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(a) Subject to applicable requirements of 7 AAC 43.1900 - 7 AAC 43.1980, the department will pay a provider enrolled under 7 AAC 43.1900 for enteral and oral nutritional products at the rate established in 7 AAC 43.1920 if the products are
(1) not provided by, or under arrangements made by, a home health agency or hospice program;
(2) prescribed by the attending physician, physician assistant, or advanced nurse practitioner;
(3) certified as medically necessary by the attending physician, physician assistant, advanced nurse practitioner, or dietitian on a form provided by the department; certification of medical necessity must indicate that sufficient caloric or protein intake is not obtainable through regular, liquefied, or pureed food; and
(4) identified as an enteral formula in the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2005, as amended from time to time and adopted by reference.
(b) In this section, "dietitian" means an individual who is licensed under AS 08.38 as a dietitian.
History: Eff. 1/11/2006, Register 177
Authority: AS 47.05.010
Editor's note: The certification of medical necessity form referred to in 7 AAC 43.1960(a) may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
The United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2005, adopted by reference in 7 AAC 43.1960(a) may be obtained by contacting the American Medical Association at P.O. Box 930876, Atlanta, GA 31193, or by visiting their Internet address: ama-assn.org/catalog/home.jsp. A copy of the HCPCS is available for examination at the Department of Health and Social Services, Division of Health Care Services, 350 Main Street., Juneau, Alaska.
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Last modified 7/05/2006