reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 4 - General Provisions › 7 AAC 135.910 - Licensed mental health professionals providing behavioral health services

Current through May 31, 2024
(a) A
				  mental health professional enrolled under
				  7 AAC 105.210 and licensed as required in AS 08 who
				  provides behavioral health services under this chapter may only request payment
				  for those services by submitting a claim for payment using the
(1) community behavioral health services
				  provider's claims processing procedures if the mental health professional is an
				  employee or volunteer of that organization; payment for services under this
				  paragraph is subject to the same requirements and restrictions placed on a
				  behavioral health services organization under this chapter;
(2) mental health physician clinic claims
				  processing procedures if the mental health professional is an employee of the
				  clinic; payment for services under this paragraph is subject to the same
				  requirements and restrictions placed on a mental health physician clinic under
				  this chapter; or
(3) mental health
				  professional's National Provider Identifier (NPI) number if providing the
				  service as an independent practitioner; payment for services under this
				  paragraph must be medically necessary and clinically appropriate, must be
				  directly rendered by the licensed mental health professional, and must meet the
				  service criteria set out in this chapter.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 4 - General Provisions › 7 AAC 135.990 - Definitions

Current through May 31, 2024
In this chapter, unless the context requires
					 otherwise.
(1) "active treatment"
				  means that the individual who renders the services actively engages the
				  recipient and provides pre-planned specific interventions, supports, or other
				  actions that assist the recipient in achieving the goals written in the
				  behavioral health treatment plan;
(2) "adjunctive treatment" means a treatment
				  that is associated with another treatment in a subordinate or auxiliary
				  capacity;
(3) "adult experiencing
				  an emotional disturbance" means an individual described in
				  7 AAC 135.050;
(4) "behavioral health clinic services" means
				  services provided under
				  7 AAC 135.010(b);
(5) "behavioral health rehabilitation
				  services" means services provided under
				  7 AAC 135.010(c);
(6)"behavioral health screening" means
				  administering and interpreting a screening tool described in
				  7 AAC 135.100, at the point of entry to a behavioral
				  health program to determine the appropriate assessments needed to identify the
				  recipient's treatment needs;
(7)
				  "behavioral health treatment plan" means
(A)
				  a written individualized treatment plan that details
(i) the goals, objectives, services, and
				  interventions selected to address a recipient's behavioral health needs
				  identified by a professional behavioral health assessment under
				  7 AAC 135.110; and
(ii) with respect to selected services and
				  interventions, their frequency and duration; or
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 136 - Alaska Substance Use Disorder and Behavioral Health Program: 1115 Demonstration Waiver › Article 1 - Administration › 7 AAC 136.010 - Purpose

Current through May 31, 2024
The purpose of this chapter is to offer individuals who
					 meet the eligibility criteria of this chapter services offered by the Substance
					 Use Disorder and Behavioral Health Program under the 1115 waiver approved by
					 the United States Department of Health and Human Services, Centers for Medicare
					 and Medicaid Services (CMS). To meet the purpose of this chapter, the
					 department will
(1) establish
				  recipient eligibility;
(2)
				  establish department approval criteria for providers of 1115 waiver
				  services;
(3) ensure that all 1115
				  waiver services are provided according to the
Special Terms and
				  Conditions for Section 1115(a) Demonstration: Alaska Substance Use Disorder and
				  Behavioral Health Program,
adopted by reference in
				  7 AAC 160.900, and according to service criteria
				  established under 7 AAC 138 and 7 AAC 139;
(4) establish service standards and
				  administrative procedures for providers of 1115 waiver services;
(5) conduct utilization reviews of the 1115
				  waiver project and 1115 waiver services;
(6) collect and report data to Centers for
				  Medicare and Medicaid Services (CMS) for project monitoring and evaluation;
				  and
(7) establish definitions and
				  service criteria for 1115 waiver services.
7 AAC 136.010 was
						effective as an emergency regulation July 1, 2019. In reviewing the permanent
						amendment in accordance with
						AS
						44.62.060 and
						44.62.125, the regulations
						attorney made technical corrections to the emergency regulation made permanent.
						The technical changes appear in
						7 AAC 136.010 as published in Register 232.
Authority:
AS
						47.05.010
AS 47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 136 - Alaska Substance Use Disorder and Behavioral Health Program: 1115 Demonstration Waiver › Article 1 - Administration › 7 AAC 136.020 - Provider requirements

Current through May 31, 2024
In addition to the requirements of 7 AAC 70, 7 AAC 105, 	 and 7 AAC 135, to qualify as a provider of 1115 waiver services, a provider
					 must
(1) obtain department
				  certification as an 1115 waiver services provider and identify the 1115 waiver
				  services the provider will provide before delivering 1115 waiver services if
				  the provider is a community behavioral health services provider;
(2) collaborate with the department or its
				  contractor to
(A) establish recipient
				  eligibility and coordinate recipient care and benefit management;
(B) report data required by the department;
				  and
(C) participate in quality
				  management, improvement, and assurance process; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 136 - Alaska Substance Use Disorder and Behavioral Health Program: 1115 Demonstration Waiver › Article 1 - Administration › 7 AAC 136.990 - Definitions

Current through May 31, 2024
In this chapter, unless the context requires
					 otherwise,
(1) "1115 waiver" has the
				  meaning given in
				  7 AAC 160.990(b);
(2) "community behavioral health services
				  provider" has the meaning given in
				  7 AAC 70.990;
(3) "substance use disorder treatment
				  provider" has the meaning given in
				  7 AAC 70.990.
Authority:
AS
						47.05.010
AS
						47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 1 - Scope; Eligibility; Service Provision, Rates, and Authorization › 7 AAC 138.010 - Recipient eligibility

Current through May 31, 2024
The following Medicaid-eligible recipients may receive
					 services under this chapter:
(1) a
				  child at least 12 years of age and under 18 years of age who may have a
				  substance use disorder, or may be at risk to develop a substance use disorder
				  as determined through a screening conducted according to 7 AAC 135.100;
(2) a youth at least 18
				  years of age and under 22 years of age who may have a substance use disorder or
				  may be at risk to develop a substance use disorder as determined through a
				  screening conducted according to 7 AAC 135.100.
(3) an adult who is diagnosed with a
				  substance use disorder or is at risk of developing a substance use disorder as
				  determined through a screening conducted according to 7 AAC 135.100.
Authority:
AS
						47.05.010
AS
						47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 1 - Scope; Eligibility; Service Provision, Rates, and Authorization › 7 AAC 138.020 - Provision of 1115 substance use disorder waiver services

Current through May 31, 2024
The department will pay for substance use disorder 1115
					 waiver services if the
(1) recipient
				  is eligible under 7 AAC 138.010;
(2) provider meets the requirements in 7 AAC 136.020;
(3) Repealed
				  11/1/2019;
(4) provider meets, in
				  addition to the requirements of this chapter, the requirements in 7 AAC 70.125
				  if providing opioid use disorder treatment services;
(5) provider provides a recipient substance
				  use disorder 1115 waiver services listed in 7 AAC 138.250 - 7 AAC 138.400 based
				  on an assessment under
				  7 AAC 135.110 and according to the assessment criteria
				  outlined in the ASAM Criteria:
Treatment Criteria for Addictive,
				  Substance-Related, and Co-Occurring Conditions
, adopted by reference
				  in 7 AAC 70.910, and that results in a
				  diagnosis according to the
(A)
Diagnostic and Statistical Manual of Mental Disorders
, adopted
				  by reference in
				  7 AAC 70.910; or
(B)
International Classification of
				  Diseases
, adopted by reference in
				  7 AAC 70.910; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 1 - Scope; Eligibility; Service Provision, Rates, and Authorization › 7 AAC 138.030 - Provision of Medicaid state plan services

Current through May 31, 2024
(a) Except as
				  provided in (b) of this section, the department will pay for a behavioral
				  health Medicaid state plan service provided to an eligible recipient even if
				  the recipient is also receiving services under this chapter.
(b)  repealed 6/30/2021.
Authority:
AS
						47.05.010
AS
						47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 1 - Scope; Eligibility; Service Provision, Rates, and Authorization › 7 AAC 138.040 - Service rates, service limits, and service authorization

Current through May 31, 2024
(a) Substance use
				  disorder 1115 waiver services rates are established in the department's
Chart of 1115 Waiver Services,
adopted by reference in
				  7 AAC 160.900.
(b) The department will not pay for substance
				  use disorder 1115 waiver services beyond the limits listed in the
Alaska Behavioral Health Provider Service Standards &
				  Administrative Procedures for SUD Provider Services,
adopted by
				  reference in
				  7 AAC 160.900, without prior authorization from the
				  department.
(c) A provider of
				  substance use disorder 1115 waiver services must file a request for prior
				  authorization of an extension of an substance use disorder 1115 waiver service
				  beyond service limitations using a form approved by the department. The request
				  must
(1) be documented in the clinical
				  record;
(2) include the expected
				  duration of the service; and
(3)
				  include an explanation for the need to extend the service.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 2 - Medicaid Substance Use Disorder 1115 Waiver Services › 7 AAC 138.100 - Assessment and treatment plan services

Current through May 31, 2024
The department will pay a provider to
(1) conduct an assessment according to 7 AAC 138.020(5) for each recipient receiving substance use disorder services under
				  this chapter;
(2) develop an
				  initial treatment plan for each recipient in accordance with
				  7 AAC 135.120; and
(3) review the treatment plan and revise the
				  plan as necessary at least every 90 days; document the results of the treatment
				  plan review in the clinical record; and include the name, signature, and
				  credentials of the individual who conducted the review.
7 AAC 136.100 was effective as an emergency regulation
						July 1, 2019. In reviewing the permanent amendment in accordance with AS
						44.62.060 and 44.62.125, the regulations attorney made technical corrections to
						the emergency regulation made permanent. The technical changes appear in 7 AAC
						136.100 as published in Register 232.
Authority:
AS
						47.05.010
AS
						47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 2 - Medicaid Substance Use Disorder 1115 Waiver Services › 7 AAC 138.200 - Prevention and engagement services

Current through May 31, 2024
(a) The department
				  will pay for a screening conducted by a provider under this chapter if the
				  provider uses
(1) one of the
				  department-approved screening tools listed in the
Alaska Behavioral
				  Health Provider Service Standards & Administrative Procedures for SUD
				  Provider Services,
adopted by reference in
				  7 AAC 160.900; and
(2) the results of the screening to identify
				  an individual who is at risk for an substance use disorder and to identify the
				  need for further assessment.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 2 - Medicaid Substance Use Disorder 1115 Waiver Services › 7 AAC 138.250 - Outpatient substance use disorder treatment services

Current through May 31, 2024
(a) The department
				  will pay for the following outpatient substance use disorder treatment services
				  under the 115 wavier if the service is provided according to this chapter:
(1) Intensive outpatient services;
(2) partial hospitalization
				  services.
(3) outpatient
				  services.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 2 - Medicaid Substance Use Disorder 1115 Waiver Services › 7 AAC 138.300 - Inpatient residential substance use disorder treatment services

Current through May 31, 2024
(a) The department
				  will pay for the following inpatient residential substance use disorder
				  treatment services if the services under the 1115 waiver is provided according
				  to 7 AAC 138.030:
(1) clinically managed
				  low-intensity residential services;
(2)Repealed 11/10/2019;
(3) clinically managed population-specific
				  high-intensity services for adults;
(4) clinically managed medium-intensity
				  residential services for adolescents;
(5) clinically managed high-intensity
				  residential services for adults;
(6) medically monitored high-intensity
				  inpatient services for adolescents;
(7) medically monitored high-intensity
				  inpatient services for adults;
(8)
				  medically managed intensive inpatient services;
(9) Repealed 11/10/2019.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 2 - Medicaid Substance Use Disorder 1115 Waiver Services › 7 AAC 138.350 - Alcohol and drug withdrawal management services

Current through May 31, 2024
(a) The department
				  will pay for the following alcohol and drug withdrawal management services
				  under the 1115 waiver for an adolescent or adult if the service is provided
				  according to 7 AAC 138.020:
(1) ambulatory
				  withdrawal management without extended on-site monitoring;
(2) ambulatory withdrawal management services
				  with extended on-site monitoring;
(3) clinically managed residential withdrawal
				  management;
(4) medically monitored
				  inpatient withdrawal management;
(5) medically managed intensive inpatient
				  withdrawal management.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 2 - Medicaid Substance Use Disorder 1115 Waiver Services › 7 AAC 138.400 - Community-based support services and payment conditions

Current through May 31, 2024
(a) The department
				  will pay a provider who meets the requirements of 7 AAC 138.020 for one or more
				  of the following substance use disorder 1115 waiver community-based support
				  services provided to an eligible recipient under this chapter:
(1) community recovery support services that
				  are provided to promote recipient recovery, through skill building and
				  counseling, and provided to
(A) assist the
				  recipient to build social, cognitive, daily living, employment, and
				  self-management skills;
(B) educate
				  and train the recipient and the recipient's family on behavioral health topics
				  related to the recipient's treatment and recovery;
(C) help the recipient access necessary
				  treatment and social support services;
(D) help the recipient participate in
				  traditional healing or spiritual activities;
(E) facilitate level-of-care transitions;
				  or
(F) assist the recipient with
				  recovery through support, mentoring, or coaching, and the services listed in
				  (A) - (E) of this paragraph provided by a peer support specialist who
(i) must have lived experience of an
				  substance use disorder or co-occurring mental health disorder or is a family
				  member of an individual with lived experience;
(ii) must work under the supervision of a
				  mental health professional clinician or a substance use disorder counselor;
				  and
(iii) is competent to provide
				  services through supervised experience or formal training;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 2 - Medicaid Substance Use Disorder 1115 Waiver Services › 7 AAC 138.410 - Requirement to pay substance use disorder care coordination services

Current through May 31, 2024
An eligible individual under this chapter who is receiving
					 medication-assisted treatment in an outpatient or inpatient care setting/must
					 also receive substance use disorder care coordination services under the 1115
					 waiver.
Authority:
AS
						47.05.010
AS
						47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 2 - Medicaid Substance Use Disorder 1115 Waiver Services › 7 AAC 138.450 - Crisis response services

Current through May 31, 2024
(a) The following
				  services may be provided to an eligible recipient under this chapter, as set
				  out in the
Alaska Behavioral Health Providers Services Standards &
				  Administrative Procedures for Behavioral Health Provider Services,
adopted by reference in
				  7 AAC 160.900, in any appropriate community setting:
(1) peer-based crisis services, provided by a
				  peer support specialist under
				  7 AAC 138.400, to help an individual avoid the need for
				  hospital emergency department services or the need for psychiatric
				  hospitalization through services identified in a crisis plan by a mental health
				  professional clinician that may include
(A) a
				  summary of crisis intervention needs;
(B) facilitation of transition to other
				  community-based resources or natural supports; and
(C) advocacy for client needs with other
				  service providers;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 138 - 1115 Substance Use Disorder Waiver Services › Article 3 - General Provisions › 7 AAC 138.900 - Transition to 1115 waiver services

Current through May 31, 2024
(a) A provider may
				  only provide the 1115 waiver services listed in this chapter upon approval by
				  the department in accordance with 7 AAC 136.020.
(b) A provider must update a recipient
				  treatment plan in accordance with
				  7 AAC 135.130 before providing a new service listed in
				  this chapter for a recipient that is currently receiving services under 7 AAC
				  70 and 7 AAC 135.
Authority:
AS
						47.05.010
AS
						47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 1 - Scope; Eligibility; Service Provision, Rates, and Authorization › 7 AAC 139.010 - Recipient eligibility

Current through May 31, 2024
The following individuals may receive services under this
					 chapter:
(1) an individual under 21
				  years of age who
(A) is diagnosed with a
				  mental, emotional, or behavioral disorder or substance use disorder;
(B) is at risk of developing a mental,
				  emotional, or behavioral disorder or substance use disorder based upon a
				  screening conducted under
				  7 AAC 135.100;
(C) is at risk of out-of-home placement;
(D) is currently in the custody of
				  the state; or
(E) has been
				  detained in a juvenile justice facility or treated in a residential treatment
				  program or psychiatric hospital within the past year;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 1 - Scope; Eligibility; Service Provision, Rates, and Authorization › 7 AAC 139.020 - Provision of behavioral health 1115 waiver services

Current through May 31, 2024
The department will pay for behavioral health 1115 waiver
					 services if the
(1) recipient is
				  eligible under 7 AAC 139.010;
(2)
				  provider meets the requirements in
				  7 AAC 136.020;
(3) services are provided under this chapter;
				  and
(4) services are based upon an
				  assessment conducted under
				  7 AAC 135.110, except for
(A) individuals described in 7 AAC 139.150(a) (1); and
(B) individuals described
				  in 7 AAC 139.350(a) (1)
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 1 - Scope; Eligibility; Service Provision, Rates, and Authorization › 7 AAC 139.030 - Provision of Medicaid state plan services (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 1 - Scope; Eligibility; Service Provision, Rates, and Authorization › 7 AAC 139.040 - Service rates, limits, and authorization

Current through May 31, 2024
(a) The behavioral
				  health 1115 waiver services rates are found in the department's
Chart
				  of 1115 Medicaid Waiver Services
, adopted by reference in
				  7 AAC 160.900.
Click
					 here to view image
(b) The department will not pay for a
				  behavioral health 1115 waiver service beyond the limits listed in the
Alaska Behavioral Health Providers Services Standards &
				  Administrative Procedures for Behavioral Health Provider Services
,
				  adopted by reference in
				  7 AAC 160.900, without prior authorization from the
				  department.
Click
					 here to view image
(c) A provider of behavioral health 1115
				  waiver services must file a request for prior authorization of an extension for
				  a behavioral health 1115 waiver service beyond service limits under (b) of this
				  section using a form approved by the department. The request must
(1) be documented in the clinical record;
(2) include the expected duration
				  of the service; and
(3) include an
				  explanation for the need to extend the service.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 2 - Medicaid Behavioral Health 1115 Waiver Services › 7 AAC 139.100 - Assessment and treatment plan services

Current through May 31, 2024
The department will pay a provider to
(1) conduct an assessment according to
				  7 AAC 135.110 for each recipient receiving services
				  under this chapter;
(2) develop an
				  initial treatment plan for each recipient under
				  7 AAC 135.120; and
(3) review the treatment plan and revise the
				  plan as necessary at least every 90 days; document the results of the treatment
				  plan review in the clinical record; and include the name, signature, and
				  credentials of the individual who conducted the review.
Authority:
AS
						47.05.010
AS
						47.07.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 2 - Medicaid Behavioral Health 1115 Waiver Services › 7 AAC 139.150 - Home-based family treatment services

Current through May 31, 2024
(a) The department
				  will pay for home-based family treatment services according to the following
				  criteria to prevent inpatient hospitalization and residential services for an
				  individual under 21 years of age listed in
				  7 AAC 139.010(1) if a combination of
				  less intensive outpatient services under 7 AAC 135 has not been effective or is
				  determined likely to not be effective:
(1)
				  level 1: for an individual at risk of out-of-home placement or diagnosed with
				  or at risk to develop a mental, emotional, or behavioral disorder or substance
				  use disorder as determined by a screening conducted under
				  7 AAC 135.100;
(2) level 2: for an individual at high risk
				  of out-of-home placement;
(3) level
				  3: for an individual who is at imminent risk of out-of-home placement or who
				  has been discharged from a residential treatment program, psychiatric hospital,
				  or juvenile detention facility.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 2 - Medicaid Behavioral Health 1115 Waiver Services › 7 AAC 139.200 - Community-based care management services

Current through May 31, 2024
(a) The following
				  community-based care management services may be provided to any eligible
				  recipient under this chapter:
(1) intensive
				  case management services, that must be provided according to the criteria
				  listed in 7 AAC 138.400(a)(3);
(2) community recovery support services, that
				  must be provided according to the criteria listed in
				  7 AAC 138.400(a)(1).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 2 - Medicaid Behavioral Health 1115 Waiver Services › 7 AAC 139.250 - Structured treatment services

Current through May 31, 2024
Structured treatment services under this section may be
					 provided to a recipient listed in 7 AAC 139.010 if the services are provided
					 according to the following criteria:
(1) partial hospitalization program services
				  provided to treat a recipient's assessed psychiatric disorder to prevent
				  relapse or the need for higher level of hospitalized care; partial
				  hospitalization program services must
(A) be
				  provided in a therapeutic environment that maintains daily scheduled treatment
				  activities by providers qualified to treat individuals with significant mental
				  health and co-occurring disorders;
(B) include direct access to psychiatric and
				  medical consultation and treatment, including medication services; and
(C) provide the range of component
				  services identified for partial hospitalization program services in the
Alaska Behavioral Health Providers Services Standards &
				  Administrative Procedures for Behavioral Health Provider Services,
adopted by reference in
				  7 AAC 160.900;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 2 - Medicaid Behavioral Health 1115 Waiver Services › 7 AAC 139.300 - Adult mental health residential services

Current through May 31, 2024
(a) Adult mental
				  health residential services in this section must be provided in a facility that
				  is approved by the department and that maintains a therapeutically structured
				  and supervised environment according to the criteria listed in the
Alaska Behavioral Health Providers Services Standards &
				  Administrative Procedures for Behavioral Health Provider Services,
adopted by reference in
				  7 AAC 160.900.
(b) Adult mental health residential services
				  must be provided in a facility with 16 or fewer beds by an interdisciplinary
				  treatment team for an individual under
				  7 AAC 139.010(2) according to the
				  following criteria:
(1) level 1: for an
				  individual
(A) diagnosed with a mental,
				  emotional, or behavioral disorder or co-occurring mental, emotional, or
				  behavioral disorder and substance use disorder; and
(B) with a prior history of continuous high
				  service needs, or who presents with behaviors or symptoms that require a
				  facility to provide intensive rehabilitative services, stabilization, and
				  maintain safety;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 2 - Medicaid Behavioral Health 1115 Waiver Services › 7 AAC 139.325 - Children's residential treatment

Current through May 31, 2024
(a) Children's
				  residential treatment in this section must be provided in a facility approved
				  by the department and that maintains a therapeutically structured and
				  supervised environment according to the criteria listed in the
Alaska
				  Behavioral Health Providers Services Standards & Administrative Procedures
				  for Behavioral Health Provider Services,
adopted by reference in
				  7 AAC 160.900.
(b) Children's residential treatment must be
				  provided by an interdisciplinary treatment team for an individual under
				  7 AAC 139.010(1) according to the
				  following criteria:
(1) level 1: for children
				  and adolescents in need of stabilization and assessment who do not require the
				  intensive services of medical personnel and who have
(A) not responded to outpatient treatment;
				  and
(B) treatment needs that cannot
				  be met in a less restrictive setting;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 2 - Medicaid Behavioral Health 1115 Waiver Services › 7 AAC 139.350 - Crisis response services

Current through May 31, 2024
(a) The following
				  services may be provided to an eligible recipient under this chapter, as set
				  out in the
Alaska Behavioral Health Providers Services Standards &
				  Administrative Procedures for Behavioral Health Provider Services,
adopted by reference in
				  7 AAC 160.900. in any appropriate community setting:
(1) peer-based crisis services, provided by a
				  peer support specialist under
				  7 AAC 138.400 to help an individual avoid the need for
				  hospital emergency department services or the need for psychiatric
				  hospitalization through
(A) a summary of
				  crisis intervention needs;
(B)
				  facilitation of transition to other community-based resources or natural
				  supports; and
(C) advocacy for
				  client needs with other service providers;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 2 - Medicaid Behavioral Health 1115 Waiver Services › 7 AAC 139.400 - Therapeutic treatment home services

Current through May 31, 2024
The department will pay for therapeutic treatment home
					 services that are provided to an eligible child or adolescent under 7 AAC 139.010(1), who experiences severe mental, emotional, or behavioral health
					 needs that cannot be stabilized in a less intensive home setting. Theraputic
					 treatment home services must
(1) be
				  provided in a licensed foster home under 7 AAC 50 by at least one licensed
				  foster parent;
(2) include
				  trauma-informed care by licensed foster parents and other providers listed in
				  the
Alaska Behavioral Health Providers Services Standards &
				  Administrative Procedures for Behavioral Health Provider Services,
adopted by reference in
				  7 AAC 160.900, who have received documented training or
				  education in principles of trauma-informed care;
(3) include the component services for
				  therapeutic treatment homes listed in the
Alaska Behavioral Health
				  Providers Services Standards & Administrative Procedures for Behavioral
				  Health Provider Services
, adopted by reference in
				  7 AAC 160.900; and
(4) be provided under the direction and
				  supervision of a community behavioral health services provider approved under
				  7 AAC 136.020.
Authority:
AS
						47.05.010
AS
						47.05.270
AS
						47.07.030
AS
						47.07.036
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 139 - Behavioral Health 1115 Waiver Services. › Article 3 - General Provisions › 7 AAC 139.900 - Transition to behavioral health 1115 waiver services

Current through May 31, 2024
(a) A provider may
				  only provide the 1115 waiver services listed in this chapter upon approval by
				  the department under
				  7 AAC 136.020.
(b) A provider must update a recipient
				  treatment plan under
				  7 AAC 135.130 before providing a new service listed in
				  this chapter for a recipient who is currently receiving services under 7 AAC 70
				  and 7 AAC 135.
Authority:
AS
						47.05.010
AS
						47.05.270
AS
						47.07.030
AS
						47.07.036
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 1 - Ambulatory Surgical Center Services › 7 AAC 140.100 - Ambulatory surgical center enrollment requirements

Current through May 31, 2024
To be eligible for payment under 7 AAC 105 - 7 AAC 160 for
					 ambulatory surgical center services, an ambulatory surgical center must
(1) be enrolled in the Medicaid program under
				  7 AAC 105.210;
(2) have a system to transfer recipients
				  requiring emergency admittance or overnight care to a licensed,
				  Medicaid-enrolled facility following any surgical procedure performed at the
				  ambulatory surgical center;
(3)
				  have a department-approved utilization review plan under
				  7 AAC 160.140; and
(4) except for ambulatory surgical centers
				  operated by a tribal health program under
				  7 AAC 155.010, comply with the requirements of 7 AAC
				  150.
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 1 - Ambulatory Surgical Center Services › 7 AAC 140.105 - Ambulatory surgical center services

Current through May 31, 2024
(a) To be covered
				  under 7 AAC 105 - 7 AAC 160, ambulatory surgical center services must be
(1) preventive, diagnostic, therapeutic,
				  rehabilitative, or palliative;
(2)
				  directly related to a surgical procedure provided to an outpatient by or under
				  the direction of a physician or dentist;
(3) provided in an ambulatory surgical
				  center; and
(4) listed in the
Ambulatory Surgical Centers (ACS) Approved HCPCS Codes and Payment
				  Rates
, adopted by reference in
				  7 AAC 160.900.
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 1 - Ambulatory Surgical Center Services › 7 AAC 140.110 - Ambulatory surgical center reports

Current through May 31, 2024
The department may request a copy of a full operative
					 report, an interpretation of any film, or a pathologist's report on tissue that
					 is removed. When a procedure requires an operative or pathologist's report or
					 particular explanation or interpretation before payment, payment to the
					 ambulatory surgical center is subject to receipt of the report, explanation, or
					 interpretation for evaluation by the department.
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 2 - Health Clinic Services; Federally Qualified Health Centers and Rural Health Clinics › 7 AAC 140.200 - Health clinic enrollment and reporting

Current through May 31, 2024
(a) The department
				  will pay a health clinic for services provided to a recipient if the health
				  clinic
(1) meets the enrollment and reporting
				  requirements of  42 C.F.R. 405.2400-405.2444, adopted by
				  reference in
				  7 AAC 160.900;
(2) is a federally qualified health center
				  that meets the requirements of
				  7 AAC 140.205 or a rural health clinic that meets the
				  requirements of
				  7 AAC 140.210;
(3) is enrolled as a Medicare
				  provider;
(4) is enrolled as a
				  federally qualified health center or rural health clinic in accordance with
				  7 AAC 105.210;
(5) is not enrolled as another type of
				  Medicaid provider of primary care or ambulatory services provided by the health
				  clinic;
(6) employs staff who meet
				  the individual provider enrollment requirements for each service that the
				  clinic provides if enrollment is required for that type of provider under 7 AAC
				  105 - AAC 160; and
(7) is enrolled
				  as follows if the health clinic is providing those services:
(A) as a dental provider under
				  7 AAC 110.140;
(B) as a dispensing pharmacy provider under
				  7 AAC 120.100;
(C) as a nurse midwife under
				  7 AAC 110.100 or direct-entry midwife under
				  7 AAC 110.180, if providing professional services
				  associated with labor and delivery.
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 2 - Health Clinic Services; Federally Qualified Health Centers and Rural Health Clinics › 7 AAC 140.205 - Federally qualified health centers

Current through May 31, 2024
(a) To qualify as a
				  federally qualified health center under
				  7 AAC 140.200 and this section and for payment under
				  7 AAC 145.700, a provider must meet at least one of the
				  following eligibility requirements for the entire period for which Medicaid
				  services are rendered:
(1) a provider is
				  receiving a grant under
				  42 U.S.C.
				  254 b;
(2) a provider is receiving money from a
				  grant under (1) of this subsection under a contract with the grant recipient,
				  and the provider also meets the requirements to receive that type of
				  grant;
(3) a provider is determined
				  by the United States Department of Health and Human Services, Centers for
				  Medicare and Medicaid Services (CMS), to meet the requirements for receiving a
				  grant under (1) of this subsection;
(4) a provider is a tribal health
				  program.
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 2 - Health Clinic Services; Federally Qualified Health Centers and Rural Health Clinics › 7 AAC 140.210 - Rural health clinics

Current through May 31, 2024
To qualify as a rural health clinic under
					 7 AAC 140.200 and this section and for payment under
					 7 AAC 145.700, a provider must be an entity that the
					 department has certified under  42 C.F.R. Part 491  as being in compliance with
					 42 C.F.R.
					 405.2400 -
					 405.2417, adopted by reference in
					 7 AAC 160.900.
Authority:
AS
						47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.073
AS
						47.07.074
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 2 - Health Clinic Services; Federally Qualified Health Centers and Rural Health Clinics › 7 AAC 140.215 - Health clinic services and payment conditions

Current through May 31, 2024
(a) The department
				  will pay a health clinic for providing services under (b) - (e) of this section
				  rendered to a patient of the clinic by an employee or a contract worker of the
				  clinic. Except as otherwise provided in this section, the department will pay a
				  provider for services under this section in accordance with the payment rate
				  established in
				  7 AAC 145.700, or
				  7 AAC 155.010, as applicable.
(b) The department will pay for primary care
				  services provided by a physician, a physician assistant, or an advanced
				  practice registered nurse acting within the scope of that individual's license
				  to practice. The department will not pay a federally qualified health center
				  under the rate methodology established in
				  7 AAC 145.700 for services that the department
				  determines to be incidental to primary care services, including laboratory
				  services, x-ray services, and supplies.
(c) The department will pay for ambulatory
				  services under 7 AAC 105 - 7 AAC 160, including
(1) vision services under
				  7 AAC 110.705;
(2) speech-language pathology services under
				  7 AAC 115.410;
(3) hearing services under
				  7 AAC 115.520 and
				  7 AAC 115.530;
(4) EPSDT screening and EPSDT services under
				  7 AAC 110.205 and
				  7 AAC 110.210;
(5) podiatry services under
				  7 AAC 110.505;
(6) nutrition services under
				  7 AAC 110.275 and
				  7 AAC 110.280;
(7) private-duty nursing services under
				  7 AAC 110.525;
(8) hospice services under
				  7 AAC 140.275 and
				  7 AAC 140.280;
(9) family planning services under
				  7 AAC 110.230;
(10) physical therapy services under
				  7 AAC 115.310;
(11) occupational therapy services under
				  7 AAC 115.110;
(12) chiropractic services under
				  7 AAC 110.120; and
(13) nonprimary care services that are
				  provided in a hospital by a rural health clinic physician, physician assistant,
				  or advanced practice registered nurse acting within the scope of that
				  individual's license to practice.
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 2 - Health Clinic Services; Federally Qualified Health Centers and Rural Health Clinics › 7 AAC 140.220 - Health clinic services provided off-site

Current through May 31, 2024
(a) The department
				  will not pay a health clinic for services provided off-site unless
(1) the health clinic patient is homebound as
				  determined under (b) of this section and if all of the following conditions are
				  met:
(A) the United States Department of
				  Health and Human Services has determined that a shortage of home health
				  agencies exists in the area;
(B)
				  services are furnished by a registered nurse, a licensed practical nurse, or a
				  licensed vocational nurse who is employed by, or receives compensation for the
				  services from, the clinic;
(C) the
				  services are furnished under a written plan of treatment that is
(i) established and reviewed at least every
				  60 days by a supervising physician of the health clinic or established by an
				  advanced practice registered nurse or a physician assistant and reviewed at
				  least every 60 days by a supervising physician; and
(ii) signed by the advanced nurse
				  practitioner, the physician assistant, or the supervising physician of the
				  health clinic;
(D) the
				  nursing care coverage is limited as specified in
				  42 C.F.R. 405.2416(b) and
				  (c), adopted by reference in
				  7
				  AAC 160.900;
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 2 - Health Clinic Services; Federally Qualified Health Centers and Rural Health Clinics › 7 AAC 140.229 - Definitions

Current through May 31, 2024
In
					 7 AAC 140.200 - 7 AAC 140.229,
(1) "ambulatory services" means
				  noninstitutional services that are payable under Medicaid and provided in
				  accordance with this chapter; "ambulatory services" includes
(A) visual care;
(B) speech;
(C) hearing;
(D) language;
(E) EPSDT;
(F) podiatry;
(G) nutrition;
(H) private duty nursing;
(I) hospice care;
(J) family planning;
(K) physical therapy;
(L) occupational therapy;
(M) chiropractic; and
(N) services that are not primary care
				  services, that are provided by a physician, physician assistant, or advanced
				  practice registered nurse, that are within the scope of that individual's
				  license to practice, and that are
(i) provided
				  in or by a hospital; or
(ii)
				  laboratory or x-ray services only;
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 3 - Hospice Care Services › 7 AAC 140.270 - Hospice care provider enrollment

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing hospice care services,
				  the provider must
(1) be enrolled in the
				  Medicaid program under
				  7 AAC 105.210;
(2) be a public or private organization that
				  the department has certified as a hospice for the purposes of the Medicare
				  program under  42 C.F.R. Part 418, adopted by reference in
				  7 AAC 160.900; and
(3) provide hospice care services for periods
				  of at least 210 days.