Alaska Administrative Code

(a) The department or its designee shall conduct fiscal audits of Medicaid providers their subcontractors, and their grantees. A provider that bills the department is responsible for ensuring that records related to the services bined are kept by employees, subcontractors, and gr…

(a) An enrolled provider who bills the department for services rendered during a calendar year shall conduct, once every two years, a review or audit of a statistically valid random sample of claims submitted to the department for reimbursement, unless the provider is being audit…

The department its designee, or a provider may use statistically valid sampling methodologies to (1) select Medicaid claims for review or audit; and (2) calculate overpayment amounts to providers that are subject to a provider self-review or self-audit under AS 47.05.235 and 7 AA…

(a) A provider may appeal the findings of a final audit conducted under 7 AAC 160.110 and determinations of overpayment amount under the audit. A provider may requeste reconsideration of the audit findings before a formal appeal. If a provider requests reconsideration, the provid…

(a) The department, through each division responsible for the administration of the Medicaid program, will establish a quality assurance program to ensure provider compliance with AS 47.05, AS 47.07, and 7 AAC 105 - 7 AAC 160. (b) Under the quality assurance program, the departme…

(a) The department will pay for a service, prescription drug, or supply only to the extent it is a covered service under AS 47.07.030 and 7 AAC 105 - 7 AAC 160 and only after the recipient has made full use of any other third-party resources available to pay for that service, pre…

(a) At the time of application, the department will notify each applicant for medical assistance that the estate of an individual who received medical assistance benefits may be subject to a claim for recovery under AS 47.07.055 and 7 AAC 160.210 - 7 AAC 160.250. (b) When the sta…

(a) For purposes of AS 47.07.055(a)(3), if a recipient resides in a medical institution for at least 120 consecutive days, the department will give the recipient (1) notice of its intent to determine that the recipient is not reasonably expected to be discharged from the institut…

(a) After receiving a notice under 7 AAC 160.220(e) from the department, the recipient, legal representative of the recipient, or estate beneficiary may file an appeal with the department to (1) contest the amount of recoverable medical assistance identified by the department; (2…

(a) After considering the information gathered in accordance with 7 AAC 160.210, or after considering an appeal based on 7 AAC 160.230, the department may waive all or part of the department's claim for recovery. (b) The department will waive recovery for undue hardship if the de…

(a) A special low-income Medicare beneficiary under 7 AAC 100.754 who receives assistance from the department only in the form of payment for the beneficiary's Medicare co-payments or deductibles is exempt from estate recovery. (b) A Medicaid expenditure made for services that a …

(a) The following documents referenced in 7 AAC 105 - 7 AAC 160 are adopted by reference: (1) American Medical Association, Current Procedural Terminology, Professional Edition, as revised for 2010 ("CPT 2010"), as amended from time to time; (2) United States Department of Health…

(a) In the definition of "health facility" in AS 47.07.900, "outpatient surgical clinic" means an ambulatory surgical center. (b) In 7 AAC 105 - 7 AAC 160, unless the context requires otherwise, (1) "Alaska Native" has the meaning given "Native" in 43 U.S.C. 1602(b); (2) "ambulat…

The purpose of this chapter is to encourage selected Medicaid providers to deploy and use electronic health record technology and the electronic health information exchange system created under AS 18.23.300-18.23.325. Notes 7 AAC 165.001 Eff. 6/1/2011, Register 198 Authority:AS 4…

(a) To participate in the Alaska Medicaid electronic health record incentive program a provider (1) must be enrolled in and in compliance with the Medicaid program under 7 AAC 105 - 7 AAC 160 as one of the following types of providers: (A) a hospital provider; (B) a physician; (C…

(a) To participate in the Alaska Medicaid electronic health record incentive program a provider must electronically register using the (1) Medicare and Medicaid electronic health record incentive program registration and attestation system; and (2) Alaska Medicaid state-level reg…

(a) If the department determines that a provider meets the requirements of 7 AAC 165.010 and 7 AAC 165.020, the department will (1) send to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), an electronic request for valid…

(a) The department will make an incentive payment to a provider under this chapter in accordance with (1) the requirements of 42 C.F.R. 495.308 - 495.312, revised as of September 4, 2012, and adopted by reference; and (2) if a hospital provider, the payment schedule identified in…

(a) A provider who has received an incentive payment under this chapter must continue to meet the eligibility standards for that payment through the entire payment year. (b) The department may investigate a provider and audit the provider's records to verify that the provider(1) …

(a) A provider may appeal the department's decision to do any of the following: (1) deny participation in the Alaska Medicaid electronic health records incentive program under 7 AAC 165.030; (2) suspend an incentive payment under 7 AAC 165.050; (3) require repayment of all or a p…

In this chapter, (1) "CMS" means the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services; (2) "hospital provider" means a hospital enrolled under 7 AAC 140.300 that is (A) an acute care hospital as defined in 42 C.F.R. 495.302, revise…

(a) A statewide electronic health information exchange (HIE) system is established. (b) The purpose of the HIE system is to facilitate (1) public and private uses and disclosures of electronic health information permissible under AS 18.23.300-18.23.325 and this chapter; and (2) t…

(a) The voting members of the governing body of the designee under AS 18.23.300 shall be nominated as follows: (1) the hospital and nursing home facility representative shall be nominated by the Alaska State Hospital and Nursing Home Association; (2) the private medical care prov…

The governing body shall (1) subject to approval by the department, set the user fee at an amount that attains self-sustainability for the HIE system; (2) inform the public by means of print and electronic media at least twice per year about the benefits and risks of participatio…

(a) An individual owns the individual's individually identifiable health information. An HIE participant owns the medical record that includes the individually identifiable health information. (b) Individually identifiable health information located on an HIE is confidential, is …

(a) An individual may opt out of an HIE. If an individual opts out of an HIE, the HIE shall remove all of that individual's electronic health information from the HIE. (b) The HIE system's procedures for opting out of an HIE must include procedures for (1) preventing storage of a…

In AS 18.23.300-18.23.325 and this chapter, unless the context requires otherwise, (1) "billing" has the meaning given "payment" in 45 C.F.R. 164.501; (2) "department" means the Department of Health and Social Services; (3) "electronic health information" means an individual's in…

Notes 18 AAC 85.010 Eff. 9/16/71, Register 39; repealed 4/9/2009, Register 190 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 b…

(a) Except as otherwise specified in AS 18.60.525, the provisions of 7 AAC 18.110 - 7 AAC 18.990 apply to a person in this state who receives, possesses, uses, transfers, owns, or acquires a radiation source. (b) The provisions of 7 AAC 18.110 - 7 AAC 18.990 may not be construed …

(a) A person that receives, possesses, uses, transfers, owns, or acquires an ionizing radiation source, except a source regulated by the United States Nuclear Regulatory Commission or a source specifically exempted in AS 18.60.525 and 7 AAC 18.125, shall register by submitting to…

(a) Not later than 30 days after a person, subject to this chapter acquires an ionizing radiation source, the person shall register the ionizing radiation source with the department. (b) An application for an initial registration and renewal of registration shall be submitted on …

(a) Before the initial operation of a device or source capable of producing radioactive material or radiation fields in excess of 200 millisieverts or 20 rems per minute, a registrant shall apply, by submitting an application prescribed and provided by the department, including a…

(a) The ionizing radiation sources described in AS 18.60.525(b) - (e) are exempt from the requirements of this chapter. (b) In addition to the ionizing radiation sources described in (a) of this section, the following sources of ionizing radiation are exempt from the requirements…

(a) Before a distributor, retailer, qualified expert, or other agent sells, leases, services, calibrates, installs, repairs, or in any other manner transfers or verifies accurate functioning of an ionizing radiation source requiring registration under 7 AAC 18.110, that person sh…

(a) Except as specified in (c) of this section, a person proposing to bring an ionizing radiation source into this state from out of state for any temporary use shall give written notice to the department at least 15 days before bringing the source into the state. The notice must…

A registrant of an ionizing radiation source or radioactive material shall keep records of (1) the receipt, transfer, or disposal of each ionizing radiation source for at least three years following the event; and (2) exposure incidents or excessive concentrations of ionizing rad…

A registrant may not (1) advertise or post the fact that an ionizing radiation source is registered with the department; and (2) state or imply that any specific application or use under the registration or authorization process has been approved by the department. Notes 7 AAC 18…

(a) A registrant shall allow the department, or the department's designee, upon request, an opportunity to inspect all ionizing radiation sources in the possession of the registrant and the facility where the sources are used or stored. (b) A registrant shall make available, upon…

A registrant, and the registrant's agent, including an operator, is responsible for complying with the applicable ionizing radiation protection requirements of 7 AAC 18.200 - 7 AAC 18.390. Notes 7 AAC 18.180 Eff. 4/9/2009, Register 190 Authority:AS 18.60.475 AS 18.60.485 State re…

(a) A person may not direct or order the application of radiation to an individual, except that a practitioner of the healing arts licensed by this state, or a person working under the direction or order of a practitioner of the healing arts licensed by this state, may apply radi…

(a) A registrant shall possess, use, receive, and transfer sources of ionizing radiation in a controlled area with adequate safeguards to assure that an individual worker's total occupational exposure to all sources of ionizing radiation in the registrant's possession during any …

(a) A registrant shall maintain records showing the ionizing radiation doses of all individuals for whom personnel monitoring is required under 7 AAC 18.280. The registrant shall keep these records on an annual occupational radiation exposure form issued by and available from the…

Notes 7 AAC 18.230 Eff. 4/9/2009, Register 190; repealed 7/1/2015, Register 214, July 2015 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 fea…

(a) Except as authorized by the department under (b) of this section, a registrant may not possess, use, or transfer sources of ionizing radiation in a manner that creates, in any uncontrolled area from the sources in the registrant's possession, ionizing radiation levels which (…

(a) A registrant may not possess, use, or transfer sources of ionizing radiation in a manner that causes a minor within a controlled area to receive from all sources of ionizing radiation in the registrant's possession a dose in excess of 10 percent of the limits specified in 7 A…

(a) A registrant may not expose a student to more than 0.1 rem or one millisievert per year for educational purposes. (b) An experiment or demonstration for teaching purposes shall be planned and performed so that a student receives no more than 0.01 rem or 0.1 millisievert while…

(a) A registrant shall ensure that a declared pregnant woman is not subject to occupational exposure to radiation that will result in a total dose equivalent to the woman's embryo or fetus during the entire pregnancy that exceeds 0.5 rem or five millisieverts. (b) The dose equiva…

Electrical equipment used for teaching purposes, and that may emit x-rays incidental to the intended purpose of the equipment, may not be operated in a manner that the external exposure exceeds 10 milliroentgens per hour at 30 centimeters from any accessible surface of the equipm…

(a) A registrant shall complete all surveys necessary to establish compliance with this chapter. (b) If applicable, a survey must include (1) a physical evaluation of the location of materials and equipment; (2) measurements of levels of ionizing radiation present; and (3) an ann…

(a) A registrant shall supply the appropriate individual monitoring device to, and require the use of the device in accordance with, the manufacturer's instructions for use by (1) an individual, except a patient, who enters a controlled area under circumstances that the individua…