Alaska Administrative Code

(a) Except as provided otherwise in this section or by federal law, the department will not pay separately for durable medical equipment while the recipient is (1) in a hospital, a skilled nursing facility, or an intermediate care facility; or (2) receiving hospice care services.…

(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 …

(a) The department may authorize the purchase of new or used durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2). The item or service becomes the property of the recipient for whom it is purch…

(a) Subject to applicable requirements of 7 AAC 120.200 - 7 AAC 120.399, a provider enrolled under 7 AAC 105.210 as a durable medical equipment provider may request a payment and the department may pay for the purchase or rental of replacement durable medical equipment, medical s…

(a) Service authorization under 7 AAC 120.210 is required for the following rentals of durable medical equipment: (1) rental of items for anticipated short-term use indicated as requiring service authorization on the Alaska Medicaid DMEPOS Fee Schedule, Tables 1-5 through 1-9, ad…

(a) Except as otherwise provided in this section, an interruption in a rental period affects the department's payment as follows: (1) a rental period is not affected by an interruption of less than 60 consecutive days, including the days remaining in the rental month in which the…

(a) The department will pay a provider enrolled under 7 AAC 120.200 for respiratory therapy equipment and supplies if the (1) provider employs or contracts with a(A) registered respiratory therapist who(i) holds a valid national registry number and certificate from the National B…

(a) Subject to applicable requirements of 7 AAC 120.200 - 7 AAC 120.399, the department will pay a provider enrolled under 7AAC105.210 as a durable medical equipment provider providing durable medical equipment., medical supplies, and prefabricated off-the-shelf orthotics or rela…

(a) The department will enroll a provider of home infusion therapy services if the provider (1) meets the requirements of this section and 7 AAC 120.200(a); (2) presents evidence of a pharmacy or pharmacist license issued under AS 08.80; and (3) documents that it meets the guidel…

Notes 7 AAC 120.299 Eff. 2/1/2010, Register 193; am 1/1/2011, Register 196; repealed 6/2/2019, Register 230, May 2019 State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly r…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing prosthetics, orthotics, and related items and supplies, a provider must (1) have and maintain a valid business license issued under AS 43.70 and 12 AAC 12; (2) be enrolled under 7 AAC 105.210 as a prosthetic…

(a) The department will not pay separately for the repair, return shipping, or preventive maintenance or service of prosthetics or orthotics for which the cost of repair, return shipping, or preventive maintenance or service is included in the rental fee or warranty. (b) The depa…

(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) items or services indicated as requiring service authorization on the Alaska Medicaid DMEPOS Fee Sche…

In 7 AAC 120.200 - 7 AAC 120.399, (1) "capped rental" means the rental of durable medical equipment for not more than 13 months; (2) "custom fabricated orthotic" means an orthotic that is individually made for a specific patient and created using measurements or an impression gen…

To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing transportation and accommodation services, the provider must (1) enroll with the department as a provider of transportation or accommodation services in accordance with 7 AAC 105.210; (2) if providing transporta…

(a) The department will pay a provider for only those transportation and accommodation services that are(1) provided to assist the recipient in receiving medically necessary services; and (2) authorized by the department under 7 AAC 120.410 and 7 AAC 120.415. (b) The department w…

(a) The department will pay for the least expensive mode of nonemergency transportation to and from an appointment with the closest appropriate provider for a recipient if the (1) services are medically necessary and covered under 7 AAC 105 - 7 AAC 160; (2) provider is enrolled u…

(a) The department will pay for medically necessary emergency air or ground transportation to the nearest facility that provides emergency care. If the recipient is an American Indian or Alaska Native, the department will, at the request of the recipient or a family member, pay f…

(a) The department will pay for air ambulance services only if (1) the recipient is being transferred to another community to receive a medically necessary higher level of care not available in the recipient's community; and (2) the patient is accompanied by appropriately credent…

(a) The department will pay for accommodation services, including food and lodging, that are authorized by the department and incurred by a recipient and the recipient's authorized escort who are required to travel to receive necessary medical care and cannot reasonably return to…

(a) The department will approve transportation and accommodation services for an authorized escort to accompany a recipient during travel authorized by the department for medical treatment if (1) the recipient is 17 years of age or younger; or (2) the recipient is 18 years of age…

(a) The department may enroll a prematernal home as a Medicaid provider tor provide transportation and accommodation services if the prematernal home is licensed to provide lodging, meals, and medically related transportation to (1) a pregnant woman; or (2) a woman with a child l…

Medical transportation services include transportation provided by the carrier up to the time death is known or until the deceased recipient, alive at the time of pickup, reaches the source of medical care. Thereafter, transportation expense of the deceased recipient is a mortuar…

The department may designate one or more enrolled providers of transportation or accommodation services to serve specific geographic regions, or an agent or organization to manage travel and accommodations services, through a contract for services under AS 36.30, a grant, or othe…

In 7 AAC 120.400 - 7 AAC 120.490, (1) "ambulance" means any privately or publicly owned vehicle that is regularly provided or offered to be provided for the emergency transportation of a person suffering from illness, injury, or disability and licensed by the department or local …

(a) The purpose of 7 AAC 125.010 - 7 AAC 125.199 is to establish standards, requirements, and procedures for the personal care services program. (b) The department will authorize and pay for personal care services that are (1) provided to a recipient that (A) experiences function…

(a) A recipient may apply for personal care services under 7 AAC 125.010 - 7 AAC 125.199 if that individual (1) is a current Medicaid recipient; (2) completes an application in a format provided by the department, with the assistance of (A) a provider of personal care services th…

(a) Except as specified in 7 AAC 125.010(c), the department, using the Consumer Assessment Tool adopted by reference in 7 AAC 160.900, (1) will conduct an assessment of a recipient(A) for an initial application for services unless an assessment is denied under (d) of this section…

(a) Using the assessment conducted in accordance with 7 AAC 125.020 for each recipient, the department will (1) determine the total time for personal care services for which the department will pay using the Personal Care Services: Service Level Computation, adopted by reference …

(a) The department will modify the time authorized for personal care services if the department determines that a recipient has experienced a change that alters the recipient's need for physical assistance with ADLs, IADLs, or other covered services. (b) To request an amendment t…

(a) Not later than 15 days after the recipient knows of the change, the recipient shall report to the recipient's personal care services agency by telephone, by facsimile transmission, by electronic mail, in writing, or in person, (1) a change in the recipient's (A) place of resi…

(a) A personal care services provider may only bill for the personal care services identified in this section for a recipient, if those services are (1) included in the recipient's service level authorization; (2) provided through either an agency-based or a consumer-directed per…

(a) Personal care services do not include (1) application of dressings involving prescription medication and aseptic techniques, except as allowed under 7 AAC 125.030(d)(3); (2) invasive body procedures, including (A) tracheostomy care, deep suctioning, and care and maintenance o…

(a) The department will pay for personal care services for a recipient only if provided (1) in the recipient's residence if that residence is(A) the dwelling that the recipient considers to be the recipient's established or principal home and to which, when absent, the recipient …

(a) To receive payment for personal care services, an agency must be certified by the department as a provider of personal care services. To be certified by the department, an agency must (1) submit an application, in a format provided by the department; before submitting the app…

(a) A provider of personal care services shall use an electronic visit verification (EW) system that is either provided or approved by the department. If a provider decides to use its own EVV system or vendor, that system must include at the time of service delivery, and report t…

(a) The department will deny an application to renew certification of, will suspend certification of, or will decertify and disenroll a personal care services agency as a provider for the consumer-directed or agency-based program (1) if the agency does not submit an application f…

(a) To be employed as a personal care assistant in either the consumer-directed program or the agency-based program, a personal care assistant (1) must be at least 18 years of age; (2) must comply with the requirements of 7 AAC 125.010 - 7AAC 125.199; (3) must be associated with …

(a) An agency certified in accordance with 7 AAC 125.060 as a provider of personal care services shall (1) protect a recipient's health, safety, and welfare while rendering services under this chapter; and (2) provide training for all employees regarding(A) the mandatory reportin…

(a) A provider of personal care services shall report to the department, in a format provided by the department, a critical incident involving a recipient not later than one business day after observing or learning of the critical incident. (b) A provider of personal care service…

(a) A personal care assistant may use restrictive intervention only (1) as a response when a recipient presents an imminent danger to the recipient's safety or to the safety of others; (2) when other types of interventions have been tried, and documented as ineffective for safe m…

(a) Notwithstanding (c) of this section, and not later than 30 days before a personal care services agency terminates personal care services to a recipient, the agency shall send written notice of the termination to the department and the recipient. (b) An agency may terminate se…

(a) A personal care assistant employed by a personal care services agency shall maintain for Medicaid billing purposes a contemporaneous record of services provided for each recipient that must include (1) a copy of the service level authorization that the department has approved…

(a) In addition to meeting the requirements under 7 AAC 125.010 - 7 AAC 125.199, a personal care services agency that administers a consumer-directed program shall (1) perform, at least once every six months, a review of the recipient's services, including (A)interviewing the rec…

(a) To qualify for personal care services through a consumer-directed program, a recipient or a recipient's representative identified in accordance with (e)(2) of this section must (1) demonstrate cognitive capacity for decision-making; (2) understand the impact of, and assume re…

(a) A personal care services agency that manages an agency - based personal care services program may provide personal care services for a recipient that has submitted an application under 7 AAC 125.012 and a request for expedited consideration under 7 AAC 125.020(b), but does no…

(a) A personal care assistant must(1) be a licensed registered nurse that is qualified to practice under AS 08.68 or 7 AAC 105.200(c); (2) be a licensed certified nurse aide that is qualified to practice under AS 08,68 or 7 AAC 105.200(c); (3) hold an active certification as a co…

(a) A personal care services agency that manages an agency-based personal care services program shall retain a supervising licensed registered nurse that is qualified to practice under AS 08.68 or 7 AAC 105.200(c) to perform the following duties:(1) monitor the delivery of servic…

(a) A recipient that is terminated from an agency-based personal care services program may appeal that termination through the complaint process established by the personal care services agency. (b) If the assessment under 7 AAC 125.020 indicates that an individual is not capable…

The department, with recipient participation, will conduct compliance reviews of the personal care services agencies at least once every two years and at other times determined to be necessary by the department. In the reviews, the department will include evaluation of (1) servic…