reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 1 - Prescription Drugs and Medical Supplies › 7 AAC 120.110 - Covered outpatient drugs and home infusion therapy

Current through May 31, 2024
(a) Except as
				  provided in
				  7 AAC 120.112, the department will pay for
(1) a covered outpatient drug described in
				  (b) of this section;
(2) a
				  compounded prescription, if
(A) at least one
				  ingredient is a covered outpatient drug and the recipient's drug therapy needs
				  cannot be met by commercially available dosage strengths or forms of the
				  therapy;
(B) the claim for a
				  compounded prescription is submitted using the national drug code (NDC) number
				  and quantity for each covered outpatient drug in the compound;
(C) not more than 25 covered outpatient drugs
				  are reimbursed in any compound; and
(D) reimbursement for each covered outpatient
				  drug is determined in accordance with
				  7 AAC 145.400;
(3) insulin;
(4) except for a recipient who resides in a
				  long-term care facility or an intermediate care facility for the intellectually
				  and developmentally disabled, the following U.S. Food and Drug Administration
				  regulated products that have been prescribed, even if that product may be sold
				  without a prescription:
(A) prenatal vitamins
				  for pregnant and nursing women;
(B)
				  nonoxynol-9 contraceptive creams, gels, foams, and sponges;
(C) respiratory saline products;
(D) repealed 3/3/2023;
(E) loratadine;
(F) fexofenadine;
(G) cetirizine;
(H) naloxone;
(I) for any recipient
(i) a
				  preventive service product consistent with
				  7 AAC 110.800;
(ii) a medical countermeasure drug or biological
				  product related to a disaster declaration or declaration of national emergency
				  under 42 U.S.C.
				  5121-
				  5207 (Stafford Disaster Relief and
				  Emergency Assistance Act) or 50 U.S.C. 1601-
				  1651 (National Emergencies Act)
				  authorized for emergency use under
				  21 U.S.C.
				  360bb b-3 (sec. 564, Federal Food, Drug, and
				  Cosmetic Act).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 1 - Prescription Drugs and Medical Supplies › 7 AAC 120.112 - Non-covered drugs

Current through May 31, 2024
Notwithstanding
					 7 AAC 120.110, the department will not pay for
(1) a drug used to treat infertility,
				  obesity, or baldness;
(2) a hair or
				  wrinkle remover;
(3) a drug that is
				  not a covered outpatient drug under
				  7 AAC 120.110(b);
(4) a covered outpatient drug under
				  7 AAC 120.110(b) for which more than a
				  34-day supply is ordered per prescription unless the covered outpatient drug is
				  listed on the department's
Alaska Medicaid 90 Day Generic Prescription
				  Medication List
, adopted by reference in
				  7 AAC 160.900;
(5) a drug used for the symptomatic relief of
				  coughs and colds;
(6) a
				  non-prescription drug, vitamin, or dietary or herbal supplement, except as
				  listed in 7 AAC 120.110(a)(4);
(7) a brand-name covered outpatient drug
				  described in
				  7 AAC 120.110(b) if a therapeutically
				  equivalent generic covered outpatient drug is on the market, unless
(A) the brand-name covered outpatient drug is
				  included as a preferred medication on the
Alaska Medicaid Preferred
				  Drug List
, adopted by reference in
				  7 AAC 160.900; or
(B) the prescriber writes on the prescription
				  "brand-name medically necessary"; the information may be submitted
				  electronically or telephonically; if the information is submitted
				  telephonically, the prescriber must document it in the recipient's record; the
				  department may require prior authorization under
				  7 AAC 120.130 for a brand-name covered outpatient drug
				  with a therapeutically equivalent generic covered outpatient drug on the
				  market; or
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 1 - Prescription Drugs and Medical Supplies › 7 AAC 120.114 - Tamper-resistant prescription requirements

Current through May 31, 2024
(a) If a covered
				  outpatient drug under
				  7 AAC 120.110(b) and payable under
				  Medicaid is not prescribed by electronic transmission in accordance with
				  12 AAC 52.490 or by verbal
				  communication, the prescription for that drug must be submitted on
				  tamper-resistant paper or on plain paper with tamper-resistant features
				  generated through an electronic medical record practice system in order to be
				  paid by the department. Each prescription form must contain the prescriber's
				  National Provider Identifier (NPI) number under
				  45 C.F.R.
				  162.402 -
				  162.414.
(b) The requirements in (a) of this section
				  do not apply to a
(1) prescription for which
				  retroactive Medicaid eligibility has been determined under
				  7 AAC 100.072, except for refills that are filled after
				  the retroactive eligibility determination date; or
(2) prescription prepared in an institutional
				  pharmacy, if the prescriber writes the prescription into the medical record,
				  the medical staff gives the order directly to the institutional pharmacy, and
				  the patient does not handle or have the opportunity to handle the prescription;
				  in this paragraph, "institutional pharmacy" has the meaning given in
				  12 AAC 52.995(a).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 1 - Prescription Drugs and Medical Supplies › 7 AAC 120.120 - Drug use review

Current through May 31, 2024
(a) The purpose of this section is to
				  establish a drug use review program to comply with the requirements of
				  42 U.S.C.
				  1396r-8(g). The drug use
				  review program primarily consists of prospective drug use review, retrospective
				  drug use review, and educational outreach. The purpose of drug use review is to
				  screen for potential drug therapy problems, identify and prevent abuse of
				  prescribed drugs, and prevent inappropriate or unnecessary drug use. This
				  section applies only to the prescription and dispensing of a drug provided to a
				  Medicaid recipient who is not a recipient in a hospital or nursing
				  facility.
(b) As part of the
				  prospective drug use review required in (a) of this section, and before the
				  department will pay a pharmacy, a pharmacist shall make a reasonable effort to
				  review a recipient's drug therapy before a prescription is delivered to the
				  recipient, including obtaining and maintaining the following information for
				  each Medicaid recipient:
(1) name;
(2) address;
(3) telephone number;
(4) date of birth or age;
(5) gender;
(6) medical history, including any current
				  illness, that the pharmacist considers significant;
(7) allergies;
(8) drug reactions;
(9) medications currently used;
(10) medical devices currently
				  used;
(11) the pharmacist's
				  comments relating to the recipient's drug therapy.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 1 - Prescription Drugs and Medical Supplies › 7 AAC 120.130 - Interim and final prior authorization medication lists and limitations on prescribed drugs

Current through May 31, 2024
(a) Except as provided in (c) of this
				  section, a prescribing or dispensing provider must obtain prior authorization
				  from the department for a medically accepted indication before dispensing a
				  drug
(1) identified on the
Alaska
				  Medicaid Prior-authorized Medications
list, adopted by reference in
				  7 AAC 160.900; or
(2) not identified on the
Alaska
				  Medicaid Prior-authorized Medications
list, if
(A) the drug is a new drug that the United
				  States Food and Drug Administration approved after the publication date of that
				  list; or
(B) the department, in
				  consultation with the drug use review committee established under
				  7 AAC 120.120, places the drug on an interim list of
				  drugs for which prior authorization is required.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 1 - Prescription Drugs and Medical Supplies › 7 AAC 120.140 - Preferred drug list

Current through May 31, 2024
(a) The department will pay for preferred
				  drugs on the
Alaska Medicaid Preferred Drug List
, adopted by
				  reference in
				  7 AAC 160.900 and established by the department under
				  this section.
(b) he department
				  will pay for drugs that are identified as nonpreferred on the Alaska Medicaid
				  Preferred Drug List, adopted by reference in
				  7 AAC 160.900, if
(1)
				  the prescriber writes the prescription in accordance with
				  7 AAC 120.112(7);
(2) the pharmacy or dispensing provider is a
				  tribal health program pharmacy or dispensing provider with access to a federal
				  supply of prescription drugs;
(3)
				  the physician or pharmacy obtains a prior authorization for drugs included in
				  the
Alaska Medicaid Prior-authorized Medications List
, adopted
				  by reference in
				  7 AAC 160.900; or
(4) the department gives prior authorization
				  under 7 AAC 120.130(e).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.200 - Enrollment; general provisions; covered items and services

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing durable medical
				  equipment, medical supplies, and related items and services, a provider must
(1) have and maintain a valid business
				  license issued under AS 43.70 and 12 AAC 12;
(2) be enrolled under 7 AAC 105.210 as a
				  durable medical equipment provider, if the provider provides
(A) durable medical equipment;
(B) medical supplies;
(C) respiratory therapy assessment
				  visits;
(D) home infusion therapy
				  services; or
(E) prefabricated
				  off-the-shelf orthotics;
(3) provide to the department evidence at
				  enrollment, and at any other time upon request, that the provider is enrolled
				  as a Medicare provider for durable medical equipment, supplies, and related
				  items and services, and Medicare enrollment is maintained concurrent with
				  Medicaid enrollment;
(4) comply,
				  throughout enrollment, with federal certification standards found in  42 C.F.R. 424.57(c), adopted by reference in 7 AAC 160.900(b); and
(5) notify the department in writing not
				  later than 30 days after the provider has a change in status of any of the
				  requirements of this subsection; the department may sanction or disenroll under
				  7 AAC 105.400 - 7 AAC 105.490 a provider for failing to continuously meet the
				  requirements of enrollment under this section.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.205 - Noncovered items and services

Current through May 31, 2024
(a) Except as
				  provided otherwise in this section or by federal law, the department will not
				  pay separately for durable medical equipment while the recipient is
(1) in a hospital, a skilled nursing
				  facility, or an intermediate care facility; or
(2) receiving hospice care services.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.215 - Purchase of items

Current through May 31, 2024
(a) The department may authorize the purchase
				  of new or used durable medical equipment, medical supplies, prefabricated
				  off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2). The item or service becomes the property of the recipient for
				  whom it is purchased. The enrolled provider shall
(1) transfer ownership of the item, including
				  a warranty, if applicable, to the recipient; and
(2) assure compliance with (j) of this
				  section if the item was previously used.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.220 - Replacement of items

Current through May 31, 2024
(a) Subject to applicable requirements of 7 AAC 120.200 - 7 AAC 120.399, a provider enrolled under 7 AAC 105.210 as a
				  durable medical equipment provider may request a payment and the department may
				  pay for the purchase or rental of replacement durable medical equipment,
				  medical supplies, prefabricated off-the-shelf orthotics, or related items and
				  services under 7 AAC 120.200(a)(2) if the
(1)
				  replacement is necessary to replace an item that that been in continuous use by
				  the recipient for the item's reasonable useful lifetime;
(2) department determines that the item is
				  lost or irreparably damaged;
(3)
				  recipient has not required replacement of the product within the immediate
				  three years due to abuse or neglect of the product;
(4) item is not covered by a manufacturer's
				  warranty; and
(5) provider replaces
				  the item with a like item, and if the original item was rented, continues
				  renting the replacement in accordance with this chapter.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.225 - Rental of items; general provisions

Current through May 31, 2024
(a) Service
				  authorization under 7 AAC 120.210 is required for the following rentals of
				  durable medical equipment:
(1) rental of
				  items for anticipated short-term use indicated as requiring service
				  authorization on the
Alaska Medicaid DMEPOS Fee Schedule, Tables 1-5
				  through 1-9,
adopted by reference in 7 AAC 160.900;
(2) capped rental of items indicated as
				  requiring service authorization on the
Alaska Medicaid DMEPOS Fee
				  Schedule, Tables 1-5 through 1-9
, adopted by reference in 7 AAC 160.900;
(3) continuous rental of
				  items indicated as requiring service authorization on the
Alaska
				  Medicaid DMEPOS Fee Schedule, Tables 1-5 through 1-9,
adopted by
				  reference in 7 AAC 160.900.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.230 - Rental of items; changes during rental periods

Current through May 31, 2024
(a) Except as
				  otherwise provided in this section, an interruption in a rental period affects
				  the department's payment as follows:
(1) a
				  rental period is not affected by an interruption of less than 60 consecutive
				  days, including the days remaining in the rental month in which the use stops;
				  if an interruption continues beyond 60 consecutive days, including the days
				  remaining in the rental month in which use stops, the department will pay for
				  the rental month in which use stopped, but will not make an additional payment
				  until use resumes, a new service authorization request is submitted under 7 AAC 120.210, and a new rental period begins;
(2) rental items for which service
				  authorization has been received, but for which no payment is made, do not apply
				  toward a capped rental period.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.235 - Respiratory therapy equipment, supplies, and assessment visits

Current through May 31, 2024
(a) The
				  department will pay a provider enrolled under
				  7 AAC 120.200 for respiratory therapy equipment and
				  supplies if the
(1) provider employs or
				  contracts with a
(A) registered respiratory
				  therapist who
(i) holds a valid national
				  registry number and certificate from the National Board for Respiratory Care
				  (NBRC) or a certificate from another body that the National Board for
				  Respiratory Care recognizes as a credentialing equivalent; and
(ii) is enrolled as a rendering provider
				  under 7 AAC 105.210; or
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.240 - Enteral and oral nutritional products

Current through May 31, 2024
(a) Subject to
				  applicable requirements of
				  7 AAC 120.200 -
				  7 AAC 120.399, the department will pay a provider
				  enrolled under 7AAC105.210 as a durable medical equipment provider providing
				  durable medical equipment., medical supplies, and prefabricated off-the-shelf
				  orthotics or related items and services under
				  7 AAC 120.200(a)(2) for enteral and
				  oral nutritional products at the rate established in
				  7 AAC 145.420 if the products are
(1) not provided by, or under arrangements
				  made by, a home health agency or hospice program;
(2) prescribed by the attending physician,
				  physician assistant, or advanced practice registered nurse;
(3) certified as medically necessary by the
				  attending physician, physician assistant, advanced practice registered nurse,
				  or dietitian on a form provided by the department; certification of medical
				  necessity must indicate that sufficient caloric or protein intake is not
				  obtainable through regular, liquefied, or pureed food; and
(4) identified as an enteral formula in the
				  United States Department of Health and Human Services, Centers for Medicare and
				  Medicaid Services's (CMS)
Healthcare Common Procedure Coding System
				  (HCPCS)
, adopted by reference in
				  7 AAC 160.900.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.245 - Home infusion therapy

Current through May 31, 2024
(a) The department will enroll a provider of
				  home infusion therapy services if the provider
(1) meets the requirements of this section
				  and 7 AAC 120.200(a);
(2) presents evidence of a pharmacy or
				  pharmacist license issued under AS 08.80; and
(3) documents that it meets the guidelines
				  for pharmacies and pharmacists under
				  12 AAC 52.400 -
				  12 AAC 52.440, on a form provided
				  by the department.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.300 - Enrollment of a prosthetics and orthotics provider; general provisions; covered items and services

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing prosthetics, orthotics,
				  and related items and supplies, a provider must
(1) have and maintain a valid business
				  license issued under AS 43.70 and 12 AAC 12;
(2) be enrolled under 7 AAC 105.210 as a
				  prosthetics and orthotics provider, if the provider provides prosthetics and
				  customized orthotic devices and services;
(3) maintain continuous accreditation or
				  certification by the American Board for Certification in Orthotics,
				  Prosthetics, and Pedorthics, the Board for Orthotist/Prosthetist Certification,
				  the National Examining Board of Ocularists, Inc., or other similar certifying
				  or accrediting agency approved by the department demonstrating applicable
				  professional standards and qualifications;
(4) continuously employ at least one
				  individual who maintains the credentials of Certified Orthotist, Certified
				  Prosthetist, Certified Prosthetist/Orthotist, or Certified Pedorthist and who
				  is in-charge; in this paragraph, "in-charge" means that the individual has the
				  authority and responsibility for the facility's compliance with practice
				  standards at the enrolled provider location;
(5) provide to the department evidence at
				  initial enrollment and upon request that the provider is enrolled as a Medicare
				  provider and Medicare enrollment is maintained concurrent with Medicaid
				  enrollment; and
(6) notify the
				  department in writing not later than 30 days after a change in status of any of
				  the requirements of this subsection; the department may sanction or disenroll
				  under 7 AAC 105.400 - 7 AAC 105.490 a provider for failing to continuously meet
				  the requirements of enrollment under this section.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.305 - Noncovered items and services

Current through May 31, 2024
(a) The department
				  will not pay separately for the repair, return shipping, or preventive
				  maintenance or service of prosthetics or orthotics for which the cost of
				  repair, return shipping, or preventive maintenance or service is included in
				  the rental fee or warranty.
(b) The
				  department will not pay for the repair or preventative maintenance or service
				  of prosthetics or orthotics for which there is no documented medical necessity
				  that is current under 7 AAC 120.200(
/
) for the continued use
				  of that item.
(c) The department
				  will not pay a provider enrolled as a prosthetics and orthotics provider under
				  7 AAC 120.300 for medical supplies that are required under federal law to be
				  provided at no cost to employees, including gloves, masks, and isolation
				  gowns.
(d) The department will not
				  pay for services rendered during any period in which the provider is out of
				  compliance with provider enrollment requirements under 7 AAC 120.300.
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 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.310 - Service authorization; prosthetic or orthotic items or services

Current through May 31, 2024
(a) A provider
				  seeking service authorization must make a request electronically or in writing
				  on a certificate of medical necessity.
(b) Service authorization is required for
(1) items or services indicated as requiring
				  service authorization on the Alaska
Medicaid DMEPOS Fee Schedules,
				  Tables 1-5 through 1-9
, adopted by reference in 7 AAC 160.900,
				  including prosthetic or orthotic items or services;
(2) medical supplies that exceed the maximum
				  units or a 30-day limit set by the department;
(3) items that are identified as
				  miscellaneous in the United States Department of Health and Human Services,
				  Centers for Medicare and Medicaid Services' (CMS)
Healthcare Common
				  Procedure Coding System (HCPCS)
, adopted by reference in 7 AAC 160.900, and that are not unique to prosthetics and customized
				  orthotics;
(4) prosthetic or
				  orthotic items or services if the charge to the department is over $10,000;
				  and
(5) items or services that,
				  based on medical necessity, may need to be replaced before the qualified time
				  that the item or service would be allowed to be replaced otherwise, even if the
				  item or service was not initially identified as requiring a service
				  authorization.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.399 - Definitions

Current through May 31, 2024
In 7 AAC 120.200 - 7 AAC 120.399,
(1) "capped rental" means the rental of
				  durable medical equipment for not more than 13 months;
(2) "custom fabricated orthotic" means an
				  orthotic that is individually made for a specific patient and created using
				  measurements or an impression generally by means of plaster or fiber cast, a
				  digital image using computer aided design-computer aided manufacture (CAD-CAM)
				  systems software, or direct form to patient;
(3) "customized or optimally configured
				  durable medical equipment" means durable medical equipment that is uniquely
				  constructed or substantially modified for a specific recipient in accordance
				  with the description and orders of a physician, a physician assistant, or an
				  advanced practice registered nurse, and that is so different from another item
				  used for the same purpose that the two items cannot be grouped together for
				  pricing purposes;
(4) "durable
				  medical equipment" means equipment that
(A)
				  can withstand repeated use;
(B) is
				  primarily and customarily used to serve a medical purpose;
(C) generally is not useful to an individual
				  in the absence of an illness or injury; and
(D) is appropriate for use in the home,
				  school, or community;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.400 - Transportation provider enrollment

Current through May 31, 2024
To be eligible for payment under 7 AAC 105 - 7 AAC 160 for
					 providing transportation and accommodation services, the provider must
(1) enroll with the department as a provider
				  of transportation or accommodation services in accordance with
				  7 AAC 105.210;
(2) if providing transportation or
				  accommodation services out of state, be enrolled as a Medicaid provider of
				  transportation or accommodation services in the jurisdiction services are
				  provided; and
(3) hold all
				  certificates and licenses required by law to perform the services.
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 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.405 - Transportation and accommodation covered services

Current through May 31, 2024
(a) The department
				  will pay a provider for only those transportation and accommodation services
				  that are
(1) provided to assist the recipient
				  in receiving medically necessary services; and
(2) authorized by the department under
				  7 AAC 120.410 and
				  7 AAC 120.415.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.410 - Prior authorization for nonemergency transportation services

Current through May 31, 2024
(a) The department
				  will pay for the least expensive mode of nonemergency transportation to and
				  from an appointment with the closest appropriate provider for a recipient if
				  the
(1) services are medically necessary and
				  covered under 7 AAC 105 - 7 AAC 160;
(2) provider is enrolled under
				  7 AAC 105.210 at the time the travel occurs;
				  and
(3) recipient does not have
				  transportation available on the recipient's own or through any voluntary
				  source.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.415 - Emergency transportation services

Current through May 31, 2024
(a) The department
				  will pay for medically necessary emergency air or ground transportation to the
				  nearest facility that provides emergency care. If the recipient is an American
				  Indian or Alaska Native, the department will, at the request of the recipient
				  or a family member, pay for medically necessary emergency transportation to the
				  nearest facility operated by a tribal health program that provides emergency
				  care even though the facility is not the nearest facility that provides
				  emergency care.
(b) A claim
				  submitted to the department for payment of costs for emergency transportation
				  service, including ground ambulance and air ambulance service, must be
				  accompanied by written justification of the medical emergency, including
				  medical documentation. A ground ambulance service's documentation of a
				  recipient's medical status and medical services provided may serve as adequate
				  written justification to support a claim for emergency transportation services
				  by a ground ambulance service.
(c)
				  The department will not pay for
(1) emergency
				  air travel in an air ambulance, on a charter airline, or on a commercial
				  airline unless the provider submits to the department medical justification for
				  the service required under (b) of this section no more than two business days
				  following the date that the recipient was transported;
(2) emergency transportation services to
				  return the recipient to a residence or other location.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.420 - Air ambulance services

Current through May 31, 2024
(a) The department
				  will pay for air ambulance services only if
(1) the recipient is being transferred to
				  another community to receive a medically necessary higher level of care not
				  available in the recipient's community; and
(2) the patient is accompanied by
				  appropriately credentialed medical personnel.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.425 - Accommodation services

Current through May 31, 2024
(a) The department
				  will pay for accommodation services, including food and lodging, that are
				  authorized by the department and incurred by a recipient and the recipient's
				  authorized escort who are required to travel to receive necessary medical care
				  and cannot reasonably return to the recipient's home community on the same day.
				  Food is covered only if the lodging provider that is enrolled under 7 AAC 105 -
				  7 AAC 160 provides food.
(b) The
				  department will pay for lodging at an all-inclusive flat rate and for food up
				  to the maximum daily rate established by the department..
(c) The department will not pay for
				  nonessential services as part of accommodation services. Nonessential services
				  include
(1) alcoholic beverages;
(2) pay television;
(3) long distance telephone calls;
(4) tips;
(5) laundry;
(6) dry cleaning;
(7) meals or lodging for a relative or guest
				  who is not serving as an authorized escort.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.430 - Authorized escort

Current through May 31, 2024
(a) The department will approve
				  transportation and accommodation services for an authorized escort to accompany
				  a recipient during travel authorized by the department for medical treatment if
(1) the recipient is 17 years of age or
				  younger; or
(2) the recipient is 18
				  years of age or older and the department determines that the escort is
				  medically necessary for the recipient.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.435 - Prematernal home services

Current through May 31, 2024
(a) The department
				  may enroll a prematernal home as a Medicaid provider tor provide transportation
				  and accommodation services if the prematernal home is licensed to provide
				  lodging, meals, and medically related transportation to
(1) a pregnant woman; or
(2) a woman with a child less than one year
				  of age.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.440 - Mortuary expenditure

Current through May 31, 2024
Medical transportation services include transportation
					 provided by the carrier up to the time death is known or until the deceased
					 recipient, alive at the time of pickup, reaches the source of medical care.
					 Thereafter, transportation expense of the deceased recipient is a mortuary
					 expenditure that is not covered by Medicaid.
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 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.445 - Contracted transportation and accommodation services

Current through May 31, 2024
The department may designate one or more enrolled providers
					 of transportation or accommodation services to serve specific geographic
					 regions, or an agent or organization to manage travel and accommodations
					 services, through a contract for services under AS 36.30, a grant, or other
					 arrangement permitted by law.
Authority:
AS
						47.05.010
AS 47.05.015
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 3 - Transportation and Accommodation Services › 7 AAC 120.490 - Definitions

Current through May 31, 2024
In
					 7 AAC 120.400 -
					 7 AAC 120.490,
(1) "ambulance" means any privately or
				  publicly owned vehicle that is regularly provided or offered to be provided for
				  the emergency transportation of a person suffering from illness, injury, or
				  disability and licensed by the department or local licensing body; police,
				  fire, funeral home, and other vehicles that serve a dual purpose, one of which
				  meets this definition, also may be considered ambulances;
(2) "emergency transportation" means the
				  transportation necessary immediately when a sudden, unexpected occurrence
				  creates a medical emergency;
(3)
				  "escort" means a person who accompanies a recipient to or from a source of
				  medical care; the purpose of the escort accompanying a recipient may be the
				  result of medical necessity or may be due to the age or physical or mental
				  capacity of the recipient; the escort may be medically trained, but medical
				  training is not required; an escort is not compensated by the
				  department;
(4) "food and lodging"
				  means meals and sleeping facilities for the recipient, escort, or both, while
				  the recipient is receiving medical care at a facility away from the place where
				  the recipient regularly resides; "food and lodging" does not include
(A) meals and sleeping facilities provided by
				  friends or relatives of either the recipient or the escort; or
(B) accommodations provided in hospitals or
				  nursing homes;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.010 - Purpose and scope of personal care services; coverage limitations

Current through May 31, 2024
(a) The purpose
				  of 7 AAC 125.010 -
				  7 AAC 125.199 is to establish standards, requirements,
				  and procedures for the personal care services program.
(b) The department will authorize and pay for
				  personal care services that are
(1) provided
				  to a recipient that
(A) experiences
				  functional limitations that
(i) are the result
				  or the recipient's physical condition;
(ii) are confirmed by an assessment of the
				  recipient conducted in accordance with
				  7 AAC 125.020; and
(iii) cause the recipient to be unable to
				  perform, independently or with an assistive device, the activities specified in
				  7 AAC 125.030;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.012 - Initial application for personal care services; reauthorization for personal care services

Current through May 31, 2024
(a) A recipient may apply for personal care
				  services under
				  7 AAC 125.010 -
				  7 AAC 125.199 if that individual
(1) is a current Medicaid
				  recipient;
(2) completes an
				  application in a format provided by the department, with the assistance of
(A) a provider of personal care services that
				  is certified and enrolled under
				  7 AAC 125.060; or
(B) the department;
(3) reviews with the provider or department
				  and completes by signing a rights and responsibilities form provided by the
				  department; the provider shall or department will retain the form in the
				  recipient's file, and provide a copy to the recipient; and
(4) submits to the department a complete
				  application that includes
(A) a release of
				  information, on a form provided by the department;
(B) current information that is not older
				  than one year before the date of the application and is in the form of
(i) verification of the recipient's physical
				  condition specified in
				  7 AAC 125.010(b)(1)(A); the
				  verification must be submitted in a format provided by the department and must
				  be completed by a licensed physician, physician assistant, or advanced practice
				  registered nurse that is qualified to practice under AS 08 or
				  7 AAC 105.200(c); and
(ii) records maintained under
				  7 AAC 105.230(d) that support the
				  recipient's diagnosis and need for physical assistance with ADLs, IADLs, or
				  other services identified in
				  7 AAC 125.030; and
(C) if the recipient has a representative
				  that will manage the recipient's personal care services, a document that
				  identifies the recipient's representative and that representative's authority
				  and responsibility.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.020 - Assessment; levels of assistance

Current through May 31, 2024
(a) Except as
				  specified in
				  7 AAC 125.010(c), the department, using
				  the
Consumer Assessment Tool
adopted by reference in
				  7 AAC 160.900,
(1)
				  will conduct an assessment of a recipient
(A)
				  for an initial application for services unless an assessment is denied under
				  (d) of this section;
(B) after
				  receiving an application for reauthorization under
				  7 AAC 125.012(b), an amendment of the
				  recipient's service level authorization under
				  7 AAC 125.026, or a report under
				  7 AAC 125.028, if a review of materials submitted
				  indicates that another assessment is necessary to evaluate the need to continue
				  the recipient's level of assistance with the activities specified in the
				  recipient's current service level authorization or to alter the service level
				  authorization as requested by an amendment; or
(C) for quality assurance purposes, if the
				  recipient is
(i) selected at random for a
				  quality assurance review; or
(ii)
				  receiving services through a personal care services agency that is the subject
				  of an audit, a program review, or an investigation;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.024 - Personal care services level authorization and reauthorization

Current through May 31, 2024
(a) Using
				  the assessment conducted in accordance with
				  7 AAC 125.020 for each recipient, the department will
(1) determine the total time for personal
				  care services for which the department will pay using the
Personal Care
				  Services: Service Level Computation,
adopted by reference in
				  7 AAC 160.900; and
(2) develop a service level authorization
				  that identifies the specific ADLs, IADLs, and other activities in 7 AAC 125.030
				  that the personal care assistant is authorized to perform to provide the level
				  of assistance approved by the department.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.026 - Amendments to service level authorization

Current through May 31, 2024
(a) The department
				  will modify the time authorized for personal care services if the department
				  determines that a recipient has experienced a change that alters the
				  recipient's need for physical assistance with ADLs, IADLs, or other covered
				  services.
(b) To request an
				  amendment to a service level authorization before the end of the recipient's
				  current authorization period, a personal care services agency must
(1) complete and submit the request in the
				  format provided by the department for that purpose; and
(2) submit all current medical or other
				  relevant documentation that supports the claim that the change alters the
				  recipient's need for physical assistance with ADLs, IADLs, or other covered
				  services.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.028 - Reporting changes

Current through May 31, 2024
(a) Not later than 15 days after the
				  recipient knows of the change, the recipient shall report to the recipient's
				  personal care services agency by telephone, by facsimile transmission, by
				  electronic mail, in writing, or in person,
(1) a change in the recipient's
(A) place of residence or living
				  arrangement;
(B) personal contact
				  information;
(C)
				  representative;
(D) medical
				  provider; or
(E) marital
				  status;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 125 - Medicaid Coverage; Personal Care Services and Home Health Care Services › Article 1 - Personal Care Services › 7 AAC 125.030 - Personal care services; covered services

Current through May 31, 2024
(a) A personal care
				  services provider may only bill for the personal care services identified in
				  this section for a recipient, if those services are
(1) included in the recipient's service level
				  authorization;
(2) provided through
				  either an agency-based or a consumer-directed personal care services program in
				  accordance with
				  7 AAC 125.010 -
				  7 AAC 125.199; and
(3) documented in case notes and verified as
				  received by the recipient on time sheets that must be signed by the recipient,
				  the recipient's representative, or the representative's designee appointed in
				  accordance with
				  7 AAC 125.100(c).