reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.230 - Screening, assessment, plan of care, and level-of-care determination (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.231 - Services during temporary absence

Current through May 31, 2024
(a) The department
				  will pay for home and community-based waiver services rendered to a recipient
				  during a recipient's temporary absence from the recipient's community when the
				  recipient travels to another location within the state or to an out-of-state
				  destination, if the services
(1) are provided
				  by a home and community-based waiver services provider that is certified under
				  7 AAC 130.220;
(2) are limited to the following:
(A) day habilitation services under
				  7 AAC 130.260;
(B) supported-living habilitation services
				  under
				  7 AAC 130.265(e);
(C) in-home support habilitation services
				  under
				  7 AAC 130.265(i);
(D) hourly respite care services under
				  7 AAC 130.280;
(E) adult day services under
				  7 AAC 130.250;
(F)
				  employment services under
				  7 AAC 130.270;
(3) are approved under
				  7 AAC 130.217 and
				  7 AAC 130.218 as part of the recipient's support plan;
				  and
(4) receive prior
				  authorization.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.233 - Provider termination of services to a recipient

Current through May 31, 2024
(a) Not later than
				  30 days before a home and community-based waiver services provider terminates
				  services to a recipient, the provider shall send written notice of service
				  termination to the department, the recipient, and the recipient's care
				  coordinator.
(b) provider may
				  terminate services to a recipient without the notice required in (a) of this
				  section if the provider has evidence that
(1)
				  continuing services for the recipient will
(A) jeopardize the safety of the provider, an
				  employee of the provider, or an individual receiving services from the
				  provider; or
(B) endanger the
				  health, safety and welfare of the recipient; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.235 - Nursing oversight and care management services

Current through May 31, 2024
(a) The department
				  may authorize nursing oversight and care management services for a recipient
				  that is eligible under the recipient category of
(1) children with complex medical conditions;
				  or
(2) individuals with
				  intellectual and developmental disabilities if the recipient meets, except for
				  the age requirement in
				  7 AAC 130.205(d)(1)(A), the criteria
				  for the recipient category for children with complex medical conditions under
				  7 AAC 130.205(d)(1).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.238 - Certification of care coordinators

Current through May 31, 2024
(a) An individual
				  may not provide care coordination services unless
(1) the department certifies the individual
				  under this section;
(2) the
				  individual is enrolled in the Medicaid program under
				  7 AAC 105.210; and
(3) the individual is an owner of or employed
				  by a care coordination services provider agency certified under
				  7 AAC 130.220(a)(2).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.240 - Care coordination services

Current through May 31, 2024
(a) The department
				  will pay for care coordination services that are
(1) provided in accordance with
				  7 AAC 130.217 and
				  7 AAC 130.218 and the department's
Care Coordination
				  Services and Long Term Services and Supports Targeted Case Management
				  Conditions of Participation,
adopted by reference in
				  7 AAC 160.900; and
(2) approved in the recipient's support plan
(A) developed under
				  7 AAC 128.010, for long term services and supports
				  targeted case management; or
(B)
				  developed under the provisions of
				  7 AAC 130.217 and
				  7 AAC 130.218 for a support plan.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.250 - Adult day services

Current through May 31, 2024
(a) The department will pay for adult day
				  services that
(1) are provided to a recipient
				  in one of the following recipient categories:
(A) older adults or adults with physical
				  disabilities;
(B) adults with
				  physical and developmental disabilities;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.255 - Residential supported-living services

Current through May 31, 2024
(a) The department
				  will pay for residential supported-living services that
(1) are provided to a recipient in one of the
				  following recipient categories:
(A) older
				  adults or adults with physical disabilities;
(B) adults with physical and developmental
				  disabilities;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.260 - Day habilitation services

Current through May 31, 2024
(a) The department
				  will pay for day habilitation services that
(1) are provided to a recipient in one of the
				  following recipient categories:
(A) children
				  with complex medical conditions, if the recipient is three years of age or
				  older;
(B) adults with physical and
				  developmental disabilities:
(C)
				  individuals with intellectual and developmental disabilities, if the recipient
				  is three years of age or older;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.265 - Residential habilitation services

Current through May 31, 2024
(a) The department
				  will pay for residential habilitation services that
(1) are provided to a recipient in one of the
				  following recipient categories:
(A) children
				  with complex medical conditions;
(B) adults with physical and developmental
				  disabilities;
(C) individuals with
				  intellectual and developmental disabilities;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.267 - Acuity payments for qualified recipients

Current through May 31, 2024
(a) The department
				  will pay for additional services under this section that
(1) are provided for a recipient who is
				  qualified under (b) of this section and is receiving
(A) residential supported-living services
				  under 7 AAC 130.255 that are assigned the
				  procedure code described in
				  7 AAC 145.520(h); or
(B) group-home habilitation services under
				  7 AAC 130.265(t) that are assigned the
				  procedure code described in
				  7 AAC 145.520(h);
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.275 - Intensive active treatment services

Current through May 31, 2024
(a) The department
				  will pay for intensive active treatment services
(1) that are provided to a recipient in one
				  of the following recipient categories:
(A)
				  adults with physical and developmental disabilities;
(B) individuals with intellectual and
				  developmental disabilities 21 years of age and older;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.280 - Respite care services

Current through May 31, 2024
(a) The department will pay for respite care
				  services that
(1) are provided in accordance
				  with the department's
Respite Care Services Conditions of
				  Participation,
adopted by reference in
				  7 AAC 160.900;
(2) are approved under
				  7 AAC 130.217 and
				  7 AAC 130.218 as part of the recipient's support
				  plan;
(3) receive prior
				  authorization; and
(4) do not
				  exceed the maximum number of hours and days specified in (c) of this
				  section.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.285 - Specialized private-duty nursing services

Current through May 31, 2024
(a) The department
				  will pay for specialized private-duty nursing services that
(1) are provided to a recipient 21 years of
				  age or older that meets the requirements of
				  7 AAC 110.525(a) (2) - (4) and that is
				  in one of the following recipient categories:
(A) adults with physical and developmental
				  disabilities;
(B) individuals with
				  intellectual and developmental disabilities;
(C) older adults or adults with physical
				  disabilities;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.290 - Transportation services

Current through May 31, 2024
(a) The department
				  will pay for transportation services that
(1)
				  are provided in accordance with the department's
Transportation
				  Services Conditions of Participation,
adopted by reference in
				  7 AAC 160.900;
(2) are approved under
				  7 AAC 130.217 and
				  7 AAC 130.218 as part of the recipient's support
				  plan;
(3) receive prior
				  authorization; and
(4) are provided
				  in a vehicle that is owned or commercially leased by a home and community-based
				  waiver services provider agency, unless otherwise approved under (b) of this
				  section; the department will not certify, as a provider of services under
				  7 AAC 130.220(a)(l)(I), an agency that uses
				  only employee- or volunteer-owned vehicles for that
				  service.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.295 - Meal services

Current through May 31, 2024
(a) The department will pay for meal services
				  that
(1) are provided to a recipient 18 years
				  of age or older;
(2) are provided
				  in accordance with the department's
Meal Services Conditions of
				  Participation
, adopted by reference in
				  7 AAC 160.900;
(3) are approved under 7 AAC 130.217 and 7 AAC 130.218 as part of the recipient's support plan; and
(4) receive prior authorization.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.300 - Environmental modification services

Current through May 31, 2024
(a) The department
				  will pay for environmental modification services that
(1) are provided in accordance with the
				  department's
Environmental Modification Services Conditions of
				  Participation
, adopted by reference in
				  7 AAC 160.900;
(2) are approved under 7 AAC 130.217 and 7 AAC 130.218 as part of the recipient's support plan ; and
(3) receive prior authorization.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.305 - Specialized medical equipment

Current through May 31, 2024
(a) The department
				  will pay for specialized medical equipment that
(1) is supported by a prescription or other
				  written documentation required by the department's
Specialized Medical
				  Equipment Fee Schedule
, adopted by reference in
				  7 AAC 160.900,
(A)
				  from an individual with an active license under AS 08 to practice as
(i) a physician, including an
				  osteopath;
(ii) a physician
				  assistant;
(iii) an advanced
				  practice regsitered nurse;
(iv) an
				  occupational therapist; or
(v) a
				  physical therapist; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.310 - Restrictions on residential supported-living services payment (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 130 - Medicaid Coverage; Home and Community-Based Waiver Services › Article 2 - Home and Community-Based Waiver Services; Nursing Facility and ICF/MR Level of Care › 7 AAC 130.319 - Definitions

Current through May 31, 2024
In this chapter, unless the context requires
					 otherwise,
(1) "active teaching or
				  training" means the use of appropriate measures or interventions that are
				  evidence-informed, address objectives described in a recipient's approved
				  support plan, lead to positive outcomes, and engage a recipient during each
				  unit of service;
(2) "applicant's
				  representative" means a person who serves, for an applicant, the functions of a
				  recipient's representative;
(3)
				  "assessment" means the process by which the department, using an assessment
				  tool specified by recipient category in
				  7 AAC 130.215, determines if an applicant meets a level
				  of care necessary to qualify for home and community-based waiver
				  services;
(4) "business day" means
				  a day other than Saturday, Sunday, or a legal holiday under
				  AS
				  44.12.010;
(5) "care coordination" means those services
				  provided in accordance with
				  7 AAC 130.240 by a care coordinator;
(6) "care coordination agency provider" means
				  a provider that the department has certified under
				  7 AAC 130.220 to provide care coordination services
				  under 7 AAC 130.240;
(7) "care coordinator" means an individual
				  that the department has enrolled under
				  7 AAC 105.210 and certified under
				  7 AAC 130.238;
(8) "habilitation" means active teaching or
				  training that
(A) assists a recipient to
				  acquire, retain, or improve the self-help, socialization, and adaptive skills
				  necessary to reside successfully in home and community-based settings;
				  and
(B) is planned to help a
				  recipient reach the level of physical, mental, and social functioning that the
				  recipient has the capacity to engage in and benefit from;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 1 - Scope; Eligibility; Enrollment; Authorization › 7 AAC 135.010 - Scope of Medicaid behavioral health services

Current through May 31, 2024
(a) The department
				  will pay for a behavioral health service under
				  7 AAC 135.010 -
				  7 AAC 135.370 if
(1)
				  the recipient meets the criteria for services under
				  7 AAC 135.020;
(2) the provider meets the criteria for
				  payment under
				  7 AAC 135.030;
(3) the service is identified as a treatment
				  need in
(A) a professional behavioral health
				  assessment under
				  7 AAC 135.110 or a reassessment conducted while the
				  recipient is receiving behavioral health services; and
(B) a behavioral health treatment
				  plan;
(4) screening and
				  brief intervention services are provided in accordance with
				  7 AAC 135.240;
(5) the department has given prior
				  authorization for the service under
				  7 AAC 105.130 and
				  7 AAC 135.040;
(6) the service is medically necessary and
				  clinically appropriate;
(7) the
				  service is provided as active treatment;
(8) the service, if it is a behavioral health
				  clinic service, is provided under the general direction of a
				  physician;
(9) the service is
				  provided by a member of the provider's staff who is performing that service as
				  a regular duty within the scope of that staff member's knowledge, experience,
				  and education;
(10) the clinical
				  record requirements of
				  7 AAC 105.230 and
				  7 AAC 135.130 are met; and
(11) the provider meets the criteria for
				  payment under
				  7 AAC 135.300, if the provider is providing autism
				  services.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 1 - Scope; Eligibility; Enrollment; Authorization › 7 AAC 135.020 - Recipient eligibility for Medicaid behavioral health services

Current through May 31, 2024
(a) The department
				  will pay for behavioral health clinic services for the following individuals
				  only:
(1) a child experiencing an emotional
				  disturbance;
(2) a child
				  experiencing a severe emotional disturbance;
(3) an adult experiencing an emotional
				  disturbance;
(4) an adult
				  experiencing a serious mental illness.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 1 - Scope; Eligibility; Enrollment; Authorization › 7 AAC 135.030 - Behavioral health provider enrollment and organization

Current through May 31, 2024
(a) To be eligible
				  for payment under
				  7 AAC 135.010 -
				  7 AAC 135.370 for providing Medicaid behavioral health
				  services, a provider must be enrolled in Medicaid under
				  7 AAC 105.210 and must be either
(1) a community behavioral health services
				  provider;
(2) a mental health
				  physician clinic that meets the requirements of (d) of this section;
(3) a psychologist who
(A) meets the requirements of
				  7 AAC 110.550; and
(B) provides psychological testing and
				  evaluation under
				  7 AAC 135.110(g);
(4) a licensed behavior analyst who
(A) meets the requirements of
				  7 AAC 135.300; and
(B) provides autism services under
				  7 AAC 135.350; or
(5) a licensed behavior analyst group
				  practice that
(A) meets the requirements of
				  7 AAC 135.300; and
(B) provides autism services under
				  7 AAC 135.350.
(6) a licensed mental health professional who
				  meets the requirements of
				  7 AAC 135.910.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 1 - Scope; Eligibility; Enrollment; Authorization › 7 AAC 135.050 - Adult experiencing an emotional disturbance

Current through May 31, 2024
An adult experiencing an emotional disturbance is an
					 individual 21 years of age or older who is experiencing a nonpersistent mental,
					 emotional, or behavioral disorder that
(1) is identified and diagnosed during a
				  professional behavioral health assessment under
				  7 AAC 135.110; and
(2) is not the result of intellectual,
				  physical, or sensory deficits.
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 135 - Medicaid Coverage; Behavioral Health Services › Article 1 - Scope; Eligibility; Enrollment; Authorization › 7 AAC 135.055 - Adult experiencing a serious mental illness

Current through May 31, 2024
(a) An adult
				  experiencing a serious mental illness is an individual 21 years of age or older
				  who currently has or at any time during the past year has had a diagnosable
				  mental, emotional, or behavioral disorder of sufficient duration to meet
				  diagnostic criteria specified in the
Diagnostic and Statistical Manual
				  of Mental Disorders
, adopted by reference in
				  7 AAC 160.900, or the
International
				  Classification of Diseases
, adopted by reference in
				  7 AAC 160.900, and that
(1) has consistently resulted in
(A) impaired thinking and judgment that may
				  include the presence of delusions or hallucinations;
(B) socially disruptive behavior that may
				  include an emotional response that is inappropriate to the situation; or
(C) conduct that is illegal or
				  outside socially accepted rules and mores;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 1 - Scope; Eligibility; Enrollment; Authorization › 7 AAC 135.060 - Child experiencing an emotional disturbance

Current through May 31, 2024
A child experiencing an emotional disturbance is an
					 individual under 21 years of age who is experiencing a nonpersistent mental,
					 emotional, or behavioral disorder that
(1) is identified and diagnosed during a
				  professional behavioral health assessment under
				  7 AAC 135.110; and
(2) is not the result of intellectual,
				  physical, or sensory deficits.
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 135 - Medicaid Coverage; Behavioral Health Services › Article 1 - Scope; Eligibility; Enrollment; Authorization › 7 AAC 135.065 - Child experiencing a severe emotional disturbance

Current through May 31, 2024
(a) A child
				  experiencing a severe emotional disturbance is an individual under 21 years of
				  age who currently has or at any time during the past year has had a diagnosable
				  mental, emotional, or behavioral disorder of sufficient duration to meet
				  diagnostic criteria specified in the
Diagnostic and Statistical Manual
				  of Mental Disorders
, adopted by reference in
				  7 AAC 160.900, the
International Classification
				  of Diseases
, adopted by reference in
				  7 AAC 160.900, or the
Diagnostic Classification
				  of Mental Health and Developmental Disorders of Infancy and Early Childhood:
				  Revised Edition (DC:0-3R)
, adopted by reference in
				  7 AAC 160.900, and that
(1) has resulted in a severe functional
				  impairment that significantly interferes with the child's ability to
				  participate in one or more life domains at a developmentally appropriate level
				  and within a culturally appropriate context; or
(2) has resulted in the individual exhibiting
				  one or more of the following:
(A) persistent
				  symptoms of distress or diminished affect that do not readily respond to
				  encouragement, reassurance, or instructional control;
(B) impeded development or inappropriate
				  attachment as a result of exposure to traumatic life events or impaired
				  relationships;
(C) pervasive
				  behavior that is disruptive, aggressive, or risk-taking and that places the
				  individual at serious risk of physical harm to self or to another person or
				  results in serious property damage;
(D) consistent inability to participate
				  appropriately in a community setting, including family, school, work, or child
				  care;
(E) imminent risk for
				  out-of-home placement;
(F) imminent
				  risk for being placed in the custody of the department under
				  AS
				  47.12.120 or as a result of exposure to
				  maltreatment under
				  AS
				  47.10.011;
(G) current hospitalization or the imminent
				  risk of hospitalization.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.100 - Behavioral health screening

Current through May 31, 2024
(a) The department
				  will pay a provider listed in
				  7 AAC 70.010(a) and an eligible
				  provider under
				  7 AAC 105.200 for conducting a behavioral health
				  screening with a new or returning recipient using a screening tool recommended
				  by the department or identified by the provider as appropriate for use with the
				  recipient.
(b) A provider under
				  this section shall include the results of the screening in the recipient's
				  clinical record including any action taken or recommended based on the
				  recipient's responses.
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 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.110 - Professional behavioral health assessments

Current through May 31, 2024
(a) If an
				  individual requests treatment, or is referred by a court or other agency, as an
				  individual who is suspected of having a behavioral health disorder that could
				  require behavioral health services, the department will pay
(1) a community behavioral health services
				  provider for the following services:
(A) one
				  of the following behavioral health intake assessments:
(i) a mental health intake assessment under
				  (b) of this section;
(ii) a
				  substance use intake assessment under (c) of this section;
(iii) an integrated mental health and
				  substance use intake assessment under (d) of this section;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.120 - Behavioral health treatment plan

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider or a mental health
				  physician clinic for services provided to a recipient only if
(1) those services are provided under an
				  individualized behavioral health treatment plan that meets the requirements of
				  this section and
				  7 AAC 135.130;
(2) the plan is based on a professional
				  behavioral health assessment under
				  7 AAC 135.110;
(3) the plan is signed and monitored by the
				  directing clinician; and
(4) if the
				  recipient is 18 years of age or younger, the plan is developed with the
				  recipient or the recipient's representative and is based upon the input of a
				  treatment team that meets the requirements of (c) of this section
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.130 - Clinical record

Current through May 31, 2024
(a) To be eligible for payment under this
				  chapter, a community behavioral health services provider or a mental health
				  physician clinic must maintain, for each recipient served, a clinical record in
				  accordance with
				  7 AAC 105.230 that also must include a
(1) written report that documents the results
				  of a professional behavioral health assessment conducted in accordance with
				  7 AAC 135.110 that also identifies the
(A) recipient's presenting problems,
				  diagnosed conditions, and functional deficits that require treatment;
				  and
(B) treatment recommendations
				  for the recipient's presenting problems, diagnosed conditions, and functional
				  impairments; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.140 - Pharmacologic management services

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider or mental health
				  physician clinic for a pharmacologic management service if that service is
				  provided directly by a professional described in
				  7 AAC 135.010(b) (2).
(b) To qualify for payment under this
				  section, a provider must monitor a recipient for the purposes of
(1) assessing a recipient's need for
				  pharmacotherapy;
(2) prescribing
				  appropriate medications to meet the recipient's need; and
(3) monitoring the recipient's response to
				  medication, including
(A) documenting
				  medication compliance;
(B)
				  assessing and documenting side effects; and
(C) evaluating and documenting the
				  effectiveness of the medication.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.150 - Psychotherapy

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider or mental health
				  physician clinic for one or more of the following forms of psychotherapy, as
				  coded in
Current Procedural Terminology (CPT)
, adopted by
				  reference in
				  7 AAC 160.900:
(1)
				  insight-oriented individual psychotherapy;
(2) interactive individual
				  psychotherapy;
(3) group
				  psychotherapy;
(4) family
				  psychotherapy - without recipient;
(5) family psychotherapy - with
				  recipient;
(6) multi-family group
				  psychotherapy.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.160 - Short-term crisis intervention services

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider or mental health
				  physician clinic for short-term crisis intervention services, provided by a
				  mental health professional clinician to a recipient, if that mental health
				  professional clinician provides an initial assessment of the
(1) nature of the short-term
				  crisis;
(2) recipient's mental,
				  emotional, and behavioral status; and
(3) recipient's overall functioning in
				  relation to the short-term crisis.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.170 - Short-term crisis stabilization services

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider for short-term crisis
				  stabilization services, provided by a substance use disorder counselor or a
				  behavioral health clinical associate to a recipient, if that substance use
				  disorder counselor or behavioral health clinical associate
(1) provides an initial assessment of the
				  recipient's overall functioning in relation to the short-term crisis;
(2) develops a short-term crisis
				  stabilization plan; and
(3)
				  documents, on a form provided by the department, the assessment, a short-term
				  crisis stabilization plan, and the services that are provided.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.180 - Case management

Current through May 31, 2024
(a) The department will pay a community
				  behavioral health services provider for case management provided to a recipient
				  or recipient's family for one or more of the following purposes only:
(1) coordinating assessments, treatment
				  planning, and service delivery;
(2)
				  providing linkage between the recipient and other needed services;
(3) monitoring, by direct observation by the
				  directing clinician, the delivery of behavioral health services other than case
				  management as those services are provided to the recipient to ensure that
				  interventions and techniques are
(A)
				  appropriate to the recipient's needs;
(B) delivered at an adequate skill level;
				  and
(C) achieving the treatment
				  goals;
(4) providing
				  advocacy and support to the parents and the foster parents of a child in foster
				  care to preserve the placement;
(5)
				  providing overall advocacy and support for the recipient's social, educational,
				  legal, and treatment needs.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.190 - Withdrawal management services

Current through May 31, 2024
(a) A community
				  behavioral health services provider may only bill the department for the
				  following alcohol and drug withdrawal management services delivered
				  face-to-face to the recipient if the services are provided in accordance with
				  this section:
(1) level 1 withdrawal
				  management: ambulatory withdrawal management services without extended on-site
				  monitoring, provided in accordance with
				  7 AAC 70.110;
(2) level 2 withdrawal management: ambulatory
				  withdrawal management services with extended on-site monitoring, provided in
				  accordance with
				  7 AAC 70.110;
(3) level 3.2 withdrawal management:
				  clinically managed residential withdrawal management services, provided in
				  accordance with
				  7 AAC 70.110;
(4) level 3.7 withdrawal management:
				  medically monitored inpatient withdrawal management services, provided in
				  accordance with
				  7 AAC 70.110
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.210 - Peer support services

Current through May 31, 2024
(a) A community
				  behavioral health services provider may only bill the department for peer
				  support services if those services
(1)
				  include
(A) one-on-one, family, or group
				  activities designed to assist the recipient attain identified treatment
				  goals;
(B) assisting the recipient
				  or recipient's family in regaining balance and control of their
				  lives;
(C) enhancing the
				  recipient's community living skills; and
(D) supporting a self-directed recovery and
				  independence;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.220 - Therapeutic behavioral health services for children

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider for therapeutic
				  behavioral health services, for a recipient under 21 years of age with a severe
				  behavioral disorder, if those services
(1)
				  improve the recipient's overall functioning and reduce the likelihood of
(A) removal from a school setting;
(B) placement out of the family home;
				  or
(C) referral to institutional
				  care;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.240 - Screening and brief intervention services

Current through May 31, 2024
(a) A community
				  behavioral health services provider, a mental health physician clinic. or an
				  individual identified in 7 AAC 135.910 may only bill the department for
				  screening and brief intervention services if that provider conducts the
				  screening component and, if needed, the brief intervention component in
				  accordance with this section.
(b) A
				  provider under (a) of this section shall provide a screening through
				  self-report questionnaires, structured interviews, or similar screening
				  techniques to detect substance use problems and to identify the appropriate
				  level of intervention. If the screening is positive for substance use problems,
				  the provider may provide brief intervention services that involve motivational
				  discussion focused on raising the recipient's awareness of their substance use,
				  the potential harmful effects of that substance use, and encouraging positive
				  change. Brief intervention services may include
(1) feedback;
(2) goal setting;
(3) coping strategies;
(4) identification of risk factors;
(5) information; and
(6) advice.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.250 - Day treatment services for children

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider for day treatment
				  services for children provided in the school setting if those services
(1) are provided to a recipient who is a
				  child experiencing a severe emotional disturbance;
(2) promote the recipient's ability to be
				  successful, independent of behavioral health services, in the community-based
				  school environment; and
(3) assist
				  the recipient in developing self-management skills consistent with academic
				  progress.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.260 - Medication administration services

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider for on-premises
				  medication administration services provided to a recipient on the premises of
				  the community behavioral health services provider.
(b) The department will pay a community
				  behavioral health services provider for off-premises medication administration
				  services provided to a recipient at home, school, or any other appropriate
				  community setting.
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 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.280 - Residential substance use treatment services

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider for residential
				  substance use disorder treatment services if the provider is operating a
				  structured residential program to treat substance use disorders in accordance
				  with 7 AAC 70.120.
(b) To qualify for payment for providing
				  residential substance use disorder treatment services, a community behavioral
				  health services provider must provide the following active treatment each day
				  the recipient is in treatment:
(1) teaching
				  of life skills designed to restore or improve the recipient's overall
				  functioning relative to their substance use disorder;
(2) counseling focused on functional
				  improvement, recovery, and relapse prevention;
(3) encouraging and coaching.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.300 - Autism services; provider qualifications

Current through May 31, 2024
(a) To qualify for
				  payment for autism services, a provider must be a community behavioral health
				  services provider, a behavior analyst who meets the requirements in (c) of this
				  section, or a behavior analyst group practice enrolled under
				  7 AAC 105.210. If the provider is
(1) a community health behavioral services
				  provider, the provider must
(A) meet the
				  qualifications in
				  7 AAC 70.100 and
				  7 AAC 135.030;
(B) employ at least one behavior analyst
				  licensed under
				  AS
				  08.15.020(a); the provider
				  may, subject to (D) of this paragraph, employ an assistant behavior analyst
				  licensed under AS 08.15.020(b), or employ an autism behavior technician under
				  (i) of this section who meets the requirements in (c)(3) of this section;
(C) obtain prior authorization for
				  providing an extension of autism services in accordance with
				  7 AAC 105.130 and
				  7 AAC 135.040(d);
(D) ensure that each individual rendering
				  autism services is supervised in accordance with (d) of this section, and
				  separately enrolled under
				  7 AAC 105.210; and
(E) provide autism services in accordance
				  with 7 AAC 135.350;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.350 - Autism services

Current through May 31, 2024
(a) The department
				  will pay for the following rehabilitative autism services provided to a
				  recipient listed in
				  7 AAC 135.020(e) or (f) if provided by
				  a provider identified in
				  7 AAC 135.300;
(1) initial
				  behavior identification assessment;
(2) behavior identification
				  reassessment;
(3) adaptive behavior
				  treatment by protocol;
(4) group
				  adaptive behavior treatment by protocol;
(5) family adaptive behavior treatment
				  guidance;
(6) adaptive behavior
				  treatment by protocol modification,
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.360 - Payment for qualified addiction professional or peer support specialist crisis services

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider for 1115 waiver
				  peer-based crisis services provided by a qualified addiction professional (QAP)
				  or peer support specialist (PSS) to a recipient if that QAP or PSS
(1) provides an initial assessment of the
				  recipient's overall functioning in relation to the short-term crisis;
(2) develops a short-term crisis
				  stabilization plan; and
(3)
				  documents the assessment, a short-term crisis stabilization plan, follow-up
				  disposition, and the services that are provided.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 135 - Medicaid Coverage; Behavioral Health Services › Article 2 - Medicaid Behavioral Health Services › 7 AAC 135.370 - Payment for qualified behavioral health professional crisis services

Current through May 31, 2024
(a) The department
				  will pay a community behavioral health services provider for 1115 waiver
				  peer-based crisis services provided by a qualified behavioral health
				  professional (QBHP) if that QBHP
(1) provides
				  an initial assessment of the recipient's overall functioning in relation to the
				  short-term crisis:
(2) develops a
				  short-term crisis stabilization plan; and
(3) documents the assessment, a short-term
				  crisis stabilization plan, follow-up disposition, and the services that are
				  provided.
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 135.900 - Physicians providing behavioral health clinic services

Current through May 31, 2024
(a) If a physician
				  provides behavioral health clinic services in a community behavioral health
				  services provider organization, the physician may request payment for those
				  services by submitting a claim for payment
(1) using the community behavioral health
				  services provider's medical assistance provider identification number; payment
				  for services under this paragraph is subject to the same requirements and
				  restrictions placed on a community behavioral health services provider under
				  this chapter; or
(2) using the
				  physician's medical assistance provider identification number; payment for
				  services under this paragraph is subject to the same requirements and
				  restrictions placed upon a physician under this chapter; the department will
				  pay a physician for medically necessary and clinically appropriate mental
				  health services only if the physician renders those services
				  directly.