reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 3 - Hospice Care Services › 7 AAC 140.275 - Hospice care services

Current through May 31, 2024
(a) Before the department will give prior
				  authorization to and pay for hospice care services provided to a recipient in
				  the recipient's place of residence, the department must receive, no more than
				  eight days after hospice care begins,
(1) a
				  certification, signed by the recipient's attending physician and the medical
				  director of the hospice, that the recipient's medical prognosis is a life
				  expectancy of six months or less if the illness runs its normal
				  course;
(2) a copy of the
				  recipient's care plan described in (d) of this section; and
(3) an election statement, signed by the
				  recipient or the recipient's representative, that includes
(A) the name of the designated
				  hospice;
(B) an acknowledgment by
				  the recipient, or the recipient's representative, of an understanding of
				  hospice care;
(C) the effective
				  date of the election;
(D) an
				  acknowledgment by the recipient, or the recipient's representative, that for
				  the duration of care, the recipient waives the recipient's rights to hospice
				  care by any other hospice unless arranged through the designated hospice, and
				  waives the recipient's rights to any other Medicaid-covered services related to
				  the recipient's terminal illness except for those provided by the designated
				  hospice, an alternative hospice under arrangement with the designated hospice,
				  or the recipient's attending physician;
(E) an acknowledgment of the recipient's
				  option to revoke the election of hospice care at any time; and
(F) an acknowledgment of the recipient's
				  option to elect to change the designation of the hospice by submitting to both
				  hospices a signed statement indicating the hospice from which care has been
				  received, the newly designated hospice, and the date the change is effective;
				  the recipient may only elect to change the designation of the hospice once in
				  each election period as described in
				  42 C.F.R.
				  418.21 and
				  418.30, adopted by reference in
				  7 AAC 160.900.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 3 - Hospice Care Services › 7 AAC 140.280 - Hospice care for individuals under 21 years of age

Current through May 31, 2024
(a) Except as
				  otherwise provided in this section, the department may enroll a hospice care
				  provider and pay for hospice care services for a recipient under 21 years of
				  age in the same manner as in
				  7 AAC 140.270 -
				  7 AAC 140.275 and
				  7 AAC 145.690. In addition to satisfying the
				  requirements in
				  7 AAC 140.275, and no earlier than 12 months before
				  hospice care services begin, the recipient must have had an EPSDT screening
				  that meets the requirements in
				  7 AAC 110.205 for coverage.
(b) In addition to the hospice care services
				  eligible for payment under
				  7 AAC 140.275(c), a recipient under 21
				  years of age may receive private-duty nursing services rendered by or under the
				  supervision of a registered nurse in a recipient's home. The department will
				  pay for those private-duty nursing services provided in a recipient's home at
				  the in-state rate established under
				  7 AAC 145.250. The department will not pay for
				  out-of-state private-duty nursing services under this section.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 3 - Hospice Care Services › 7 AAC 140.289 - Definitions

Current through May 31, 2024
In
					 7 AAC 140.200 -
					 7 AAC 140.289,
(1) "continuous home care" means care
				  provided during a period of crisis in which a recipient requires constant care
				  to reduce or manage acute medical symptoms as necessary to maintain a recipient
				  at home;
(2) "general inpatient
				  care" means care provided in a participating hospice inpatient unit or a
				  participating general acute care hospital or nursing facility that meets the
				  standards for staffing and recipient areas in
				   42 C.F.R.
				  418.98  or
				  42 C.F.R.
				  418.100, adopted by reference in
				  7 AAC 160.900, for procedures necessary for pain control
				  or acute or chronic symptom management that cannot feasibly be provided in
				  another setting;
(3) "inpatient
				  respite care" means a short-term admission of no more than five days for
				  inpatient care in a facility that meets the standards in
				   42 C.F.R.
				  418.98(b), adopted by
				  reference in
				  7 AAC 160.900, in order to provide relief to the
				  caregiver; "inpatient respite care" does not include care provided to a
				  recipient residing in a long-term care facility;
(4) "interdisciplinary group" means a group
				  of individuals designated by a hospice who provide or supervise the care and
				  services offered by the hospice;
(5) "routine home care" means any combination
				  of the services listed in
				  7 AAC 140.275(c) (1) - (8) provided to
				  a recipient electing hospice care that are not provided at the level and
				  intensity of continuous home care.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 4 - Hospital Services › 7 AAC 140.300 - Hospital provider requirements

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing hospital services, a
				  provider must
(1) be enrolled as a hospital
				  in accordance with
				  7 AAC 105.210;
(2) if located in the state,
(A) be licensed under AS 47.32, except for a
				  hospital operated by a tribal health program; and
(B) comply with the requirements of 7 AAC
				  150;
(3) if located out
				  of state, meet all applicable licensing and accreditation requirements of the
				  jurisdiction in which the hospital is located;
(4) have a department-approved plan of
				  utilization review; and
(5) comply
				  with all prior authorization requirements established under 7 AAC 105 - 7 AAC
				  160.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 4 - Hospital Services › 7 AAC 140.305 - Admission to a hospital

Current through May 31, 2024
The department will pay for inpatient hospital services
					 only if the
(1) recipient is admitted
				  to the hospital by the written order of a physician or other licensed health
				  care professional authorized to admit a patient to a hospital;
(2) recipient requires a general acute care
				  hospital level of care or meets the requirements for administrative-wait bed or
				  swing-bed status; and
(3)
				  department gives prior authorization for admission as required under 7 AAC 105
				  - 7 AAC 160.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 4 - Hospital Services › 7 AAC 140.310 - Covered hospital services

Current through May 31, 2024
(a) The department
				  will pay for those hospital services for which a revenue code is listed in
				  Section I of the Inpatient/Outpatient Hospital Services section of the Alaska
Provider Billing Manual
, adopted by reference in
				  7 AAC 160.900, and in the Covered Revenue Codes for
				  Outpatient Hospitals and the Covered Revenue Codes for Inpatient Hospitals of
				  the Indian Health Service (IHS)/Tribal Facility Services section of the Alaska
Provider Billing Manual
, adopted by reference in
				  7 AAC 160.900. Some revenue codes are for services that
				  are limited based on recipient age, gender, and eligibility category as
				  otherwise provided in AS 47.07, 7 AAC 100, or 7 AAC 105 - 7 AAC 160.
(b) The department will pay for the standard
				  daily hospital service, which includes room, linen service, meals, special
				  diets, general nursing service, medical records and admitting service, use of
				  ordinary hospital equipment and instruments, routine treatments, routine drugs,
				  and routine supplies.
(c) The
				  department will pay for the central hospital service, which includes supplies
				  and preparing, handling, and storing supplies.
(d) The department will pay a hospital for
				  drugs prescribed by the attending physician or other dispensing provider only
				  if the drugs are administered to the recipient while the patient is receiving
				  care in the hospital.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 4 - Hospital Services › 7 AAC 140.315 - Noncovered hospital services

Current through May 31, 2024
(a) Except as
				  otherwise provided in 7 AAC 105 - 7 AAC 160, the department will not pay for
				  services
(1) identified as noncovered services
				  in 7 AAC 105.110; or
(2) for which a revenue code is not listed as
				  described in
				  7 AAC 140.310(a).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 4 - Hospital Services › 7 AAC 140.320 - Length of hospitalization

Current through May 31, 2024
(a) Except as
				  provided in (b) of this section, the department will not pay for more than
				  three days of hospitalization for any single admission, except that, for a
				  maternal and newborn hospital stay related to childbirth, the department will
				  not pay for more than 48 hours of inpatient hospitalization for a single
				  recipient following a normal vaginal delivery and no more than 96 hours of
				  inpatient hospitalization for a single recipient following a cesarean
				  delivery.
(b) The department will
				  not pay for coverage beyond the days or hours of hospitalization specified in
				  (a) of this section unless the department has given prior authorization for
				  those days or hours under
				  7 AAC 105.130.
(c) If the department reimburses a provider
				  under the Diagnosis Related Groups (DRG) methodology, the department will use
				  the method specified in
				  7 AAC 150.250(a)(4) to calculate the
				  amount that will be reimbursed for the length of stay.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 4 - Hospital Services › 7 AAC 140.325 - Billing for hospital services

Current through May 31, 2024
(a) The quality
				  improvement organization (QIO) certification of necessity for hospital stays
				  over three days or for stays for treatment or procedures on the
Select
				  Diagnoses and Procedures Pre-certification List
, adopted by reference
				  in 7 AAC 160.900, must appear on the
				  invoice submitted by the hospital in order to receive payment. The department
				  will pay only for days that are medically necessary and within the scope of
				  Medicaid coverage. If a recipient refuses to leave the hospital at the end of a
				  covered stay, the hospital may bill the recipient for days beyond the
				  noncovered or noncertified portion of the hospital stay. Payment by the
				  department for covered services is considered by the department to be payment
				  in full for those covered services.
(b) When a health care-acquired condition or
				  provider-preventable condition described in
				  7 AAC 140.315(e) is not present on
				  admission, but is reported as a diagnosis associated with the hospitalization,
				  the hospital must submit a claim identifying the condition, even if the
				  hospital does not seek reimbursement for the hospitalization.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 5 - Inpatient Psychiatric Hospital Services › 7 AAC 140.350 - Inpatient psychiatric hospital provider requirements

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing inpatient psychiatric
				  hospital services, a provider must
(1) be
				  enrolled as an inpatient psychiatric hospital in accordance with
				  7 AAC 105.210;
(2) if located in this state,
(A) be licensed under AS 47.32 and accredited
				  by the Joint Commission;
(B) comply
				  with the requirements of 7 AAC 150;
(3) if located out of state, meet all
				  applicable licensing and accreditation requirements of the jurisdiction in
				  which the inpatient psychiatric hospital is located; and
(4) meet the requirements of
				  7 AAC 140.350 -
				  7 AAC 140.365.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 5 - Inpatient Psychiatric Hospital Services › 7 AAC 140.355 - Inpatient psychiatric hospital services

Current through May 31, 2024
(a) Subject to the
				  admission and prior authorization requirements of
				  7 AAC 140.360 and plan-of-care requirements of
				  7 AAC 140.365, the department will pay for
				  therapeutically appropriate, medically necessary diagnostic and treatment
				  services for recipients who are admitted to an inpatient psychiatric hospital,
				  including the following services:
(1) intake
				  assessment;
(2) admitting history
				  and physical examination;
(3)
				  individual psychotherapy;
(4) group
				  psychotherapy;
(5) family
				  psychotherapy;
(6) pharmacologic
				  management;
(7) crisis
				  intervention;
(8) medication
				  administration.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 5 - Inpatient Psychiatric Hospital Services › 7 AAC 140.360 - Inpatient psychiatric hospital admission

Current through May 31, 2024
(a) The department
				  will not pay for inpatient psychiatric hospital services unless the department
				  has authorized the recipient's admission. Before the department will authorize
				  admission, the department will verify that the requirements of (b) and (c) of
				  this section are met.
(b) Upon
				  admission, an inpatient interdisciplinary team that meets the requirements of
				  (d) of this section must
(1) complete a
				  diagnostic evaluation that
(A) includes a
				  psychiatric assessment;
(B) is
				  performed no more than 60 days before admission or no more than 72 hours after
				  admission; and
(C) indicates the
				  need for inpatient psychiatric services;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 5 - Inpatient Psychiatric Hospital Services › 7 AAC 140.365 - Inpatient psychiatric hospital plan of care

Current through May 31, 2024
(a) The individual
				  plan-of-care established by the inpatient interdisciplinary team in accordance
				  with 7 AAC 140.360(b) (4), and a subsequent plan of care review,
				  must
(1) be comprehensive and in
				  writing;
(2) be developed based
				  upon a diagnostic evaluation as required in
				  7 AAC 140.360(b) (1);
(3) be formulated in consultation with the
				  recipient and the recipient's family, guardian, or other individual into whose
				  care or custody the recipient will be released following discharge;
(4) document individualized treatment
				  objectives and prescribe an integrated program of appropriate therapies,
				  activities, and experiences designed to develop the recipient's ability to
				  function independently in the recipient's own environment;
(5) include appropriate treatments that are
				  reasonably expected to improve the recipient's condition to the extent that
				  inpatient psychiatric services will become unnecessary; for a recipient under
				  21 years of age, the treatment plan must include family psychotherapy unless
				  family psychotherapy is contraindicated; and
(6) include a discharge plan prepared at the
				  time of admission and updated during the recipient's inpatient stay as the
				  recipient's mental health service needs change, that specifies the approximate
				  date for discharge, the recipient's anticipated post-discharge service needs,
				  the recipient's prospective community-based service providers, and other
				  provisions necessary for the transition to a less restrictive
				  environment.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 6 - Residential Psychiatric Treatment Center (RPTC) Services › 7 AAC 140.400 - Residential psychiatric treatment center provider requirements

Current through May 31, 2024
(a) To be
				  eligible for payment under 7 AAC 105 - 7 AAC 160 for providing residential
				  psychiatric treatment center (RPTC) services, a provider must
(1) be enrolled as an RPTC in accordance with
				  7 AAC 105.210;
(2) if located in this state, be licensed by
				  the department under AS 47.32;
(3)
				  if located out of state, meet the licensing and accreditation requirements of
				  the jurisdiction in which the RPTC is located;
(4) be accredited by The Joint Commission,
				  the Commission on Accreditation of Rehabilitation Facilities, or the Council on
				  Accreditation of Services for Families and Children as a residential
				  psychiatric treatment center for care of children under 21 years of
				  age;
(5) comply with the
				  requirements of
				  7 AAC 140.400 -
				  7 AAC 140.415;
(6) comply with
				  42 C.F.R.
				  483.350 -
				  483.376, adopted by reference in
				  7 AAC 160.900, governing the use of restraint and
				  seclusion; and
(7) provide basic
				  residential care and services that include
(A)
				  dwelling space provided in separate buildings or units with no more than 60
				  residential beds per building and no more than 30 beds provided for sleeping
				  accommodation per unit; if the residential unit is part of a larger facility,
				  the residential unit must be a separate and distinct area from other designated
				  psychiatric or treatment units; and
(B) equipment, supplies, maintenance, and
				  insurance used by residents for program activities and case-specific
				  services.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 6 - Residential Psychiatric Treatment Center (RPTC) Services › 7 AAC 140.405 - Residential psychiatric treatment center admission

Current through May 31, 2024
(a) The department
				  will not pay for RPTC services unless the department has authorized the
				  recipient's admission. Before the department will authorize admission, the
				  department will verify that the requirements of (b) and (c) of this section are
				  met.
(b) Upon admission, an
				  inpatient interdisciplinary team that meets the requirements of (d) of this
				  section must
(1) complete a diagnostic
				  evaluation that
(A) includes a psychiatric
				  assessment;
(B) is performed before
				  admission or no more than seven days after admission; and
(C) indicates the need for RPTC
				  services;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 6 - Residential Psychiatric Treatment Center (RPTC) Services › 7 AAC 140.410 - Residential psychiatric treatment center plan of care

Current through May 31, 2024
(a) The individual
				  plan of care established by the inpatient interdisciplinary team in accordance
				  with 7 AAC 140.405(b) (4) must
(1) be comprehensive and in
				  writing;
(2) be developed based
				  upon a diagnostic evaluation as required in
				  7 AAC 140.405(b) (1);
(3) be formulated in consultation with the
				  recipient and the recipient's family, guardian, or other individual to whose
				  care or custody the recipient will be released following discharge;
(4) document treatment objectives and
				  prescribe an integrated program of appropriate therapies, activities, and
				  experiences designed to develop the recipient's ability to function
				  independently in the recipient's own environment;
(5) include appropriate treatments that are
				  reasonably expected to improve the recipient's condition to the extent that
				  RPTC services will become unnecessary; and
(6) include a discharge plan prepared at the
				  time of admission and updated during the recipient's inpatient stay as the
				  recipient's mental health service needs change, that specifies the approximate
				  date for discharge, the recipient's anticipated post-discharge service needs,
				  the recipient's prospective service providers, and other provisions necessary
				  for the transition to a less restrictive environment.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 6 - Residential Psychiatric Treatment Center (RPTC) Services › 7 AAC 140.415 - Residential psychiatric treatment center services

Current through May 31, 2024
(a) Subject to the
				  requirements of admission and prior authorization requirements of
				  7 AAC 140.405 and plan-of-care requirements of
				  7 AAC 140.410, the department will pay for
				  therapeutically appropriate, medically necessary diagnostic and treatment
				  services for a child experiencing a severe emotional disturbance as described
				  in 7 AAC 135.065, including the
				  following services:
(1) individual
				  psychotherapy;
(2) group
				  psychotherapy;
(3) family
				  psychotherapy;
(4) group skill
				  development services;
(5)
				  individual skill development services;
(6) family skill development
				  services;
(7) pharmacologic
				  management and medication administration;
(8) crisis intervention;
(9) intake assessment.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.500 - Nursing facility enrollment and conditions for payment

Current through May 31, 2024
For a nursing facility to be eligible for payment under 7
					 AAC 105 - 7 AAC 160 for providing nursing facility services, the following
					 requirements must be met:
(1) the
				  nursing facility must
(A) be enrolled with
				  the department under
				  7 AAC 105.210 as an intermediate care facility or
				  skilled nursing facility;
(B) if
				  located out of state, be enrolled in the Medicaid program in the jurisdiction
				  where services are provided;
(C)
				  meet all federal utilization control and Medicare long-term care facility
				  requirements under  42 C.F.R. Part 456  and  42 C.F.R. Part 483, adopted by
				  reference in
				  7 AAC 160.900; and
(D) meet all certification and licensing
				  requirements of the jurisdiction in which the nursing facility is located; if
				  located in this state, the nursing facility must be licensed and certified
				  under AS 47.32;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.505 - Authorization for admission and determination of level of care

Current through May 31, 2024
(a) The
				  department will authorize an individual for nursing facility services as a new
				  admission, transfer, or continuing placement. Authorization may be given even
				  if an individual is currently receiving services in a general acute care
				  hospital or in an inpatient psychiatric hospital, or nonacute care services in
				  a skilled nursing facility, an intermediate care facility, a home, or other
				  nonacute setting. The department will determine the appropriate level of care
				  by considering
(1) the type of care
				  required;
(2) the qualifications of
				  the person necessary to provide direct care; and
(3) whether the recipient's overall condition
				  is relatively stable or unstable.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.510 - Intermediate care facility services

Current through May 31, 2024
(a) The department
				  will pay an intermediate care facility for providing the services described in
				  (b) and (c) of this section if those services are
(1) needed to treat a stable
				  condition;
(2) ordered by and under
				  the direction of a physician, except as provided in (c) of this section;
				  and
(3) provided to a recipient who
				  does not require the level of care provided by a skilled nursing
				  facility.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.515 - Skilled nursing facility services

Current through May 31, 2024
(a) The department
				  will pay a skilled nursing facility for providing skilled nursing described in
				  (b) of this section or structural rehabilitation services described in (c) of
				  this section if those services are
(1) needed
				  to treat an unstable condition;
(2)
				  ordered by and under the direction of a physician; and
(3) provided directly by or under supervision
				  of qualified technical or professional personnel who are authorized by state
				  law to provide that service and who are on the premises at the time service is
				  rendered; technical or professional personnel include a registered nurse, a
				  licensed practical nurse, a licensed physical therapist, a licensed physical
				  therapy assistant, a licensed occupational therapist, a certified occupational
				  therapy assistant, a licensed speech-language pathologist, a registered
				  speech-language pathologist assistant, and an audiologist.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.520 - Care plan counseling

Current through May 31, 2024
(a) The department will provide care plan
				  counseling to a recipient, or to an individual who may become a recipient, who
				  appears to require placement in a nursing facility before that individual is
				  admitted to the nursing facility. A care plan counselor shall provide an
				  individual with information about alternative methods of meeting the
				  individual's need for nursing facility care.
(b) The department will prepare and submit
				  the nursing facility level-of-care authorization form required by
				  7 AAC 140.525(c) or
				  7 AAC 140.530(b) for each individual
				  who receives care plan counseling from the department.
(c) The department may exempt an individual
				  from care plan counseling in specific geographic regions of the state if the
				  department determines care plan counseling is impractical because of the low
				  volume of nursing facility admissions, the lack of alternative methods of
				  meeting long-term care needs, or the inability to provide care plan counseling
				  on a timely basis. If an individual in a geographic region is exempted from
				  care plan counseling, the nursing facility that admits the individual must meet
				  the requirements of
				  7 AAC 140.525,
				  7 AAC 140.530, or
				  7 AAC 140.535, whichever is applicable to the
				  recipient.
(d) Unless the
				  individual is exempt under (c) of this section, a general acute care hospital,
				  inpatient psychiatric hospital, or nursing facility shall inform the department
				  that an individual is in need of care plan counseling by following the
				  procedure in
				  7 AAC 140.525,
				  7 AAC 140.530, or
				  7 AAC 140.535, whichever is applicable to the
				  recipient.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.525 - Transfer from hospital care to nursing facility care

Current through May 31, 2024
(a) This section
				  applies only to a recipient in a general acute care hospital or inpatient
				  psychiatric hospital who appears to require placement in a nursing
				  facility.
(b) The department will
				  consider authorizing placement in a nursing facility under this section only if
(1) the nursing facility placement of the
				  recipient is cooperatively planned by the recipient's attending physician, the
				  medical director of the nursing facility, relevant specialists, the director of
				  nursing of the nursing facility, and the discharge coordinator of the general
				  acute care hospital or inpatient psychiatric hospital;
(2) the discharge coordinator and the
				  director of nursing evaluate the level-of-care needs of the recipient;
				  and
(3) the nursing facility
				  submits a preliminary evaluation establishing the need for nursing facility
				  placement; the primary evaluation must be made by
(A) the attending physician;
(B) the director of nursing; and
(C) any therapist, specialist, or other
				  professional involved in planning for the care of the recipient.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.530 - Transfer from nonacute care to nursing facility care

Current through May 31, 2024
(a) This section
				  applies only to a recipient who
(1) already
				  receives services in a nursing facility and who appears to require placement in
				  another nursing facility; or
(2) is
				  in the recipient's home or other nonacute care setting and who appears to
				  require placement in a nursing facility.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.535 - Continuing placement in a nursing facility

Current through May 31, 2024
(a) The department
				  will consider authorizing the continuing placement of a recipient in a nursing
				  facility if the nursing facility
(1) submits
				  a request for nursing facility level-of-care authorization, on a form provided
				  by the department, and that includes the information required in
				  7 AAC 140.505(b); subsequent request
				  forms must be submitted no less than semiannually following admission to an
				  intermediate care facility and no less than quarterly following admission to a
				  skilled nursing facility;
(2) has
				  determined that the level of care is appropriate based upon the recommendation
				  of the nursing facility's utilization review committee;
(3) gives the authorized department
				  representative full access to the nursing facility's records pertaining to the
				  recipient, including the opportunity for the department representative to
				  personally read charts and records;
(4) has included in the recipient's record a
				  copy of all utilization review committee reports and request for nursing
				  facility level-of-care authorization forms;
(5) has written policies that state that only
				  those persons are accepted whose needs can be met by the nursing facility
				  directly or in cooperation with community resources or other providers of care
				  with which the facility is affiliated or has a contract; it is the
				  responsibility of the facility to monitor admissions carefully to ensure that
				  the nursing facility only admits recipients that it has the capability to
				  treat.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.540 - Transfer of recipients

Current through May 31, 2024
(a) No later than
				  seven days after a nursing facility transfers a recipient to another level of
				  care within the same facility, the nursing facility must notify the department
				  of the transfer by submitting a current request for a level-of-care
				  authorization on a form provided by the department.
(b) Before a nursing facility transfers a
				  recipient to another nursing facility or hospital, the facility shall, at least
				  10 days before the transfer, provide a written notice
(1) to the recipient;
(2) if applicable, to the recipient's family
				  or guardian;
(3) to the attending
				  physician;
(4) to the division of
				  the department responsible for payment for health care services;
(5) to the division of the department
				  responsible for senior and disabilities services, if the nursing facility is
				  proposing the transfer; and
(6) to
				  the nursing facility, if the division of the department responsible for senior
				  and disabilities services is proposing the transfer.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.545 - Discharge of recipients

Current through May 31, 2024
(a) When a nursing
				  facility's utilization review committee or the department determines that a
				  recipient does not, or in the future will not, require continued nursing
				  facility placement, the nursing facility shall provide, at least 10 days before
				  the date of discharge, a written notice of proposed discharge
(1) to the recipient;
(2) if applicable, to the recipient's family
				  or guardian;
(3) to the attending
				  physician;
(4) to the division of
				  the department responsible for payment for health care services;
(5) to the division of the department
				  responsible for senior and disability services, if the nursing facility is
				  proposing the discharge; and
(6) to
				  the nursing facility, if the division of the department responsible for senior
				  and disability services is proposing the discharge.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.550 - Third-party resources

Current through May 31, 2024
The department will immediately notify a nursing facility
					 of a known third-party resource or credit available to a recipient, including
					 the amount and source. A recipient's income, and third-party resources or
					 credits, exclusive of the allowance under
					 7 AAC 100.554 and
					 7 AAC 100.558 for personal incidental needs, must be
					 offset as part of the recipient's cost-of-care liability against the
					 all-inclusive rate in accordance with
					 7 AAC 145.670. Third-party resources and credits that
					 become known to the nursing facility must be reported to the department. The
					 nursing facility is responsible for collecting those resources or
					 credits.
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 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.555 - Days chargeable

Current through May 31, 2024
The department will pay from the day of admission to a
					 nursing facility but not for the day of discharge, transfer, or death. Transfer
					 includes transfer from one level of care to another level of care within a
					 single nursing facility as well as between different nursing
					 facilities.
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 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.560 - Payment during impending decertification

Current through May 31, 2024
If the department determines that a nursing facility is
					 deficient in areas relating to recipient care and has initiated decertification
					 proceedings, the department will not pay for services provided to a recipient
					 admitted to the facility, or who becomes eligible for assistance, after the
					 date the department has notified the nursing facility that the department has
					 initiated decertification proceedings. If a nursing facility provides both
					 intermediate care services and skilled nursing services, the department may
					 implement this section independently for each level of
					 certification.
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 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.565 - Payment for nursing facility transfers

Current through May 31, 2024
(a) If the
				  department determines that a nursing facility is deficient in areas related to
				  recipient care and the facility transfers a recipient to another facility at
				  the same level-of-care certification to avoid decertification or any other
				  enforcement penalty, the department will recover from the facility the costs of
				  transferring that recipient to the other facility.
(b) If the department determines that a
				  recipient needs a higher or lower level of care than the facility is certified
				  to provide, the department will pay the cost of moving the recipient to a
				  facility certified to provide a higher or lower level of care.
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 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.570 - Other payments

Current through May 31, 2024
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 nursing facility shall refund
					 or credit the additional payments to the department.
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 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.580 - Required all-inclusive services

Current through May 31, 2024
(a) A nursing
				  facility shall provide rehabilitative nursing care, including the services of
				  restorative aides and nurses, as part of nursing and supportive care
				  services.
(b) If a recipient needs
				  nonemergency, continuous heavy use of oxygen, the nursing facility shall make
				  it available for use at all times. The nursing facility shall submit a request
				  for authorization, on a form provided by the department, shall provide on that
				  form a detailed description of the recipient's need for continuous heavy use of
				  oxygen, and shall include physician orders or physician or nursing notes.
				  Payment will be made to the nursing facility at the facility's cost for the
				  oxygen. The amount of oxygen given to the recipient must be accurately metered
				  and measurable to the recipient. On the billing, the nursing facility shall
				  note the metered amount of oxygen and dates used.
(c) A nursing facility is responsible for
				  transportation planning. To determine the appropriate type of carrier, the
				  nursing facility shall consider the recipient's condition, distance to the
				  medical facility or provider of service, and the frequency of the trip. The
				  least expensive mode of transportation must be used consistent with these
				  conditions.
(d) Nonemergency,
				  in-state transportation must receive prior authorization from the department.
				  Emergency transportation must be reported to the department as soon as possible
				  but not later than three working days after the transportation
				  occurred.
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 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.585 - Absence from nursing facility

Current through May 31, 2024
(a) Except as
				  provided in (b) of this section, the department will pay for reserving a bed
				  during a planned temporary absence of a recipient from a nursing facility if
				  the absence is not more than 12 consecutive days and the time of departure and
				  return of the recipient are recorded in the nursing facility's records. A
				  planned temporary absence of not more than 12 consecutive days for which the
				  department will pay for reserving a bed includes
(1) a visit with relatives and friends;
				  and
(2) leave to participate in
				  therapeutic or rehabilitative programs, including
(A) trial visits to alternative care settings
				  to determine if permanent placement is feasible;
(B) gradually increasing lengths of visits to
				  prepare recipients for return to their home or community; and
(C) an extended absence to participate in
				  workshop evaluation for rehabilitative programs.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.590 - Medicare coinsurance

Current through May 31, 2024
(a) The department will pay, on behalf of a
				  recipient, the coinsurance established under part A of Medicare for care
				  rendered from the 21st through the 100th day of care in a nursing facility. The
				  department will pay the nursing facility rate established for care in that
				  particular facility beyond the 100th day.
(b) Rejection or nonpayment by Medicare of
				  services provided by a nursing facility because the services were custodial in
				  nature or because the facility did not choose to participate as a Medicare
				  provider is not, by itself, justification for the department to make full
				  payment to a nursing facility during the period from the 1st to the 100th day
				  of care at a nursing facility. The department will make payment to the nursing
				  facility in accordance with the level of care appropriate to the recipient's
				  needs as determined by the nursing facility's utilization review committee and
				  approved by the department.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 7 - Nursing Facility Services: ICF and SNF › 7 AAC 140.595 - Definitions

Current through May 31, 2024
In
					 7 AAC 140.500 -
					 7 AAC 140.595,
(1) "licensed nursing personnel" means those
				  persons who are registered nurses or licensed practical nurses;
(2) "utilization review committee" means the
				  facility-based medical review team composed of private physicians and other
				  professional persons.
Authority:
AS
						47.05.010
AS 47.07.030
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 8 - Intermediate Care Facility for the Mentally Retarded Services › 7 AAC 140.600 - ICF/IID enrollment and conditions for payment

Current through May 31, 2024
(a) For an
				  intermediate care facility for the mentally retarded (ICF/MR) to be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing intermediate care
				  services for the mentally retarded, the following requirements must be met:
(1) the ICF/MR must
(A) be enrolled in accordance with
				  7 AAC 105.210 as an ICF/MR;
(B) if located out of state, be enrolled in
				  the Medicaid program in the jurisdiction where services are provided;
(C) meet all federal standards for payment
				  and certification requirements under  42 C.F.R. Part 442, adopted by reference
				  in 7 AAC 160.900;
(D) meet all certification and licensing
				  requirements of the jurisdiction in which the ICF/MR is located; if located in
				  this state, the ICF/MR must be certified under AS 47.32;
(E) comply with
				  7 AAC 140.600 - 140.640, 7 AAC 150, and other applicable
				  requirements of 7 AAC 105 - 7 AAC 160; and
(F) meet the requirements of (b) of this
				  section;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services › Article 8 - Intermediate Care Facility for the Mentally Retarded Services › 7 AAC 140.605 - ICF/IID interdisciplinary teams

Current through May 31, 2024
(a) An ICF/MR shall
				  assign a recipient an interdisciplinary team, to be directly involved in the
				  treatment of the recipient, and to develop, implement, monitor, and evaluate
				  the habilitative plan of care required under
				  7 AAC 140.610. An interdisciplinary team must include,
				  at a minimum,
(1) the recipient;
(2) the recipient's
(A) family members, including parents,
				  guardians, siblings, and others similarly involved in providing general
				  oversight of the recipient; or
(B)
				  legal guardian, if any;
(3) at least one qualified mental retardation
				  professional; and
(4) other
				  professionals involved in the recipient's care.