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Alaska Administrative Code
Title 07 . Health and Social Services
Chapter 43 . Medical Assistance

Chapter 43. Medical Assistance

Section 5 . Scope
Section 10 . Exclusions
Section 15 . Alternate resources
Section 20 . Eligibility
Section 21 . Verification of eligibility criteria
Section 25 . Conditions for payment
Section 27 . Restriction of recipient
Section 30 . Requirements for provider records
Section 32 . Request for records
Section 35 . Eligible providers
Section 40 . Rates of payment
Section 45 . Prohibition against reassignment
Section 50 . Payment
Section 52 . Recipient cost-sharing
Section 55 . Billing date
Section 60 . Payment from other sources
Section 65 . Medical provider agreement
Section 67 . Reviews and audits
Section 68 . Use of statistical sampling
Section 70 . Civil Rights Act
Section 75 . Out-of-state covered services
Section 80 . (Repealed)
Section 81 . Recovery of an overpayment
Section 83 . Review of a denied or reduced claim
Section 85 . Provider appeals
Section 87 . Appeals by provider of denied enrollment or disenrollment
Section 90 . (Deleted)
Section 100 . Basis of payment
Section 101 . Usual charge
Section 102 . Customary charge
Section 103 . Prevailing charge
Section 104 . Modifiers
Section 105 . Concomitant care
Section 106 . Physician services
Section 107 . Hospital-based physicians
Section 108 . Resource-based relative value scale payment; anesthesiology services and other payment
Section 109 . Surgical procedures
Section 110 . Surgical assistants
Section 115 . Limitations
Section 120 . X-ray services
Section 121 . Low osmolar contrast material
Section 125 . Laboratory services
Section 130 . (Repealed)
Section 131 . Mental health services
Section 135 . Sterilization
Section 140 . Abortions
Section 145 . Reports
Section 150 . Payment for services provided in another state
Section 170 . Conditions for payment
Section 180 . Skilled level of care
Section 185 . Intermediate level of care
Section 190 . Determination of level of care
Section 200 . Structured rehabilitation services
Section 205 . Care plan counseling
Section 210 . Placement and level-of-care planning
Section 215 . Facility payments
Section 220 . Days chargeable
Section 225 . Payment during impending decertification
Section 230 . Transfer to avoid penalty
Section 235 . Other payments
Section 240 . Rates
Section 250 . Personal incidental funds
Section 255 . All-inclusive rate
Section 260 . Absence from facility
Section 265 . Transfer of recipients
Section 270 . Discharge of recipients
Section 275 . Medicare coinsurance
Section 280 . Definitions
Section 300 . Eligibility, admission, and payment authorization
Section 302 . ICF/MR interdisciplinary teams
Section 305 . Records, habilitative plan of care, treatment, and reevaluation
Section 310 . (Repealed)
Section 312 . All-inclusive rate
Section 315 . Absence from facility
Section 320 . Transfer of recipients
Section 325 . Discharge of recipients
Section 330 . Applicability of prior sections
Section 333 . Qualified mental retardation professionals
Section 335 . Definitions
Section 350 . Eligibility
Section 355 . Treatment and services
Section 360 . Payment
Section 365 . Conditions for payment
Section 375 . Standard hospital services
Section 380 . Out-of-state hospitals
Section 385 . Non-covered hospital services
Section 390 . Retroactive coverage
Section 391 . Retroactive coverage
Section 395 . Length of hospitalization
Section 400 . Billing
Section 405 . Admission
Section 420 . Outpatient and emergency room
Section 425 . Drugs
Section 430 . Utilization review
Section 435 . Exclusions
Section 450 . Purpose
Section 452 . EPSDT program
Section 453 . Podiatry services
Section 454 . Nutrition services
Section 455 . (Repealed)
Section 456 . Private duty nursing services
Section 458 . Hospice care for individuals under age 21
Section 460 . (Repealed)
Section 461 . Payment for school-based services
Section 465 . (Repealed)
Section 466 . Targeted case management for children with disabilities
Section 467 . Targeted case management payment rates
Section 470 . Children
Section 471 . Severely emotionally disturbed children
Section 472 . Family skill development services
Section 474 . Group skill development services
Section 475 . (Repealed)
Section 476 . Day treatment services
Section 478 . Recipient support services
Section 479 . (Repealed)
Section 480 . (Repealed)
Section 481 . Behavioral rehabilitation services
Section 484 . Prior authorization of mental health rehabilitation services
Section 486 . Medical necessity determinations for mental health rehabilitation services
Section 488 . Extension of service limitations in exceptional circumstances
Section 500 . (Repealed)
Section 501 . Transportation provider enrollment
Section 502 . Transportation and accommodation services; general requirements
Section 503 . Non-emergency transportation services
Section 505 . Emergency transportation services
Section 507 . Accommodation services
Section 509 . Medical escort
Section 510 . (Repealed)
Section 512 . Prematernal home services
Section 515 . Mortuary expenditure
Section 517 . Payment for transportation and accommodations services
Section 519 . Contracted transportation and accommodation services
Section 520 . (Repealed)
Section 525 . (Repealed)
Section 530 . Definitions
Section 550 . Eligibility
Section 552 . Admission
Section 555 . Plan of care
Section 556 . Services
Section 557 . Per diem rate
Section 558 . (Repealed)
Section 560 . Conditions for payment
Section 565 . Patient funds
Section 570 . Payment
Section 580 . (Repealed)
Section 590 . Drug coverage
Section 591 . Drug reimbursement
Section 592 . (Repealed)
Section 593 . Drug use review
Section 594 . Prior authorization and limitations on prescribed drugs
Section 598 . (Repealed)
Section 600 . Payment for dental services
Section 605 . Orthodontia
Section 610 . Diagnostic X-ray
Section 615 . Billings to patients
Section 620 . Excluded dental services
Section 630 . Vision care services
Section 633 . Complete vision examination
Section 635 . (Repealed)
Section 636 . (Repealed)
Section 640 . (Repealed)
Section 642 . Reimbursement for vision services
Section 645 . Exclusions
Section 647 . Contracted frames and lenses
Section 650 . (Repealed)
Section 655 . (Repealed)
Section 656 . (Deleted)
Section 670 . Purpose
Section 672 . Applicability
Section 673 . Establishment of rates
Section 674 . (Repealed)
Section 675 . (repealed)
Section 676 . Prospective rates defined
Section 677 . Methodology and criteria for proportionate share payments to hospitals under 42 U.S.C. 1396b
Section 678 . (Repealed)
Section 679 . Establishment of uniform accounting, budgeting, and financial reporting
Section 680 . Processing of annual year-end report
Section 681 . (Repealed)
Section 682 . (Repealed)
Section 683 . Adjustment factors
Section 684 . (Repealed)
Section 685 . Methodology and criteria for approval or modification of a payment rate
Section 686 . Allowable reasonable operating costs
Section 687 . Methodology and criteria for additional payments as a disproportionate share hospital
Section 688 . (Repealed)
Section 689 . Optional payment rate methodology and criteria for small facilities
Section 690 . (Repealed)
Section 691 . (Repealed)
Section 692 . (Repealed)
Section 693 . Facility audits and desk reviews
Section 694 . (Repealed)
Section 695 . (Repealed)
Section 696 . (Repealed)
Section 697 . (Repealed)
Section 698 . (Repealed)
Section 699 . (Repealed)
Section 700 . (Repealed)
Section 701 . Procedure for establishment of rates
Section 702 . (Repealed)
Section 703 . Administrative appeal
Section 704 . Appeal procedures
Section 708 . Exceptional relief to prospective payment rate setting
Section 709 . Definitions
Section 725 . Conditions for payment
Section 726 . Coverage for mental health clinic services
Section 727 . Service limitations
Section 728 . Clinical records, treatment plans, and assessments
Section 729 . Rates
Section 730 . (Repealed)
Section 731 . (Repealed)
Section 732 . (Repealed)
Section 733 . (Repealed)
Section 734 . Mental health rehabilitation services
Section 735 . Functional assessment
Section 736 . Individual skill development services
Section 737 . Case management
Section 738 . Crisis intervention
Section 739 . Medication administration services
Section 740 . Substance abuse rehabilitative services
Section 741 . Assessment and diagnosis services
Section 742 . Outpatient services
Section 743 . Intensive outpatient services
Section 744 . Intermediate services
Section 745 . Medical services
Section 746 . Limitations and payments for services
Section 750 . Purpose and scope of personal care services
Section 751 . Personal care assessment tool (PCAT)
Section 752 . Covered services
Section 755 . Excluded services
Section 760 . Place of service
Section 765 . (Repealed)
Section 766 . (Repealed)
Section 768 . Consumer-directed program; recipient requirements
Section 770 . Employment of personal care assistants; qualifications
Section 771 . Agency-based program; personal care assistant education and training requirements
Section 772 . (Repealed)
Section 775 . Responsibilities of personal care assistant
Section 780 . Agency-based program; supervising registered nurse
Section 785 . (Repealed)
Section 786 . Consumer-directed program; personal care agencies
Section 787 . Agency-based program; personal care agencies
Section 788 . Safety of recipients
Section 789 . Consumer-directed and agency-based programs; safety of employees; termination of service
Section 790 . Payment for services
Section 791 . Review and appeal rights
Section 792 . Consumer-directed and agency-based programs; compliance reviews
Section 793 . Provider certification and enrollment
Section 794 . Provider decertification and disenrollment
Section 795 . Definitions
Section 800 . Home health care services and coverage
Section 801 . Requirements for home health care services
Section 805 . Payment for care
Section 810 . (Repealed)
Section 815 . (Repealed)
Section 820 . Definitions
Section 825 . Program
Section 830 . Payment for services
Section 835 . Definition
Section 850 . Enrollment and reporting
Section 855 . Covered services
Section 860 . Payment
Section 865 . Medicare coverage
Section 866 . Re-basing
Section 868 . Exceptional relief
Section 870 . Enrollment and reporting
Section 871 . Exceptional relief
Section 872 . Payment for services
Section 873 . Re-basing
Section 874 . Definitions
Section 875 . Covered services
Section 880 . Conditions for payment
Section 885 . Payment
Section 890 . (Repealed)
Section 895 . Reports
Section 910 . Conditions of and limitations on payment
Section 920 . Covered services
Section 921 . Physical therapy
Section 922 . Advanced nurse practitioner services
Section 923 . Occupational therapy services
Section 924 . Nutrition services for pregnant women
Section 925 . (Repealed)
Section 926 . Speech-language pathology services
Section 927 . Hearing services and items
Section 928 . (Expired)
Section 929 . (Expired)
Section 930 . (Expired)
Section 931 . (Expired)
Section 932 . (Expired)
Section 933 . (Expired)
Section 934 . (Expired)
Section 935 . (Expired)
Section 936 . (Expired)
Section 937 . (Expired)
Section 938 . Hospice care
Section 939 . Payment for hospice care services
Section 940 . X-ray services
Section 942 . Direct-entry midwife services
Section 950 . Grounds for sanctioning providers
Section 955 . Sanctions
Section 960 . Imposition of sanction
Section 965 . Scope of sanction
Section 970 . Notice of sanction
Section 975 . Provider education
Section 980 . Appeal of sanction
Section 982 . Restrictions on payments
Section 983 . Withholding of payments
Section 985 . Definitions
Section 990 . (Relocated)
Section 1000 . Purpose
Section 1002 . Notification of option for home and community-based waiver services
Section 1010 . Recipient enrollment and eligibility
Section 1020 . Recipient disenrollment
Section 1030 . Screening, assessment, plan of care, and level of care determination
Section 1035 . Nursing oversight
Section 1040 . Requirements for all reimbursable waiver services
Section 1041 . Care coordination services
Section 1042 . Chore services
Section 1043 . Adult day services
Section 1044 . Residential supported living services
Section 1045 . Day habilitation services
Section 1046 . Residential habilitation services
Section 1047 . Supported employment services
Section 1048 . Intensive active treatment services
Section 1049 . Respite care services
Section 1050 . (Repealed)
Section 1051 . Specialized private duty nursing services
Section 1052 . Transportation services
Section 1053 . Meals services
Section 1054 . Environmental modification services
Section 1055 . Specialized medical equipment and supplies
Section 1058 . Amounts of reimbursement for home and community-based waiver services
Section 1060 . Determination of administrative and general cost rate
Section 1070 . (Repealed)
Section 1080 . Restrictions on residential supported living services reimbursement
Section 1090 . Provider certification and enrollment
Section 1100 . Provider disenrollment and decertification
Section 1110 . Definitions
Section 1200 . Scope
Section 1210 . Telemedicine applications; limitations
Section 1220 . Conditions for payment
Section 1230 . Exclusions
Section 1240 . Payment
Section 1290 . Definitions
Section 1800 . Recovery of Medicaid expenditures
Section 1810 . Intentional program violations, program abuse, and criminal offenses
Section 1850 . Estate recovery
Section 1885 . Undue hardship
Section 1890 . Definitions
Section 1900 . Enrollment; general provisions; covered items and services
Section 1905 . Noncovered items and services
Section 1910 . Prior authorization
Section 1920 . Payment rates
Section 1930 . Purchase of items
Section 1935 . Replacement of items
Section 1940 . Rental of items; general provisions
Section 1945 . Rental of items; payment
Section 1950 . Rental of items; changes during rental periods
Section 1955 . Respiratory therapy equipment, supplies, and assessment visits
Section 1960 . Enteral and oral nutritional products
Section 1970 . Home infusion therapy
Section 1980 . Definitions
Section 1990 . Definitions

Editor's note: As of Register 103 (October 1987), remaining references to "beneficiary," "beneficiaries," and "beneficiary's" have been changed to "recipient," "recipients," "recipient's," respectively, by the regulations attorney under the authority of AS 44.62.125 (b)(6) and AS 01.05.031 (b)(11), for the sake of consistency.

As of Register 135 (Oct. 1995), Articles 21 - 25, as they appeared, were renumbered as Articles 22 - 26 and a new Article 20 (Federally Qualified Health Centers) was added.


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The Alaska Administrative Code was automatically converted to HTML from a plain text format. Every effort has been made to ensure its accuracy, but neither Touch N' Go Systems nor the Law Offices of James B. Gottstein can be held responsible for any possible errors. This version of the Alaska Administrative Code is current through June, 2006.

If it is critical that the precise terms of the Alaska Administrative Code be known, it is recommended that more formal sources be consulted. Recent editions of the Alaska Administrative Journal may be obtained from the Alaska Lieutenant Governor's Office on the world wide web. If any errors are found, please e-mail Touch N' Go systems at E-mail. We hope you find this information useful. Copyright 2006. Touch N' Go Systems, Inc. All Rights Reserved.

Last modified 7/05/2006