designated facility shall, at a minimum, have in place with that other facility a memorandum of understanding that includes terms identical to those required under (b) of this section. 7 AAC 72.120. Availability of services. Repealed. 7 AAC 72.130. Environment. Repealed. 7 AAC 72.140. Patient rights. Repealed. 7 AAC 72.150. Patient records. (a) For each patient, a facility shall maintain a clinical record with forms that document the facility's use of the emergency examination or the evaluation procedure set out in 7 AAC 72.220 - 7 AAC 72.260 . (b) The facility shall safeguard patient records, including electronic records, against loss, defacement, tampering, and use by unauthorized persons. Information from patient records, including electronic records, may be released only in accordance with AS 47.30.845 and (c) of this section. (c) For a patient being treated for alcohol or drug abuse in a facility that receives federal assistance as described in 42 C.F.R. 2.12(b), the facility may disclose information from that patient's records only as allowed under 42 C.F.R. Part 2, including use of the consent form required under 42 C.F.R. 2.31. (d) Patient records that are required to be submitted to the department are subject to the applicable requirements of 7 AAC 85 . 7 AAC 72.155. Quarterly report of patient information. Within 60 days after the end of each calendar quarter, the administrator shall submit to the department, on a form supplied by the department, the following information regarding patients admitted to the facility during the previous quarter who were found to be suffering from a mental illness and who posed a danger to self or others, or who were gravely disabled, as determined by each patient's treating physician or psychiatrist: (1) the number of patients admitted voluntarily; (2) the number of patients admitted involuntarily; (3) the number of patients admitted who had insurance or self-pay coverage that was billed; (4) the average length of stay for all patients admitted during the quarter, whether voluntary or involuntary; (5) the number of patients who were readmitted during the quarter. 7 AAC 72.160. Quality assurance plan. Repealed. 7 AAC 72.165. Transfer of patients between designated facilities. An already committed patient may not be transferred from a designated evaluation or treatment facility to another designated facility or to a state-operated hospital, unless (1) a mental health professional (A) determines that the transfer is in the best treatment interests of the patient; (B) obtains, before the transfer, certification from the patient's attending physician that the patient is medically stable; and (C) contacts authorized admitting personnel at the receiving facility or hospital, and explains why the patient's mental condition or behavior necessitates transfer to another facility or hospital; and (2) the administrator of the facility proposing the transfer obtains, before the transfer, permission from the administrator at the receiving facility or hospital to transfer the patient. 7 AAC 72.170. Evaluation. Repealed. 7 AAC 72.180. Reports. Repealed. 7 AAC 72.190. Standards for treatment facility. Repealed. 7 AAC 72.200. Handicapped, cultural, and testing services. Repealed. 7 AAC 72.210. Clinical services and treatment plan. Repealed. 7 AAC 72.220. Scope of 7 AAC 72.230 - 7 AAC 72.260. The requirements of 7 AAC 72.230 - 7 AAC 72.260 apply to all facilities, whether licensed under 7 AAC 12.100 or otherwise designated under this chapter. 7 AAC 72.230. Emergency examinations. An evaluation facility shall comply with 7 AAC 72.240 - 7 AAC 72.260 when conducting an emergency examination under AS 47.30.710 . 7 AAC 72.240. Physician and mental health professional. An emergency examination under AS 47.30.710 must consist of a physical examination conducted by a physician and a mental health evaluation conducted by a mental health professional. 7 AAC 72.250. Physical examination. (a) In conducting the physical examination required by 7 AAC 72.240 , the physician shall determine whether the patient has any reasonably apparent physical problems that require specialized medical care and treatment, and that may either more urgently require care than the patient's present psychiatric problems, or cause or aggravate the patient's psychiatric problems. (b) The physical examination required by 7 AAC 72.240 must include (1) an examination of the patient's chief complaint; (2) a review of the patient's history; (3) a review of systems; (4) a routine physical examination; (5) a diagnosis; and (6) the physician's recommendations. 7 AAC 72.260. Mental health evaluation. (a) A mental health professional shall conduct the mental health evaluation required by 7 AAC 72.240 for the purposes of determining the specific mental health problems and needs of the patient and determining whether the patient meets the involuntary commitment criteria established in AS 47.30.730 . (b) A mental health evaluation required by 7 AAC 72.240 must, when reasonably possible, include (1) an interview with the peace officers who brought the patient to the facility for the examination; (2) a brief history of the patient, including observations or information obtained by other persons relating to the background, development, and circumstances of the patient's current problems; (3) a brief evaluation of the patient's mental status; (4) a history of the patient's previous treatment and medication; (5) a diagnosis; and (6) a determination of whether the patient meets the involuntary commitment criteria established in AS 47.30.730 . (c) If a mental health professional conducting a mental health evaluation under 7 AAC 72.240 determines that the patient meets the involuntary commitment criteria established in AS 47.30.730 and will not accept treatment on a voluntary basis, the mental health professional shall develop a treatment plan for the patient's care in the least restrictive setting. (d) If the mental health professional conducting the mental health evaluation under 7 AAC 72.240 determines that the patient does not meet the involuntary commitment criteria established in AS 47.30.730 , the facility shall develop an appropriate outpatient referral plan for the purpose of follow-up and continuing care if the patient is in need of these services. 7 AAC 72.270. Evaluations. An evaluation facility, whether licensed under 7 AAC 12.100 or otherwise designated under this chapter, shall comply with 7 AAC 72.280 - 7 AAC 72.290 when evaluating a patient after an emergency examination under 7 AAC 72.220 - 7 AAC 72.260 or after admitting a patient for a 72-hour evaluation period under AS 47.30.715 . 7 AAC 72.280. Procedures. An evaluation facility shall (1) perform routine laboratory studies ordered by the attending physician; (2) follow-up and further evaluate physical problems noted at the time of the patient's emergency examination, if any; (3) obtain available background information relating to the patient's present condition, including relevant developmental, family, social, and occupational history; (4) develop an initial treatment plan appropriate to the patient's target symptoms and behavior; (5) note and record pertinent behavioral manifestations that indicate whether the patient continues to meet the involuntary commitment criteria established in AS 47.30.730 ; and (6) record progress notes that document the effectiveness of treatment interventions, untoward incidents, complications, and adverse effects. 7 AAC 72.290. Referral plan. If the mental health professional of an evaluation facility who is evaluating or treating a patient determines that the patient does not meet the involuntary commitment criteria established in AS 47.30.730 , the mental health professional shall ensure that the patient, upon the patient's release, is provided an appropriate outpatient referral plan for the purpose of follow-up and continuing care, if the care is needed. 7 AAC 72.300. Scope of 7 AAC 72.310 - 7 AAC 72.350. The provisions of 7 AAC 72.310 - 7 AAC 72.350 apply to a mental health professional who requests designation by the department to conduct evaluations when no staffed evaluation facility exists. 7 AAC 72.310. Application for evaluation personnel designation. A mental health professional who requests designation as evaluation personnel shall apply for the designation on a form provided by the department. The mental health professional shall certify that he or she qualifies as a mental health professional under AS 47.30.915 (13). 7 AAC 72.320. Approval. Within 60 days after receiving a written application for designation, the department will either approve or deny the application. If the department approves the application, it will authorize the individual, in writing, to perform evaluations when no staffed evaluation facility exists. 7 AAC 72.330. Reconsideration. A mental health professional whose application is denied under 7 AAC 72.320 may, within 30 days after the denial, request reconsideration of the application by the department. The request for reconsideration may contain additional materials that support the application and are relevant to the denial. The department will rule on the request for reconsideration within 30 days after receiving a request. 7 AAC 72.340. Annual renewal. A mental health professional designated by the department to conduct evaluations shall, on an annual basis, submit a statement to the department certifying that he or she continues to qualify as a mental health professional under AS 47.30.915 (13). Upon receipt of the statement, the department will renew the designation for the next year unless it finds that the mental health professional no longer meets the standards for designation. 7 AAC 72.350. Revocation. The department will, in its discretion and upon 30 days' written notice, revoke a mental health professional's designation as evaluation personnel if the department finds that the individual no longer meets the criteria to qualify as a mental health professional under AS 47.30.915 (13). 7 AAC 72.360. Evaluation where no evaluation facility exists. In an area in which no designated evaluation facility exists, a mental health professional designated as evaluation personnel under 7 AAC 72.300 - 7 AAC 72.350 may conduct a mental health evaluation of a person suspected of being mentally ill and in need of involuntary commitment, using the procedure established under 7 AAC 72.360 - 7 AAC 72.390 . 7 AAC 72.370. Request for evaluation. Upon application by a peace officer under AS 47.30.705 , a mental health professional designated as evaluation personnel under 7 AAC 72.300 - 7 AAC 72.350 may conduct an evaluation of a person for the purpose of determining whether the person being evaluated requires hospitalization on an emergency basis under AS 47.30.710 (b). 7 AAC 72.380. Emergency examination procedures. In conducting an evaluation under 7 AAC 72.370 , the mental health professional shall follow the procedures for emergency mental health examinations set out in 7 AAC 72.220 - 7 AAC 72.260 . 7 AAC 72.390. Hospitalization. If the mental health professional determines that the person being evaluated under 7 AAC 72.260 is mentally ill, that the mental illness causes the person to be gravely disabled or to present a likelihood of serious harm to that person or others, and that the person is in need of hospital care or treatment, the mental health professional may initiate involuntary commitment by arranging for the hospitalization of that person in an appropriate local facility for a period not to exceed 72 hours for evaluation, in accordance with AS 47.30.715 . 7 AAC 72.400. Transfer requirements. Repealed. 7 AAC 72.410. Scope of 7 AAC 72.420 - 7 AAC 72.440. The provisions of 7 AAC 72.420 - 7 AAC 72.440 apply to appeals from (1) the revocation of a facility's designation under 7 AAC 72.070 ; (2) the revocation of a mental health professional's designation under 7 AAC 72.350 as evaluation personnel; and (3) the denial of a mental health professional's application under 7 AAC 72.320 . 7 AAC 72.420. Notice of appeal. (a) A facility administrator or a mental health professional wishing to appeal a department action described in 7 AAC 72.410 shall submit a notice of appeal to the commissioner. (b) The notice of appeal must be written, and may be hand-delivered, mailed, or sent by facsimile, courier-type delivery service, or telegram. The notice must be delivered or postmarked within 10 days after receipt of the notice of revocation. The notice of appeal must contain (1) a clear statement of the action appealed; (2) a concise statement of facts showing the reason for the appeal; and (3) any argument on an issue or law relevant to the appeal. 7 AAC 72.430. Procedure for appeal. (a) The commissioner will notify an appellant of a decision to accept or reject the appeal within seven days after the department receives a notice of appeal. The commissioner will reject an appeal if the notice of appeal is untimely or if it does not allege any facts which, if true, would permit reversal of the decision appealed. (b) The commissioner will, in a notice of a decision to accept an appeal, set a time and place for a hearing and name an impartial hearing officer. (c) The department will record all hearings conducted under this section. The appellant may appear, be represented by legal counsel, present exhibits and witnesses on the appellant's own behalf, and examine all evidence and witnesses presented by the department. The hearing officer shall establish all other procedures for the hearing. After the hearing, the hearing officer shall prepare written findings and recommendations to the commissioner, and the commissioner will make a final decision based on the evidence presented at the hearing. 7 AAC 72.440. Hearing on shortened time. (a) If the department revokes a designation under this chapter and does not notify the person or facility at least 30 days before the effective date of the revocation, then the person or facility may request a hearing on shortened time. (b) A request for a hearing on shortened time must be designated as such, and must otherwise meet the standards of 7 AAC 72.420 (b). (c) The commissioner will appoint a hearing officer and will schedule a hearing for a time within five days, excluding weekends and state holiday, after the department receives the request. (d) The hearing officer shall, at the close of the hearing, announce a decision to uphold or reverse the department's decision. The hearing officer's decision is effective immediately and will be the final decision in the matter except as provided in (e) of this section. Within two days after the hearing on shortened time, the hearing officer shall transmit a written notice of the decision and a transcript or electronic recording of the hearing to the commissioner. (e) Within seven days after the close of the hearing on shortened time, the appellant or the department staff may request that the commissioner grant a rehearing in the matter. The request for a rehearing must be designated as such, and must include a concise statement of facts showing the reason for disagreement with the hearing officer's decision and any views or arguments on any issue of fact or law presented. The commissioner will reject a request for rehearing if it is untimely or if the request fails to state any facts, which, if true would permit reversal of the hearing officer's decision. The commissioner will, in a notice that a request for a rehearing has been accepted, set a time and place for rehearing. The hearing officer shall follow the procedure set out at 7 AAC 72.430 (c) in conducting the rehearing. The commissioner will issue a final decision within 60 days after the request for a rehearing. 7 AAC 72.500. Purpose of 7 AAC 72.500 - 7 AAC 72.540. The purpose of 7 AAC 72.500 - 7 AAC 72.540 is to (1) establish the rates to be paid for certain mental health services that are provided to persons eligible for financial assistance under AS 47.31.010 ; (2) identify the types and level of mental health services for which financial assistance is available to eligible persons; (3) set standards for verifying eligibility under AS 47.31.020 ; and (4) set additional standards to interpret or implement AS 47.31 . 7 AAC 72.510. Rate of reimbursement for mental health services. As the payor of last resort, subject to department approval and the availability of appropriations from the legislature, the department will reimburse a designated facility for a service provided under 7 AAC 72.520 (a) or (b) to a person who is eligible for financial assistance under AS 47.31.010 . Reimbursement will be at the Medicaid rate that is (1) set under 7 AAC 43.670 - 7 AAC 43.709 in accordance with AS 47.07.070 ; and (2) in effect for the facility at the time the service was rendered, before any year-end review under 7 AAC 43.670 - 7 AAC 43.709 . 7 AAC 72.520. Mental health services eligible for financial assistance. (a) Subject to (d) of this section, if the department determines under 7 AAC 72.540 that a person who received evaluation or treatment at a designated facility is eligible for financial assistance, the department will provide reimbursement under 7 AAC 72.510 for the following mental health services that are provided by a designated facility and that are directly related to a patient's mental health condition that resulted in eligibility for financial assistance under AS 47.31.010 : (1) emergency room costs; (2) staff physician services, if those services are not already included in the facility's daily rate; (3) physician services, if those services require the action of a physician who is not a member of the designated facility's staff; (4) physician court time costs for participation in a commitment hearing; (5) medical costs, if related to the evaluation, diagnosis, and treatment of a patient's mental illness; (6) room and board costs related to the evaluation, diagnosis, and treatment of a patient's mental illness; (7) laboratory costs that are required for all patients entering a facility and laboratory costs related to mental health evaluation, diagnosis, and treatment; (8) medication costs related to mental health diagnosis and treatment; (9) transportation costs that are not covered by AS 47.30.870 or 47.30.905; (10) other services directly related to the admission being billed, as determined by the department on a case-by-case basis. (b) The department will reimburse a designated evaluation facility for no more than seven days for evaluation and crisis stabilization or for transition to community-based services if the department determines the amount of time is clinically appropriate and (1) the patient continues under, or has transferred to, voluntary commitment and the treating physician has certified, on a form supplied by the department, that the patient meets the involuntary commitment criteria in AS 47.30.700 - 47.30.815; or (2) the court extends the time for evaluation and treatment for a patient who continues to meet the involuntary commitment criteria in AS 47.30.700 - 47.30.815. (c) The department will reimburse a designated treatment facility for no more than 40 days for evaluation, treatment, and crisis stabilization or for transition to community-based services if the department determines the amount of time is clinically appropriate and (1) the patient continues under, or has transferred to, voluntary commitment and the treating physician has certified, on a form supplied by the department, that the patient meets the involuntary commitment criteria in AS 47.30.700 - 47.30.815; or (2) the court extends the time for evaluation and treatment for a patient who continues to meet the involuntary commitment criteria in AS 47.30.700 - 47.30.815, or the patient is authorized to remain at the facility under AS 47.30.745 (g). (d) The department will not reimburse a designated facility under 7 AAC 72.510 for (1) physician time spent performing administrative or supervisory duties; this exclusion does not include time spent participating in a commitment hearing; (2) facility costs for space, overhead, supplies, or equipment; (3) local ambulance service, unless (A) a medical emergency directly related to the patient's mental condition results in eligibility for financial assistance under AS 47.31.010 ; (B) the patient requires restraint; or (C) ambulance service is necessary to meet the requirements of 42 U.S.C. 1395dd (Emergency Medical Treatment and Active Labor Act (EMTALA)) and 42 C.F.R. 489.24; (4) the co-pay portion of a third-party reimbursement; (5) any transportation or other expense to be paid by the court system for proceedings under AS 47.30 ; or (6) any service that is not directly related to the patient's mental condition that resulted in eligibility for financial assistance under AS 47.31.010 . (e) For a patient admitted after an involuntary commitment under AS 47.30.700 - 47.30.815 or a voluntary commitment chosen after the patient's physician determines that the patient meets the involuntary commitment criteria in AS 47.30.700 - 47.30.815, the treating physician shall (1) using a form supplied by the department, certify upon admission that the patient meets the involuntary commitment criteria in AS 47.30.700 - 47.30.815; if the patient subsequently transfers to voluntary commitment, the treating physician shall certify daily, on the patient's chart, whether the patient continues to meet the involuntary commitment criteria; and (2) recertify every seven days, on the form supplied by the department, whether the patient continues to meet the involuntary commitment criteria. (f) The department may, on a case-by-case basis, deny reimbursement under 7 AAC 72.540 if the department determines that a service provided is not directly related to the patient's mental health condition. 7 AAC 72.530. Application for financial assistance. (a) An application for assistance that is submitted under AS 47.31.015 (a) must include (1) a copy of the invoice for the services for which financial assistance is sought; (2) proof of gross monthly household income; this proof includes paycheck stubs, tax records, unemployment check stubs, a signed statement from an employer, or any other document that shows evidence of income for the month during which a patient received care provided by a designated facility; and (3) identification of and information about any third-party payor that provides insurance coverage to the patient; for purposes of this paragraph, the following persons are not third-party payors under AS 47.31.010 : (A) the United States Department of Interior, Bureau of Indian Affairs; (B) the United States Department of Health and Human Services, Indian Health Service; (C) the patient's private insurance company, if the company does not cover mental health inpatient treatment or the maximum benefit level for that treatment has been reached. (b) If a designated facility makes a notification under AS 47.31.015 (b), the notification must (1) be signed and submitted by the administrator; and (2) include (A) any information as to whether a thirty-party payor is responsible for payment; and (B) subject to the disclosure restrictions of 42 C.F.R. Part 2 for a patient who is also being treated for alcohol or drug abuse in a facility that receives federal assistance as described in 42 C.F.R. Part 2, a copy of the invoice for the services for which financial assistance is sought. (c) If the facility receives payment from a patient or a third-party payor after being reimbursed by the department under this chapter, the administrator shall return the money to the department. 7 AAC 72.540. Decision regarding eligibility for financial assistance. (a) The department will review information submitted under 7 AAC 72.530 to verify that the patient meets the eligibility requirements of AS 47.31.010 and that each service for which financial assistance is sought is an eligible service under 7 AAC 72.520 (a) or (b). Subject to the disclosure restrictions of 42 C.F.R. Part 2 for a patient who has also received treatment for alcohol or drug abuse in a facility that receives federal financial assistance as described in 42 C.F.R. Part 2, the department may, after 10 days notice to the facility, review all financial and medical records related to a patient for whom application for financial assistance has been made. (b) If the department determines that the patient is eligible for financial assistance, payment will be made directly to the designated facility that provided any service listed in 7 AAC 72.520 (a) or (b), as required by AS 47.31.030 . (c) If the department determines that the patient is ineligible for financial assistance, or that a service provided is not eligible under 7 AAC 72.520 , the department will, as required by AS 47.31.020 , notify the patient and the designated facility that the application for financial assistance has been denied, and will advise the patient, the patient's legal representative, if any, and the designated facility of the right to appeal the denial of assistance under AS 47.31.035 . 7 AAC 72.900. Definitions. In this chapter (1) "administrator" means the person with primary responsibility for the administration and operation of a facility subject to this chapter; "administrator" includes that person's designee; (2) "commissioner" means the commissioner of family and community services; (3) "crisis stabilization" means the administration of medication and provision of structure, observation, support, case management, or discharge planning for a person subject to voluntary or involuntary admission for treatment under AS 47.30.660 - 47.30.815; (4) "department" means the Department of Family and Community Services; (5) "designated" means designated by the department as an evaluation or treatment facility under this chapter; (6) "evaluation facility" has the meaning given in AS 47.30.915 ; (7) "designated treatment facility" has the meaning given in AS 47.30.915 ; (8) "evaluation" means an examination and assessment of a person's (A) mental health, conducted by a mental health professional; and (B) physical condition, conducted by a physician, physician assistant, or advanced practice registered nurse; (9) "gravely disabled" has the meaning given in AS 47.30.915 ; (10) "gross monthly household income" has the meaning given in AS 47.31.100 ; (11) "household" has the meaning given in AS 47.31.100 ; (12) repealed 4/25/2025; (13) "medication management" means a review by a physician, a physician's assistant, an advanced nurse practitioner with prescriptive authority, or other appropriately licensed medical professional to assess a person's need for medication, to prescribe appropriate medication to meet the person's needs, and to monitor the person's response to medication, including documentation of medication compliance, assessment and documentation of side effects, and evaluation and documentation regarding effectiveness of the medication; (14) "mental health professional" has the meaning given in AS 47.30.915 ; (15) "mental illness" has the meaning given in AS 47.30.915 ; (16) repealed 4/25/2025; (17) "single-point-of-entry psychiatric facility" means a facility licensed by the state to perform initial assessments of persons suffering from mental illness and to make initial determinations regarding placement of those persons for voluntary or involuntary commitment or respite care; (18) "treatment" means mental health or psychiatric treatment under As 47.30.660 - 47.30.915; (19) repealed 4/25/2025. Chapter 74 Alaska Pioneers' Homes 7 AAC 74.010. Quality and levels of service. (a) It is the policy of the department that a pioneers' home will provide a safe and sanitary environment. Each resident or recipient will be treated with consideration and respect for personal dignity, individuality, and the need for privacy. Each resident will receive a lifestyle assessment that identifies the appropriate service level in (c) of this section and is further specified in each resident's assisted living plan. A pioneers' home will make reasonable efforts to provide the proper service level to residents who require the same or a different service level after being admitted. However, a pioneers' home cannot guarantee that all service levels described in (c) of this section will be available to every resident. Availability of service levels is subject to the funding, facilities, and staff that are available at each pioneers' home. (b) A pioneers' home is neither an acute care facility nor a skilled nursing facility. A pioneers' home is an assisted living facility, operating in accordance with the statutes and regulations pertaining to assisted living homes. If a resident requires services not normally provided by a pioneers' home, the resident will be referred to another appropriate health care facility until the resident is able to return to the pioneers' home. (c) The service levels provided at a pioneers' home are as follows: (1) level I services include housing, meals, emergency assistance, opportunities for recreation, and required transportation for recreation; the resident is independent in activities of daily living; (2) level II services include level I services, medication management, and assistance with up to two activities of daily living; during the night shift, the resident is independent in performing activities of daily living and capable of self-supervision; (3) level III services include (A) level I services, medication management, and one of the following: (i) assistance with up to four activities of daily living; (ii) assistance with up to two activities of daily living and behavior management, excluding complex behaviors; or (iii) assistance with up to two activities of daily living and nursing services as described in AS 47.33.020 ; and (B) during the night shift, assistance with activities of daily living, limited to an average of two times per week; (4) level IV services include level I services, medication management, assistance with five or more activities of daily living, behavior management, excluding complex behaviors, and nursing services as described in AS 47.33.020 ; services will be provided 24 hours a day; (5) level V services include all services that exceed level IV services; (6) day services include services provided in a pioneers' home to a recipient who requires services for up to eight hours a day between 6:00 a.m. and 6:00 p.m., including meals scheduled during the period the recipient is receiving day services; (7) respite services include room and board provided in a pioneers' home to a recipient who requires services for up to 14 consecutive days, 24 hours a day. 7 AAC 74.015. Eligibility for admission. (a) An applicant is eligible for admission to a pioneers' home on a space-available basis if the applicant (1) is a resident of the state under 7 AAC 74.035 ; (2) subject to AS 47.55.035 , has been a resident of the state continuously for at least one year immediately preceding application and maintains residency in the state while on any waiting list for admission to a pioneers' home; (3) is in need of the aid, benefit, or safety of a pioneers' home because of a physical disability or other reason, as defined in AS 47.55.900 ; (4) is 60 years of age or older; and (5) either (A) agrees to pay the applicable monthly rate set out in 7 AAC 74.025 plus ancillary charges; or (B) if not financially able, applies to the department for payment assistance in accordance with 7 AAC 74.045 , and pays the applicable monthly rate set out in 7 AAC 74.025 plus ancillary charges. (b) The spouse of a resident of a pioneers' home is eligible for admission to that home if the spouse meets the requirements of (a)(1), (2), (4), and (5) of this section, regardless of whether the spouse meets the requirements of (a)(3) of this section. (c) After admission, continued residence in a pioneers' home is contingent on the person's compliance with the resident's assisted living plan, the requirements of AS 47.55 and this chapter, and all other appropriate conditions. 7 AAC 74.020. Eligibility for day services and respite services. (a) A person is eligible, upon application, for day services and respite services in a pioneers' home, if the person is (1) eligible for admission to a pioneers' home; and (2) on the active waiting list for admission maintained under 7 AAC 74.060 (f)(2). (b) A person who is eligible for day services and respite services, and who is financially able to do so, shall pay the appropriate rate set out in 7 AAC 74.025 . An eligible person who is not financially able to pay the appropriate rate shall apply to the department for payment assistance in accordance with 7 AAC 74.045 . The department will determine eligibility for payment assistance in accordance with 7 AAC 74.045 and AS 47.55 . 7 AAC 74.025. Rates. (a) The monthly rate for each level of service described in 7 AAC 74.010 (c)(1) - (4) is the maximum rate allowed under AS 47.55.030 (f). (b) The monthly rate for level V services described in 7 AAC 74.010 (c)(5) is $15,000. (c) The daily rate for day services described in 7 AAC 74.010 (c)(6) or respite services described in 7 AAC 74.010 (c)(7), that are provided under 7 AAC 74.020 , is the maximum rate allowed under AS 47.55.030 (f). (d) The department will adjust the rates in (a) - (c) of this section in accordance with AS 47.55.030 (g) by a percentage equal to the percentage increase in the cost-of-living adjustment for social security benefits. If consistent with the 90-day time period described in AS 47.55.030 (g), new rates will be published on the department's website by the first day of December and implemented on the first day of January. 7 AAC 74.030. Notice of intent to move out of a pioneers' home. (a) A resident planning to move out of a pioneers' home must give at least 30 days' written notice of the intent to move. (b) If a resident fails to give at least 30 days' notice, the resident shall pay the appropriate rate for the 30-day period beginning on the date that the resident gives notice. 7 AAC 74.035. Residence requirements. (a) Except for an absence allowed under this section, to be considered a state resident under AS 47.55.020 (a) and this chapter, a person must be physically present in the state for at least 185 days of each year, with the intent to remain in the state indefinitely and to make a home in the state. (b) Subject to AS 47.55.035 and (d) of this section, absences from the state totaling more than 180 days in the year preceding the date of the application, or in any year that the applicant is on a waiting list for a pioneers' home, constitute a break from the continuous residence requirement for purposes of 7 AAC 74.015 (a)(2) unless the absences were for any of the following reasons, and the person returns to the state within 60 days after completing the matter that required the absence: (1) pursuit of a formal course of study under the supervision of an established primary or secondary school, college, university, vocational school, or professional school, or performance of an internship or residency necessary to establish a professional specialty; (2) medical treatment upon the recommendation of a licensed physician or psychologist if the absence did not include a permanent change of residence; (3) service in the United States Army, Navy, Air Force, Marines, or Coast Guard, Alaska National Guard, or Alaska Naval Militia, if the person enlisted or was drafted while a resident of the state; (4) employment by the State of Alaska in a location outside of the state; (5) service in the United States Congress as a representative or senator for the State of Alaska, or service on the staff of such a representative or senator; (6) service as a presidential appointee as a cabinet member or as an ambassador, or service on the staff of such an appointee; (7) confinement in an out-of-state correctional institution by order of a court, if the person was a resident of the state before the confinement began; (8) medical necessity of a nonresident spouse, parent, dependent, or sibling requiring the applicant to be out of the state to provide care for the spouse, parent, dependent, or sibling, if the applicant was a resident of the state when the medical necessity arose; (9) family necessity requiring the applicant, whose relationship with another state resident was that of a spouse, parent, dependent, or sibling, to accompany that individual who was absent for reasons allowed by (1) - (8) and (10) of this subsection, if the applicant was a resident of the state when the family necessity to accompany the absent individual arose; (10) admission to a licensed long-term care facility outside of the state upon the written recommendation of a licensed physician, if the applicant continuously maintained residency in the state while temporarily absent from the state. (c) Subject to AS 47.55.035 and (d) of this section, an applicant, after establishing eligibility and while retaining residency under AS 01.10.055 , may be absent from the state for 181 to 365 days in any five-year period, and remain on the waiting list, if the applicant (1) notifies the department at least 30 days before departure, of the period that the applicant intends to be absent; (2) provides an out-of-state address and telephone number that the department may use to contact the applicant during the absence; and (3) informs the department of the applicant's return not later than 30 days after the applicant returns to the state. (d) If an applicant who is out of state is offered placement in a pioneers' home and refuses the offer or fails to enter the home within 30 days after the date of the offer, the applicant's name will be removed from the active waiting list and put on the inactive list, as provided by 7 AAC 74.060 (f)(6). 7 AAC 74.040. Payment for services in a pioneers' home. (a) Every resident and recipient shall pay the appropriate monthly or daily rate plus ancillary charges if financially able to do so. Every applicant and resident shall provide income and resource verification to the department upon admission, if there is a change in resources or income, and if there is a change in the level of service. The department will use the income and resource verification to determine the ability of the applicant and resident to pay and evaluate eligibility for other assistance. (b) A resident and a recipient who is not financially able to pay the appropriate rate shall apply to the department for payment assistance on a form supplied by the department. The department will determine the amount of assistance in accordance with 7 AAC 74.045 . (c) The department is not liable for the medical expenses of a resident or recipient and, except for the medication expenses described in 7 AAC 74.050 (b)(2), is not responsible for the payment of those expenses. (d) A person applying for or receiving payment assistance as a resident or a recipient under AS 47.55 shall apply for the following state or federally sponsored programs that may reduce the amount of payment assistance under AS 47.55 : (1) Medicaid under 42 U.S.C. 1396b - 1396v (Title XIX of the Social Security Act); (2) Medicare under 42 U.S.C. 1395 - 1395hhh (Title XVIII of the Social Security Act); (3) Supplemental Security Income under 43 U.S.C. 1382 - 1383a (Title XVI of the Social Security Act); (4) any program that the department identifies in writing to the person that may reduce the amount of payment assistance needed under AS 47.55 ; the department will make the identification authorized under this paragraph after a review of information available to the department. (e) To meet the requirement of (d) of this section, the person shall complete any forms necessary to apply for the programs specified in (d)(1) - (4) of this section within 60 days of a request from the department. If the person is unable to complete those forms, the department may designate staff to complete the forms on the person's behalf. (f) If the department determines that a person is ineligible for a program specified in (d) of this section, the department may waive the application requirement and inform the person that the person is not required to apply to the program. 7 AAC 74.045. Payment assistance. (a) Payment assistance will be provided in an amount that, when added to the applicant's income and resources, other than those described in (c) of this section, is necessary to cover the appropriate monthly or daily rate. Except as otherwise provided in this section, payment assistance begins on the first day of the month following the month in which the application for payment assistance is approved by the department. (b) A payment assistance application must contain a complete and accurate disclosure of income and resources, including, for the applicant and for the applicant's spouse, (1) a description, including location, of all real property owned in whole or in part, whether inside or outside the state, during the preceding 36 months; (2) a description, including location, of all major resources other than real property owned in whole or in part during the preceding 36 months, including automobiles, boats, airplanes, jewelry, cash, stocks, bonds, notes, livestock, and major equipment; (3) a listing of the amount and sources of all income that might be received while the applicant is a resident or recipient; (4) copies of federal income tax filings for the preceding three years; and (5) the number, location, and contents of all savings, checking, brokerage, or other accounts and safe-deposit boxes held either individually or jointly during the preceding 36 months. (c) A resident's or a recipient's income and resources, up to the full amount of the income and resources if necessary, must be applied to the appropriate monthly or daily rate established by 7 AAC 74.025 and to ancillary charges. However, the value of the following items held by a resident or recipient is exempt for the purpose of determining eligibility for payment assistance: (1) any income or asset listed in AS 47.55.020 (d)(1) - (10), subject to the following: (A) for purposes of AS 47.55.020 (d)(1), the amount to be exempted is $300 a month; (B) for purposes of AS 47.55.020 (d)(2)(A), the amount to be exempted is $2,500; (C) for purposes of AS 47.55.020 (d)(7), sufficient burial provisions for the resident or recipient and the resident's or recipient's spouse or dependent include burial insurance, a specific account designed for burial expenses with a value up to $4,500 for each person, or a combination of insurance and a specific account; (D) for purposes of AS 47.55.020 (d)(8), and (9), for a resident or recipient with a spouse or dependent, (i) the resident's or recipient's home or real property used as the primary residence of the resident's or recipient's spouse or dependent is exempt; (ii) the exemption for other real property not used as the primary residence of the resident's or recipient's spouse or dependent, and personal property, both tangible and intangible, is a total value of not more than the community spouse resource allowance; property necessitated by the resident's or recipient's physical condition, such as a prosthetic device, is not subject to this value limitation; in this sub-subparagraph, "community spouse resource allowance" has the meaning given in 7 AAC 100.519 ; (iii) the income of the resident's or recipient's spouse is exempt; and (iv) notwithstanding (ii) of this subparagraph, the department will consider the following to be disregarded personal property: the portion of the resident's or recipient's income that will bring the income of the resident's or recipient's spouse up to the maximum community spouse monthly maintenance allowance authorized under 7 AAC 100.560 (a), without exceeding that allowance, if that portion is accumulated as personal property in an account to pay for expenses related to the home or real property described in (i) of this subparagraph and if the spouse's income would otherwise be less than the maximum community spouse monthly maintenance allowance a month; and (E) for purposes of AS 47.55.020 (d)(8) and (9), for a resident or recipient without a spouse or dependent, the exemption for other real and personal property, both tangible and intangible, is a total value of not more than $10,000; property necessitated by the resident's or recipient's physical condition, such as a prosthetic device, is not subject to this value limitation; (2) a motor vehicle; (3) Agent Orange Settlement Fund payments made under P.L. 101-201 and sec. 10405 of P.L. 101-239; (4) one or more life insurance policies except for any cash surrender value of each insurance policy; (5) burial spaces owned by the resident or recipient and intended for use by the resident or recipient and the resident's or recipient's spouse or dependent. (d) In determining the resources of an applicant for payment assistance under this section, the department will include the value of any resources owned by the applicant within the 36 months preceding the date of the payment assistance application if the applicant gave away the resource, or sold or assigned it for less than fair market value. The department will make the rebuttable presumption that any such transaction was for the purpose of reducing the applicant's ability to pay the state for services in a pioneers' home. (e) A resident or recipient who receives payment assistance under this section is indebted to the state for the amount of the assistance. If the resident or recipient who is indebted to the state receives income or a resource that disqualifies the resident or recipient for payment assistance under this section, that resident or recipient shall apply the additional income and resources to reduction of the debt to the state. The resident or recipient may then reapply for payment assistance under (b) of this section if the resident or recipient again becomes financially unable to pay the appropriate monthly or daily rate. (f) The department may issue tentative approval for payment assistance, and may commence payment assistance, to an applicant who has completed the payment assistance application process and whose income and resources appear to make the applicant eligible for payment assistance, if the applicant requires additional time to supply complete application information, such as a valuation for property. Complete application information must be provided no later than 60 days after tentative approval is issued, unless the department, for good cause shown, authorizes additional time. Failure to provide complete application information within 60 days, plus any extension that may be authorized, will result in denial of the final application, and will require repayment of any payment assistance received as a result of the tentative approval. (g) The department may issue temporary payment assistance to an applicant who meets the income requirements for payment assistance, but who has noncash resources in excess of those requirements, in order to allow time for the applicant to liquidate those noncash resources at fair market value. Temporary payment assistance under this subsection will not be made unless the applicant agrees in writing to (1) submit documentation to the department at least once every six months showing active attempts to dispose of the resources; and (2) repay the payment assistance in full upon the liquidation of the noncash resources. (h) Failure to submit the documentation required under the agreement described in (g) of this section will result, absent a showing of good cause, in cessation of the payment assistance, and will require repayment of any payment assistance already received. After the noncash resources are liquidated, the applicant's application for payment assistance will be reevaluated, if the applicant reapplies for payment assistance. 7 AAC 74.050. Personal needs allowance; priority of payments from income. (a) If the department determines that legislative appropriations are sufficient, the department will pay to a resident who does not receive income of at least $200 a month the amount necessary to bring the resident's income up to $200 a month. The resident may accumulate this money in an account, but loses eligibility for the personal needs allowance if the resident accumulates $5,000 or more from any source. (b) Except as otherwise provided by law or by a court or administrative order, a resident who is receiving payment assistance and who receives a total of more than $300 in income in a month from all sources other than the department shall apply the excess income to payments for the listed purposes, in the following priority sequence: (1) the resident's federal income tax; (2) the resident's medication expenses not included under (4) of this subsection; (3) the resident's health insurance premiums; (4) the resident's monthly rate established by 7 AAC 74.025 , and ancillary charges. 7 AAC 74.055. Required information. (a) An application for admission to a pioneers' home must include (1) the names and addresses of the applicant's adult relatives, and the name and address of any guardian, conservator, holder of a power of attorney, or other responsible party; and (2) a description of any physical or cognitive disability of the applicant, and the name of the physician, if any, who last treated the condition. (b) The department may require additional information relevant to an applicant's eligibility, and may require that the applicant give the department and its agents access to various items, including medical records and financial records. (c) An applicant shall inform the department of any change in information provided under this section. (d) Information provided by an applicant is confidential, and not subject to disclosure, to the extent provided by law. 7 AAC 74.060. Admission and discharge. (a) Except as provided in (b) and (d) of this section, decisions concerning admission, continued residence and participation, and discharge shall be made by the pioneers' home administrator with advice from the interdisciplinary care team for the pioneers' home. (b) Admission to or continued residency or participation in a pioneers' home or service will not be approved for a person while the person has (1) a communicable, contagious, or infectious disease that would pose a significant threat to the health, safety, or welfare of other residents or recipients; a cold, influenza, or similar illness is not considered a significant threat for purposes of this paragraph; or (2) a behavior problem that would threaten the health, safety, or welfare of that person or other residents or recipients, as determined by the department. (c) A person will not be admitted as a resident or recipient, or be required to remain as a resident or recipient, unless that person or the person's legal representative freely and knowingly consents to the person's entering or remaining at the pioneers' home or in the service program. (d) A resident may not continue residency at a pioneers' home, or a recipient may not continue to receive day services or respite services, if the department determines that the resident or recipient has sufficient assets and income to pay for care and support and that payments for care and support are in arrears. (e) A resident will be discharged if the resident is absent from the home for more than 60 consecutive days, unless the absence (1) was necessitated by a referral to another health care facility under 7 AAC 74.010 (c); or (2) is authorized under 7 AAC 74.035 (b). (f) For applicants for admission as a pioneers' home resident, the department will (1) receive all new applications, verify eligibility, and list all eligible applicants in chronological order by date that the application was received; (2) maintain a waiting list, known as the active waiting list, comprised of all applicants who desire to enter the pioneers' home of their choice within 30 days after an admission invitation is received; (3) maintain a waiting list, known as the inactive waiting list, comprised of all applicants who desire to enter the pioneers' home of their choice at some future undetermined time, but not within the time period specified in (2) of this subsection; (4) verify continued eligibility for admission under 7 AAC 74.015 annually for all applicants on the active and the inactive waiting lists using available data; (5) transfer an applicant's name from the inactive waiting list to the active waiting list upon written request from the applicant or the applicant's representative; the applicant's name will be listed on the active waiting list in the chronological order in which the original application was received; (6) transfer an applicant's name from the active waiting list to the inactive waiting list if the applicant is offered placement in a pioneers' home in which the applicant has expressed interest, but refuses the offer or fails to enter the home within 30 days after the date of the offer; (7) require an applicant who is transferred to the inactive waiting list under (6) of this subsection to remain on that list for at least 180 days before applying for a transfer to the active waiting list under (5) of this subsection; and (8) require an applicant to verify continued eligibility for admission under 7 AAC 74.015 if the department is unable to verify continued eligibility under (4) of this subsection. (g) Admission to or continued residency in a pioneers' home will not be approved unless the person provides proof, from the United States Social Security Administration, that the person is currently enrolled, if eligible, in Medicare Part A 42 U.S.C. 1395c - 1395i-6, Medicare Part B 42 U.S.C.1395j - 1395w-6 coverage under the Social Security Act, and Medicare Part D (42 U.S.C. 1395w-101 - 1395w-154) under the Medicare Modernization Act of 2003 or has private medical insurance providing coverage at least as extensive as that provided by Medicare Parts A, B, and D. If the person is not currently enrolled in Medicare Parts A, B, and D and the general enrollment period open for Medicare Parts A, B, and D for a calendar year has passed, the person may satisfy the requirements of this subsection by providing evidence from the United States Social Security Administration that the person has applied for Medicare Parts A, B, and D during the last open enrollment. 7 AAC 74.065. Appeal procedures. (a) Subject to (d) of this section, the following decisions may be appealed to the director within 30 days after the mailing or personal delivery of the decision: (1) a decision made by a pioneers' home administrator in the case of admission, discharge, length of absence, continued stay in a pioneer home, or eligibility for day services and respite services; (2) a decision made by a designated department employee in the case of payment assistance applications and discharge for nonpayment of any appropriate rate. (b) During the course of the appeal, the director or the director's designee shall accept all written evidence that the appellant, pioneers' home administrator, or designated employee wishes to submit. If the appellant, the pioneers' home administrator, or a designated employee requests a hearing, the director or the director's designee shall conduct an evidentiary hearing. Witnesses called to testify at an evidentiary hearing shall testify under oath and shall furnish relevant documents upon request. If an evidentiary hearing is not held, the director or the director's designee shall review and consider the written evidence submitted. (c) The director shall issue a written decision, or the director's designee shall prepare a recommended decision, within 10 working days after the written and testimonial records are closed, unless that period is extended by the commissioner or the commissioner's designee for good cause shown. Grounds for extension include allowance of time to present post-hearing briefs or newly-discovered evidence not previously discovered or discoverable. If the director's designee prepares a recommended decision, the director shall adopt, modify, or disapprove the recommended decision within 10 days after receiving it. If the director disapproves the decision prepared by a designee, the director shall issue the director's own decision. The decision shall be mailed to the appellant by certified mail, return receipt requested, or personally delivered to the appellant. (d) If the director is the person who made the initial decision under 7 AAC 74.060 (d) or another provision of this chapter, an appeal under this section may be taken directly to the commissioner, within 30 days after the mailing or personal delivery of the director's decision. The commissioner will provide an opportunity for an evidentiary hearing, and the final agency decision will be rendered in accordance with (e) of this section. (e) Within 30 days after the mailing or personal delivery of the director's decision, a party to the proceeding may appeal that decision in writing to the commissioner. The commissioner may assign the authority to hear and decide appeals under this section to a deputy commissioner, special assistant to the commissioner, or hearing officer. Except as provided in (c) of this section, the appeal will be on the record, and will be decided within 10 days after the full record is received, or the hearing is concluded, by the commissioner or the commissioner's designee. This decision constitutes final agency action for the purposes of judicial review. 7 AAC 74.070. Deceased residents. (a) Upon the death of a resident, the resident's property that is under the department's control will be disposed of in accordance with appropriate court-approved documents. (b) The department is not responsible for funeral, burial, cremation, or similar costs for a resident. 7 AAC 74.990. Definitions. (a) In this chapter, (1) "activities of daily living" has the meaning given in AS 47.33.990 ; (2) "ancillary charges" means monthly charges for the cost of supplies, medication, equipment, and services beyond those covered by the appropriate rate set in 7 AAC 74.025 , furnished to a resident or recipient; (3) "assisted living plan" means the assisted living plan prepared under AS 47.33.220 and 47.33.230; (4) "commissioner" means the commissioner of family and community services; (5) "day services" means services described in 7 AAC 74.010 (c)(6); (6) "department" means the Department of Family and Community Services; (7) "dependent" means a minor child under the age of 18 or an adult with a physician-certified mental or physical impairment or developmental disability that prevents the adult from performing self-care; (8) "director" means the director of the subunit of the department that oversees Alaska pioneer homes; (9) "financially able" means that an applicant, resident, or recipient has (A) enough monthly income or resources, after excluding the items listed in 7 AAC 74.045 (c), to pay the appropriate monthly or daily rate under 7 AAC 74.025 and ancillary charges; and (B) income of at least $300 a month left for personal use after paying the appropriate monthly or daily rate and ancillary charges; (10) "health-related services" means services described in AS 47.33.020 (c) - (i); (11) "income" means earned and unearned income, including wages, net earnings from self-employment, other remuneration for services, royalties, tax refunds, annuities, pensions, prizes and awards, support payments, and alimony payments; (12) "income and resources" means income and resources of an individual and of the individual's spouse, including income and resources that the individual or spouse is entitled to but does not receive because of action (A) by the individual or spouse; (B) by a person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or spouse; or (C) by a person, including a court or administrative body, acting at the direction or upon the request of the individual or spouse; (13) "level I services" means services described in 7 AAC 74.010 (c)(1); (14) "level II services" means services described in 7 AAC 74.010 (c)(2); (15) "level III services" means services described in 7 AAC 74.010 (c)(3); (16) "rate" means the monthly charge for a designated level of service, or the daily charge for day services or respite services, as established in 7 AAC 74.025 ; (17) "recipient" means a person receiving day services or respite services; (18) "resident" means a resident of a pioneers' home; (19) "resources" means assets consisting of real and personal property; (20) "respite services" means services described in 7 AAC 74.010 (c)(7). (21) "behavior management" means non-pharmacological staffing assistance to structure the environment, increase safety, and decrease triggers of maladaptive behavior for a person who can no longer regulate their own behavior due to the dementia-disease process, but excludes complex behaviors; (22) "complex behaviors" means those behaviors exhibited by a resident of this state that is 60 years of age or older with a primary diagnosis of dementia and related disorders, with the level of severity described in this paragraph; the dementia must significantly affect the person's orientation to time and place, and the person's ability to start or finish activities of daily living; the person must have difficulty articulating their basic needs and must display behavior that includes neglect of self or harm to self or others that is not purposeful or planned, but is reactive to the environment and caused by the dementia disease process; (23) "level IV services" means services described in 7 AAC 74.010 (c)(4); (24) "level V services" means services described in 7 AAC 74.010 (c)(5); (25) "maximum community spouse monthly maintenance allowance" has the meaning given in 7 AAC 100.560 (a); (26) "nursing services" means nursing duties under 12 AAC 44.970 that require the exercise of professional nursing knowledge or judgment, or complex nursing skills that must not be delegated. (b) In AS 47.55.020 , "cost of the person's care," and in AS 47.55.030 , "cost of care and support," mean the cost of services provided to a pioneers' home resident or recipient. (c) In AS 47.55.095 , "undue hardship" means that, as determined by the department after considering other reasonable alternatives to obtain medical care, food, clothing, shelter, or other necessities of life, an individual would be deprived of (1) medical care such that the individual's health or life would be endangered; or (2) food, clothing, shelter, or other necessities of life. Chapter 75 Assisted Living Homes Article 1 Licensing of Assisted Living Homes 7 AAC 75.010. Applicability. (a) The requirements of this chapter apply to the licensure and operation of assisted living homes as follows: (1) an assisted living home licensed on or after April 6, 2002 is subject to all applicable requirements of this chapter; (2) an assisted living home licensed before April 6, 2002 is subject to all applicable requirements of this chapter, except that the home is exempt from (A) those training and experience requirements of 7 AAC 75.230 (c), that an administrator of a home on April 6, 2002 does not already meet; that administrator shall comply with the continuing education requirements of 7 AAC 75.220 (e); however, an administrator hired after April 6, 2002 is subject to all requirements of 7 AAC 75.230 in addition to all other requirements for administrators in this chapter; and (B) the requirements of 7 AAC 75.260 (a)(7), dealing with bedroom standards. (b) A home licensed under 7 AAC 50 or 7 AAC 57 is exempt from licensing under AS 47.33 and this chapter. 7 AAC 75.020. Types of license; duration; licensing responsibility. (a) There are two types of assisted living home licenses, as follows: (1) probationary, for homes (A) that have not previously been licensed under AS 47.33 and this chapter; or (B) for which a standard license has been converted to probationary status because of noncompliance with AS 47.33 or this chapter; (2) standard, for homes that have passed the probationary period. (b) Subject to the possibility of suspension or revocation under AS 47.33 and this chapter, a license is valid for the following periods: (1) probationary: a period set by the department, not to exceed two consecutive years, with a possible one-year extension; and (2) standard: two years, except as stated in 7 AAC 75.090 . (c) Repealed 4/6/2002. (d) A license will be issued to a home providing care (1) primarily to persons with a mental or developmental disability; (2) primarily to persons who have a physical disability, who are elderly, or who suffer from dementia, but who are not diagnosed as chronically mentally ill; and (3) to approximately equal numbers of persons described in both (1) and (2) of this subsection, or to a home seeking its probationary license and for which the administrator has not yet decided which specific category of persons to serve; in such a case the department will consider the purposes of AS 47.33 , the service features of the particular home, and, if any, the preference of the home, and decide whether to issue that home a license entitling the home to serve persons described in both (1) and (2) of this subsection. 7 AAC 75.030. Powers and duties of the department. (a) The department will (1) license assisted living homes in accordance with AS 47.33 and this chapter; (2) investigate license applicants, licensees, and homes that are required to be licensed for compliance with AS 47.33 and this chapter; (3) enforce the standards established by AS 47.33 and this chapter; and (4) inspect and investigate complaints of abandonment, abuse, exploitation, neglect, or self-neglect in assisted living homes. (b) The department may designate by a written agreement conforming to (c) of this section a state, municipal, or private agency to investigate and make recommendations to the department for the licensing of assisted living homes under procedures and standards of operation established by the department. (c) An agreement executed under (b) of this section must include (1) a description of the respective regulatory responsibilities of the department and the other agency; (2) procedures for processing variance requests; (3) procedures for record maintenance and sharing; and (4) procedures for appealing the investigative findings and recommendations made by the designated agency for and to the department. 7 AAC 75.040. Conversion of other licenses. Repealed. 7 AAC 75.050. Voluntary licensure. The department may, as time permits, issue a license to an assisted living home that serves one or two adult residents whether or not the residents are related to the owner by blood or marriage, and that is not required by AS 47.33.010 and 47.33.400 to be licensed, but that wishes to become licensed voluntarily. All provisions of this chapter apply to this type of licensure. 7 AAC 75.060. Probationary license. (a) The department will issue a probationary license to operate an assisted living home if the department finds that the application and the home's plan for operation comply with AS 47.33 and this chapter. In determining compliance with AS 47.33 and this chapter, the department will consider the nature, size, and character of the home and its residents, and whether the prevailing residential standards of the community and neighborhood in which the home is located are protective of life, health, and safety. (b) At any time before the expiration of a probationary license, but after the assisted living home is operating, the department may convert a probationary license to a standard license. 7 AAC 75.070. Standard license. (a) The department will issue a standard license to operate an assisted living home if, upon completion of the probationary period, and after inspection or investigation, the department finds that the home is operating in compliance with AS 47.33 and this chapter. (b) In determining compliance with AS 47.33 and this chapter, the department will consider the nature, size, and character of the home and its residents, and whether the prevailing residential standards of the community and neighborhood in which the home is located are protective of life, health, and safety. 7 AAC 75.080. Application for license; modification. (a) A person may not begin operation of an assisted living home until that person has obtained a probationary or standard license from the department. A person may not move the location or make a major modification of a licensed assisted living home, or increase the number of residents the home is licensed to serve until that person has obtained approval for a modification of its license from the department. An application under this section must be made on a form supplied by the department. A person may not apply for a license to operate one or more additional homes until each current home has passed the probationary period and been issued a standard license. For purposes of this subsection, "major modification" means a change to the home that, during construction of the modification, would adversely affect the residents, services to the residents, or emergency evacuation of the residents. (b) An application for a license to operate an assisted living home must be notarized and must contain (1) the name, title, address, telephone number, and, if available, electronic mail address and facsimile number of (A) the applicant; (B) each person who has an ownership interest in the home; (C) the chief executive officer of the unit or subunit of government, if the applicant is a government entity; (D) the owner of the premises in which the home will be located, if the applicant is not the owner of the premises; and (E) the administrator of the home; (2) the name of the assisted living home, if known by a name; (3) the address of the assisted living home or the proposed new location of the assisted living home; (4) evidence that the administrator meets the requirements of 7 AAC 75.215 , 7 AAC 75.220 , and 7 AAC 75.230 ; (5) repealed 4/6/2002; (6) the number of individuals within the maximum occupancy number established by the fire safety inspection required under 7 AAC 10.1010 that a home intends to serve; (7) the number of residents the home intends to serve who are expected to be persons who (A) have a primary diagnosis of mental illness or physical or developmental disability; or (B) are elderly or suffering from dementia, but who are not mentally ill; (8) the services the home proposes to offer; (9) copies of all permits and approvals required by state or local government agencies, other than the department, for construction or operation of the home; (10) any request for a general variance from a provision of AS 47.32 , 7 AAC 10.1000 - 7 AAC 10.1095 , or this chapter, as provided in 7 AAC 10.9500 - 7 AAC 10.9535 and 7 AAC 75.405 ; (11) a staff plan that describes the number of employees that will be employed by the home and each employee's responsibilities; the application must indicate that the home is prepared to modify the proposed staff plan to meet the terms of an individual residential services contract executed under AS 47.33.210 or an assisted living plan prepared under AS 47.33.220 and 47.33.230; (12) a disaster preparedness and emergency evacuation plan that complies with 7 AAC 10.1010 to protect the residents of the home from a disaster or other emergency; (13) a business plan, if applying to operate a home licensed for 11 or more residents or to operate multiple homes; the plan must include a description of the plan, services offered, the location of the business, a management and personnel plan, and projected detail of anticipated monthly expenses for six months; and (14) information concerning any denial of a prior application, voluntary termination of a license during an investigation, or termination of an administrator or care provider for cause. (c) An application to modify a license must contain the applicant's name, title, address, telephone number, and, if available, electronic mail address and facsimile number. The application must also describe the modification sought. If the modification is to increase the number of residents served to 11 or more, the application must also include the business plan described in (b)(13) of this section. 7 AAC 75.085. Inspection of financial records. Before the department will approve an application under 7 AAC 75.080 , the applicant must demonstrate that the home has sufficient financial resources to operate for a minimum of three months without considering resident income. If requested by the department, the home shall allow the department to inspect the home's financial records to determine whether the home has sufficient financial resources to meet the requirements of this section. 7 AAC 75.090. Renewal; staggered renewal; extension. (a) Before a license expires, the department will notify the licensee that the license is due for renewal. (b) The department may inspect an assisted living home at any time before a license expires, to determine compliance with AS 47.33 and this chapter and eligibility for renewal. (c) If the department finds that the home is not in compliance with AS 47.33 or this chapter, the home, in coordination with the department, shall develop a plan of correction with a date for achieving compliance with each provision found to be in noncompliance. If the home is in substantial compliance by each applicable date set out in the plan of correction, the department will issue a probationary license. If the home is in compliance, the department will issue a standard license. (d) If the department finds that the home is in compliance with AS 47.33 and this chapter, has provided services to residents in accordance with its contracts and plans of care, has maintained the home in good repair, and is in compliance with all applicable local and state building code, fire code, and sanitation code requirements, the department will renew the home's standard license for two years. (e) If several licensees apply for renewal within a short time, the department may stagger the license renewal dates to facilitate handling the renewals. The department may adjust renewal dates to facilitate the licensing of each assisted living home located in the same geographic area at the same time. The department will not extend or adjust a renewal date for an assisted living home that, during the licensing period, has had more than one complaint filed against it for which the department (1) and the home have developed a plan of correction; or (2) has issued a notice of violation. (f) Repealed 4/6/2002. (g) Repealed 4/6/2002. (h) Repealed 4/6/2002. (i) The department will promptly notify the licensee in writing of any rescheduled renewal date. 7 AAC 75.100. Fees. (a) An application for a license, or renewal of a license, must be accompanied by the appropriate fee, as follows: (1) voluntary license........................................................$ 25 (2) probationary or standard license for homes with capacity to serve three to five residents.................................................. 75 (3) probationary or standard license for homes with capacity to serve six or more residents...................................................150. (b) In addition to the base license application fee, set out in (a) of this section, an application under (a)(2) of this section must be accompanied by a fee of $25 for each resident accommodation beyond three that the home seeks licensure to provide, and an application under (a)(3) of this section must be accompanied by a fee of $25 for each resident accommodation beyond six that the home seeks licensure to provide. (c) An assisted living home that applies for a license modification to move its location or make some other major modification, or to expand its capacity to serve additional residents, at any time other than at the time of license renewal, shall (1) in the case of a modification not involving additional resident capacity, pay a fee of $25; (2) in the case of a modification seeking only to add to the home's resident capacity, pay $25 for each additional resident accommodation, regardless of the amount of time left in the current license period; (3) in the case of a home seeking modifications described in both (1) and (2) of this subsection, pay the fees stated in both (1) and (2). (d) After the first two onsite visits following an inspection that reveals noncompliance with AS 47.33 or this chapter, the licensee shall pay a fee of $150 for each additional onsite visit by the department that results from failure of the licensee to achieve and maintain compliance within a reasonable time set by the department. (e) Fees due under this section are nonrefundable. 7 AAC 75.110. Content of license; posting. (a) A license to operate an assisted living home will state (1) whether it is a probationary or standard license; (2) the effective date of the license; (3) the name of the licensee; (4) the location and mailing address of the home to which the license applies; (5) the number of residents the home is licensed to serve; (6) the expiration date of the license; (7) the special conditions, waivers, or variances that have been approved by the department; and (8) the department's address and phone number. (b) An assisted living home shall post the license in the home or otherwise make it readily accessible to residents, prospective residents, or resident representatives, service providers, staff, and the public. 7 AAC 75.120. Denial of license. (a) If the department denies an application for a license, or a license renewal, the department will deliver to the applicant by hand or certified mail a notice of denial containing a summary of the reasons for denial of the application. (b) If an application is denied, the applicant may reapply or may contest the denial under AS 47.32 . (c) Deleted 7/1/2022. 7 AAC 75.130. License not transferable. Unless modified under 7 AAC 75.080 , a license issued under this chapter is limited to the location, individuals, and organizations named in the application and may not be transferred to a different location, individual, or organization. 7 AAC 75.140. Access and inspection. (a) An applicant for a license and a licensee shall permit representatives of the department to inspect a home when necessary to implement AS 47.32 , AS 47.33 , and this chapter. (b) If an applicant for a license refuses to permit an inspection, the department may take action under AS 47.32.110 . (c) A licensee that refuses to allow access and inspection is in violation of AS 47.32 and AS 47.33 . The department may take action under AS 47.32.110 . (d) If the department has reason to believe that a home is operating as an assisted living home and has not applied for a license or refuses to permit an inspection, the department may take action under AS 47.32.110 . Article 2 Operation of Assisted Living Homes 7 AAC 75.210. Organization; administration; staff. (a) An assisted living home shall (1) provide the department with (A) the name, address, telephone number, and, if available, electronic mail address and facsimile transmission number of the individual or entity ultimately responsible for operation of the home or proposed home; and (B) if the home is operated by an association, corporation, or other entity, the name, address, telephone number, and, if available, electronic mail address and facsimile transmission number of each member of its board or governing body and the executive director of the board or governing body; the home may provide information under this subparagraph with its application for a license, and annually thereafter; (2) appoint an administrator who meets the requirements of 7 AAC 75.230 and an administrator designee to act on the administrator's behalf for any period during which the administrator is on vacation, is ill, or is otherwise unable to perform regular duties for 24 hours or more; if the administrator designee will be required to manage the daily operation of the home for (A) less than 90 consecutive days, the designee must meet the requirements of 7 AAC 75.215 and 7 AAC 75.220 ; the administrator designee must be available and must receive proper orientation to manage the daily operation of the home in the administrator's absence; or (B) 90 consecutive days or longer, the designee must have the same qualifications as an administrator under 7 AAC 75.230 ; (3) adopt written personnel practices and, at the time of employment, inform each employee of the individual to whom the employee is responsible, the organization of the home and physical plant layout, the employee's duties and responsibilities, including those to be carried out in emergencies, and the policies, procedures, and equipment relevant to those duties and responsibilities; (4) provide the department with a current master list, updated as necessary, that includes the name, address, and telephone number of each resident and the name, address, telephone number, and, if available, electronic mail address and facsimile transmission number of each resident's representative; a home that serves three or more residents shall maintain a current copy of the master list in at least one place that can be easily accessed if the home must be evacuated; (5) ensure that recordkeeping complies with AS 47.33.070 and uses forms prescribed or approved by the department for the preparation and protection of resident records; and (6) establish policies and procedures for the completion of residential services contracts and involuntary termination of those contracts in compliance with AS 47.33.210 and 47.33.360, respectively; (7) repealed 6/24/2004; (8) repealed 6/24/2004. (b) The governing body of a home operated by an association, corporation, or other entity shall (1) determine policy and provide for implementation of that policy by an administrator; (2) select an administrator and evaluate the administrator's performance; and (3) maintain minutes of meetings, relevant portions of which must be made available to the department to enable the department to carry out its responsibilities under AS 47.33 and this chapter. (c) An assisted living home shall employ the type and number of care providers and other employees necessary to operate the home in compliance with AS 47.33 and this chapter. The home must have a sufficient number of care providers and other employees with adequate training to implement the home's general staffing plan and to meet the specific needs of residents as defined in the residents' residential services contracts and assisted living plans. (d) Subject to (e) of this section, an assisted living home shall (1) have on duty a care provider or another employee with documented proof of (A) cardiopulmonary resuscitation (CPR) training provided within the previous two years by an instructor certified as required in 7 AAC 26.985 ; the training must be provided through the (i) American Red Cross; (ii) American Heart Association's CPR for Family and Friends Training Program or a more advanced program offered by the American Heart Association; or (iii) an organization equivalent to those listed in (i) - (ii) of this subparagraph, as determined by the department; and (B) first aid training provided within the previous three years by an instructor certified by the American Red Cross, the American Heart Association, or an equivalent organization as determined by the department; and (2) have the means and materials available to enable the home to implement the home's disaster preparedness and emergency evacuation plan required by 7 AAC 10.1010 . (e) If the training required by (d)(1) of this section is not regularly available within 100 miles of where the home is located, the administrator shall ensure that care providers and other employees obtain this training not less than every three years. 7 AAC 75.215. Barrier crimes and conditions; background checks. An assisted living home is subject to the applicable requirements of AS 47.05.300 - 47.05.390 and 7 AAC 10.900 - 7 AAC 10.990 (barrier crimes and conditions; background checks). 7 AAC 75.220. General requirements. (a) An assisted living home shall provide safeguards to ensure that persons entering or living in the home, including employees, volunteers, contractors, and visitors do not abuse, neglect, or exploit a resident of the home. An assisted living home shall (1) develop and implement written policies and procedures that prohibit the abuse, neglect, exploitation, and mistreatment of residents; (2) report alleged or suspected abuse to a local, municipal, or state law enforcement agency; (3) take any necessary action to remove the potential for further abuse, neglect, exploitation, or mistreatment of a resident or further misappropriation of a resident's property; (4) document alleged or suspected incidents of abuse, neglect, exploitation, or mistreatment by an employee, a volunteer, a contractor, a visitor, or another resident; (5) investigate alleged or suspected incidents of abuse, neglect, exploitation, or mistreatment by an employee, a volunteer, a contractor, a visitor, or another resident; (6) document the result of the investigation and the corrective action taken; and (7) submit the documentation prepared under this subsection to the department as required in AS 47.32.200 (c). (b) A person seeking to be associated with an assisted living home in a manner described in 7 AAC 10.900 (b) shall provide (1) the names, addresses, and telephone numbers of at least three character references who are unrelated to the person seeking association with the assisted living home; (2) at least two employment references; an employment reference may also serve as a character reference required under (1) of this subsection; and (3) the signed release of information authorization and other items required to request a criminal history check under 7 AAC 10.910 . (c) A person who will be in direct contact with residents in an assisted living home shall provide evidence to the administrator that the person is free from active pulmonary tuberculosis before contact with a resident. This evidence must be provided annually and must be placed in the person's file for review by the department. (d) Before hiring, the administrator shall ensure that each person who will be in direct, unsupervised contact with residents in an assisted living home has sufficient language skills to meet the needs of the residents of the home and the ability to access emergency services, including giving clear directions to emergency personnel of the home's location and describing the nature of the emergency in the primary language of the community. The administrator shall assess language skill level for employees, contractors, and volunteers. The department will assess the language skill level of the administrator. (e) Each administrator, each administrator designee who will serve in that capacity for 90 consecutive days or longer, and each care provider who is an employee of an assisted living home shall participate in continuing education that is relevant to that person's primary job responsibilities and the ongoing care of residents. If courses for continuing education are not available within 100 miles of where the home is located or through correspondence or distance learning, the administrator shall ensure that the continuing education is obtained not less than every 18 months. Training requirements are as follows: (1) each administrator shall complete 18 clock hours of continuing education annually; (2) each care provider shall complete 12 clock hours of continuing education annually; (3) a home may count in-service training as continuing education if that training increases the knowledge, abilities, or skills of care providers and is approved by the department; (4) continuing education, whether in-service training or received from a state agency, a seminar, or a university, must be documented and placed in the employee's personnel file for review and approval by the department. An assisted living home is subject to the reporting requirements of AS 47.24.010 . (f) An assisted living home is subject to the reporting requirements of AS 47.24.010 . 7 AAC 75.230. Administrator. (a) An assisted living home shall have on staff an administrator who is at least 21 years of age and meets the requirements of 7 AAC 75.215 , 7 AAC 75.220 , and this section. (b) If the administrator does not manage the daily operation of the home, the administrator, or the governing body of a larger organization responsible for the home, shall appoint a resident manager who meets the requirements for an administrator under this chapter. (c) In addition to the other requirements of this chapter, an individual may not serve as an administrator of an assisted living home unless the individual meets the training and experience requirements of this subsection. The department will accept a baccalaureate or higher degree in gerontology, health administration, or another health-related field in place of all or part of the required experience, if the degree work serves, to the department's satisfaction, as an equivalent to the required experience. Training and experience requirements are as follows: (1) for a home licensed to serve 1 - 10 residents, the individual must fulfill at least one of the following requirements: (A) the individual must complete an approved management or administrator training course and have at least one year of documented experience, relevant to the population of residents to be served, as a care provider, if the administrator will be providing direct care in the home; (B) the individual must (i) complete a certified nurse aide training program that the Board of Nursing has approved under 12 AAC 44.830 , or that is equivalent in content to the requirements of 12 AAC 44.835 (c); and (ii) have at least one year of documented experience, relevant to the population of residents to be served, as a care provider; (C) the individual must have at least two years of documented experience, relevant to the population of residents to be served, as a care provider, with documented skills or training relevant to the population of residents to be served; (D) the individual must have sufficient documented experience in an out-of-home care facility, and sufficient training, education, or other similar experience to fulfill the duties of an administrator of the type and size of home where the individual is to be employed and to meet the needs of the population of residents to be served; an administrator under this subparagraph is subject to department approval on a case-by-case basis; for purposes of this subparagraph, an out-of-home care facility includes a foster care home, a board and care home, and a nursing home; (2) for a home licensed to serve 11 or more residents, or if operating multiple homes with a total capacity of 11 or more residents, the administrator must fulfill at least one of the following requirements: (A) the individual must complete an approved management or administrator training course and have at least two years of documented experience, relevant to the population of residents to be served, as a care provider, if the administrator will be providing direct care in the home; (B) the individual must (i) complete a certified nurse aide training program that the Board of Nursing has approved under 12 AAC 44.830 , or that is equivalent in content to the requirements of 12 AAC 44.835 (c); and (ii) have at least two years of documented experience, relevant to the population of residents to be served, as a care provider; (C) the individual must have at least five years of documented experience, relevant to the population of residents to be served, as an administrator or staff supervisor of a home serving 10 or fewer residents; (D) the individual must submit proof that the individual is a licensed practical nurse or a registered nurse with documented experience relevant to the population of residents to be served. 7 AAC 75.240. Care provider. (a) An individual may not be hired or retained as a care provider in an assisted living home subject to AS 47.32 , AS 47.33 , and this chapter unless the person meets the requirements of 7 AAC 75.215 and 7 AAC 75.220 and is at least (1) 21 years of age if the individual will serve as a supervisor of other care providers; (2) 18 years of age if the individual will serve as a care provider working without direct supervision; or (3) 16 years of age if the individual will serve only as a care provider and has access to assistance from the administrator or another care provider who is at least 21 years of age. (b) An administrator shall ensure and document that each care provider, within the first 14 days of employment, is oriented to the assisted living home's policies and procedures, including emergency procedures, fire safety, resident rights, prohibition against abuse, neglect, exploitation, and mistreatment of residents, recognition of abuse, neglect, exploitation, and mistreatment of residents, reporting requirements under AS 47.24.010 , universal precautions for infection control, biohazards, applicable state regulations and statutes, resident interaction, any house rules established under AS 47.33.060 , sanitation, duties and responsibilities, medication management and security, and physical plant layout. Before caring for a resident without direct supervision, a care provider shall receive the orientation required in this subsection and, unless the care provider has sufficient documented experience working with the population of residents to be served, shall work under the direct supervision of the administrator or an experienced care provider who is at least 21 years of age for not less than three complete work days. Direct supervision must be documented in the personnel file of the supervised care provider. (c) For purposes of this section, "direct supervision" means that the administrator, or a care provider who is at least 21 years of age and has received the training required under this chapter, is present in the same building as the individual being supervised and available for consultation or assistance. 7 AAC 75.250. Advertising. (a) An assisted living home may not advertise that it is a "nursing home" or that it provides "nursing care," unless it holds a license under AS 18.20.020 - 18.20.130. (b) A home may advertise that it provides housing, food service, personal assistance, assistance with the activities of daily living, or health-related services, as described in AS 47.33.010 and 47.33.020, including intermittent nursing care or short-term skilled nursing care. 7 AAC 75.260. General environmental requirements. (a) A home shall ensure that each resident has (1) room furniture that is typical for residents of homes in the community and neighborhood in which the assisted living home is located; the furniture may be provided by the resident; (2) storage space for clothing and personal possessions; (3) adequate linen, soap, and personal hygiene facilities necessary for cleanliness; (4) a signal device, as provided for in the assisted living plan of a resident who must use a device when verbal communication is not possible; (5) reasonable privacy when sharing a room; and (6) appropriate storage and work areas adjacent to the area of use to accommodate the following functions, if conducted on the premises: (A) food preparation and serving; and (B) laundry; (7) a bedroom that meets the following standards, subject to 7 AAC 75.070 (b): (A) if the bedroom is for single occupancy, it must contain at least 80 square feet of open floor space, measured before furniture is placed in the room; (B) if the bedroom is for double occupancy, it must contain at least 140 square feet of open floor space, measured before furniture is placed in the room; (C) no more than two residents may be assigned to a bedroom. (b) A home must occupy a building that is used exclusively for assisted living, except that a home may be licensed in a building that has more than one occupancy if (1) the other occupancy is consistent with the health, safety, comfort, and well-being of the residents of the assisted living home; and (2) the other users of the building comply with applicable state and municipal building and fire codes and environmental health codes. 7 AAC 75.265. Food service. (a) An assisted living home shall offer three balanced, nutritious meals and at least one snack daily at consistent times. A home shall ensure that the meals and snacks offered include the recommended number of servings of each food type set out in the United States Department of Agriculture publication, The Food Guide Pyramid, as revised as of October 1996 and adopted by reference. The home shall offer a wide variety of food that includes fresh fruits and vegetables as often as possible. (b) The home shall consider each resident's health-related or religious restrictions, cultural or ethnic preferences in food preparation, and preference for smaller portions, as reflected in the resident's residential services contract executed under AS 47.33.210 and assisted living plan prepared under AS 47.33.220 and 47.33.230. The home shall also consider a resident's decision, from time to time, to be served smaller portions even if that issue is not addressed in the contract or plan. (c) An assisted living home shall keep a written record of each day's menu, document whether the meals served were as described in those menus, and keep the documented menus on file for at least one year for review by the department. 7 AAC 75.270. Life and fire safety. An assisted living home must meet the applicable life and fire safety requirements of 7 AAC 10.1010 . 7 AAC 75.280. Sanitation and environmental protection. An assisted living home must satisfy applicable standards for sanitation and environmental protection, including the applicable standards of 7 AAC 10.1000 - 7 AAC 10.1095 . An assisted living home shall allow inspection by the department as required by AS 47.32.100 and 7 AAC 10.9600 - 7 AAC 10.9620 , and by any municipal authority responsible for ensuring that the home meets applicable municipal sanitation and environmental protection requirements. The home shall maintain a copy of each inspection report for at least two years and make any report from a municipal authority available for department review. The department may request an inspection by the municipal authority on the home's behalf. The home is responsible for any fee charged. 7 AAC 75.290. Emergency situations. (a) If a resident experiences a medical emergency, serious injury, or accident, is involved in assaultive behavior that could injure the resident or another person or that requires police intervention, or is absent without prior notice to the home and could pose a risk of harm to the resident or others, the assisted living home shall (1) access emergency services, if needed, and provide the emergency care that a reasonably prudent person would provide under the circumstances, including notice to the resident's physician and representative; and (2) record the date, time, and circumstances of the accident, serious injury, medical emergency, or incident in the resident's file and in any general daily log kept by the home, and provide a copy of the report to the department as required under 7 AAC 75.340 . (b) An assisted living home shall maintain readily-available first aid supplies appropriate to its size, and post or make readily available the first aid procedures. 7 AAC 75.295. Use of intervention and physical restraint. (a) An assisted living home must have a written procedure regarding the use of physical restraint. That procedure must be approved by the department under AS 47.33.330 . (b) As provided in AS 47.33.330 (a)(4), an assisted living home may use physical restraint if a resident's actions present an imminent danger to the resident or others, but only after other interventions, including the use of a time out, have failed. A time out or physical restraint may not be used as a punishment, as a substitute for a less restrictive form of intervention, or as a convenience for the home's staff. A time out or physical restraint must be terminated as soon as the resident no longer presents an imminent danger to that resident or others. (c) At the time of a resident's admission to the home, the home shall (1) explain its approved physical restraint procedures to the resident or resident's representative; (2) perform an assessment, at the time of admission, regarding the potential need for the use of time outs or physical restraint asking for information (A) about the resident's prior behavior that might indicate a need for the use of time outs or physical restraint; and (B) that might help minimize use of time outs or physical restraint; (3) address the need for using time outs or physical restraint in the resident's assisted living plan if the home has reason to believe that time outs or physical restraint may be necessary because the resident's prior behavior or medical condition indicates that the resident may occasionally present an imminent danger to the resident or others; the plan must include information regarding (A) when time outs or physical restraint should be used; (B) what forms of physical restraint should be used, based on recommendations from the resident's primary physician; and (C) any prenotification procedures requested by the resident's representative in addition to the 24-hour notice required by (d)(1) of this section or the five-day written report required under (d)(2) of this section. (d) If physical restraint is used, the assisted living home shall (1) notify the resident's representative (A) before physical restraint is used, if prenotification is made a part of the resident's assisted living plan under (c)(3)(C) of this section; and (B) within 24 hours, unless the representative has agreed, as reflected in the resident's assisted living plan, that notification under (2) of this subsection is sufficient; and (2) document any use of physical restraint in the written report required under 7 AAC 75.340 (a)(4) that includes (A) the resident's name; (B) a description of the incident that led to the decision to use physical restraint; (C) a brief description of any other form of intervention used or attempted before the use of physical restraint; (D) the type of physical restraint used; (E) the time when physical restraint began; and (F) the time when physical restraint ended. (e) For purposes of this section, a time out is the restriction of a resident, with that resident's consent, to a quiet area or unlocked quiet room for a period not to exceed 30 minutes. A home may not require a resident to take a time out without that resident's consent, and may not use a time out that exceeds 30 minutes, with or without that resident's consent. (f) For purposes of this section, physical restraint is a manual method that restricts body movement, or a physical or mechanical device, material, or piece of equipment that is attached or adjacent to the resident's body, that prevents the resident from easily removing it, and that restricts movement or normal access to the body. The use of the following safety equipment will not be considered physical restraint, if authorized in writing by the resident's primary physician, and if the necessity for its use is set out in the resident's assisted living plan: (1) self-release safety belts; (2) lap-top trays; (3) wedge chair cushions; (4) concave mattresses; and (5) bedside rails if used for a resident who (A) lacks independent mobility but has involuntary movement, including a seizure disorder, that could cause the resident to fall from bed; or (B) needs the rails to assist in mobility. 7 AAC 75.300. Assisted living plan. (a) Preparation of an assisted living plan in accordance with AS 47.33.220 , 47.33.230, and this chapter shall include a review of any other existing plan of care that may already be in place for the resident. A plan of care already in place for a resident may substitute for the assisted living plan required by AS 47.33.220 and 47.33.230 if the existing plan incorporates substantially the same provisions and addresses the same requirements as would an assisted living plan. (b) When an existing plan of care cannot be substituted for an assisted living plan, the assisted living plan required by AS 47.33.220 and 47.33.230 must, insofar as possible, incorporate the provisions of the plan of care already in place for the resident. (c) Evaluation of assisted living plans for residents will take into account the timelines established for evaluation of existing plans of care, and will, insofar as possible, set similar evaluation timelines to avoid duplicative evaluation efforts. (d) Copies of existing plans of care for a resident shall be placed in the assisted living file, along with the assisted living plan.