Alaska Administrative Code

(a) Except as otherwise provided in this section, the department will pay for services rendered by an intermediate care facility (ICF) or skilled nursing facility (SNF) at the all-inclusive rate determined in accordance with 7 AAC 150, less the cost-of-care liability determined u…

(a) The rate established for an intermediate care facility or a skilled nursing facility includes all services, supplies, and equipment required for complete care, except as otherwise provided in this section. (b) The following services are included in the ICF or SNF all-inclusiv…

(a) The rate established for an intermediate care facility for the mentally retarded (ICF/MR) includes all services, supplies, and equipment required for complete care, except as otherwise provided in this section. (b) The following services are included in the ICF/MR all-inclusi…

(a) The payment determined under 7 AAC 145.650 and 7 AAC 145.660 will be reduced by the amount of the recipient cost-of-care liability determined by the department in accordance with 7 AAC 100.554. (b) The facility is responsible for collecting from the recipient the amount of th…

(a) The department will pay a free-standing birth center, in accordance with 7 AAC 145.020, an all-inclusive flat rate that is adjusted annually to be effective July 1. (b) The department will not set an all-inclusive flat rate that exceeds 75 percent of the weighted average of t…

(a) The department will pay an in-state hospice at the Medicaid rates established under 42 C.F.R. 418.306, adopted by reference in 7 AAC 160.900, for routine home care, continuous home care, inpatient respite care, and general inpatient care. The hospice shall pay a participating…

The department will pay a Medicaid provider for an abortion if the provider submits a completed Certificate to Request Funds for Abortion, adopted by reference in 7 AAC 160.900, documenting that the requirements set out in the certificate are satisfied. Notes 7 AAC 145.695 Eff. 1…

(a) Except for services listed in (e) of this section, and as otherwise provided in (I) of this section, the department will determine a rural health clinic's payment rate or a federally qualified health center's payment rate based on the health clinic's reasonable costs. Reasona…

For newly rebased rates on or after February 16, 2024, for the purposes of calculating a rate under 7 AAC 145.700(c) for a rural health clinic, or a federally qualified health center, the department will consider the total number of visits to be the sum of the total visits from W…

(a) The base years used to establish rates in future rate years for a rural health clinic or federally qualified health center will be changed periodically to more current years, and re-basing may be subject to audit. The first cost-based rate is not a re-basing. The department m…

A rural health clinic or federally qualified health center may apply, under 7 AAC 150.240, for exceptional relief from the rate-setting methodology in 7 AAC 145.700. Notes 7 AAC 145.730 Eff. 2/1/2010, Register 193 Authority:AS 47.05.010 AS 47.07.070 AS 47.07.073 AS 47.07.074 Stat…

In 7 AAC 145.700 - 7 AAC 145.739, (1) "charity care" means health care services that(A) a health clinic does not expect to result in cash payments; (B) result from a health clinic's policy to provide health care services free of charge to an individual who meets certain financial…

(a) The supplemental emergency medical transportation (SEMT) program is a voluntary program that makes supplemental payments to publicly owned or operated SEMT providers that provide qualifying emergency medical transportation services to Medicaid recipients. The supplemental pay…

(a) If a provider elects to participate in the SEMT program, the provider must comply with the following requirements to qualify and receive supplemental payments: (1) provide emergency medical transportation services to Medicaid fee-for-service (FFS) recipients under 7 AAC 120.4…

(a) For SEMT, the department will pay an interim supplemental payment that approximates the SEMT costs eligible for federal financial participation claimed through the certified public expenditure (CPE) process. (b) The department will calculate the interim supplemental payment r…

(a) The department will adjust the cost report submitted by the provider for costs based on financial documentation provided during the desk review process, and to revenues and medical transports based on the reconciliation results from the most recently retrieved report from the…

(a) The provider must pay the department an administrative fee to cover the cost of the SEMT program. (b) The fee is equal to the state general fund cost to the department to administer the SEMT program. The department will use the fee to pay the required state match for federal …

(1) "allowable cost" means an expenditure that meets the test of the appropriate Executive Office of the President of the United States' Office of Management and Budget (0MB) circular; (2) "cognizant agency" means the federal agency with the largest dollar value of a direct feder…

The purpose of this chapter is to implement the provisions of AS 47.07.040 and 47.07.070-47.07.900. Notes 7 AAC 150.010 Eff. 2/1/2010, Register 193 Authority:AS 47.05.010 AS 47.07.040 AS 47.07.070 AS 47.07.071 AS 47.07.073 AS 47.07.074 AS 47.07.075 AS 47.07.900 AS 47.25.195 State…

(a) All health facilities seeking payment from the department for services provided to Medicaid recipients in this state are subject to the provisions of this chapter. (b) To receive a change in a prospective payment rate, a health facility must obtain the department's approval i…

(a) The department will establish prospective per-day payment rates in accordance with 7 AAC 150.210 for facilities not less than annually for each facility subject to the per-day reimbursement methodology. (b) The department will establish prospective per-stay Diagnosis Related …

(a) Prospective payment rates are units of payment the department will pay to enrolled facilities that render services to Medicaid recipients. A facility may not charge the department an amount that exceeds the charge to the general public for the same service. (b) Prospective pa…

Notes 7 AAC 150.100 Eff. 2/1/2010, Register 193; repealed 1/1/2024, Register 248, January 2024 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…

(a) To implement the provisions of 42 U.S.C. 1396 b regarding federal financial participation under Medicaid, and subject to legislative appropriations for that purpose, the department will make a private hospital proportionate share payment to, and will require under (2) - (4) o…

(a) To implement the provisions of 42 U.S.C. 1396 b regarding federal financial participation under Medicaid, and subject to legislative appropriations for that purpose, the department will make a state hospital proportionate share payment to, and may require specific services to…

(a) The department adopts a uniform system of accounting, financial reporting, budgeting, cost allocation, and prospective rate setting for facilities. The financial reporting, budgeting, and cost allocation requirements are described in the Medicaid Hospital and Long-Term Care F…

(a) The department will process facilities' annual year-end reports required by 7 AAC 150.130(c) in the manner set out in (a) - (e) of this section, unless the facility is a rural health clinic or ambulatory surgical center. Each annual year-end report will be date-stamped upon r…

(a) To calculate adjustment factors for facility fiscal years, the department will use the most recent quarterly publication of Global Insight's Healthcare Cost Review available 60 days before the beginning of a facility's fiscal year, as follows: (1) for general acute care, spec…

(a) The department will use the following methodology and criteria in reviewing and establishing prospective payment per-day and percentage-of-charges rates for the Medicaid program: (1) the department will consider the following with the relative importance of each criterion bei…

(a) Allowable costs for prospective per-day and percentage of charges rates are the costs from the appropriate base year's Medicare cost report, in accordance with Medicare requirements and regulations, as audited or adjusted in accordance with this section. The department will c…

(a) A qualifying hospital that provides services to a disproportionate share of low-income patients with special needs is eligible for Medicaid payments as a disproportionate share hospital (DSH). These payments are in addition to the Medicaid payment rate established under 7 AAC…

(a) The provisions of this section apply to a small facility that (1) had 4,000 or fewer acute care patient days at an general acute care, specialty, or inpatient psychiatric hospital or at a combined general acute care hospital-nursing facility or had 15,000 or fewer Medicaid nu…

(a) In administering the Medicaid program, the department may perform facility audits, desk reviews, and field audits of various types and scope and take the results of those facility audits, desk reviews, and field audits into account in establishing a facility's payment rate. T…

(a) Based on consideration of the documents submitted by the facility, audit or review of the facility the facility's responses to audit or review testimony at the public hearing, and the requirements of AS 47.07 and 7 AAC 105 - 7 AAC 160, the department staff that oversees Medic…

(a) Not later than 30 days after a written determination under 7 AAC 150.210(a) is mailed or electronically delivered to a facility, a facility aggrieved by that determination may request reconsideration under 7 AAC 150.210(b) or may file a written notice of appeal with the commi…

(a) If a notice of appeal satisfies the requirements of 7 AAC 150.220, the department will file, in accordance with the prehearing schedule established under (c) of this section, and with both the administrative law judge that the office of administrative hearings (AS 44.64.010) …

(a) If application of the methodology in 7 AAC 145.700 or in 7 AAC 150.040 - 7 AAC 150.190 and 7 AAC 150.250 results in a permanent prospective payment rate that does not allow reasonable access to quality patient care provided by an efficiently and economically managed facility,…

(a) For discharges on or after January 1, 2024, the department will reimburse inpatient hospital services provided by general acute care hospitals on a per-stay basis using a Diagnosis Related Groups (DRG) payment methodology. The department will apply the DRG payment methodology…

(1) "adjusted Medicare cost report" means a base year's Medicare cost report that has been adjusted in accordance with 7 AAC 150.170 or 7 AAC 150.200; (2) "All Patient Refined Diagnosis Related Groups" or "APR DRG" means a type of classification system used to assign inpatient st…

Notwithstanding any other payment provisions of 7 AAC 105 - 7 AAC 160, the department will pay a tribal health program using (1) the Indian Health Service encounter rates, adopted by reference in 7 AAC 160.900; or (2) the payment methodology applicable to a nontribal provider in …

Notes 7 AAC 155.020 Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199; repealed 3/30/2018,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…

A certified health provider is a (1) community health aide; (2) community health practitioner; (3) behavioral health aide; or (4) behavioral health practitioner. Notes 7 AAC 155.030 Eff. 3/30/2018,Register 225, April 2018 State regulations are updated quarterly; we currently have…

(a) The department will pay a single statewide certified health provider encounter rate for the services of a (1) community health aide or community health practitioner certified by the Community Health Aide Program Certification Board; and (2) behavioral health aide or behaviora…

(a) This section, and the Provider Orders for Life Sustaining Treatment (POLST) Program, adopted by reference in 7 AAC 16.020, establish the do-not-resuscitate (DNR) protocol for a health care provider to withhold cardiopulmonary resuscitation under AS 13.52.065. The health care …

The department adopts by reference the department's Provider Orders for Life Sustaining Treatment (POLST) Program, dated January 4, 2024, as its standards for the department-approved do-not-resuscitate (DNR) protocol. Notes 7 AAC 16.020 Eff. 10/10/96, Register 140; am 5/6/2021, R…

(1) "CPR" has the meaning given "cardiopulmonary resuscitation" in AS 13.52.390; (2) "department" means the Department of Health and Social Services; (3) "DNR order" has the meaning given "do-not-resuscitate order" in AS 13.52.390; (4) "MOLST" means medical orders for life sustai…

The department or its designee shall provide for and operate program integrity activities designed to promote the economical and effective administration of the department's Medicaid program. These activities may include the following: (1) operation of a surveillance, utilization…