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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 (Repealed)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 (Repealed)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

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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