Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services › Article 2 - Durable Medical Equipment and Medical Supplies; Related Services › 7 AAC 120.210 - Service authorization

Current through May 31, 2024
(a) A provider seeking service authorization
				  must make a request electronically or in writing on a certificate of medical
				  necessity.
(b) Service
				  authorization is required for
(1) the rental
				  of durable medical equipment, medical supplies, prefabricated off-the-shelf
				  orthotics, or related items and services under 7 AAC 120.200(a)(2) that is
				  indicated as requiring service authorization in the
Alaska Medicaid
				  DMEPOS Fee Schedule, Tables 1-5 through 1-9
, adopted by reference in 7 AAC 160.900;
(2) medical supplies
				  that exceed the maximum units or a 30-day limit set by the
				  department;
(3) customized or
				  optimally configured durable medical equipment, medical supplies, prefabricated
				  off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2);
(4) items that are
				  listed as requiring service authorization on the
Alaska Medicaid DMEPOS
				  Fee Schedule, Tables 1-5 through 1-9
, adopted by reference in 7 AAC 160.900 or the Alaska Medicaid DMEPOS Interim Fee Schedule;
(5) items that are identified as
				  miscellaneous in the United States Department of Health and Human Services,
				  Centers for Medicare and Medicaid Services (CMS)
Healthcare Common
				  Procedure Coding System (HCPCS)
, adopted by reference in 7 AAC 160.900;
(6) respiratory therapy
				  assessment visits for ventilator-dependent recipients;
(7) home infusion therapy;
(8) enteral and oral nutritional
				  products;
(9) the purchase of
				  durable medical equipment, medical supplies, prefabricated off-the-shelf
				  orthotics, or related items and services under 7 AAC 120.200(a)(2) for a
				  recipient in a skilled nursing facility or intermediate care
				  facility;
(10) continuous oxygen
				  for a recipient in a skilled nursing facility or an intermediate care
				  facility;
(11) the purchase of
				  durable medical equipment, medical supplies, prefabricated off-the-shelf
				  orthotics, or related items and services under 7 AAC 120.200(a)(2) if the
				  charge to the department exceeds $1,000;
(12) medical supplies and services for a
				  single claim or for a 30-day supply if the charge to the department exceeds
				  $1,000;
(13) durable medical
				  equipment, medical supplies, prefabricated off-the-shelf orthotics, or related
				  items and services under 7 AAC 120.200(a)(2) requiring CMS prior authorization
				  under  42 C.F.R. 414.234(c)(1);
(14)
				  Medicare-covered durable medical equipment, medical supplies, prefabricated
				  off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2) that are for a recipient who is eligible under both Medicare and
				  Medicaid, and that Medicare
(A) has
				  determined medically unnecessary for that recipient; or
(B) has denied after finding that a provider
				  sought payment in excess of copay and deductible;
(15) optimally configured power wheelchairs
				  that require payment under capped rental rules provided where the provider of
				  durable medical equipment, medical supplies, prefabricated off-the-shelf
				  orthotics, or related items and services under 7 AAC 120.200(a)(2) requests
				  direct purchase; and
(16) items
				  that are medically necessary to be replaced before the qualified replacement
				  time, even if they had not initially been identified as requiring service
				  authorization.