Alaska Administrative Code

(a) Regardless of the payment methodology or payment rate adopted under 7 AAC 105 - 7 AAC 160, and except as provided in 7 AAC 155.010 with regard to tribal health programs, the department will pay a provider for a covered service at the lowest of the (1) specific payment rate es…

(a) Unless otherwise provided in 7 AAC 105 - 7 AAC 160, the department will pay an out-of-state enrolled provider at the lowest of (1) the billed charges; (2) 70 percent of the in-state rate identified in 7 AAC 105 - 7 AAC 160 for the specific type of provider; or (3) the rate es…

(a) Except as otherwise provided in 7 AAC 105 - 7 AAC 160 for certain types of providers or services, the department will establish fees for use in payment for each type of provider and service subject to 7 AAC 105 - 7 AAC 160 using the resource-based relative value scale (RBRVS)…

(a) The department will pay an in-state advanced practice registered nurse, including a nurse midwife, in accordance with 7 AAC 145.020, not to exceed 85 percent of the rate determined under 7 AAC 145.050. (b) The department will pay an out-of-state advanced practice registered n…

(a) The department will pay an in-state chiropractor in accordance with 7 AAC 145.020, not to exceed 100 percent of the amount determined under 7 AAC 145.050. (b) The department will pay an out-of-state chiropractor in accordance with 7 AAC 145.025. Notes 7 AAC 145.110 Eff. 2/1/2…

(a) The department will pay a dentist for dental services provided to a recipient 21 years of age or older in accordance with 7 AAC 110.145 and the Fee Schedule: Emergent Adult Dental Services, Fee Schedule: Prosthodontic Adult Dental Services, and Fee Schedule: Enhanced Adult De…

(a) The department will pay an in-state direct-entry midwife in accordance with 7 AAC 145.020, not to exceed 85 percent of the amount determined under 7 AAC 145.050. (b) The department will pay an out-of-state direct-entry midwife in accordance with 7 AAC 145.025. Notes 7 AAC 145…

(a) Except as otherwise provided in this section, the department will pay a provider in accordance with 7 AAC 145.020 for providing initial and subsequent periodic medical screening, evaluation, diagnosis, and management of a recipient under 7 AAC 110.200, not to exceed 100 perce…

(a) The department will pay for family planning services in accordance with 7 AAC 145.020 from a provider described in 7 AAC 110.230, not to exceed 85 percent of the amount determined under 7 AAC 145.050. (b) The department will pay for laboratory services in accordance with the …

(a) The department will pay an in-state provider of x-ray services in accordance with 7 AAC 145.020, not to exceed 100 percent of the rate established under 7 AAC 145.050. (b) The department will pay an out-of-state x-ray provider in accordance with 7 AAC 145.025. Notes 7 AAC 145…

(a) The department will pay an in-state registered nurse anesthetist in accordance with 7 AAC 145.020, not to exceed 85 percent of the rate established under 7 AAC 145.050. (b) The department will pay an out-of-state registered nurse anesthetist in accordance with 7 AAC 145.025. …

The department will pay an in-state provider of nutrition services in accordance with 7 AAC 145.020, not to exceed (1) $50 for the first 30 minutes of an initial assessment; (2) $25 for each 15 minutes of an initial assessment in addition to the first 30 minutes under (1) of this…

(a) Except as otherwise provided in this section, the department will pay an in-state physician in accordance with 7 AAC 145.020, not to exceed 100 percent of the amount determined under 7 AAC 145.050. (b) The department will pay an out-of-state physician in accordance with 7 AAC…

(a) The department will pay an in-state physician for surgical procedures in accordance with the physician payment rates determined under 7 AAC 145.050, subject to the following exceptions: (1) the highest-valued procedure of multiple surgeries performed on the same recipient dur…

(a) The department will pay an in-state podiatrist in accordance with 7 AAC 145.020, not to exceed 100 percent of the amount determined under 7 AAC 145.050. (b) The department will pay an out-of-state podiatrist in accordance with 7 AAC 145.025. Notes 7 AAC 145.240 Eff. 2/1/2010,…

(a) The department will pay an in-state private-duty nurse in accordance with 7 AAC 145.020. For state fiscal year 2020, the payment rates will be 95 percent of the payment rates listed in this subsection. The payment rates must not exceed (1) $20 per 15 minutes of service provid…

The department will pay for psychologist services in accordance with 7 AAC 145.020, not to exceed 100 percent of the amount determined under 7 AAC 145.050. The department will pay for neuropsychological testing in accordance with 7 AAC 145.020, not to exceed 150 percent of the am…

(a) Before billing the department for targeted case management services, a provider of those services shall bill the recipient's alternate resources under 7 AAC 160.200. After it receives notification from each third party of the amount, if any, that the third party will pay, the…

(a) The department will pay in accordance with 7 AAC 145.020 for a service delivered by means of a telehealth modality by a rendering provider or a consulting provider in accordance with 7 AAC 110.620 - 7 AAC 110.639 as set out under 7 AAC 145.020. (b) The department will pay a r…

The department will pay for (1) a vaccine product that is covered under 7 AAC 110.750 at the lesser of the (A) billed charges; (B) Medicare Part B upper payment limit, if established; or (C) estimated acquisition cost as defined in 7 AAC 145.400(p); and (2) administration of a va…

(a) The department will pay an in-state ophthalmologist, optometrist, or optician in accordance with 7 AAC 145.020, not to exceed 100 percent of the amount determined under 7 AAC 145.050. (b) The department will pay for postoperative management services provided by an optometrist…

(a) For long-term services and supports targeted case management services provided under 7 AAC 128.010, the department will pay a unit of service at the lesser of the (1) amount charged by the provider to the public; or (2) the payment rate established in the department's Chart o…

(a) The department will pay an in-state occupational therapist in accordance with 7 AAC 145.020, not to exceed 85 percent of the rate determined under 7 AAC 145.050. (b) The department will pay an outpatient occupational therapy program operated by a tribal health program in acco…

(a) The department will pay for outpatient therapy center services provided in state in accordance with 7 AAC 145.020, not to exceed 85 percent of the amount determined under 7 AAC 145.050. (b) The department will pay an out-of-state outpatient therapy center in accordance with 7…

(a) The department will pay an in-state physical therapist in accordance with 7 AAC 145.020, not to exceed 85 percent of the rate determined under 7 AAC 145.050. (b) The department will pay an outpatient physical therapy program operated by a tribal health program in accordance w…

(a) The department will pay an in-state speech-language pathologist in accordance with 7 AAC 145.020, not to exceed 85 percent of the rate determined under 7 AAC 145.050. (b) The department will pay an outpatient speech-language therapy program operated by a tribal health program…

(a) Subject to the limitations in 7 AAC 115.530, and this section, the department will pay an in-state audiologist for audiology services (1) in accordance with 7 AAC 145.020, not to exceed 85 percent of the rate determined under 7 AAC 145.050; and (2) in accordance with the CPT …

(a) The department will pay for school-based services in accordance with 7 AAC 145.020, not to exceed 85 percent of the rate established under 7 AAC 145.050. For school-based services for which a rate is not established under 7 AAC 145.050, the department will pay for those servi…

(a) In addition to complying with the requirements of 7 AAC 105.220, and before submitting a claim for payment from the department, a pharmacy provider shall bill any third-party prescription drug plan in which the recipient is enrolled and that is in effect on the date of servic…

(a) Except as provided under (b) of this section, and in accordance with the following, the department will pay a dispensing fee for a covered outpatient drug if the claim satisfies all coverage criteria under 7 AAC 120.110 - 7 AAC 120.140: (1) to a nontribal pharmacy located on …

(a) Payment by the department to a provider enrolled under 7 AAC 105.210 as a durable medical equipment provider will be made in accordance with this section. (b) A provider enrolled under 7 AAC 105.210 as a durable medical equipment provider providing durable medical equipment, …

(a) Payment by the department to a provider that is enrolled under 7 AAC 120.300 as a prosthetics and orthotics provider will be made in accordance with 7 AAC 145.020. (b) A provider enrolled under 7 AAC 120.300 as a prosthetics and orthotics provider providing prosthetics, ortho…

(a) Except as otherwise provided in this section, when the only home infusion therapy service being provided is skilled nursing, the department will pay a provider of home infusion therapy services for skilled nursing services in accordance with 7 AAC 145.020, not to exceed 85 pe…

(a) The department will pay for transportation and accommodation services in accordance with 7 AAC 145.020, not to exceed the maximum amount identified in the Transportation/Accommodation Fee Schedule table, adopted by reference in 7 AAC 160.900. For state fiscal year 2020, the p…

(a) The department will pay for laboratory services provided in state by an independent laboratory in accordance with 7 AAC 145.020, at the rate established for Medicare in 42 C.F.R. 405.515, adopted by reference in 7 AAC 160.900; laboratory services for which no rate is establis…

(a) For providing personal care services under 7 AAC 125.010 - 7 AAC 125.199 and Community First Choice services under 7 AAC 127, the department will pay a unit of service at the lesser of (1) payment rates established in the department's Chart of Personal Care Services, Communit…

Unless otherwise provided in 7 AAC 105 - 7 AAC 160, the department will pay at a rate of 80 percent of the provider's charges that are billed in accordance with 7 AAC 145.020. Notes 7 AAC 145.510 Eff. 2/1/2010, Register 193 Authority:AS 47.05.010 AS 47.07.030 AS 47.07.040 State r…

(a) The department will pay a home and community-based waiver services provider in accordance with the rates and methodologies set out in this section. (b) For care coordination services provided under 7 AAC 130.240, (1) the department will pay a unit of service at the lesser of …

(a) The payment rates in the department's Chart of Waiver Services Rates, adopted by reference in 7 AAC 160.900, will be re-established at least every four years using the department's Rate-Setting Methodology for Personal Care Services, Community First Choice Services, Long-Term…

Notes 7 AAC 145.530 Eff. 2/1/2010, Register 193; repealed 3/1/2011, Register 197 State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will…

(a) For personal care services under 7 AAC 125.010-7 AAC 125.199, Community First Choice services under 7 AAC 127, adult day services under 7 AAC 130.250, day habilitation services provided under 7 AAC 130.260, residential habilitation services under 7 AAC 130.265, employment ser…

(a) For purposes of the annual report required in 7 AAC 145.531, costs are allowable costs if they are reasonable, necessary, and related to the service provided. For purposes of this section, (1) a cost is reasonable if the amount expended does not exceed what a prudent buyer wh…

Notes 7 AAC 145.535 Eff. 3/1/2011, Register 197; am 11/3/2012, Register 204; repealed 3/1/2018, Register 225, April 2018 State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterl…

For purposes of 7 AAC 145.533, a related party is (1) a person with an immediate family relationship with an owner, director, or officer of the contracted target provider; for purposes of this paragraph, the following individuals have an immediate family relationship with an owne…

Notes 7 AAC 145.540 Eff. 2/1/2010, Register 193; repealed 11/3/2012, Register 204 State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features wil…

(a) If application of the methodology in the department's Rate-Setting Methodology for Personal Care Services, Community First Choice Services, Long-Term Services and Supports Targeted Case Management Services, and Waiver Services, adopted by reference in 7 AAC 160.900, results i…

(a) The department will pay a corresponding unit of service for providing community behavioral health services under 7 AAC 135.100 - 7 AAC 135.280, at the lesser of the following rates: Click here to view image (1) the amount charged by the provider in accordance with 7 AAC 145.0…

(a) The department will pay an in-state general acute care hospital for services rendered in the state at the rate determined in accordance with 7 AAC 150. (b) The department will pay an out-of-state general acute care hospital for (1) outpatient care services at the Medicaid rat…

Notes 7 AAC 145.605 Eff. 4/1/2012, Register 201; repealed 1/1/2013, Register 204 State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will…

(a) The department will pay a facility that meets the requirements of 7 AAC 140.700 - 7 AAC 140.720 a rate based upon the formula set out in this section, including a composite, per-treatment payment rate for hemodialysis and a separate composite, per-treatment payment rate for p…