reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 8 - Intermediate Care Facility for the Mentally Retarded Services › 7 AAC 140.610 - Records, habilitative plan of care, treatment, and reevaluation

Current through May 31, 2024
(a) An ICF/MR shall
				  maintain a clinical record of services provided to a recipient. The clinical
				  record must include the evaluation required in
				  7 AAC 140.600(b) (1). The clinical
				  record must also include a written, individualized habilitative plan of care
				  that includes
(1) information identifying the
				  recipient;
(2) a list of the
				  members of the interdisciplinary team organized under
				  7 AAC 140.605;
(3) a prioritized summary of the presenting
				  problems and needs as identified during the evaluation;
(4) a description of the functional level of
				  the recipient;
(5) diagnoses,
				  symptoms, complaints, and complications indicating the need for admission or
				  continued stay;
(6) clearly stated
				  measurable goals or behaviorally stated objectives derived from the evaluation
				  and designed to attain or maintain the optimal physical, intellectual, social,
				  or vocational functioning of which the recipient is presently or potentially
				  capable;
(7) orders, as
				  appropriate, for services that are individually designed to accomplish the
				  stated goals and objectives, including medications, treatment, habilitation
				  services, nutrition services, social services, therapies, experiences,
				  activities, and any special procedures; in this paragraph, "habilitation
				  services" has the meaning given in
				  7 AAC 130.319;
(8) reasons why alternative placement is not
				  feasible or appropriate;
(9) a plan
				  for discharge and for care following discharge to assure the maximum
				  development of self-help and living skills; that plan must include provision
				  for appropriate services, protective supervision, and other follow-up services
				  in the recipient's new environment;
(10) documentation that the recipient or the
				  recipient's representative actively participated in the development of the
				  habilitative plan of care, or if active involvement is not possible, a
				  statement of the reasons for the lack of participation; and
(11) signatures of the following individuals,
				  indicating review and approval:
(A) the
				  recipient or the recipient's representative, unless the recipient or the
				  recipient's representative is not willing or able to participate as described
				  in (10) of this subsection;
(B) at
				  least one physician or qualified mental retardation professional;
(C) those participating members of the
				  interdisciplinary team organized under
				  7 AAC 140.605 who have reviewed and approved the
				  plan.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 8 - Intermediate Care Facility for the Mentally Retarded Services › 7 AAC 140.615 - Required all-inclusive services

Current through May 31, 2024
(a) If a recipient
				  needs non-emergency, continuous heavy use of oxygen, the ICF/MR shall make it
				  available for use at all times. The facility shall submit a request for
				  authorization, on a form provided by the department, shall provide on that form
				  a detailed description of the recipient's need for continuous heavy use of
				  oxygen, and shall include physician orders or physician or nursing notes.
				  Payment will be made to the ICF/MR at the facility's cost for the oxygen. The
				  amount of oxygen given to the recipient must be accurately metered and
				  measurable to the recipient. In the billing, the ICF/MR shall note the metered
				  amount of oxygen and dates used.
(b) An ICF/MR is responsible for
				  transportation planning. To determine the appropriate type of carrier, the
				  facility shall consider the recipient's condition, distance to the medical
				  facility or provider of service, and the frequency of the trip. The least
				  expensive mode of transportation must be used consistent with these
				  conditions.
(c) Nonemergency,
				  in-state transportation must be given prior authorization by the department.
				  Emergency transportation must be reported to the department as soon as possible
				  but not later than three working days after the transportation
				  occurred.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 8 - Intermediate Care Facility for the Mentally Retarded Services › 7 AAC 140.620 - Absence from an ICF/IID

Current through May 31, 2024
(a) Except as
				  provided in (b) of this section, the department will pay for reserving a bed
				  during a planned temporary absence of a recipient from an ICF/MR if
(1) the absence is not more than 12
				  consecutive days;
(2) the time of
				  departure and return of the recipient are recorded in the facility's records;
				  and
(3) the absence is for a visit
				  with relatives or friends.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 8 - Intermediate Care Facility for the Mentally Retarded Services › 7 AAC 140.625 - Transfer of recipients

Current through May 31, 2024
(a) Transfer to
				  another ICF/MR may not occur without 30 days' prior written notice to the
				  recipient and, if appropriate, the family or guardian, and to either the
				  department or the facility, depending on whether the department or the facility
				  is proposing the transfer. Recipients who receive notice of a proposed transfer
				  have the hearing rights set out in 7 AAC 49.
(b) The department may withhold payment to an
				  ICF/MR if the facility fails to comply with this section.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 8 - Intermediate Care Facility for the Mentally Retarded Services › 7 AAC 140.630 - Discharge of recipients

Current through May 31, 2024
(a) If the
				  interdisciplinary team assigned under
				  7 AAC 140.605 or the department recommends that a
				  recipient does not, or in the future will not, require continued placement in
				  an ICF/MR, the recipient and, where appropriate, the family or guardian, and
				  either the department or the facility, depending on whether the department or
				  the facility is proposing the discharge, must be given 30 days' written notice
				  before discharge. Recipients who receive notice of a proposed discharge have
				  the hearing rights set out in 7 AAC 49.
(b) The department may withhold payment to an
				  ICF/MR if the facility fails to comply with this section.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 8 - Intermediate Care Facility for the Mentally Retarded Services › 7 AAC 140.635 - Applicability of other sections

Current through May 31, 2024
The provisions of
					 7 AAC 140.550 -
					 7 AAC 140.575 also apply to and ICF/MR except where they
					 conflict with specific provisions of
					 7 AAC 140.600 -
					 7 AAC 140.640.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 8 - Intermediate Care Facility for the Mentally Retarded Services › 7 AAC 140.640 - Qualified intellectual disability professional

Current through May 31, 2024
To be considered a qualified mental retardation
					 professional for purposes of
					 7 AAC 140.600 -
					 7 AAC 140.640, an individual must meet the standard for
					 a qualified mental retardation professional set out in
					 42 C.F.R.
					 483.430(a), adopted by
					 reference in
					 7 AAC 160.900.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 9 - Facilities Providing Services for End-Stage Renal Disease › 7 AAC 140.700 - End-stage renal disease facility enrollment requirements

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for outpatient end-stage renal disease
				  services, a provider must
(1) be enrolled as
				  an end-stage renal disease services facility in accordance with
				  7 AAC 105.210;
(2) meet the requirements of 42 C.F.R. Part
				  494 (conditions for coverage for end-stage renal disease facilities), adopted
				  by reference in
				  7 AAC 160.900; and
(3) be enrolled as a Medicare
				  provider.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 9 - Facilities Providing Services for End-Stage Renal Disease › 7 AAC 140.710 - End-stage renal disease facility services

Current through May 31, 2024
The department will pay a facility that meets the
					 requirements of
					 7 AAC 140.700 for services that are furnished in an
					 end-stage renal disease facility, and that are covered under
					 42 C.F.R.
					 410.50 and
					 410.52, adopted by reference in
					 7 AAC 160.900. The department will pay a provider for
					 services under this section in accordance with the payment conditions
					 established under
					 7 AAC 140.720 and the rate established in
					 7 AAC 145.607.
Authority:
AS
						47.05.010
AS 47.07.030
AS 47.07.040
AS
						47.07.070
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 9 - Facilities Providing Services for End-Stage Renal Disease › 7 AAC 140.720 - End-stage renal disease payment conditions

Current through May 31, 2024
(a) The department
				  will pay an end-stage renal disease facility under
				  7 AAC 145.607 for the recipient's first day of treatment
				  through the last day of the third month of treatment.
(b) The department will continue to pay a
				  facility for outpatient end-stage renal disease services beginning the fourth
				  month of treatment only if
(1) the recipient
(A) is enrolled in Medicare Part B;
				  or
(B) has been determined
				  ineligible for Medicare Part B, and the ineligibility is not related to failure
				  to comply with any part of the Medicare enrollment process; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 10 - Free-Standing Birth Centers › 7 AAC 140.800 - Free-standing birth center enrollment requirements

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for free-standing birth center
				  services, a facility
(1) must be enrolled as
				  a free-standing birth center under
				  7 AAC 105.210;
(2) must be licensed under AS 47.32;
(3) may not be enrolled under
				  7 AAC 105.210 as another type of provider; and
(4) must be located in this state.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 10 - Free-Standing Birth Centers › 7 AAC 140.810 - Free-standing birth center services and payment conditions

Current through May 31, 2024
(a) The department
				  will pay for the use of a free-standing birth center under this section in
				  accordance with the payment rate established in
				  7 AAC 145.680.
(b) The department will pay for the use of a
				  free-standing birth center under
				  7 AAC 145.680 only when a delivery occurs at the
				  facility. The department will not pay for labor-only services.
(c) Newborn care is considered a component of
				  labor and delivery services provided by a free-standing birth center and may
				  not be billed separately.
(d) For
				  purposes of billing for free-standing birth center services, the date of
				  service is the date of delivery.
(e) Nurse midwife and direct-entry midwife
				  services provided in a free-standing birth center are not payable to the center
				  and must be billed separately.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.070
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 1 - Medicaid Payment; Conditions and Methods › 7 AAC 145.005 - Conditions for payment

Current through May 31, 2024
(a) The department
				  will pay a provider for a covered service identified in AS 47.07 and 7 AAC 105
				  - 7 AAC 160 only if the
(1) claim is
				  submitted by a provider who is enrolled with the department under 7 AAC 105 - 7
				  AAC 160;
(2) services were rendered
				  to an individual who was eligible under 7 AAC 100 at the time the service was
				  rendered; and
(3) the department
				  gave prior authorization for the service if required under 7 AAC 105 - 7 AAC
				  160.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 1 - Medicaid Payment; Conditions and Methods › 7 AAC 145.010 - Prohibition against reassignment

Current through May 31, 2024
(a) The department
				  will not make payment on a claim known by a provider to be covered by Medicaid
				  if the claim has been assigned, sold, or transferred, including transfers
				  through the use of power of attorney, to a collection agency, service bureau,
				  or individual who advances money to a provider for the provider's accounts
				  receivable.
(b) The use of a
				  billing agent or accounting firm that bills and receives payment in the name of
				  the provider is permitted if payment for this service is not related on a
				  percentage or other basis to the amount to be billed or collected.
Authority:
AS
						47.05.010
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 1 - Medicaid Payment; Conditions and Methods › 7 AAC 145.012 - Cost containment measure for inflation adjustments to Medicaid payment rates

Current through May 31, 2024
(a) To address that
				  appropriations for fiscal year 2020 are insufficient to cover the costs of
				  medical assistance for all persons eligible under AS 47.07 and 7 AAC 100, the
				  department will implement cost containment measures that prohibit the following
				  adjustments to Medicaid payment rates for Medicaid claims with dates of
				  services after June 30, 2019 and before July 1, 2020:
(1) inflation adjustments required under
				  7 AAC 145.050(b)(3), except as noted in
				  7 AAC 145.050(c)-(e);
(2) inflation adjustments required under
				  7 AAC 145.265(b)(9);
(3) inflation adjustments required under
				  7 AAC 145.525;
(4) repealed 7/1/2019;
(5) inflation adjustments required under
				  7 AAC 150.150, except as noted in
				  7 AAC 150.150(h);
(6) inflation adjustments required under
				  7 AAC 150.160(j) as that subsection
				  relates to 7 AAC 150.150; and
(7) inflation adjustments required under
				  7 AAC 150.190(g) in accordance with
				  7 AAC 150.190(d)(2)(B), except as noted
				  in 7 AAC 150.190(g)(1).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 1 - Medicaid Payment; Conditions and Methods › 7 AAC 145.015 - Payment reduced by cost-sharing

Current through May 31, 2024
Payment provided by the department will be reduced by the
					 amount of cost-sharing required under
					 7 AAC 105.610, and represents full payment from the
					 department for those covered services authorized under Medicaid. A recipient
					 may be charged only for the amount of cost-sharing specified in
					 7 AAC 105.610 and may not be charged for any additional
					 difference between the amount billed and the amount received in payment from
					 the department for those covered services provided. A recipient is responsible
					 for payment of the cost-sharing amounts required under
					 7 AAC 105.610 and for payment of all services not
					 covered under Medicaid.
Authority:
AS
						47.05.010
AS 47.07.040
AS
						47.07.042
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 1 - Medicaid Payment; Conditions and Methods › 7 AAC 145.020 - Methodology used to establish provider payment rates

Current through May 31, 2024
(a) Regardless of
				  the payment methodology or payment rate adopted under 7 AAC 105 - 7 AAC 160,
				  and except as provided in
				  7 AAC 155.010 with regard to tribal health programs, the
				  department will pay a provider for a covered service at the lowest of the
(1) specific payment rate established in 7
				  AAC 105 - 7 AAC 160;
(2) provider's
				  billed charges; or
(3) provider's
				  lowest charge that is advertised, quoted, posted, billed, or discounted for any
				  other purchaser of services for that unit of service and provided on the same
				  date, determined in accordance with (b) of this section.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 1 - Medicaid Payment; Conditions and Methods › 7 AAC 145.025 - Payment for services provided out of state

Current through May 31, 2024
(a) Unless
				  otherwise provided in 7 AAC 105 - 7 AAC 160, the department will pay an
				  out-of-state enrolled provider at the lowest of
(1) the billed charges;
(2) 70 percent of the in-state rate
				  identified in 7 AAC 105 - 7 AAC 160 for the specific type of provider;
				  or
(3) the rate established by the
				  Medicaid agency in the jurisdiction where the service was provided, if the rate
				  information is available.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 2 - RBRVS Methodology › 7 AAC 145.050 - Resource-based relative value scale rate-setting methodology

Current through May 31, 2024
(a) Except as
				  otherwise provided in 7 AAC 105 - 7 AAC 160 for certain types of providers or
				  services, the department will establish fees for use in payment for each type
				  of provider and service subject to 7 AAC 105 - 7 AAC 160 using the
				  resource-based relative value scale (RBRVS) methodology described in this
				  section.
(b) The RBRVS methodology
				  set out in this section applies to procedures that have a Medicare nonfacility
				  individual relative value unit (RVU) established for Medicare by CMS. Medicare
				  nonfacility individual RVUs are adopted by reference in
				  7 AAC 160.900. The RBRVS payment for these procedures
				  consists of
(1) an RVU that contains
(A) a work component (RVUw) that is measured
				  by the time and intensity of effort required to provide a service;
(B) a practice expense component (RVUp) that
				  includes costs related to the provision of services, including rent, salaries,
				  equipment, and supplies; and
(C) a
				  malpractice expense component (RVUm) that is measured by professional liability
				  insurance premium costs;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.100 - Advanced practice registered nurse services payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state advanced practice registered nurse, including a nurse
				  midwife, in accordance with
				  7 AAC 145.020, not to exceed 85 percent of the rate
				  determined under
				  7 AAC 145.050.
(b) The department will pay an out-of-state
				  advanced practice registered nurse the rate determined under
				  7 AAC 145.025.
(c) The department will pay an advanced
				  practice registered nurse acting as a surgical assistant the lesser of the
				  billed charges or 25 percent of the rates established for an advanced practice
				  registered nurse under (a) of this section. The department will not pay for an
				  advanced practice registered nurse as the primary surgeon.
(d) The department will not pay separately
				  for office medical supplies and services associated with office visits and
				  procedures because they are included in the practice expense component of the
				  RBRVS methodology used in
				  7 AAC 145.050. The department will pay for nonroutine
				  office medical and surgical supplies in accordance with
				  7 AAC 145.050(h).
(e) Repealed 5/1/2016.
(f) The department will pay for laboratory
				  services in accordance with payment methodology identified in
				  7 AAC 145.460.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.110 - Chiropractic services payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state chiropractor in accordance with
				  7 AAC 145.020, not to exceed 100 percent of the amount
				  determined under
				  7 AAC 145.050.
(b) The department will pay an out-of-state
				  chiropractor in accordance with
				  7 AAC 145.025.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.120 - Dental services payment rates

Current through May 31, 2024
(a) The department
				  will pay a dentist for dental services provided to a recipient 21 years of age
				  or older in accordance with
				  7 AAC 110.145 and the
Fee Schedule: Emergent
				  Adult Dental Services, Fee Schedule: Prosthodontic Adult Dental Services, and
				  Fee Schedule:
Enhanced Adult Dental Services, adopted by reference in
				  7 AAC 160.900.
(b) Except for orthodontic services, the
				  department will pay a dentist for dental services provided to a recipient under
				  21 years of age in accordance with
				  7 AAC 110.150 and the
Fee Schedule: Dental
				  Services for Children
, adopted by reference in
				  7 AAC 160.900.
(c) The department will pay for orthodontic
				  services in accordance with
				  7 AAC 110.153 and the
Fee Schedule: Dental
				  Services for Children,
adopted by reference in
				  7 AAC 160.900.
(d) The department will review dental payment
				  rates at the beginning of each fiscal year and may adjust the rates to reflect
				  changes in the United States Department of Labor consumer price index and after
				  reviewing fee profiles from the most recent calendar year's Medicaid dental
				  claims to determine the need for adjusting payment rates. For state fiscal year
				  2020, payment rates will not be adjusted by the consumer price index.
(e) The department will pay for services
				  provided by an advanced practice dental hygienist in accordance with
				  7 AAC 110.165 and the
Fee Schedule: Advanced
				  Practice Dental Hygienist Services,
adopted by reference in
				  7 AAC 160.900.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.130 - Direct-entry midwife services payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state direct-entry midwife in accordance with
				  7 AAC 145.020, not to exceed 85 percent of the amount
				  determined under
				  7 AAC 145.050.
(b) The department will pay an out-of-state
				  direct-entry midwife in accordance with
				  7 AAC 145.025.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.140 - Payment for EPSDT services

Current through May 31, 2024
(a) Except as
				  otherwise provided in this section, the department will pay a provider in
				  accordance with
				  7 AAC 145.020 for providing initial and subsequent periodic
				  medical screening, evaluation, diagnosis, and management of a recipient under
				  7 AAC 110.200, not to exceed 100 percent of the rate
				  determined under
				  7 AAC 145.050, even if the provider rendering the
				  service is normally paid at a different rate for non-EPSDT services.
(b) Except as provided under (c) of this
				  section, for any dental, vision, or hearing screening or for a medically
				  necessary treatment or required service provided in response to an EPSDT
				  screening, the department will pay a provider in accordance with the rate
				  established in 7 AAC 105 - 7 AAC 160 for that service and for that type of
				  provider.
(c) If an EPSDT service
				  is provided by a tribal health program, the department will pay for that
				  service at the applicable Indian Health Service encounter rate adopted by
				  reference in
				  7 AAC 160.900.
(d) If an EPSDT service is provided by a
				  federally qualified health clinic or rural health clinic, the department will
				  pay for that service at the rate determined under
				  7 AAC 145.700.
(e) If an EPSDT service is provided by a
				  certified health provider described in 7 AAC 155.030 and employed by a tribal
				  health program, or by a public health nurse employed by a tribal health
				  program, the department will pay for that service in accordance with (a) of
				  this section.
(f) The department
				  will pay the United States Internal Revenue Service optional standard mileage
				  rate for medical purposes, adopted by reference in
				  7 AAC 160.900, for use of a private vehicle driven for
				  medical purposes as described in
				  7 AAC 110.210(d) (3).
Authority:
AS
						47.05.010
AS
						47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.150 - Family planning services payment rates

Current through May 31, 2024
(a) The department
				  will pay for family planning services in accordance with
				  7 AAC 145.020 from a provider described in
				  7 AAC 110.230, not to exceed 85 percent of the amount
				  determined under
				  7 AAC 145.050.
(b) The department will pay for laboratory
				  services in accordance with the payment methodology identified in
				  7 AAC 145.460.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.160 - Imaging services payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state provider of x-ray services in accordance with
				  7 AAC 145.020, not to exceed 100 percent of the rate
				  established under
				  7 AAC 145.050.
(b) The department will pay an out-of-state
				  x-ray provider in accordance with
				  7 AAC 145.025.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.170 - Nurse anesthetist payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state registered nurse anesthetist in accordance with
				  7 AAC 145.020, not to exceed 85 percent of the rate
				  established under
				  7 AAC 145.050.
(b) The department will pay an out-of-state
				  registered nurse anesthetist in accordance with
				  7 AAC 145.025.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.180 - Nutrition services payment rates

Current through May 31, 2024
The department will pay an in-state provider of nutrition
					 services in accordance with
					 7 AAC 145.020, not to exceed
(1) $50 for the first 30 minutes of an
				  initial assessment;
(2) $25 for
				  each 15 minutes of an initial assessment in addition to the first 30 minutes
				  under (1) of this section; or
(3)
				  $17.50 for each 15-minute period of service following the initial
				  assessment.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.200 - Physician services payment rates

Current through May 31, 2024
(a) Except as
				  otherwise provided in this section, the department will pay an in-state
				  physician in accordance with
				  7 AAC 145.020, not to exceed 100 percent of the amount
				  determined under
				  7 AAC 145.050.
(b) The department will pay an out-of-state
				  physician in accordance with
				  7 AAC 145.025.
(c) The department will not pay separately
				  for office medical supplies and services associated with office visits and
				  procedures because they are included in the practice expense component of the
				  RBRVS methodology used in
				  7 AAC 145.050. The department will pay for nonroutine
				  office medical and surgical supplies in accordance with
				  7 AAC 145.050(h).
(d) The department will pay for laboratory or
				  pathology services provided by a physician for which a Medicare payment rate
				  has been established in
				  42
				  C.F.R. 405.515, adopted by reference in
				  7
				  AAC 160.900, in accordance with the methodology used
				  to determine payment for laboratory services in
				  7 AAC 145.460.
(e) Repealed 7/1/2019.
(f) The department will pay, in accordance
				  with 7 AAC 145.020, a supervising
				  physician, or will pay, in accordance with
				  7 AAC 155.010, a tribal health program, for the services
				  of an in-state physician assistant, except that
(1) the department will pay 85 percent of the
				  rate identified in the fee schedule established under
				  7 AAC 145.050;
(2) laboratory charges will be paid in
				  accordance with
				  7 AAC 145.460; and
(3) drugs will be paid in accordance with
				  7 AAC 145.410(g).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.220 - Physician surgical procedures payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state physician for surgical procedures in accordance with the
				  physician payment rates determined under
				  7 AAC 145.050, subject to the following exceptions:
(1) the highest-valued procedure of multiple
				  surgeries performed on the same recipient during the same operative session or
				  on the same day will be paid at 100 percent of the rate determined under
				  7 AAC 145.050, and each additional surgery at 50 percent
				  of the rate determined under
				  7 AAC 145.050;
(2) bilateral surgeries will be paid at the
				  lesser of billed charges or 150 percent of the rate determined under
				  7 AAC 145.050;
(3) co-surgeons will be paid for the same
				  surgical procedure, if medically necessary, by increasing the payment rate
				  determined under
				  7 AAC 145.050 by 25 percent and splitting the payment
				  equally between the surgeons;
(4)
				  intra-operative procedures only billed using modifier -54 from the list of
				  modifiers set out in
Current Procedural Terminology
, adopted
				  by reference in
				  7 AAC 160.900, will be paid at the lesser of billed
				  charges or 80 percent of the rate determined under
				  7 AAC 145.050;
(5) pre-operative services that are performed
				  by a physician other than the surgeon, and that are billed using modifier -56
				  from the list of modifiers set out in
Current Procedural
				  Terminology
, adopted by reference in
				  7 AAC 160.900, will be paid at the lesser of the billed
				  charges or 10 percent of the rate determined under
				  7 AAC 145.050;
(6) postoperative services that are performed
				  by a physician other than the surgeon, and that are billed using modifier -55
				  from the list of modifiers set out in
Current Procedural
				  Terminology
, adopted by reference in
				  7 AAC 160.900, will be paid at the lesser of billed
				  charges or 10 percent of the rate determined under
				  7 AAC 145.050;
(7) supplies associated with surgical
				  procedures performed in a physician's office will be paid only when a surgical
				  procedure is approved for payment for the same date of service in the
				  physician's office; the department will pay the lesser of the billed charges or
				  the rate determined under
				  7 AAC 145.050(h).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.240 - Podiatry services payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state podiatrist in accordance with
				  7 AAC 145.020, not to exceed 100 percent of the amount
				  determined under
				  7 AAC 145.050.
(b) The department will pay an out-of-state
				  podiatrist in accordance with
				  7 AAC 145.025.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.250 - Private-duty nursing payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state private-duty nurse in accordance with
				  7 AAC 145.020. For state fiscal year 2020, the payment
				  rates will be 95 percent of the payment rates listed in this subsection. The
				  payment rates must not exceed
(1) $20 per 15
				  minutes of service provided by a registered nurse or advanced practice
				  registered nurse, including a nurse midwife; or
(2) $18.75 per 15 minutes of service provided
				  by a licensed practical nurse.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.260 - Psychologist services payment rates

Current through May 31, 2024
The department will pay for psychologist services in
					 accordance with
					 7 AAC 145.020, not to exceed 100 percent of the amount
					 determined under
					 7 AAC 145.050. The department will pay for
					 neuropsychological testing in accordance with
					 7 AAC 145.020, not to exceed 150 percent of the amount
					 determined under
					 7 AAC 145.050.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.270 - Telehealth payment rates

Current through May 31, 2024
(a) The department
				  will pay in accordance with
				  7 AAC 145.020 for a service delivered by means of a
				  telehealth modality by a rendering provider or a consulting provider in
				  accordance with
				  7 AAC 110.620 -
				  7 AAC 110.639 as set out under
				  7 AAC 145.020.
(b) The department will pay a rendering provider or a consulting
				  provider in the same manner as payment is made for the same service provided
				  through in-person mode of delivery, not to exceed 100 percent of the rate
				  established under
				  7 AAC 145.050.
(c) In this section, "telehealth," "rendering
				  provider," and "consulting provider" have the meanings given in
				  7 AAC 110.639.
Authority:
AS
						47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.069
AS
						47.07.585
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.275 - Vaccine services payment rates

Current through May 31, 2024
The department will pay for
(1) a vaccine product that is covered under 7 AAC 110.750 at the lesser of the
(A) billed
				  charges;
(B) Medicare Part B upper
				  payment limit, if established; or
(C) estimated acquisition cost as defined in
				  7 AAC 145.400(p); and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.280 - Vision examinations and services payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state ophthalmologist, optometrist, or optician in accordance
				  with 7 AAC 145.020, not to exceed 100
				  percent of the amount determined under
				  7 AAC 145.050.
(b) The department will pay for postoperative
				  management services provided by an optometrist at 10 percent of the rate
				  determined under (a) of this section.
(c) The department will pay an out-of-state
				  ophthalmologist, optometrist, or optician in accordance with
				  7 AAC 145.025.
(d) In addition to the rate paid under (a) -
				  (c) of this section, the department will pay a provider for shipping eyeglasses
				  and contact lenses that are dispensed by mail. Effective July 1 of each year,
				  the department will establish the reimbursement rate for shipping at a rate
				  equal to the United States Postal Service Priority Mail Small Flat Rate Box
				  rate effective on July 1 of that year.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.290 - Long-term services and supports targeted case management

Current through May 31, 2024
(a) For long-term
				  services and supports targeted case management services provided under
				  7 AAC 128.010, the department will pay a unit of service
				  at the lesser of the
(1) amount charged by
				  the provider to the public; or
(2)
				  the payment rate established in the department's
Chart of Long Term
				  Services and Supports Targeted Case Management Services Rates
, adopted
				  by reference in
				  7 AAC 160.900.
Click here to view
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Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 4 - Payment Rates; Therapies and Related Services › 7 AAC 145.300 - Occupational therapy services payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state occupational therapist in accordance with
				  7 AAC 145.020, not to exceed 85 percent of the rate
				  determined under
				  7 AAC 145.050.
(b) The department will pay an outpatient
				  occupational therapy program operated by a tribal health program in accordance
				  with 7 AAC 155.010.
(c) The department will pay an out-of-state
				  occupational therapist for services in accordance with
				  7 AAC 145.025.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 4 - Payment Rates; Therapies and Related Services › 7 AAC 145.310 - Outpatient therapy center payment rates

Current through May 31, 2024
(a) The department
				  will pay for outpatient therapy center services provided in state in accordance
				  with 7 AAC 145.020, not to exceed 85
				  percent of the amount determined under
				  7 AAC 145.050.
(b) The department will pay an out-of-state
				  outpatient therapy center in accordance with
				  7 AAC 145.025.
(c) The department will pay an out-of-state
				  outpatient therapy center in accordance with
				  7 AAC 145.025 for the services of an occupational
				  therapy assistant, physical therapy assistant, or speech-language therapist
				  assistant.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 4 - Payment Rates; Therapies and Related Services › 7 AAC 145.320 - Physical therapy services payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state physical therapist in accordance with
				  7 AAC 145.020, not to exceed 85 percent of the rate
				  determined under
				  7 AAC 145.050.
(b) The department will pay an outpatient
				  physical therapy program operated by a tribal health program in accordance with
				  7 AAC 155.010.
(c) The department will pay an out-of-state
				  physical therapist for services in accordance with
				  7 AAC 145.025.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 4 - Payment Rates; Therapies and Related Services › 7 AAC 145.330 - Speech-language pathology services payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state speech-language pathologist in accordance with
				  7 AAC 145.020, not to exceed 85 percent of the rate
				  determined under
				  7 AAC 145.050.
(b) The department will pay an outpatient
				  speech-language therapy program operated by a tribal health program in
				  accordance with
				  7 AAC 155.010.
(c) The department will pay an out-of-state
				  speech-language pathologist for services in accordance with
				  7 AAC 145.025.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 4 - Payment Rates; Therapies and Related Services › 7 AAC 145.340 - Hearing services payment rates

Current through May 31, 2024
(a) Subject to the
				  limitations in
				  7 AAC 115.530, and this section, the department will pay
				  an in-state audiologist for audiology services
(1) in accordance with
				  7 AAC 145.020, not to exceed 85 percent of the rate
				  determined under
				  7 AAC 145.050; and
(2) in accordance with the
CPT Fee
				  Schedule for Audiology Services
table and HCPC Fee Schedule for
				  Audiology Services table, adopted by reference in
				  7 AAC 160.900; for state fiscal year 2020, starting the
				  later date of August 1, 2019, or after a 30 day notice to the providers, the
				  payment rates for audiology services reimbursed under the Resource Based
				  Relative Value Scale (RBRVS) methodology will be as described in
				  7 AAC 145.050 and the payment rates for audiology
				  services not reimbursed under RBRVS will be 95 percent of the state fiscal year
				  2019 payment rates.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 4 - Payment Rates; Therapies and Related Services › 7 AAC 145.350 - School-based services payment rates

Current through May 31, 2024
(a) The department
				  will pay for school-based services in accordance with
				  7 AAC 145.020, not to exceed 85 percent of the rate
				  established under
				  7 AAC 145.050. For school-based services for which a
				  rate is not established under
				  7 AAC 145.050, the department will pay for those
				  services in accordance with the
CPT Fee Schedule for School-Based
				  Services
table and
HCPC Fee Schedule for School-Based
				  Services
table, adopted by reference in
				  7 AAC 160.900.
(b) In this section, "school-based services"
				  has the meaning given
				  7 AAC 115.600(h).
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 5 - Payment Rates; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Transportation; Laboratory Services › 7 AAC 145.410 - Dispensing fee

Current through May 31, 2024
(a) The department will pay a dispensing fee
				  to an in-state pharmacy in accordance with the following schedule:
(1) for a pharmacy located on the road
				  system, the dispensing fee is $13.36, to be paid not more than once every 22
				  days per pharmacy per covered outpatient drug;
(2) for a pharmacy not located on the road
				  system, the dispensing fee is $21.28, to be paid not more than once every 22
				  days per pharmacy per covered outpatient drug;
(3) the dispensing fee for an out-of-state
				  pharmacy is $10.76, to be paid not more than once every 22 days per pharmacy
				  per covered outpatient drug;
(4)
				  the dispensing fee for a mediset pharmacy is $16.58, to be paid not more than
				  once every 14 days per pharmacy per covered outpatient drug;
(5) the dispensing fee for a compounded
				  covered outpatient drug is the applicable fee listed in (1) - (4) of this
				  subsection;
(6) a claim submitted
				  by a provider for a recipient for the same covered outpatient drug for which a
				  dispensing fee was paid within the last 14 or 22 days, as applicable under (1)
				  - (5) of this subsection, will be paid without the dispensing fee listed in (1)
				  - (5) of this subsection if the claim satisfies all coverage criteria under
				  7 AAC 120.110-7 AAC 120.140.