Alaska Administrative Code

(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 Outpati…

(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). (b) Except as otherwise provided in 7 AAC 105…

(a) Except as provided in (b) and (d) 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…

(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 s…

(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 an…

(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 …

(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)…

(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…

(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.…

(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 inpati…

(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 cons…

(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 experienci…

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…

(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 ho…

(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 sec…

(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 t…

(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 individua…

(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 …

(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 nursin…

(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 requi…

(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 t…

(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…

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.…

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 facilitie…

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, …

(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 wi…

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 …

(a) A recipient has the right to manage the recipient's personal funds unless the recipient has been adjudicated incapacitated or the recipient's incapacity has been established in accordance with AS 13.26.353, or the recipient has had a full guardian appointed under AS 13.26.116…

(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 ava…

(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 recor…

(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 particul…

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 per…

(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 accor…

(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 m…

(a) An ICF/MR shall maintain a clinical record of services provided to a recipient. The clinical record must include the evaluation required in 7 AAC 140.600(b) (1). The clinical record must also include a written, individualized habilitative plan of care that includes(1) informa…

(a) If a recipient needs non-emergency, continuous heavy use of oxygen, the ICF/MR shall make it available for use at all times. The facility shall submit a request for authorization, on a form provided by the department, shall provide on that form a detailed description of the r…

(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 an ICF/MR if (1) the absence is not more than 12 consecutive days; (2) the time of departure and return of the recipient are recorded …

(a) Transfer to another ICF/MR may not occur without 30 days' prior written notice to the recipient and, if appropriate, the family or guardian, and to either the department or the facility, depending on whether the department or the facility is proposing the transfer. Recipients…

(a) If the interdisciplinary team assigned under 7 AAC 140.605 or the department recommends that a recipient does not, or in the future will not, require continued placement in an ICF/MR, the recipient and, where appropriate, the family or guardian, and either the department or t…

The provisions of 7 AAC 140.550 - 7 AAC 140.575 also apply to and ICF/MR except where they conflict with specific provisions of 7 AAC 140.600 - 7 AAC 140.640. Notes 7 AAC 140.635 Eff. 2/1/2010, Register 193 Authority:AS 47.05.010 AS 47.07.030 AS 47.07.040 State regulations are up…

To be considered a qualified mental retardation professional for purposes of 7 AAC 140.600 - 7 AAC 140.640, an individual must meet the standard for a qualified mental retardation professional set out in 42 C.F.R. 483.430(a), adopted by reference in 7 AAC 160.900. Notes 7 AAC 140…

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for outpatient end-stage renal disease services, a provider must(1) be enrolled as an end-stage renal disease services facility in accordance with 7 AAC 105.210; (2) meet the requirements of 42 C.F.R. Part 494 (conditions…

The department will pay a facility that meets the requirements of 7 AAC 140.700 for services that are furnished in an end-stage renal disease facility, and that are covered under 42 C.F.R. 410.50 and 410.52, adopted by reference in 7 AAC 160.900. The department will pay a provide…

(a) The department will pay an end-stage renal disease facility under 7 AAC 145.607 for the recipient's first day of treatment through the last day of the third month of treatment. (b) The department will continue to pay a facility for outpatient end-stage renal disease services …

(a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for free-standing birth center services, a facility (1) must be enrolled as a free-standing birth center under 7 AAC 105.210; (2) must be licensed under AS 47.32; (3) may not be enrolled under 7 AAC 105.210 as another typ…

(a) The department will pay for the use of a free-standing birth center under this section in accordance with the payment rate established in 7 AAC 145.680. (b) The department will pay for the use of a free-standing birth center under 7 AAC 145.680 only when a delivery occurs at …

(a) The department will pay a provider for a covered service identified in AS 47.07 and 7 AAC 105 - 7 AAC 160 only if the (1) claim is submitted by a provider who is enrolled with the department under 7 AAC 105 - 7 AAC 160; (2) services were rendered to an individual who was elig…

(a) The department will not make payment on a claim known by a provider to be covered by Medicaid if the claim has been assigned, sold, or transferred, including transfers through the use of power of attorney, to a collection agency, service bureau, or individual who advances mon…

(a) To address that appropriations for fiscal year 2020 are insufficient to cover the costs of medical assistance for all persons eligible under AS 47.07 and 7 AAC 100, the department will implement cost containment measures that prohibit the following adjustments to Medicaid pay…

Payment provided by the department will be reduced by the amount of cost-sharing required under 7 AAC 105.610, and represents full payment from the department for those covered services authorized under Medicaid. A recipient may be charged only for the amount of cost-sharing spec…