reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 11 - Podiatry Services › 7 AAC 110.505 - Podiatry services

Current through May 31, 2024
(a) The department will pay for the podiatry
				  services and supplies identified in the
CPT Fee Schedule for Podiatry
				  Services
table and
HCPC Fee Schedule for Podiatry
				  Services
table, adopted by reference in
				  7 AAC 160.900, provided to a Medicaid recipient under 21
				  years of age who has been found to need medical services relating to specific
				  conditions of the ankle or foot, if
(1) a
				  physician has prescribed the treatment; and
(2) the treatment provided is within the
				  scope of practice of the treating podiatrist who meets the requirements of
				  7 AAC 110.500.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 12 - Private-Duty Nursing Services › 7 AAC 110.520 - Private-duty nursing agency enrollment requirements

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing private-duty nursing
				  services, a provider must
(1) be enrolled as
				  a private-duty nursing agency in accordance with
				  7 AAC 105.210; and
(2) be enrolled as either a hospice service
				  provider under
				  7 AAC 140.270, or a home health service provider under
				  7 AAC 125.300, who employs a registered nurse, a
				  licensed practical nurse, or an advanced practice registered nurse.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 12 - Private-Duty Nursing Services › 7 AAC 110.525 - Private-duty nursing services; covered and noncovered services

Current through May 31, 2024
(a) The
				  department will pay for private-duty nursing services, if they are provided to
				  a recipient who
(1) is under 21 years of
				  age;
(2) has been recently
				  discharged from a general acute care hospital or long-term care facility, or
				  has a physical health status that would justify admission to a general acute
				  care hospital or long-term care facility;
(3) with the provision of private-duty
				  nursing services, will be able to live in a family setting, and for whom those
				  services will prevent admission to, or promote early discharge from, a general
				  acute care hospital or long-term care facility; and
(4) requires more individual and continuous
				  care than is available from a visiting nurse or is routinely provided by the
				  nursing staff of a hospital, a skilled nursing facility, or an intermediate
				  care facility; in this paragraph, "continuous care" means a minimum of eight
				  hours provided to an individual in a 24-hour period;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 12 - Private-Duty Nursing Services › 7 AAC 110.530 - Private-duty nursing services; prior authorization

Current through May 31, 2024
(a) Private-duty
				  nursing services must be authorized by the department before services are
				  provided. The department will authorize private-duty nursing services for
				  periods up to 60 days, starting on the date the first service is to be
				  provided.
(b) To be considered by
				  the department, a prior authorization request must originate from a
				  private-duty nursing agency provider who submits the request in writing or
				  electronically on a form provided by the department. The prior authorization
				  request must
(1) include the plan of care
				  developed in accordance with
				  7 AAC 110.525(b) (2) and signed by the
				  recipient's attending physician;
(2) include a nursing assessment;
(3) include any supporting documentation, if
				  applicable;
(4) identify the day of
				  actual or planned hospital or nursing facility discharge, if
				  applicable;
(5) identify any
				  planned surgical interventions;
(6)
				  identify the number of days services are needed, not to exceed a 60-day period;
				  and
(7) identify the exact number
				  of hours requested per day.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 13 - Psychologist testing Services › 7 AAC 110.550 - Psychologist testing services

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing psychologist testing
				  services, a provider must be an independently practicing psychologist who
(1) is enrolled as a psychologist in
				  accordance with
				  7 AAC 105.210;
(2) has an active license to practice
				  psychology issued by the jurisdiction in which the psychologist provides
				  services; if services are provided in this state, the psychologist must hold an
				  active license under
				  AS
				  08.86.130 or
				  08.86.135; and
(3) maintains records in accordance with (e)
				  of this section.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 13 - Psychologist testing Services › 7 AAC 110.555 - Psychologist behavioral health services

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105-7 AAC 160, psychologist behavioral health services
				  must be provided by an individual who meets the requirements in
				  7 AAC 110.550(a)(1) and (2).
(b) A provider may only bill the department
				  for the following psychologist behavioral health services, provided in
				  accordance with this chapter:
(1) a mental
				  health intake assessment;
(2) an
				  integrated mental health and substance use intake assessment;
(3) individual psychotherapy;
(4) group psychotherapy;
(5) family psychotherapy;
(6) multi-family group
				  psychotherapy;
(7) screening and
				  brief intervention services described in
				  7 AAC 135.240;
(8) behavioral health screening under
				  7 AAC 135.100.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 14 - Clinical Social Worker Services › 7 AAC 110.565 - Clinical social worker services

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing clinical social worker
				  services, a provider must
(1) be enrolled as
				  a clinical social worker in accordance with
				  7 AAC 105.210; and
(2) have an active license to practice as a
				  clinical social worker issued by the jurisdiction in which the clinical social
				  worker provides services; if services are provided in this state, the clinical
				  social worker must hold an active license under
				  AS
				  08.95.110 or
				  08.95.120.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 15 - Marital and Family Therapy Services › 7 AAC 110.575 - Marital and family therapy services

Current through May 31, 2024
(a) To be eligible
				  to provide marital and family therapy services for payment under 7 AAC 105 - 7
				  AAC 160, a provider must
(1) be enrolled as a
				  marital and family therapist under 7 A AC 105.210; and
(2) have an active license to practice as a
				  marital and family therapist issued by the jurisdiction in which the marital
				  and family therapist provides services; if services are provided in this state,
				  the marital and family therapist must hold an active license under
				  AS
				  08.63.100.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 16 - Professional counseling services › 7 AAC 110.585 - Professional counseling services

Current through May 31, 2024
(a) To be eligible
				  to provide professional counseling services for payment under 7 AAC 105-7 AAC
				  160, a provider must
(1) be enrolled as a
				  licensed professional counselor under
				  7 AAC 105.210; and
(2) have an active license to practice as a
				  professional counselor issued by the jurisdiction in which the professional
				  counselor provides services; if services are provided in this state, the
				  professional counselor must hold an active license under AS
				  08.29.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 17 - Targeted Case Management › 7 AAC 110.600 - Targeted case management for children with disabilities

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing targeted case management
				  services, a provider must
(1) be enrolled as a
				  provider of those services in accordance with
				  7 AAC 105.210;
(2) be a grantee of the department under AS
				  47.20 and 7 AAC 23; and
(3) provide
				  documentation of at least one year of experience in
(A) effective work with children and
				  families, involving a demonstrated capacity to provide all core elements of
				  case management including assessment, development of the individualized family
				  service plan, implementation, coordination, and reassessment;
(B) coordinating and linking community
				  medical, social, educational, and other resources as required by the target
				  population identified in (b) of this section;
(C) working with the target population
				  identified in (b) of this section; and
(D) financial management that provides
				  documentation of service and costs.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 18 - Telehealth › 7 AAC 110.620 - Scope of telehealth

Current through May 31, 2024
Subject to the requirements of
					 7 AAC 110.620-7 AAC 110.639, the department will pay for a service
					 delivered by means of a telehealth modality if the service
(1) would be covered under 7 AAC 105-7 AAC
				  160 if delivered in person; and
(2)
				  is delivered in compliance with
(A) the same
				  requirements of 7 AAC 105-7 AAC 160, including prior authorization requirements
				  and service limitations, as if the service was delivered in person;
				  and
(B) the requirements of AS
				  08.01, AS 08.68, AS 47.07, and 7 AAC 105 - 7 AAC 160, including the telehealth
				  requirements and limitations of
				  7 AAC 110.620 -
				  7 AAC 110.639, as applicable to the service, the
				  provider, and the mode of delivery.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 18 - Telehealth › 7 AAC 110.625 - Telehealth modalities

Current through May 31, 2024
(a) Subject to the
				  requirements of
				  7 AAC 110.620 -
				  7 AAC 110.639, the department will pay for a service
				  delivered by means of one of the following telehealth modalities if the
				  modality and use of the modality meet the requirements of
				  P.L.
				  104-191(Health Insurance Portability and
				  Accountability Act of 1996 (HIPAA)):
(1)
				  synchronous: live or interactive, through a real-time, interactive
(A) two-way audio-video technology that
				  includes, at a minimum, an operational camera, microphone, speaker or
				  headphones, and capability to view video feed;
(B) two-way audio-only technology that allows
				  for oral communication between the provider and the
				  recipient;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 18 - Telehealth › 7 AAC 110.630 - Telehealth provider requirements and conditions for payment

Current through May 31, 2024
Subject to the requirements of
					 7 AAC 110.620 -
					 7 AAC 110.639, to be eligible for payment under 7 AAC
					 105 - 7 AAC 160 for providing a service by means of a telehealth modality, a
					 provider must meet the following requirements:
(1) the provider must have an active license
				  under AS 08 or AS 47, an active certification in the state, or an active
				  license under the applicable laws of the jurisdiction in which the provider is
				  located;
(2) the provider must be
				  enrolled under
				  7 AAC 105.210;
(3) the provider, if licensed under AS 08 and
				  required under
				  12 AAC 02.600, must be registered
				  under 12 AAC 02.600 (telemedicine
				  business registry);
(4) the service
				  must be delivered within the rendering provider's, and if applicable,
				  consulting provider's scope of licensure or certification;
(5) a claim submitted to the department must
				  include applicable telehealth modifiers and place-of-service coding;
(6) if the rendering provider or consulting
				  provider determines, during a telehealth encounter, that a service extends
				  beyond the scope of that provider's license or certification, the provider must
				  discontinue the encounter and refer the recipient to an appropriate provider;
				  the rendering provider or consulting provider may bill only for the portion of
				  the encounter that was within that provider's scope of license or certification
				  and only if the rendered portion of the encounter met all criteria of a
				  separately billable service;
(7)
				  except as otherwise provided in 7 AAC 105-7 AAC 160, a recipient must be
				  present during and participate in a telehealth encounter;
(8) the provider must comply with all record
				  keeping requirements set out under
				  7 AAC 105.230 for all telehealth services
				  rendered;
(9) the rendering
				  provider and consulting provider, when delivering a service by means of a
				  synchronous telehealth modality, must annotate the patient's clinical record
				  with the method of delivery, the recipient's location during the delivery of
				  the service, and confirmation that the recipient has consented to a telehealth
				  method of delivery.
Authority:
AS
						47.05.010
AS 47.07.030
AS 47.07.040
AS
						47.07.069
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 18 - Telehealth › 7 AAC 110.635 - Telehealth exclusions

Current through May 31, 2024
The department will not pay
(1) for the use, or any costs associated with
				  the use, of technological equipment and systems associated with the delivery of
				  a service by means of a telehealth modality;
(2) a provider for communication with that
				  provider's supervising provider or communication with a provider who is acting
				  in a supervisory capacity;
(3) a
				  supervising provider or a provider who is acting in a supervisory capacity for
				  communication with a supervisee or for review of a supervisee's work;
(4) a provider participating in a telehealth
				  encounter whose sole purpose is to facilitate the telehealth encounter between
				  the recipient and a rendering provider or a consulting provider;
(5) for a failed or unsuccessful telehealth
				  connection or transmission;
(6) for
				  the following services when provided by means of a telehealth modality:
(A) chiropractic services;
(B) dental services;
(C) private-duty nursing services;
(D) pharmacy dispensing services;
(E) durable medical equipment and related
				  services;
(F)  prosthetic and
				  orthotic devices and related services;
(G) transportation services;
(H) accommodation services;
(I) personal care services;
(J) home health services;
(K) Community First Choice
				  services;
(L) home and
				  community-based waiver services, except for
(i) care coordination services under
				  7 AAC 130.240;
(ii) day habilitation services under
				  7 AAC 130.260;
(iii) employment services under
				  7 AAC 130.270; or
(iv) intensive active treatment services
				  under 7 AAC 130.275;
(M) Long term services and supports targeted
				  case management services, except for case management services provided under
				  7 AAC 128.010(b)(2).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 18 - Telehealth › 7 AAC 110.639 - Telehealth definitions

Current through May 31, 2024
In
					 7 AAC 110.620 -
					 7 AAC 110.639,
(1) "consulting provider" means a provider
				  who evaluates a recipient's healthcare information by means of a telehealth
				  modality based on a referral or request from another provider;
(2) "patient-initiated online digital
				  service" means evaluation, assessment, and management services of an
				  established patient through a secure platform such as an electronic health
				  record portal, secure electronic mail, or digital application when the patient
				  is the originator of the interaction with the provider;
(3) "provider" means a professional,
				  facility, or other type of provider and includes a rendering provider, a
				  referring provider, and a consulting provider;
(4) "rendering provider" means a provider who
				  evaluates, diagnoses, and treats a recipient;
(5) "referring provider" means a rendering
				  provider who refers a recipient to another rendering provider to diagnose or
				  treat the recipient when the recipient requires services or a specialty beyond
				  the scope of the license or certification of the rendering provider making the
				  referral;
(6) "telehealth" means the
				  practice of health care delivery, evaluation, diagnosis, consultation, or
				  treatment using the transfer of medical data, audio, visual, or data
				  communications at two or more locations between a provider and recipient who
				  are physically separated from each other.
Authority:
AS
						47.05.010
AS 47.07.030
AS 47.07.040
AS
						47.07.069
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 19 - Vision Care Services › 7 AAC 110.700 - Vision care provider enrollment requirements

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing vision care services, a
				  provider must
(1) be enrolled as a vision
				  care provider in accordance with
				  7 AAC 105.210;
(2) have an active license to practice as an
				  ophthalmologist, an optometrist, or an optician issued by the jurisdiction in
				  which the individual provides services; if services are provided in this state
				  the individual must be actively licensed as
(A) a physician under AS 08.64, who is
				  certified as an ophthalmologist by the American Academy of
				  Ophthalmology;
(B) an optometrist
				  under AS 08.72; or
(C) a dispensing
				  optician under AS 08.71.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 19 - Vision Care Services › 7 AAC 110.705 - Vision care services

Current through May 31, 2024
(a) The department will pay for only the
				  vision services and products identified in the
Fee Schedule for Vision
				  Services,
adopted by reference in
				  7 AAC 160.900, subject to the provisions of this
				  section.
(b) The department will
				  pay for the following services in each calendar year for a recipient under 21
				  years of age:
(1) one vision examination if
				  the vision examination meets the requirements of
				  7 AAC 110.710;
(2) any vision examination, in addition to
				  the examination in (1) of this subsection, if the department gives prior
				  authorization based upon medical justification submitted by the
				  provider;
(3) one complete pair of
				  eyeglasses, or a one-year supply of contact lenses, that meets the requirements
				  of (d) of this section;
(4) one
				  additional complete pair of eyeglasses, or additional supply of contact lenses
				  prorated for the remainder of the year, that meets the requirements of (d) of
				  this section, if the
(A) first pair of
				  eyeglasses or supply of contact lenses is lost or broken; or
(B) prescription changes;
(5) any subsequent complete pair
				  of eyeglasses, or subsequent supply of contact lenses prorated for the
				  remainder of the year, that meets the requirements of (d) of this section, if
				  the department gives prior authorization based upon medical justification
				  submitted by the provider;
(6) one
				  fitting for each pair of glasses covered under this subsection.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 19 - Vision Care Services › 7 AAC 110.710 - Complete vision examination

Current through May 31, 2024
(a) For a
				  clinically indicated complete vision examination with a check of refractive
				  state, the ophthalmologist or optometrist performing the examination shall
(1) record a complete case history, including
				  ocular, physical, occupational, and medical data and other pertinent
				  information;
(2) determine the best
				  corrected visual acuity;
(3)
				  perform an external examination of the eyes and adnexa;
(4) perform an internal ophthalmoscopic
				  examination;
(5) determine ocular
				  motility and neurological integrity;
(6) perform a near-point subjective
				  examination, dynamic retinoscopy, and subjective refraction; and
(7) if clinically indicated, perform test
				  accommodation, convergence, and binocular coordination at far and near
				  distances with a phorometer.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 19 - Vision Care Services › 7 AAC 110.715 - Noncovered vision care services

Current through May 31, 2024
The department will not pay for
(1) aspherical lenses;
(2) progressive or no-line multi-focal
				  lenses;
(3) vision therapy services
				  for a recipient 21 years of age or older;
(4) polarized lenses;
(5) anti-reflective or mirror
				  coating;
(6) lenses for placement
				  into frames that are not covered under
				  7 AAC 110.705;
(7) the placement of any lenses into frames
				  that are not covered under
				  7 AAC 110.705;
(8) fitting of a vision product that is not
				  covered under
				  7 AAC 110.705; or
(9) repair of a vision product that is not
				  covered under
				  7 AAC 110.705.
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 110 - Medicaid Coverage; Professional Services › Article 20 - Vaccine Services › 7 AAC 110.750 - Vaccine services

Current through May 31, 2024
(a) To be a covered vaccine product, a
				  vaccine product must be one
(1) for which the
				  United States Food and Drug Administration (FDA) requires a national drug code
				  (NDC) number; and
(2) that is
				  listed electronically with the FDA.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 110 - Medicaid Coverage; Professional Services › Article 21 - Preventive Services for Adults › 7 AAC 110.800 - Preventive services for adults

Current through May 31, 2024
(a) The department
				  will pay for the following preventive and screening services for a recipient 21
				  of age or older:
(1) an evidence-based item
				  or service with an A or B rating by the United States Preventive Services Task
				  Force (USPSTF)
A & B Recommendations for Adults,
adopted
				  by reference in
				  7 AAC 160.900;
(2) an immunization for routine use recommended by the Advisory
				  Committee on Immunization Practices (ACIP) and listed on the current
				  immunization schedules of the Centers for Disease Control and Prevention (CDC),
				  adopted by reference in
				  7 AAC 160.900;
(3) evidence-informed preventive care and
				  screening based on the Health Resources and Services Administration (HRSA),
Women's Preventive Services Guidelines,
adopted by reference
				  in 7 AAC 160.900; and
(4) an item, a service, and an immunization
				  that is intended to prevent or mitigate coronavirus disease 2019 (COVID-19) and
				  that is
(i) an evidence-based item or service
				  with an A or B rating by the United States Preventive Services Task Force
				  (USPSTF); or
(ii) an immunization
				  recommended by the Advisory Committee on Immunization Practices (ACIP) and
				  adopted by the director of the Centers for Disease Control and Prevention
				  (CDC).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 1 - Occupational Therapy Services › 7 AAC 115.100 - Occupational therapy provider enrollment requirements

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing outpatient occupational
				  therapy services, a provider must be an
(1)
				  occupational therapist who
(A) is enrolled in
				  accordance with
				  7 AAC 105.210;
(B) provides documentation of an active
				  license to practice occupational therapy in the jurisdiction in which the
				  individual provides services; if services are provided in this state, the
				  individual must hold an active license under AS 08.84; and
(C) if providing occupational therapy
				  services out of state, is enrolled in the Medicaid program in the jurisdiction
				  in which the individual provides services; or
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 1 - Occupational Therapy Services › 7 AAC 115.110 - Occupational therapy services

Current through May 31, 2024
(a) The department
				  will pay for occupational therapy services and supplies
(1) that are identified in the
Fee
				  Schedule for Therapy Services
, adopted by reference in
				  7 AAC 160.900; and
(2) if those services, except the initial
				  evaluation, are
(A) prescribed by a
				  physician, an advanced practice registered nurse, a physician assistant, or
				  another licensed health care professional, within the scope of the
				  practitioner's license;
(B) within
				  the scope of practice of an occupational therapist or occupational therapy
				  assistant;
(C) provided by or under
				  the direction of an occupational therapist who is enrolled under 7 AAC 105 - 7
				  AAC 160;
(D) provided in accordance
				  with the initial evaluation conducted under
				  7 AAC 115.120(a) and treatment plan
				  developed by the occupational therapist under
				  7 AAC 115.120(b); and
(E) documented in a progress note to include
				  start and stop times for time-based billing codes used as provided in the
Healthcare Common Procedure Coding System (HCPCS)
, adopted by
				  reference in
				  7 AAC 160.900.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 1 - Occupational Therapy Services › 7 AAC 115.120 - Occupational therapy evaluation and treatment plan

Current through May 31, 2024
(a) Before
				  initiating treatment, the occupational therapist shall conduct an initial
				  evaluation of the recipient that includes an assessment of the
(1) recipient's significant past medical
				  history;
(2) diagnosis and
				  prognosis, if established, and the extent to which the recipient is aware of
				  the diagnosis and prognosis;
(3)
				  prescribing health care practitioner orders, if any;
(4) rehabilitation goals and potential for
				  achievement;
(5) contraindications,
				  if any;
(6) summary of any known
				  prior treatment; and
(7) goals of
				  any maintenance occupational therapy as described in
				  7 AAC 115.110(d).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 2 - Outpatient Therapy Center Services › 7 AAC 115.200 - Outpatient therapy center enrollment requirements

Current through May 31, 2024
To be eligible for payment under 7 AAC 105 - 7 AAC 160 for
					 providing physical therapy, occupational therapy, speech-language pathology
					 services, or an combination of those services, an outpatient therapy center
					 must be
(1) enrolled in as an
				  outpatient therapy center provider in accordance with
				  7 AAC 105.210;
(2) certified by the department under
				  42 C.F.R.
				  488.11 and
				  42 C.F.R.
				  488.26 to be in compliance with
				  42 C.F.R.
				  485.701 -
				  485.729 and, for occupational
				  therapy made applicable by 42 U.S.C. 1395 x(g), by the
				  jurisdiction in which services are provided;
				  42 C.F.R.
				  488.11,
				  42 C.F.R.
				  488.26, and
				  42 C.F.R.
				  485.701 -
				  485.729 are adopted by reference
				  in 7 AAC 160.900; and
(3) if providing outpatient therapy center
				  services out of state, enrolled as an outpatient therapy center provider in the
				  jurisdiction in which services are provided.
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 115 - Medicaid Coverage; Therapies and Related Services › Article 2 - Outpatient Therapy Center Services › 7 AAC 115.210 - Outpatient therapy center services

Current through May 31, 2024
(a) The department
				  will pay for only the physical therapy, occupational therapy, and
				  speech-language pathology services and supplies identified in the
Fee
				  Schedule for Therapy Services
, adopted by reference in
				  7 AAC 160.900, if those services and supplies, except
				  the initial evaluation, are
(1) prescribed by
				  a physician, an advanced practice registered nurse, or a physician assistant
				  who may prescribe those services and supplies within the scope of the
				  practitioner's license;
(2)
				  delivered by a physical therapist, an occupational therapist, or a
				  speech-language pathologist who holds an active license to practice issued by
				  the jurisdiction in which services are provided and who provides direct
				  services only within the scope of that license; if services are provided in
				  this state the individual must hold an active license under AS 08;
				  and
(3) provided in accordance with
				  the initial evaluation and treatment plan developed under
				  7 AAC 115.220.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 2 - Outpatient Therapy Center Services › 7 AAC 115.220 - Outpatient therapy center evaluation and treatment plan

Current through May 31, 2024
(a) Before or at
				  the time of initiating treatment, the outpatient therapy center shall conduct
				  an initial evaluation of the recipient that includes an assessment of the
(1) recipient's significant past medical
				  history;
(2) diagnosis and
				  prognosis, if established, and the extent to which the recipient is aware of
				  the diagnosis and prognosis;
(3)
				  prescribing health care practitioner orders, if any;
(4) rehabilitation goals and potential for
				  achievement;
(5) contraindications,
				  if any; and
(6) summary of any
				  prior treatment, if known.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 3 - Physical Therapy Services › 7 AAC 115.300 - Physical therapy provider enrollment requirements

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing outpatient physical
				  therapy services, the individual must be
(1)
				  a physical therapist who
(A) is enrolled in
				  accordance with
				  7 AAC 105.210;
(B) provides documentation of an active
				  license to practice physical therapy in the jurisdiction in which the
				  individual provides services; if services are provided in this state, the
				  individual must hold an active license under AS 08.84; and
(C) if providing physical therapy services
				  out of state, is enrolled in the Medicaid program in the jurisdiction in which
				  the individual provides service; or
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 3 - Physical Therapy Services › 7 AAC 115.310 - Physical therapy services

Current through May 31, 2024
(a) Payment for
				  physical therapy services is limited to
(1)
				  evaluations;
(2) physical
				  agents;
(3) massage and
				  manipulation;
(4) therapeutic
				  exercise;
(5) hydrotherapy;
				  and
(6) other forms of treatment
				  for rehabilitation and restoration of normal bodily functions following acute
				  physical illness or acute physical trauma.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 3 - Physical Therapy Services › 7 AAC 115.320 - Physical therapy evaluation and treatment plan

Current through May 31, 2024
(a) Before
				  initiating treatment, the physical therapist shall conduct an initial
				  evaluation of the recipient that includes an assessment of the
(1) recipient's significant past medical
				  history;
(2) diagnosis and
				  prognosis, if established, and the extent to which the recipient is aware of
				  the diagnosis and prognosis;
(3)
				  prescribing health care practitioner orders, if any;
(4) rehabilitation goals and potential for
				  achievement;
(5) goals of any
				  maintenance physical therapy as described in
				  7 AAC 115.310(c);
(6) contraindications, if any; and
(7) summary of any known prior
				  treatment.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 4 - Speech-Language Pathology Services › 7 AAC 115.400 - Speech-language pathology enrollment requirements

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing speech-language pathology
				  services, a provider must be
(1) a
				  speech-language pathologist who
(A) is
				  enrolled in accordance with
				  7 AAC 105.210;
(B) provides documentation of an active
				  license to practice speech-language pathology in the jurisdiction in which the
				  individual provides services; if services are provided in this state, the
				  individual must hold an active license under AS 08.11; and
(C) if providing speech-language pathology
				  services out of state, is enrolled in the Medicaid program in the jurisdiction
				  in which the individual provides services; or
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 4 - Speech-Language Pathology Services › 7 AAC 115.410 - Speech-language pathology services

Current through May 31, 2024
The department will pay for speech-language pathology
					 services and supplies
(1) that are
				  identified in the
Fee Schedule for Therapy Senvcis
, adopted by
				  reference in
				  7 AAC 160.900; and
(2) if those services and supplies, except
				  the initial evaluation, are
(A) prescribed by
				  a physician, advanced practice registered nurse (APRN), or physician assistant
				  (PA) enrolled under 7 AAC 105 - 7 AAC 160 and the services and supplies
				  prescribed are within the scope of the practitioner's license;
(B) within the scope of practice of an
				  speech-language pathologist or speech-language pathology assistant;
(C) provided by or under the direction of a
				  speech-language pathologist who is enrolled under 7 AAC 105 - 7 AAC
				  160;
(D) provided in accordance
				  with the initial evaluation conducted under
				  7 AAC 115.420(a) and treatment plan
				  developed by the speech-language pathologist under
				  7 AAC 115.420(b); and
(E) documented in a progress note to include
				  start and stop times for time-based billing codes used as provided in the
Healthcare Common Procedure Coding System (HCPCS)
, adopted by
				  reference in
				  7 AAC 160.900.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 4 - Speech-Language Pathology Services › 7 AAC 115.420 - Speech-language evaluation and treatment plan

Current through May 31, 2024
(a) Before
				  initiating treatment, the speech-language pathologist shall conduct an initial
				  evaluation of the recipient that includes an assessment of the
(1) recipient's significant past medical
				  history;
(2) diagnosis and
				  prognosis, if established, and the extent to which the recipient is aware of
				  the diagnosis and prognosis;
(3)
				  prescribing health care practitioner orders, if any;
(4) rehabilitation goals and potential for
				  achievement;
(5) contraindications,
				  if any; and
(6) summary of any
				  known prior treatment.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 5 - Hearing Services › 7 AAC 115.500 - Hearing services provider enrollment

Current through May 31, 2024
(a) To be eligible
				  for payment under 7 AAC 105 - 7 AAC 160 for providing hearing services, the
				  individual must
(1) be enrolled in accordance
				  with 7 AAC 105.210; and
(2) have an active license to practice as an
				  audiologist or hearing aid dealer issued by the jurisdiction in which the
				  individual provides services; if services are provided in this state, the
				  individual must hold an active license as an audiologist under AS 08.11 or a
				  hearing aid dealer under AS 08.55.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 5 - Hearing Services › 7 AAC 115.510 - Audiologist services

Current through May 31, 2024
(a) Subject to the requirements of
				  7 AAC 115.500 -
				  7 AAC 115.549 and
				  7 AAC 145.340, the department will pay an audiologist
				  for hearing services and hearing items identified in
				  7 AAC 115.530 that are rendered within the scope of the
				  audiologist's license.
(b) The
				  department will pay an audiologist for cochlear implantation-related services,
				  including
(1) a preliminary
				  assessment;
(2) programming of the
				  cochlear device;
(3)
				  adjustments;
(4) recipient
				  education;
(5) auditory
				  rehabilitation; and
(6) treatment
				  sessions.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 5 - Hearing Services › 7 AAC 115.520 - Hearing aid dealer services

Current through May 31, 2024
(a) Subject to the
				  requirements of
				  7 AAC 115.500 -
				  7 AAC 115.549 and
				  7 AAC 145.340, the department will pay a hearing aid
				  dealer for the hearing services and hearing items identified in
				  7 AAC 115.530
(1) that
				  are provided within the scope of the hearing aid dealer's license;
				  and
(2) if the hearing item is a
				  hearing aid,
(A) the hearing aid is prescribed
				  by a physician; and
(B) the
				  requirements of
				  AS
				  08.55.060(a) and (b) are
				  met.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 5 - Hearing Services › 7 AAC 115.530 - Hearing services and items

Current through May 31, 2024
(a) The department
				  will pay a hearing services provider for providing a hearing service or hearing
				  item, if that hearing service or hearing item is
(1) prescribed by an audiologist, otologist,
				  otolaryngologist, or a physician, except as provided in
				  7 AAC 115.520(a) (2); and
(2) identified by the prescriber in (1) of
				  this subsection as
(A) medically necessary to
				  alleviate a disability caused by a hearing impairment; and
(B) the least costly alternative that fits
				  the recipient's medical need.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 5 - Hearing Services › 7 AAC 115.540 - Prior authorization of hearing services and items

Current through May 31, 2024
(a) A provider must
				  obtain prior authorization from the department before the department will pay
				  for
(1) the purchase of a replacement
				  cochlear implant part or rechargeable lithium ion battery;
(2) the rental of hearing aids;
(3) the purchase of a hearing item that
				  exceeds a limit under
				  7 AAC 115.530;
(4) a payment request that exceeds the
				  maximum allowable payment for a hearing item;
(5) a customized hearing aid;
(6) a monaural hearing aid or binaural
				  hearing aid for which a payment rate has not been established;
(7) the purchase of the following hearing
				  services or hearing items identified as miscellaneous in the
Healthcare
				  Common Procedure Coding System (HCPCS)
, adopted by reference in
				  7 AAC 160.900:
(A) a
				  personal FM system, for a recipient under 21 years of age with hearing loss
				  diagnosed by an audiologist licensed under AS 08.11;
(B) a hearing aid;
(C) a hearing aid accessory;
(D) a hearing aid supply;
(E) a hearing service.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 5 - Hearing Services › 7 AAC 115.549 - Definitions

Current through May 31, 2024
In
					 7 AAC 115.500 -
					 7 AAC 115.549,
(1) "customized hearing aid" means a hearing
				  aid that is uniquely constructed or substantially modified to fit the anatomy
				  of a specific recipient;
(2)
				  "hearing aid" has the meaning given in
				  AS
				  08.55.200;
(3) "hearing aid accessory" means an
				  accessory that is
(A) not included with the
				  dispensing of a hearing aid;
(B)
				  not physically connected to the hearing aid when the hearing aid is being worn
				  by the individual; and
(C) used to
				  prolong the life of the hearing aid by providing maintenance, hygiene, or
				  safekeeping.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 115 - Medicaid Coverage; Therapies and Related Services › Article 6 - School-Based Services › 7 AAC 115.600 - School-based services

Current through May 31, 2024
(a) The department will enroll an in-state
				  school district as a Medicaid provider of school-based services if the school
				  district meets the requirements of AS 47.07 and 7 AAC 105 - 7 AAC 160 and
				  enters into an agreement with the department as required by
				  AS
				  47.07.063.
(b) The school district shall submit each
				  request for payment for a school-based service using the provider code number
				  assigned to the school district at enrollment.
(c) The department will pay the cost of an
				  evaluation, screening, or assessment of a Medicaid-eligible child's need for a
				  school-based service only if the outcome indicates the child's need for
				  services included in the individualized education plan described in (d) of this
				  section.
(d) The department will
				  pay for school-based services for a Medicaid-eligible child if the
				  individualized education plan developed for the child under
				  AS
				  14.30.278 specifies the services that the
				  school district is seeking payment for, each health condition to be addressed,
				  the anticipated treatment goals, and the type, amount, frequency, and duration
				  of each service to be offered. Any change to a plan that adds, eliminates, or
				  alters a service, material, or supply described under this section must be
				  documented in the Medicaid-eligible child's clinical record by or under the
				  direction of a physician, a physician assistant, an advanced practice
				  registered nurse, a physical therapist, an occupational therapist, a
				  speech-language pathologist, an audiologist, a psychologist or psychological
				  associate, a behavioral health professional, a behavioral health associate, or
				  other health care provider who is
(1) acting
				  within the scope of that health care provider's
(A) license under AS 08; or
(B) training and experience, if the health
				  care provider is a psychologist or psychological associate described in
				  (h)(7)(A)(ii) of this section, a behavioral health professional, or a
				  behavioral health associate; and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 1 - Prescription Drugs and Medical Supplies › 7 AAC 120.100 - Provider requirements

Current through May 31, 2024
(a) A provider seeking payment for providing
				  pharmacy services under 7 AAC 105 - 7 AAC 160 must be
(1) enrolled as a pharmacist or retail
				  pharmacy in accordance with
				  7 AAC 105.210;
(2) submit verification of an active
(A) pharmacist license issued under AS 08.80;
				  or
(B) retail pharmacy license
				  issued under AS 08.80; and
(3) identify the floor space of the pharmacy
				  in square feet.