reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 1 - Catastrophic Illness › 7 AAC 48.060 - Required documentation; investigation

Current through May 31, 2024
(a) The division
				  will review each application for completeness, including documentation of
				  medical expenses, gross income, and assets.
(b) If an applicant has previously received
				  catastrophic illness assistance, the applicant must document timely payment of
				  the applicant's share for the previous period of eligibility. An applicant who
				  has not paid the applicant's share for a previous catastrophic illness or who
				  is not following a payment schedule is not eligible for additional
				  assistance.
(c) The division will,
				  in its discretion, request more complete information and contact other sources
				  to verify information contained in an application. By applying for catastrophic
				  illness assistance, an applicant consents to release of confidential and other
				  information to the division.
Authority:
AS
						47.05.010
AS
						47.08.130
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 1 - Catastrophic Illness › 7 AAC 48.070 - Calculation of applicant's share

Current through May 31, 2024
(a) Except as
				  provided in (d) and (g) of this section, the committee will determine the
				  applicant's share according to the following formula:
(40 percent of adjusted gross annual income) + (value of
					 liquid resources - $1,000) + (10 percent of value of nonliquid resources) =
					 applicant's share
(b)
				  Adjusted gross income is determined by subtracting 20 percent of the
				  applicant's gross annual income, and by then subtracting $1,000 for each
				  dependent from the gross annual income.
(c) The value of liquid and nonliquid
				  resources includes all assets of the applicant and his family which are not
				  excluded by
				  AS
				  47.08.060 or this subsection. The following
				  assets are excluded:
(1) not more than five
				  acres of land on which the applicant's permanent place of abode is
				  situated;
(2) repealed
				  8/17/84;
(3) repealed
				  8/17/84;
(4) repealed
				  8/17/84;
(5) $1,000 of liquid
				  assets; liquid assets other than cash are evaluated according to their equity
				  value; and
(6) repealed
				  8/17/84;
(7) repealed
				  8/17/84;
(8) repealed
				  8/17/84;
(9) repealed
				  8/17/84;
(10) 90 percent of
				  nonliquid assets.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 1 - Catastrophic Illness › 7 AAC 48.080 - Standards for reimbursement to providers

Current through May 31, 2024
The department, acting through a fiscal agent, will
					 reimburse providers for medical services rendered to individuals eligible under
					 this chapter in an amount to exceed 100 percent of the total unpaid bills
					 related to the catastrophic illness subject to the following
					 limitations:
(1) Medical bills must be
				  incurred during the 12-month period following the onset of the illness or
				  injury for which assistance is granted; the initial 12-month period begins with
				  the date of the first charges incurred because of the illness, but no charges
				  incurred before July 1, 1976, will be considered;
(2) repealed 8/17/84;
(3) The department will not reimburse a
				  provider for the applicant's share of the total medical expenses; however,
				  reimbursement is conditioned on an agreement by the provider to enter into a
				  payment schedule with the applicant for a period of at least three years to
				  permit repayment of the applicant's share;
(4) The department will reimburse a provider
				  at the rates and in the manner established under 7 AAC 105 - 7 AAC
				  160;
(5) repealed
				  8/17/84;
(6) repealed
				  8/17/84.
Authority:
AS
						47.05.010
AS 47.08.070
AS
						47.08.130
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 1 - Catastrophic Illness › 7 AAC 48.190 - Definitions related to catastrophic illness

Current through May 31, 2024
In
					 7 AAC 48.005 -
					 7 AAC 48.190
(1) "committee" means the Catastrophic
				  Illness Committee, established under
				  AS
				  47.08.020;
(2) "income" means the wages, salaries, tips,
				  and other employee compensation, interest, income, dividends, state and federal
				  income tax refunds, alimony, business income, capital gains, pensions,
				  annuities, rents, royalties, farm income, and other income;
(3) "fiscal agent" means an organization
				  under contract to process provider claims and authorization requests for the
				  division;
(4) "gross annual income"
				  means the gross income for the calendar year in which the applicant applies for
				  catastrophic illness assistance.
Before Register 147, 7/1/98, definitions under this
						section were listed at
						7 AAC 48.900. The history note for this section does not
						reflect the history of definitions formerly located at
						7 AAC 48.900.
Authority:
AS
						47.05.010
AS
						47.08.130
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.500 - Purpose and scope

Current through May 31, 2024
The Chronic and Acute Medical Assistance (CAMA) program is
					 designed to pay, in accordance with
					 AS
					 47.08.150 and this chapter, health care
					 providers who provide covered medical services to eligible chronically ill,
					 needy persons suffering from certain chronic or acute medical conditions who
					 are not eligible for Medicaid under AS 47.07.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.505 - Application

Current through May 31, 2024
(a) An individual, or a person acting on that
				  individual's behalf, may apply for assistance under the CAMA program by
				  submitting a complete identifiable application.
(b) Repealed 11/1/2002.
(c) A caseworker must interview the applicant
				  before eligibility can be determined unless the caseworker determines that an
				  interview is impossible or inadvisable because of illness, distance, or other
				  reason. If an applicant cannot be interviewed, the caseworker may rely on
				  statements of other persons who have knowledge of the applicant's need or
				  circumstances that affect eligibility.
(d) An applicant shall provide adequate
				  evidence to demonstrate the applicant's eligibility and financial need. If
				  there are compelling reasons beyond the control of the applicant or the
				  department why adequate evidence cannot be obtained in a timely manner, and if
				  there is no reasonable cause to doubt statements of fact presented by or on
				  behalf of the applicant, assistance under the CAMA program may be granted
				  before receipt of the necessary evidence, upon approval by the
				  department.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.510 - Eligibility decision

Current through May 31, 2024
The department will make an eligibility determination in
					 accordance with
					 7 AAC 47.050 and
					 7 AAC 47.070, which are adopted by reference as revised
					 as of July 31, 1998.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.515 - Period of eligibility

Current through May 31, 2024
(a) The period of CAMA eligibility is one
				  calendar month, unless the department, in its discretion, extends the
				  eligibility period. However, the department may not extend an eligibility
				  period longer than six consecutive calendar months. At the expiration of the
				  eligibility period, or at any time during the eligibility period when a change
				  is indicated in the recipient's need or circumstances, the department may
				  require a new application and full supporting verification.
(b) Beginning with applications received on
				  or after 11/1/2002, the first calendar month of CAMA eligibility is the
				  calendar month following the calendar month that an eligibility determination
				  is made under
				  7 AAC 48.510. CAMA eligibility is not available for the
				  calendar month of application.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.520 - Report of change

Current through May 31, 2024
A recipient shall comply with
					 7 AAC 47.080, which is adopted by reference as revised
					 as of July 31, 1998.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.525 - General factors of eligibility

Current through May 31, 2024
(a) The department
				  will determine eligibility for CAMA based upon the following:
(1) financial need;
(2) lack of income to meet that financial
				  need;
(3) lack of prior or personal
				  resources;
(4) age;
(5) residency in this state at the time of
				  application;
(6) United States
				  citizenship or status as a legal alien; and
(7) immediate and specific need for covered
				  services under CAMA for medical care and transportation related to the
				  provision of that care.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.530 - Household composition

Current through May 31, 2024
(a) In addition to including the financial
				  need, income, and resources of the applicant, the spouse, child, parent,
				  grandparent, grandchild, or sibling of an applicant for CAMA is liable for the
				  support of that applicant, and will have their financial needs, income, and
				  resources considered in determining financial eligibility of the applicant, if
				  that relative
(1) at the time of application
				  has continuously resided in the same household with the applicant for a period
				  of 30 days or more;
(2) does not
				  maintain a separate residence from the applicant; and
(3) is financially able to provide
				  support.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.535 - Resource eligibility

Current through May 31, 2024
The department will determine a CAMA applicant's access to
					 prior resources available to meet the specific medical need or personal
					 resources in accordance with
					 7 AAC 47.160, which is adopted by reference as revised
					 as of July 31, 1998.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.540 - Income eligibility

Current through May 31, 2024
An applicant for CAMA shall demonstrate financial need in
					 accordance with
					 7 AAC 47.150(b) -(c) and
					 7 AAC 47.155, which are adopted by reference as revised
					 as of July 31, 1998.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.545 - Provision of medical benefits

Current through May 31, 2024
The department will provide a written certification of
					 eligibility for CAMA in accordance with
					 7 AAC 47.180, which is adopted by reference as revised
					 as of July 31, 1998.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.550 - CAMA coverage

Current through May 31, 2024
(a) The department will pay for services
				  furnished to eligible recipients under
				  7 AAC 48.525(b), subject to the limits
				  set out in this section and in
				  7 AAC 48.555 -
				  7 AAC 48.590.
(b) Medical services furnished under the CAMA
				  program are subject to the same limits placed on the amount, duration, and
				  scope of services furnished under the Medicaid program as set out in 7 AAC 105
				  - 7 AAC 160, except as provided in this section.
(c) For services furnished on or after July
				  1, 2004, the department will pay for the services listed in
				  AS
				  47.08.150(c)(1) and (4) only
				  if those services are directly related to the medical condition that makes the
				  recipient eligible under
				  7 AAC 48.525(b).
(d) The department will pay for the following
				  services:
(1) outpatient hospital radiation
				  and chemotherapy services furnished under
				  AS
				  47.08.150(c)(4) that are
				  rendered to a recipient in need of treatment for cancer, if prior authorization
				  for those services is obtained from the department;
(2) prescription drugs and medical supplies,
				  subject to the limits set out in
				  7 AAC 48.560;
(3) physician services furnished in a clinic,
				  physician's office, or an outpatient setting if those services are directly
				  related to the medical condition that makes the recipient eligible under
				  7 AAC 48.525(b).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.555 - Exclusions from the CAMA program

Current through May 31, 2024
For services furnished on or after July 1, 2004, the
					 department will not make a payment under the CAMA program for any expense that
					 is
(1) for major medical
				  care;
(2) for nursing facility
				  care;
(3) for items and services
				  not properly prescribed or determined necessary by a health care provider
				  enrolled with the department;
(4)
				  for a person in the care and custody of a federal, state, or local correctional
				  facility;
(5) for an elective
				  procedure;
(6) for services
				  furnished at no charge to an Indian Health Service beneficiary by an Indian
				  Health Service facility or a facility funded by the Indian Health
				  Service;
(7) not directly related
				  to the treatment of a medical condition listed in
				  7 AAC 48.525(b);
(8) for prescriptions after the first three
				  are filled within a calendar month;
(9) for transportation; or
(10) for physician services if the physician
				  services are furnished in an inpatient hospital or in a nursing
				  facility.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.560 - Limited reimbursement for prescribed drugs and medical supplies

Current through May 31, 2024
(a) Except as
				  provided in this section, the department will pay for prescribed drugs and
				  medical supplies in accordance with
				  7 AAC 47.271, revised as of July 31, 1998, adopted by
				  reference.
(b) Subject to
				  7 AAC 48.550(c), for prescriptions
				  filled or refilled on or after July 1, 2004, payment for prescribed drugs is
				  limited to three prescriptions filled or refilled in a calendar
				  month.
(c) On or after July 1,
				  2004, payment for medical supplies is limited to a 30-day supply of supplies
				  necessary for the monitoring or treatment of the medical condition that makes
				  the recipient eligible under
				  7 AAC 48.525(b).
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.565 - Length of hospitalization (Repealed)

Current through May 31, 2024
Repealed 9/20/2003.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.570 - Responsibility of recipient

Current through May 31, 2024
(a) The recipient
				  bears the responsibilities listed in
				  7 AAC 47.220(a), and is responsible for
				  all charges incurred for services that are not covered under 7 AAC 48 and the
				  charges listed in
				  7 AAC 47.220(b).
(b) The department will restrict a
				  recipient's choice of provider in accordance with
				  7 AAC 47.220(c).
(c) The department will pay a provider or
				  health facility in accordance with
				  7 AAC 47.220(d).
(d) In this section,
				  7 AAC 47.220 is adopted by reference, as revised as of
				  July 31, 1998.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.575 - Third-party liability

Current through May 31, 2024
An applicant for CAMA shall provide information and assign
					 rights as described for the General Relief Medical program at
					 7 AAC 47.260, which is adopted by reference as revised
					 as of July 31, 1998.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.580 - Responsibilities of provider

Current through May 31, 2024
Health care providers under the CAMA program are bound by
					 the provisions of
					 7 AAC 48.500 -
					 7 AAC 48.900 and the provisions of 7 AAC 105 - 7 AAC
					 160. If the provisions of
					 7 AAC 48.500 -
					 7 AAC 48.900 conflict with provisions of 7 AAC 105 - 7
					 AAC 160, the provisions of
					 7 AAC 48.500 -
					 7 AAC 48.900 take precedence over the provisions of 7
					 AAC 105 - 7 AAC 160 when the service is being provided under the CAMA
					 program.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.585 - Reimbursement of provider

Current through May 31, 2024
(a) Claims for
				  payment must be filed with the fiscal intermediary on contract with the
				  department within 12 months of the date of service to be considered for
				  payment.
(b) Payment will be made
				  in the amount determined under the provisions of 7 AAC 105 - 7 AAC
				  160.
(c) Repealed
				  9/20/2003.
(d) Payment provided by
				  the department represents full and total reimbursement for those covered
				  services authorized under the CAMA program. By accepting reimbursement from the
				  department, the provider of services covered by the CAMA program agrees not to
				  charge the recipient for any difference between the amount billed and the
				  amount received in payment from the department, except charges for which the
				  recipient is responsible under
				  7 AAC 48.570(a).
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.590 - Payment made directly to the provider

Current through May 31, 2024
The department will pay the provider directly for medical
					 services under the CAMA program. The department will not make payments directly
					 to the recipient.
Authority:
AS
						47.05.010
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 2 - Chronic and Acute Medical Assistance › 7 AAC 48.598 - Incorporation of definitions from 7 AAC 47.290 (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 48 - Catastrophic Illness and Chronic and Acute Medical Assistance › Article 3 - General Provisions › 7 AAC 48.900 - Definitions

Current through May 31, 2024
In this chapter,
(1) "CAMA" means chronic and acute medical
				  assistance;
(2) "correctional
				  facility" has the meaning given in
				  AS
				  11.81.900;
(3) "department" means the Department of
				  Health and Social Services;
(4)
				  "disability" means being unable to or the inability to engage in substantial
				  gainful activity by reason of a medically determinable physical or mental
				  impairment that can be expected to result in death or that has lasted or can be
				  expected to last for a continuous period of not less than 12 months;
(5) "division" means the division of public
				  assistance in the Department of Health and Social Services;
(6) "elective procedure" means a procedure
				  that is subject to the choice or decision of the patient or health care
				  provider regarding medical services that are advantageous to the patient but
				  not necessary to prevent the death or disability of the patient;
(7) "identifiable application" means an
				  application form that contains at least the applicant's name, mailing address,
				  and signature or witnessed mark;
(8) "juvenile detention facility" has the
				  meaning given in AS 47.14.900;
(9)
				  "major medical care" means non-elective inpatient hospital services that cannot
				  be performed on an outpatient basis and that are the result of a condition
				  listed in 7 AAC 48.525(b)
				  that has been certified as life threatening or disabling; "major medical care"
				  does not include inpatient psychiatric hospital services;
(10) "prescribed drugs" means a simple or
				  compound substance, or mixtures of substances, prescribed for the cure,
				  mitigation, or prevention of disease, or for health maintenance that is
				  prescribed by a physician or other licensed practitioner of the healing arts
				  within the scope of practice as defined and limited by federal and state law,
				  and is dispensed by a licensed pharmacist on a valid prescription that is
				  recorded and maintained in the pharmacist's records; "prescribed drugs" also
				  includes chemotherapy provided on an outpatient basis;
(11) "recipient" means an individual who is
				  financially eligible for CAMA and who may receive a covered medical service if
				  determined to be eligible to receive the service;
(12) "residency" has the same meaning as in
				  AS 01.05.055.
Authority:
AS
						47.05.010
AS 47.08.130
AS
						47.08.150
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.010 - Hearing; special provisions

Current through May 31, 2024
(a)
(a) Except as expressly stated in this
				chapter, hearings for recipients of financial, food, or medical assistance
				granted by the department in the following programs are conducted under
				AS
				44.64.060 and
				2 AAC 64.100 -
				2 AAC 64.990:
(1)
				General Relief Assistance (GRA);
(2) General Relief Medical (GRM);
(3) Chronic and Acute Medical Assistance
				(CAMA);
(4) adult public assistance
				(APA);
(5) Medicaid, including
				personal care services and home and community-based waiver services;
(6) Alaska Temporary Assistance Program
				(ATAP);
(7) Women, Infant and
				Children (WIC);
(8) food
				stamps;
(9) child care
				assistance;
(10) heating
				assistance.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.020 - Opportunity for hearing

Current through May 31, 2024
An opportunity for a hearing must be granted to a recipient
				  whose
(1) request for financial, food,
				or medical assistance is denied or is not acted upon with reasonable
				promptness; or
(2) financial, food,
				or other medical assistance benefits are suspended, terminated, or
				reduced.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.030 - Request for hearing

Current through May 31, 2024
(a) Unless otherwise provided in federal law,
				a request for a hearing within the scope of
				7 AAC 49.020 must be made to the department in writing
				by a recipient, or by a legal representative acting on the recipient's behalf,
				not later than 30 days after the date of the notice required under
				7 AAC 49.060. A hearing request may be accepted after
				the time limit under this section only if the administrative law judge finds,
				based on the evidence submitted, that the request for a hearing could not be
				filed within the time limit.
(b)
				Unless the request is denied under
				7 AAC 49.080, the department will refer the matter to
				the office of administrative hearings (AS
				44.64.010)  as provided under
				AS
				44.64.060 and
				2 AAC 64.120.
(c) Other than a care coordinator, a service
				provider may not request a hearing for a recipient if it concerns services by
				that provider or if the outcome of the hearing affects the level of paid
				services to that provider.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.060 - Notice of proposed agency action

Current through May 31, 2024
The department will give written notice to the recipient not
				  later than 10 days before the date the department intends to take action
				  denying, reducing, suspending, or terminating assistance, unless
(1) factual evidence exists of the death of
				the recipient;
(2) a recipient
				indicates in writing that the recipient no longer desires assistance, or gives
				information that requests termination or reduction of assistance and also
				indicates in writing that the recipient understands the consequences of
				reporting this information;
(3) a
				recipient has been admitted or committed to an institution in which residents
				are not eligible for assistance of the type the recipient has been
				receiving;
(4) the recipient's
				whereabouts are unknown and department mail directed to the recipient's last
				known address has been returned by the post office indicating no known
				forwarding address;
(5) factual
				evidence exists that a recipient has been accepted for assistance in another
				jurisdiction;
(6) a change in the
				level of medical care is prescribed by the recipient's physician;
(7) the notice involves an adverse
				determination made with regard to the preadmission screening requirements of
				42 U.S.C.
				1396 r(e)(7) (sec. 1919(e)(7) of the Social
				Security Act); or
(8) federal
				regulations governing the Medicaid or food stamp programs specify shorter
				notice time limits or allow advance notice to be waived for certain groups of
				recipients.
Authority:
AS
					 47.05.010
AS 47.25.170
AS
					 47.25.460
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.070 - Contents of notice regarding denial, reduction, suspension, or termination of benefits

Current through May 31, 2024
In a written notice provided under
				  7 AAC 49.060 of a department action to deny, reduce,
				  suspend, or terminate assistance, and unless otherwise specified in applicable
				  federal regulations, the department will state in the written notice the
				  reasons for the proposed action, including the statute, regulation, or policy
				  upon which that action is based. In the notice the department also will inform
				  the recipient
(1) of the recipient's
				right to a hearing;
(2) how to
				request a hearing;
(3) that if
				requested the department will assist the recipient in making a hearing
				request;
(4) by whom the recipient
				may be represented or assisted; and
(5) the conditions, if any, under which
				assistance may continue if a hearing is requested.
Authority:
AS
					 47.05.010
AS 47.25.130
AS 47.25.170
AS
					 47.25.460
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.080 - Time and place of hearing

Current through May 31, 2024
Not later than 10 days after the department receives a
				  hearing request, the department will either
(1) deny the request in writing for reasons
				allowed by law, stating the reasons as required under
				AS
				44.64.060(b) and
				2 AAC 64.130, and forward notice of that denial to the
				party who requested the hearing and the office of administrative hearings
				(AS
				44.64.010); or
(2) grant the request and immediately refer
				the request for hearing to the office of administrative hearings for scheduling
				of a hearing or other appropriate proceeding.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.090 - Group hearings

Current through May 31, 2024
The administrative law judge may consolidate a series of
				  individual requests for hearing by conducting a single group hearing if the
				  sole issue involved is one of state or federal law or policy, or changes in
				  state or federal law or policy. A consolidation of requests does not affect the
				  right of a member of the group to withdraw from the group before or during the
				  group hearing in favor of an individual hearing, and does not affect the right
				  of each member of the group to present the member's own case or be represented
				  by the member's authorized representative at the group hearing. The
				  administrative law judge shall inform each individual affected by a
				  consolidation of requests that a consolidation has been made and that the right
				  to individual withdrawal exists.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.100 - Denial or dismissal of hearings

Current through May 31, 2024
The administrative law judge shall deny or dismiss a hearing
				  request or terminate a hearing if
(1)
				the issues by which the recipient is aggrieved are not those set out in
				7 AAC 49.020;
(2) the recipient withdraws the request in
				writing or orally on the record;
(3) the sole issue is one of state or federal
				law requiring automatic benefit adjustments affecting groups of recipients or
				all recipients, and the issue is not one of incorrect benefit
				computation;
(4) the recipient
				fails, without good cause as determined by the administrative law judge, to
				appear in person, telephonically, or by authorized representative at the
				scheduled hearing; or
(5) the
				appeal was untimely under
				7 AAC 49.030.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.115 - Access to agency records

Current through May 31, 2024
(a) After granting
				a request for a hearing under
				7 AAC 49.080, the department will provide the recipient
				and the administrative law judge with a position statement. In the position
				statement the department will include a
(1)
				summary of the proposed action and the reasons for the proposed
				action;
(2) copy of each law the
				department is relying upon to support its proposed action; and
(3) copy of each document the department is
				relying upon to support its proposed action.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.120 - Conduct of hearings

Current through May 31, 2024
During a hearing under this chapter,
(1) the recipient has the right to
				self-representation, representation by an attorney, or the assistance of an
				agent under a power of attorney, a guardian, a family member, a friend, or
				another person who may be helpful in the presentation of the case;
(2) the department has the right to
				self-representation or representation by an attorney; and
(3) the recipient, the department, the
				recipient's authorized representative, or a person who has been designated to
				assist the recipient has the right to
(A)
				present witnesses and documents relevant to the case;
(B) establish facts and advance arguments
				relevant to the case;
(C) question
				or refute testimony or evidence, including the opportunity to confront and
				cross-examine adverse witnesses; and
(D) request a de novo review in a hearing
				related to the administration of the Medicaid program.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.135 - Burden of proof

Current through May 31, 2024
For actions involving termination or reduction of benefits,
				  the burden of proving evidence supporting the termination or reduction is on
				  the department and is by a preponderance of evidence, unless otherwise provided
				  by law. For a request for new or additional benefits, the burden of proof is on
				  the applicant or recipient requesting the service, and is by a preponderance of
				  evidence.
Authority:
AS
					 47.05.010
AS 47.25.180
AS
					 47.25.460
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.140 - Medical evidence in Medicaid hearings

Current through May 31, 2024
In hearings brought under AS 47.07 or 7 AAC 105 - 7 AAC 160,
				  if an administrative law judge finds that a medical assessment is necessary,
				  the administrative law judge may order the assessment at department expense as
				  provided in 42 C.F.R.
				  431.240(b). Payment at
				  department expense will be made in accordance with Medicaid payment rates and
				  conditions under 7 AAC 145.
Authority:
AS
					 47.05.010
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.150 - Hearing and final decision authority

Current through May 31, 2024
(a) For hearings
				under this chapter, the hearing authority is with the administrative law judge
(1) that the office of administrative
				hearings (AS 44.64.010)  assigns to the
				matter, subject to
				2 AAC 64.170; and
(2) who conducts the hearing on behalf of the
				commissioner.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.170 - Limits of the hearing authority

Current through May 31, 2024
Unless the applicant or recipient has requested a de novo
				  review under the Medicaid program, or if otherwise specified under applicable
				  federal regulations, the scope of the administrative law judge's review is
				  limited to ascertaining whether
(1)
				the laws and policies have been properly applied in the case according to the
				record as it existed at the time the initial decision was made, and as
				supplemented by evidence admitted in the hearing; and
(2) whether the computation of the benefit
				amount, if in dispute, is in accordance with the laws and policies in effect at
				the time the decision was made.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.180 - Proposed and final decisions

Current through May 31, 2024
Except as otherwise specified in applicable federal
				  regulations, and unless the period is extended by mutual agreement of the
				  recipient and the department and approved by the assigned administrative law
				  judge, the administrative law judge shall issue the proposed decision required
				  under AS
				  44.64.060(d) in time to
				  allow the commissioner or commissioner's delegee to issue a final decision as
				  described in 7 AAC 150(c) not later than 90 days after the date on which the
				  department received the request for a hearing.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.190 - Continuation of assistance

Current through May 31, 2024
Except as otherwise specified in applicable federal
				  regulations, a recipient of assistance other than General Relief, General
				  Relief Medical, or Chronic and Acute Medical assistance that continues to
				  satisfy all eligibility criteria other than those at issue in the hearing
				  request will, upon filing that hearing request, have the assistance reinstated
				  retroactively or continued until the date that the final decision is issued,
				  unless the recipient informs the department that the recipient does not want to
				  receive continuing assistance.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.200 - Liability if assistance is continued

Current through May 31, 2024
If a request for a hearing has caused a recipient's
				  assistance to be reinstated or continued pending the hearing under
				  7 AAC 49.190, and if the final decision is that the
				  department action at issue was correct, the administrative law judge may order
				  the recipient to repay the assistance provided during the hearing process.
				  Nothing in this section limits the ability of the department to seek recoupment
				  of assistance paid as authorized under state or federal law.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.210 - Retroactive assistance

Current through May 31, 2024
If the final decision is that the department action at issue
				  was in error, the department will provide assistance retroactive to the
				  effective date of the erroneous denial, suspension, termination, or
				  reduction.
Authority:
AS
					 47.05.010
AS 47.25.180
AS 47.25.460
AS
					 47.27.080
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.240 - Decisions public

Current through May 31, 2024
Subject to state and federal statutes and regulations
				  safeguarding public assistance information, hearing decisions of the department
				  are public information.
Authority:
AS
					 47.05.010
AS 47.05.020
AS
					 47.05.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.250 - Confidentiality

Current through May 31, 2024
(a) Recordings of hearings, transcripts
				created from those recordings, and exhibits and other documents submitted to
				the office of administrative hearings in connection with a matter heard under
				this chapter are confidential and are not subject to public disclosure without
				consent of the Medicaid or public assistance recipient, or by order of the
				assigned administrative law judge or a court of competent
				jurisdiction.
(b) Final decisions
				issued in matters heard under this chapter may be made publicly available if
				first redacted to remove information identifying the recipient, the recipient's
				family, and the recipient's employer.
Authority:
AS
					 47.05.010
AS 47.05.020
AS
					 47.05.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 3 - Public Assistance and Medical Assistance › Chapter 49 - Hearings › 7 AAC 49.900 - Definitions

Current through May 31, 2024
In this chapter, unless the context requires
				  otherwise,
(1) "administrative law
				judge" has the meaning given in
				AS
				44.64.200;
(2) "adult public assistance" means the
				program administered under
				AS
				47.25.430-47.25.615 and 7 AAC 40;
(3) "Alaska Temporary Assistance Program"
				means the program administered under AS 47.27 and 7 AAC 45;
(4) "applicant" means a person who completes
				or had an application submitted on the person's behalf for public assistance or
				medical assistance under one of the programs listed in
				7 AAC 49.010;
(5) "child care assistance" means the program
				administered under AS 47.25, 7 AAC 41, and
				7 AAC 45.258;
(6) "Chronic and Acute Medical Assistance"
				means the program administered under
				AS
				47.08.150 and
				7 AAC 48.500 -
				7 AAC 48.900;
(7) "commissioner" means the commissioner of
				health and social services;
(8)
				"department" means the Department of Health and Social Services;
(9) "food stamp program" means the program
				administered under
				AS
				47.25.975-47.25.990 and 7 AAC 46;
(10) "General Relief Assistance" means the
				program administered under
				AS
				47.25.120-47.25.300 and 7 AAC 47;
(11) "General Relief Medical" means the
				program administered under
				AS
				47.25.120-47.25.300 and
				7 AAC 47.200 -
				7 AAC 47.290;
(12) "heating assistance" means the program
				administered under
				AS
				47.05.010,
				AS
				47.25.621-47.25.626, and 7 AAC 44;
(13) "Medicaid" means the program
				administered under AS 47.07 and 7 AAC 105 - 7 AAC 160;
(14) "recipient" means an applicant for, a
				recipient of, or a person that requests an application for public assistance or
				medical assistance under one of the programs listed in
				7 AAC 49.010.
Authority:
AS
					 25.23.230
AS
					 47.05.010
Alaska Administrative Code › Title 7 - Health and Social Services › Part 4 - Children's Services and Juvenile Justice › Chapter 50 - Community Care Licensing › Article 1 - Licensing Process › 7 AAC 50.005 - Applicability

Current through May 31, 2024
(a) The provisions of this chapter apply to a
				  residential child care facility licensed or required to be licensed by the
				  Department of Health under
				  AS
				  47.10.300 and
				  47.10.392;
				  AS
				  47.32.020; or
				  AS
				  47.80.140.
(b) In the event of a conflict between a
				  generally applicable requirement and a specific requirement applicable to a
				  particular facility, the requirement specifically applicable to the facility
				  applies.
Authority:
AS
						44.29.020
AS
						47.32.030
Alaska Administrative Code › Title 7 - Health and Social Services › Part 4 - Children's Services and Juvenile Justice › Chapter 50 - Community Care Licensing › Article 1 - Licensing Process › 7 AAC 50.010 - Exemptions from licensure requirements

Current through May 31, 2024
(a) The following
				  persons are exempt from the licensure requirements of AS 47.32 and this
				  chapter:
(1) a person caring for a child in
				  the child's own home, whether related to the child or not;
(2) repealed 7/1/2022;
(3) a person operating a residential child
				  care facility on a United States Department of Defense installation or on a
				  federal reserve;
(4) a person
				  licensed as an assisted living home under AS 47.33 who admits a child for care
				  depending on an evaluation of
(A) the number,
				  ages, needs, and characteristics of children that the facility intends to admit
				  for care;
(B) the physical
				  accommodations, staff qualifications, plan for supervision, and health and
				  safety provisions; and
(C) the
				  proposed length of stay of children in the program;
(5) a person providing boarding care
				  exclusively for children 16 years of age and older if
(A) each parent of a child has agreed to the
				  placement of the child in a home selected by the school in which the child is
				  enrolled; and
(B) the person
				  providing the boarding care has, for each child in care, an authorization for
				  emergency medical care; and
(6) repealed 7/1/2022;
(7) repealed 7/1/2022;
(8) a person operating a foster home without
				  a license issued under this chapter, if that home provides care only for one or
				  more minor children of any age placed by a parent or guardian who, through a
				  power of attorney in accordance with AS 13.26.023, has delegated powers to that
				  person regarding the care and custody of each minor child.