reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 5 - Payment Rates; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Transportation; Laboratory Services › 7 AAC 145.420 - Durable medical equipment, supplies, prosthetics, orthotics, and respiratory therapy payment rates

Current through May 31, 2024
(a) Payment by the department to a provider
				  enrolled under 7 AAC 105.210 as a durable medical equipment provider will be
				  made in accordance with this section.
(b) A provider enrolled under 7 AAC 105.210
				  as a durable medical equipment provider providing durable medical equipment,
				  medical supplies, prefabricated off-the-shelf orthotics, or related items and
				  services under 7 AAC 120.200(a)(2) to eligible recipients may submit, as
				  follows, claims covered in the
Healthcare Common Procedure Coding
				  System (HCPCS),
adopted by reference in 7 AAC 160.900, for which a
				  rate or rate methodology has been established by CMS or the department or for
				  covered codes with rate-setting methodologies set out in (c) - (e) of this
				  section:
(1) payment rates set by the
				  department for items and services provided by enrolled providers to recipients
				  physically located in this state will be based on 100 percent of the current
				  quarter's Medicare DMEPOS Fee Schedule established by CMS for these items and
				  services in this state;
(2) payment
				  rates set by the department for items and services provided to recipients when
				  the recipient is physically located outside of this state will be based on 100
				  percent of the current quarter's Medicare DMEPOS Fee Schedule established by
				  CMS for these items and services in the state where the item or service was
				  provided;
(3) payment rates set by
				  the department for items and services not established on the current quarter's
				  Medicare DMEPOS Fee Schedule will be based on the methodology set out in (c) -
				  (f) of this section.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 5 - Payment Rates; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Transportation; Laboratory Services › 7 AAC 145.421 - Prosthetics and orthotics payment rates

Current through May 31, 2024
(a) Payment by the
				  department to a provider that is enrolled under 7 AAC 120.300 as a prosthetics
				  and orthotics provider will be made in accordance with 7 AAC 145.020.
(b) A provider enrolled under 7 AAC 120.300 as a prosthetics and orthotics provider providing prosthetics,
				  orthotics, related medical equipment, items, and supplies to eligible
				  recipients may submit claims covered by the
Healthcare Common Procedure
				  Coding System (HCPCS)
, adopted by reference in 7 AAC 160.900, for
				  which a rate has been established by CMS or the department or for covered codes
				  with rate-setting methodologies set out in (c) - (e) of this section, as
				  follows:
(1) payment rates set by the
				  department for items and services provided by providers enrolled under 7 AAC 120.300 to recipients physically located in this state will be based on 100
				  percent of the current quarter's Medicare DMEPOS Fee Schedule established by
				  CMS for these items and services in this state, except items and services
				  billable only by providers enrolled under 7 AAC 120.300 will be based on 120
				  percent of the current quarter's Medicare DMEPOS Fee Schedule established by
				  CMS for these items and services in this state;
(2) payment rates set by the department for
				  items and services provided by providers enrolled under 7 AAC 120.300 who
				  provide services to recipients when the recipients are physically located
				  outside of this state will be based on 100 percent of the current quarter's
				  Medicare DMEPOS Fee Schedule established by CMS for these items and services in
				  the state where the item or service was provided; the department will base
				  location on the provider's Medicare accreditation location address;
(3) payment rates set by the department for
				  items and services not established on the current quarter's Medicare DMEPOS Fee
				  Schedule established by CMS will be based on the rate-setting methodology set
				  out in (c) - (f) of this section.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 5 - Payment Rates; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Transportation; Laboratory Services › 7 AAC 145.425 - Home infusion therapy payment rates

Current through May 31, 2024
(a) Except as
				  otherwise provided in this section, when the only home infusion therapy service
				  being provided is skilled nursing, the department will pay a provider of home
				  infusion therapy services for skilled nursing services in accordance with
				  7 AAC 145.020, not to exceed 85 percent of the amount
				  determined under
				  7 AAC 145.050 per visit.
(b) The department will pay a provider on a
				  per diem basis, for the duration of the therapy period, for home infusion
				  therapy services and specialty drug administration when the home infusion
				  therapy includes the concurrent delivery of home infusion administrative
				  services, professional pharmacy services, care coordination, and necessary
				  supplies and equipment; the per diem amount is determined as follows:
(1) the department will pay a percentage of
				  the maximum allowed amount under (2) and (3) of this subsection that is
(A) 100 percent for the first administered
				  therapy;
(B) 80 percent for the
				  second concurrently administered therapy; and
(C) 75 percent for the third and each
				  subsequent concurrently administered therapy;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 5 - Payment Rates; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Transportation; Laboratory Services › 7 AAC 145.440 - Transportation and accommodation services payment rates

Current through May 31, 2024
(a) The department
				  will pay for transportation and accommodation services in accordance with
				  7 AAC 145.020, not to exceed the maximum amount
				  identified in the
Transportation/Accommodation Fee Schedule
table, adopted by reference in
				  7 AAC 160.900. For state fiscal year 2020, the payment
				  rates will be 95 percent of the state fiscal year 2019 payment rates. The
				  services paid at 1 (10 percent of hilled charges during state fiscal year 2019,
				  will continue to be paid at 100 percent of billed charges during state fiscal
				  year 2020.
(b) The department will
				  pay for air ambulance services under (a) of this section with the following
				  limitations:
(1) payment for mileage will be
				  based on patient-loaded statute miles from the point of patient pick-up to the
				  destination city;
(2) the point of
				  patient pick-up determines whether the air ambulance is paid at urban or rural
				  rates as provided in the
Transportation/Accommodation Fee
				  Schedule
table, adopted by reference in
				  7 AAC 160.900;
(3) if a flight included multiple patients,
				  the department will split the cost of the flight among the occupants if all
				  patients are not Medicaid recipients;
(4) if a flight includes multiple patients
				  and all patients are Medicaid recipients, the department will pay the
				  appropriate rate established in (a) of this section for the first recipient and
				  a flat rate of $500 for each additional recipient;
(5) if a patient dies while the air ambulance
				  is en route to the pick-up location, the department will pay the ambulance at
				  the base-rate, lift-off fee only.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 5 - Payment Rates; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Transportation; Laboratory Services › 7 AAC 145.460 - Laboratory services payment

Current through May 31, 2024
(a) The department
				  will pay for laboratory services provided in state by an independent laboratory
				  in accordance with 7 AAC 145.020, at the rate established for Medicare in  42 C.F.R. 405.515, adopted by reference in 7 AAC 160.900; laboratory services for
				  which no rate is established will be paid at a rate established under 7 AAC 145.050(e).
(b) The department will
				  pay for laboratory services provided out of state by an independent laboratory
				  in accordance with
				  7 AAC 145.025, not to exceed the maximum amount
				  identified in (a) of this section.
(c) Routine collection of venous blood by
				  venipuncture performed with a surgical or laboratory procedure is considered
				  incidental to that procedure and is not paid separately.
(d) The department will not pay for the
				  handling or conveyance of a specimen for transfer from the physician's office
				  or from the patient in other than the physician's office to a laboratory. These
				  procedures are considered incidental to the other services performed for the
				  patient.
(e) For state fiscal year
				  2020, payment rates for laboratory services will be 95 percent of the payment
				  rates established in (a) of this section starting on the later date of August
				  1, 2019, or after a 30 day notice to the providers, for providers who are not
				  enrolled in the Medicaid Management Information System (MMIS) as the provider
				  types or provider specialties listed in 7 AAC 145.050(c) and who are identified
				  as the rendering provider on the claims submitted to the Medicaid Management
				  Information System (MMIS).
Authority:
AS
						47.05.010
AS
						47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 6 - Payment Rates; Personal Care, Community First Choice, and Home Health Care Services › 7 AAC 145.500 - Personal care and Community First Choice services payment rates

Current through May 31, 2024
(a) For providing
				  personal care services under
				  7 AAC 125.010 -
				  7 AAC 125.199 and Community First Choice services under
				  7 AAC 127, the department will pay a unit of service at the lesser of
(1) payment rates established in the
				  department's
Chart of Personal Care Services, Community First Choice
				  Services Rates
, adopted by reference in
				  7 AAC 160.900; or
(2) the amount charged by the provider in
				  accordance with
				  7 AAC 145.020.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 6 - Payment Rates; Personal Care, Community First Choice, and Home Health Care Services › 7 AAC 145.510 - Home health care services rate

Current through May 31, 2024
Unless otherwise provided in 7 AAC 105 - 7 AAC 160, the
					 department will pay at a rate of 80 percent of the provider's charges that are
					 billed in accordance with
					 7 AAC 145.020.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 7 - Payment Rates; Home and Community-Based Waiver Services › 7 AAC 145.520 - Home and community-based waiver services payment rates

Current through May 31, 2024
(a) The department
				  will pay a home and community-based waiver services provider in accordance with
				  the rates and methodologies set out in this section.
(b) For care coordination services provided
				  under 7 AAC 130.240,
(1) the department will pay a unit of service
				  at the lesser of the
(A) amount charged by
				  the provider to the public; or
(B)
				  rates established in the department's
Chart of Waiver Services
				  Rates
, adopted by reference in
				  7 AAC 160.900;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 7 - Payment Rates; Home and Community-Based Waiver Services › 7 AAC 145.525 - Re-establishing and adjusting payment rates in the department's rate charts

Current through May 31, 2024
(a) The payment
				  rates in the department's
Chart of Waiver Services Rates,
adopted by reference in
				  7 AAC 160.900, will be re-established at least every
				  four years using the department's
Rate-Setting Methodology for Personal
				  Care Services, Community First Choice Services, Long-Term Services and Supports
				  Targeted Case Management Services, and Waiver Services,
adopted by
				  reference in
				  7 AAC 160.900, as follows:
(1) rates for personal care services under
				  7 AAC 125.010 -
				  7 AAC 125.199, Community First Choice services under 7
				  AAC 127, adult day services under
				  7 AAC 130.250, day habilitation services under
				  7 AAC 130.260, residential habilitation services under
				  7 AAC 130.265, employment services under
				  7 AAC 130.270, intensive active treatment services under
				  7 AAC 130.275, respite care services under
				  7 AAC 130.280, and meal services under
				  7 AAC 130.295, will be re-established using annual
				  reports in 7 AAC 145.531, as described in the
				  department's
Rate-Setting Methodology for Personal Care Services,
				  Community First Choice Services, Long-Term Services and Supports Targeted Case
				  Management Services, and Waiver Services,
adopted by reference in
				  7 AAC 160.900;
(2) rates for care coordination services under
				  7 AAC 130.240 will be reestablished as described in the
				  department's
Rate-Setting Methodology for Personal Care Services,
				  Community First Choice Services, Long-Term Services and Supports Targeted Case
				  Management Services, and Waiver Services,
adopted by reference in
				  7 AAC 160.900, and using sources that include the
				  Department of Labor and Workforce Development, Research and Analysis Section,
				  and the United States Internal Revenue Service;
(3) rates for residential supported-living
				  services under
				  7 AAC 130.255 will be re-established as described in the
				  department's
Rate-Setting Methodology for Personal Care Services,
				  Community First Choice Services, Long-Term Services and Supports Targeted Case
				  Management Services, and Waiver Services,
adopted by reference in
				  7 AAC 160.900, and using long-term care facility
				  Medicare cost reports;
(4) rates
				  for transportation services under
				  7 AAC 130.290(a) will be reestablished
				  as described in the department's
Rate-Setting Methodology for Personal
				  Care Services, Community First Choice Services, Long-Term Services and Supports
				  Targeted Case Management Services, and Waiver Services,
adopted by
				  reference in
				  7 AAC 160.900.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 7 - Payment Rates; Home and Community-Based Waiver Services › 7 AAC 145.530 - Home and community-based waiver services; nursing facility and ICF/MR level-of-care determination of administrative and general cost rates (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 7 - Payment Rates; Home and Community-Based Waiver Services › 7 AAC 145.531 - Personal care services, Community First Choice services, or home and community-based waiver services accounting and reporting

Current through May 31, 2024
(a) For personal
				  care services under
				  7 AAC 125.010-7 AAC 125.199, Community First Choice services under 7 AAC
				  127, adult day services under
				  7 AAC 130.250, day habilitation services provided under
				  7 AAC 130.260, residential habilitation services under
				  7 AAC 130.265, employment services under
				  7 AAC 130.270, intensive active treatment services under
				  7 AAC 130.275, respite care services under
				  7 AAC 130.280, and meal services under
				  7 AAC 130.295, each target provider described in (b) of
				  this section and in the department's
Rate-Setting Methodology for
				  Personal Care Services, Community First Choice Services, Long-Term Services and
				  Supports Targeted Case Management Services, and Waiver Services,
adopted by reference in
				  7 AAC 160.900, shall complete and submit an annual
				  report to the department in accordance with this section.
(b) Each August 1, the department will
				  publish a list of target providers on the department's website and on the
				  Alaska Online Public Notice System (AS
				  44.62.175). The department will establish
				  target providers as follows:
(1) the
				  department will establish the list of target providers using
(A) the department's
Rate-Setting
				  Methodology for Personal Care Services, Community First Choice Services,
				  Long-Term Services and Supports Targeted Case Management Services, and Waiver
				  Services
, adopted by reference in
				  7 AAC 160.900;
(B) Medicaid units of service; and
(C) a time period consisting of the state
				  fiscal year that precedes the state fiscal year that ends in the calendar year
				  in which the list is published;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 7 - Payment Rates; Home and Community-Based Waiver Services › 7 AAC 145.533 - Personal care services, Community First Choice services, or home and community-based waiver services allowable costs

Current through May 31, 2024
(a) For purposes of
				  the annual report required in
				  7 AAC 145.531, costs are allowable costs if they are
				  reasonable, necessary, and related to the service provided. For purposes of
				  this section,
(1) a cost is reasonable if the
				  amount expended does not exceed what a prudent buyer who seeks to minimize
				  costs would pay for an item or service; and
(2) a cost, direct or indirect, is necessary
				  if it is appropriate in developing and maintaining the required standard of
				  operation for providing recipient care in accordance with state
				  law.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 7 - Payment Rates; Home and Community-Based Waiver Services › 7 AAC 145.537 - Related parties for purposes of personal care services or home and community-based waiver services

Current through May 31, 2024
For purposes of
					 7 AAC 145.533, a related party is
(1) a person with an immediate family
				  relationship with an owner, director, or officer of the contracted target
				  provider; for purposes of this paragraph, the following individuals have an
				  immediate family relationship with an owner, director, or officer of the
				  contracted target provider:
(A) a
				  spouse;
(B) a natural parent,
				  child, or sibling;
(C) an adopted
				  parent, child, or sibling;
(D) a
				  stepparent, stepchild, or stepsibling;
(E) a father-in-law, mother-in-law,
				  brother-in-law, son-in-law, sister-in-law, or daughter-in-law;
(F) a grandparent or grandchild;
(G) an uncle or aunt by blood or
				  marriage;
(H) a first cousin by
				  blood or marriage;
(I) a nephew or
				  niece by blood or marriage;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 7 - Payment Rates; Home and Community-Based Waiver Services › 7 AAC 145.540 - Home and community-based waiver services; residential psychiatric treatment center level-of-care payment rates (Repealed)

Current through May 31, 2024
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 7 - Payment Rates; Home and Community-Based Waiver Services › 7 AAC 145.545 - Exceptional changes to payment rates for personal care services, Community First Choice services, long-term services and supports targeted case management services, and home and community-based waiver services

Current through May 31, 2024
(a) If application
				  of the methodology in the department's
Rate-Setting Methodology for
				  Personal Care Services, Community First Choice Services, Long-Term Services and
				  Supports Targeted Case Management Services, and Waiver Services,
adopted by reference in
				  7 AAC 160.900, results in a rate in the Chart of
				  Personal Care Services and Community First Choice Services Rates,
Chart
				  of Long-Term Services and Supports Targeted Case Management Services Rates, or
				  Chart of Waiver Services Rates,
adopted by reference in
				  7 AAC 160.900, that does not allow reasonable access to
				  quality care provided by an efficiently and economically managed provider, the
				  department may increase the rate if
(1) the
				  department finds by clear and convincing evidence that the rate established
				  using the department's
Rate-Setting Methodology for Personal Care
				  Services, Community First Choice Services, Long-Term Services and Supports
				  Targeted Case Management Services, and Waiver Services,
adopted by
				  reference in
				  7 AAC 160.900, does not allow for reasonable access to
				  quality care provided by an efficiently and economically managed provider;
				  and
(2) increasing the rate is in
				  the public interest.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 8 - Payment Rates; Behavioral Health Services › 7 AAC 145.580 - Behavioral health services payment rates

Current through May 31, 2024
(a) The department
				  will pay a corresponding unit of service for providing community behavioral
				  health services under
				  7 AAC 135.100 -
				  7 AAC 135.280, at the lesser of the following rates:
Click
					 here to view image
(1) the
				  amount charged by the provider in accordance with
				  7 AAC 145.020; or
(2) the rate established in the department's
Chart of Community Behavioral Health Services Medicaid Rates
,
				  adopted by reference in
				  7 AAC 160.900; for state fiscal year 2020, the payment
				  rates will be 95 percent of the state fiscal year 2019 payment
				  rates.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.600 - General acute care hospital payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state general acute care hospital for services rendered in the
				  state at the rate determined in accordance with 7 AAC 150.
(b) The department will pay an out-of-state
				  general acute care hospital for
(1)
				  outpatient care services at the Medicaid rate used by the jurisdiction where
				  the hospital is located, or if no Medicaid rate has been established, the
				  hospital's Medicare rate;
(2)
				  inpatient care services at the All Patient Refined (APR) Diagnosis Related
				  Groups (DRG) rates established in
				  7 AAC 150.250.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.610 - Inpatient psychiatric hospital payment rates

Current through May 31, 2024
(a) Except as
				  provided in (c) of this section, the department will pay for inpatient
				  psychiatric services provided in accordance with
				  7 AAC 140.350 -
				  7 AAC 140.365 at the rates determined under 7 AAC
				  150.
(b) The department will pay
				  for the day of admission but not for the day of discharge, transfer to another
				  facility, or death.
(c) Except for
				  costs related to a physical examination at the time of admission to the
				  inpatient psychiatric hospital, the department will pay separately for the
				  covered services provided in the hospital by a physician or an advanced
				  practice registered nurse. The department will pay separately for other
				  necessary covered medical or dental services not related to the inpatient
				  psychiatric admission that are provided in accordance with 7 AAC 105 - 7 AAC
				  160. The department will not pay separately for drugs provided in an inpatient
				  psychiatric hospital, because drugs are included in determining the
				  all-inclusive daily payment rate under 7 AAC 150.
(d) The department will pay in accordance
				  with 7 AAC 105.120 for inpatient
				  psychiatric treatment center services provided outside the state.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.620 - Residential psychiatric treatment center payment rate

Current through May 31, 2024
(a) Except as
				  provided in (b) of this section, the department will pay for residential
				  psychiatric treatment center services provided in accordance with
				  7 AAC 140.400 -
				  7 AAC 140.415 at the daily rate determined under (c) of this
				  section.
(b) The department will
				  pay a provider separately for
(1)
				  psychological testing and evaluation services if those services are not
				  available through the residential psychiatric treatment center; in this
				  paragraph, "psychological testing and evaluation" means the administration of
				  standardized psychological tests and interpretation of findings by a
				  psychologist, a psychological associate, or another mental health professional
				  clinician with appropriate education and training, for the purpose of providing
				  assistance in the psychiatric diagnosis of mental and emotional disorders or
				  the assessment of functional capabilities;
(2) prescription drugs and other covered
				  services provided directly by a physician or advanced practice registered
				  nurse; or
(3) other necessary
				  covered medical or dental services not related to the residential psychiatric
				  treatment center admission.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.630 - Ambulatory surgical center payment rates

Current through May 31, 2024
(a) The department
				  will pay for services rendered in an ambulatory surgical center at the rate
				  determined in accordance with 7 AAC 150. The department shall establish payment
				  rates for each group code as assigned by the
Ambulatory Surgical Center
				  (ACS) Approved HCPCS Codes and Payment Rates
spreadsheet, adopted by
				  reference in
				  7 AAC 160.900. The department will pay the highest
				  valued procedure of multiple procedures at 100 percent of the procedure's group
				  rate and all additional procedures will be paid at 50 percent of the procedure
				  group rate.
(b) A payment made
				  under (a) of this section covers all operative functions attendant to medically
				  necessary surgery performed at the clinic by a private physician or dentist,
				  including admitting and laboratory tests, recipient history and examination,
				  operating room staffing and attendants, recovery room care, and discharge. The
				  payment includes all supplies related to the surgical care of the recipient
				  while in the clinic. The payment excludes the physician's fee, radiologist's
				  fee, and anesthesiologist's fee.
Authority:
AS
						47.05.010
AS 47.07.030
AS 47.07.040
AS
						47.07.070
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.640 - Nursing facility payment rates

Current through May 31, 2024
(a) Except as
				  otherwise provided in this section, the department will pay for services
				  rendered by an intermediate care facility (ICF) or skilled nursing facility
				  (SNF) at the all-inclusive rate determined in accordance with 7 AAC 150, less
				  the cost-of-care liability determined under
				  7 AAC 100.554.
(b) Partial payment may be made to a nursing
				  facility upon request. Partial payment may be made monthly in an amount not to
				  exceed 80 percent of the average monthly billing for the previous state fiscal
				  quarter.
(c) A recipient's income
				  is a prior resource. If a recipient remains in a nursing facility for a period
				  of less than a full month, the recipient's income for the month, after
				  subtracting all allowable deductions, must be divided by the number of days in
				  the month and that daily amount applied to those days that the recipient was in
				  the nursing facility.
(d) The
				  department will pay an out-of-state nursing facility at the Medicaid rate used
				  by the jurisdiction where the facility is located.
(e) Payment by the department is payment in
				  full for those services authorized under Medicaid. If the nursing facility
				  obtains from another source any additional payment for the care provided to a
				  recipient for services that have been paid for by Medicaid, the facility shall
				  refund or credit the additional payments to the department.
(f) A nursing facility may not submit a claim
				  for payment that exceeds the rate charged to a private client for any item or
				  service charged by the facility.
Authority:
AS
						47.05.010
AS 47.07.030
AS 47.07.040
AS
						47.07.070
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.650 - ICF and SNF all-inclusive rates

Current through May 31, 2024
(a) The rate
				  established for an intermediate care facility or a skilled nursing facility
				  includes all services, supplies, and equipment required for complete care,
				  except as otherwise provided in this section.
(b) The following services are included in
				  the ICF or SNF all-inclusive rate and will not be paid for separately:
(1) rehabilitative nursing care, including
				  service of restorative aides and nurses, as part of nursing and supportive care
				  services;
(2) nonprescription
				  drugs;
(3) direct physical or
				  occupational therapy services to an individual recipient, prescribed by a
				  physician;
(4) consultation,
				  training, and other nondirect recipient care services by a physical therapist,
				  physical therapy assistant, occupational therapist, or occupational therapy
				  assistant, whether or not the therapist or assistant is an employee of the
				  facility;
(5) periodic oxygen, if
				  that is all that is required by the recipient;
(6) all transportation in a facility's
				  vehicle and related to the recipient's care and recreation;
(7) an annual physical examination for a
				  recipient in a long-term care facility.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.660 - ICF/IID all-inclusive rate

Current through May 31, 2024
(a) The rate
				  established for an intermediate care facility for the mentally retarded
				  (ICF/MR) includes all services, supplies, and equipment required for complete
				  care, except as otherwise provided in this section.
(b) The following services are included in
				  the ICF/MR all-inclusive rate and will not be paid for separately:
(1) resident living staff, dental services,
				  training and habilitation services, medical services, nursing services,
				  pharmacy services, physical and occupational therapy services, psychological
				  services, recreational services, social services, and speech pathology and
				  audiology services, as prescribed in  42 C.F.R. 442.300 - 442.516, adopted by
				  reference in
				  7 AAC 160.900;
(2) nonprescription drugs;
(3) periodic oxygen, if that is all that is
				  required by the recipient;
(4) all
				  transportation in a facility's vehicle and related to the recipient's care and
				  recreation;
(5) an annual physical
				  examination for a recipient in a long-term care facility.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.670 - Recipient cost-of-care liability

Current through May 31, 2024
(a) The payment
				  determined under
				  7 AAC 145.650 and
				  7 AAC 145.660 will be reduced by the amount of the
				  recipient cost-of-care liability determined by the department in accordance
				  with 7 AAC 100.554.
(b) The facility is responsible for
				  collecting from the recipient the amount of the recipient's cost-of-care
				  liability. The department will not increase its payment to the facility because
				  the recipient fails to pay the recipient cost-of-care amount.
Authority:
AS
						47.05.010
AS 47.07.030
AS 47.07.040
AS
						47.07.070
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.680 - Free-standing birth center payment rates

Current through May 31, 2024
(a) The department
				  will pay a free-standing birth center, in accordance with
				  7 AAC 145.020, an all-inclusive flat rate that is
				  adjusted annually to be effective July 1.
(b) The department will not set an
				  all-inclusive flat rate that exceeds 75 percent of the weighted average of the
				  Medicaid hospital inpatient rates paid to the general acute care hospitals in
				  Anchorage, Fairbanks, Juneau, Palmer, and Soldotna, for one inpatient hospital
				  day. For state fiscal year 2020, the payment rate will be 95 percent of the
				  payment rate that would have been calculated in this subsection.
(c) The department will calculate the
				  weighted average described in (b) of this section using the Medicaid hospital
				  inpatient rates for each facility under (b) of this section that are in effect
				  at the start of the fourth quarter of the state fiscal year preceding the July
				  1 effective date. For state fiscal year 2021, the inpatient hospital payment
				  rates used in the calculation will be what the rates would have been April 1,
				  2020, had the 5 percent rate reduction not been applied excluding the inflation
				  that would have been granted in state fiscal year 2019. The department will
				  base the weighted average on the number of paid Medicaid inpatient claims filed
				  for a normal vaginal hospital delivery with a one-day length of stay
(1) designated by a primary diagnosis code of
				  080 as described in the
International Classification of Diseases - 10th
				  Revision, Clinical Modification (ICD-10-CM)
, adopted by reference in
				  7 AAC 160.900; and
(2) for each facility under (b) of this
				  section during the most recent 12-month period that starts at the beginning of
				  the state fiscal year's fourth quarter and for which timely filing has
				  passed.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.690 - Hospice care payment rates

Current through May 31, 2024
(a) The department
				  will pay an in-state hospice at the Medicaid rates established under
				  42 C.F.R.
				  418.306, adopted by reference in
				  7 AAC 160.900, for routine home care, continuous home
				  care, inpatient respite care, and general inpatient care. The hospice shall pay
				  a participating facility for general inpatient and inpatient respite
				  care.
(b) The department will pay
				  an in-state hospice for the cost of room and board for care provided to a
				  recipient in a nursing facility or intermediate care facility for the mentally
				  retarded if the hospice has a written agreement under which the hospice takes
				  full responsibility for the professional management of the recipient's hospice
				  care and the nursing facility or facility agrees to provide room and board to
				  the recipient. The room and board provided by the facility must, at a minimum,
				  include personal care services, administration of medication, maintenance of
				  the recipient's room, and supervision and assistance in the use of durable
				  medical equipment and prescribed therapies.
(c) In addition to the payment described in
				  (a) of this section, the department will pay for
(1) room and board, as described under (b) of
				  this section, at the rate of 95 percent of the daily rate established under 7
				  AAC 150; and
(2) physician services
				  rendered by the hospice medical director as a licensed physician or by the
				  licensed physician member of the interdisciplinary group, at the rate
				  determined under
				  7 AAC 145.200(a) - (c).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 9 - Payment Rates; Facility and Facility-Based Services › 7 AAC 145.695 - Abortion payment conditions

Current through May 31, 2024
The department will pay a Medicaid provider for an abortion
					 if the provider submits a completed
Certificate to Request Funds for
					 Abortion
, adopted by reference in
					 7 AAC 160.900, documenting that the requirements set out
					 in the certificate are satisfied.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 10 - Payment Rates; Rural Health Clinic and Federally Qualified Health Center Services › 7 AAC 145.700 - Health clinic payment rates

Current through May 31, 2024
(a) Except for
				  services listed in (e) of this section, and as otherwise provided in (I) of
				  this section, the department will determine a rural health clinic's payment
				  rate or a federally qualified health center's payment rate based on the health
				  clinic's reasonable costs. Reasonable costs must be determined by using the
				  same methodology used under
				  42 U.S.C.
				  1395I(a)(3) and  42 C.F.R. 413.1 - 413.157. Costs must be related to furnishing medically necessary and
				  appropriate services to Medicaid-eligible patients in accordance with
				  7 AAC 140.215. Costs may not include the cost of
				  providing prescription drugs. The department will consider only costs that are
				  related to providing Medicaid-eligible services to Medicaid-eligible patients,
				  and will exclude other costs. A health clinic may receive payment only for
				  services provided to a patient of the clinic by an employee or a contract
				  worker of the clinic. The department's payment for services provided by the
				  health clinic will be paid to the health clinic.
(b) Unless the department and a health clinic
				  make an agreement for the department to pay the clinic at the rates calculated
				  under (g) of this section, the department will pay the clinic in accordance
				  with
				  42 U.S.C.
				  1396a(bb)(1) - (5), adopted
				  by reference in
				  7
				  AAC 160.900. For state fiscal year 2018, the
				  department will not adjust for inflation, the payment rate under this
				  subsection.
(c) If, consistent with
				  the alternative payment methodology provisions of
				  42 U.S.C.
				  1396 a(bb)(6), adopted by reference in
				  7
				  AAC 160.900, the department and a health clinic make
				  an agreement for the department to pay the clinic at the rate calculated under
				  this subsection, the department will calculate a prospective payment rate as
				  follows:
(1) base rates will be calculated
				  prospectively,
(A) in an amount calculated on
				  a per-visit basis and equal to 100 percent of the inflated average of the
				  allowable costs
(i) of the health clinic of
				  furnishing services during the health clinic's fiscal years 1999 and 2000;
				  and
(ii) that are reasonable and
				  related to the cost of furnishing those services; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 10 - Payment Rates; Rural Health Clinic and Federally Qualified Health Center Services › 7 AAC 145.710 - Calculating total health clinic visits

Current through May 31, 2024
For newly rebased rates on or after February 16, 2024, for
					 the purposes of calculating a rate under
					 7 AAC 145.700(c) for a rural health
					 clinic, or a federally qualified health center, the department will consider
					 the total number of visits to be the sum of the total visits from
Worksheet B Parts I & II
of the adjusted Medicare cost
					 report, and if applicable, dental visits.
Authority:
AS
						47.05.010
AS 47.07.030
AS 47.07.040
AS 47.07.070
AS
						47.07.073
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 10 - Payment Rates; Rural Health Clinic and Federally Qualified Health Center Services › 7 AAC 145.720 - Health clinic re-basing

Current through May 31, 2024
(a) The base years
				  used to establish rates in future rate years for a rural health clinic or
				  federally qualified health center will be changed periodically to more current
				  years, and re-basing may be subject to audit. The first cost-based rate is not
				  a re-basing. The department may determine the timing for a re-basing under this
				  section and whether and when to conduct an audit. The department
(1) will perform a re-basing no less than
				  every four years;
(2) may perform a
				  re-basing sooner than every four years.
(3) will not implement re-basing for state
				  fiscal year 2018; and
(4) will not
				  apply (3) of this subsection to facilities that are currently under a state
				  -weighted average and that are scheduled to have their first cost-based rate
				  established in state fiscal year 2018.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 10 - Payment Rates; Rural Health Clinic and Federally Qualified Health Center Services › 7 AAC 145.730 - Health clinic exceptional relief

Current through May 31, 2024
A rural health clinic or federally qualified health center
					 may apply, under
					 7 AAC 150.240, for exceptional relief from the
					 rate-setting methodology in
					 7 AAC 145.700.
Authority:
AS
						47.05.010
AS 47.07.070
AS 47.07.073
AS
						47.07.074
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 10 - Payment Rates; Rural Health Clinic and Federally Qualified Health Center Services › 7 AAC 145.739 - Definitions

Current through May 31, 2024
In
					 7 AAC 145.700 -
					 7 AAC 145.739,
(1) "charity care" means health care services
				  that
(A) a health clinic does not expect to
				  result in cash payments;
(B) result
				  from a health clinic's policy to provide health care services free of charge to
				  an individual who meets certain financial criteria; and
(C) are provided for by a health care
				  provider, clinician, volunteer, or staff member, and for which the health care
				  provider, clinician, volunteer or staff member does not expect to receive
				  payment;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 11 - Payment Rates; Rural Health Clinic and Federally Qualified Health Center Services › 7 AAC 145.750 - Supplemental emergency medical transportation (SEMT) program

Current through May 31, 2024
(a) The
				  supplemental emergency medical transportation (SEMT) program is a voluntary
				  program that makes supplemental payments to publicly owned or operated SEMT
				  providers that provide qualifying emergency medical transportation services to
				  Medicaid recipients. The supplemental payment covers the gap between the
				  eligible SEMT provider's total allowable costs for providing SEMT services as
				  reported on the
Supplemental Emergency Medical Transportation (SEMT)
				  Cost Report,
adopted by reference in
				  7 AAC 160.900, and the amount of the base payment,
				  mileage, and all other sources of reimbursement.
(b) The department will make supplemental
				  payments only up to the amount uncompensated by all other sources of
				  reimbursement for the SEMT services provided to applicable Medicaid recipients.
				  The total reimbursement, including the fee-for-service Medicaid payment, third
				  party liability payment, and SEMT payment, may not exceed 100 percent of actual
				  costs.
(c) A supplemental payment
				  does not increase the current Medicaid fee-for-service (FFS) reimbursement
				  rates. A participating provider shall continue to bill for the applicable FFS
				  services and will be paid at the rates listed in the
				  Transportation/Accommodation Fee Schedule adopted by reference in
				  7 AAC 160.900. The supplemental payment includes only
				  SEMT services provided to FFS Medicaid recipients by eligible SEMT providers
				  for dates of service on or after August 31, 2019.
(d) The SEMT program is only available for
				  transportation of FFS Medicaid recipients who are currently eligible under
				  42 U.S.C.
				  1396- 1396w-6 (Title XIX of the Social
				  Security Act), under
				  42 U.S.C.
				  1397aa-
				  1397mm
				  (Title XXI of the Social Security Act), under
				  P.L.
				  111-148 (Patient Protection and Affordable Care
				  Act), or through the Indian Health Service established under
				  25
				  U.S.C. 1661. A participating provider may not
				  receive supplemental payments for transporting
(1) Medicaid applicants; or
(2) Medicare recipients with dual eligibility
				  for Medicaid.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 11 - Payment Rates; Rural Health Clinic and Federally Qualified Health Center Services › 7 AAC 145.760 - SEMT provider participation, qualification, and reporting requirements

Current through May 31, 2024
(a) If a provider elects to participate in
				  the SEMT program, the provider must comply with the following requirements to
				  qualify and receive supplemental payments:
(1) provide emergency medical transportation
				  services to Medicaid fee-for-service (FFS) recipients under
				  7 AAC 120.415 -
				  7 AAC 120.420;
(2) be publicly owned or operated;
(3) be enrolled as a ground, water, or air
				  ambulance Medicaid provider for the service period specified in the claim;
				  and
(4) include only claims for
				  dates of service on or after the provider's Medicaid enrollment date, if a
				  provider meets all other qualifications for the SEMT program and enrolls as a
				  ground, water, or air ambulance Medicaid provider in the middle of the
				  provider's fiscal year; the department will not make payment for claims for
				  services provided before the provider's Medicaid enrollment
				  date.