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(a) Subject to AS 47.05, AS 47.07, and this chapter, the division will enroll as a Medicaid provider an advanced nurse practitioner who practices independently, either individually or in a group, and who is authorized to practice under AS 08.68.
(b) The division will reimburse an independently practicing advanced nurse practitioner directly. If an advanced nurse practitioner has a relationship to a facility like that of a hospital-based physician described in 7 AAC 43.107(c) , the division will not enroll the advanced nurse practitioner under this section. The division will not separately reimburse for inpatient advanced nurse practitioner services provided to a patient in a hospital or nursing home.
(c) The division will reimburse an enrolled advanced nurse practitioner for procedures identified in the January 1999 version of the Medicaid Procedures Guide, which is adopted by reference. The descriptions and billing codes for these procedures are provided in the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 1998, as amended from time to time, and adopted by reference. The division will reimburse in-state advanced nurse practitioner services in accordance with 7 AAC 43.040, except that
(1) the division will pay 85 percent of the rate identified in the fee schedule established under 7 AAC 43.108;
(2) laboratory charges will be reimbursed in accordance with 7 AAC 43.125; and
(3) drugs will be reimbursed as provided for a dispensing provider under 7 AAC 43.591.
(d) To be reimbursed by the division, an out-of-state advanced nurse practitioner must be licensed to practice in the state in which the service is provided, enrolled as a Medicaid provider in this state, and enrolled in the Medicaid program in the state in which the service is provided. The division will reimburse an out-of-state advanced nurse practitioner at the lesser of the Medicaid rate in the state in which the service is provided or 80 percent of the amount the advanced nurse practitioner charges to the general public.
History: Eff. 12/31/92, Register 124; readopt 8/7/96, Register 139; am 2/1/97, Register 141; am 6/26/98, Register 146; am 5/5/99, Register 150; am 3/3/2001, Register 157
Authority: AS 47.05.010
Editor's note: The reimbursement rates for advanced nurse practitioner services calculated under 7 AAC 43.108 appear in Table I-3 of the advanced nurse practitioner section of the Alaska Medicaid Provider Billing Manual, which may be obtained by contacting the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.922 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.
The Medicaid Procedures Guide may be obtained by contacting 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) may be obtained by contacting the Superintendent of Documents, United States Government Printing Office, Washington, D.C. 20402. A copy of the HCPCS is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
On December 10, 1999, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.922, would be in effect on January 1, 2000: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2000. The amended version may be be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska, 99503-7167.
On February 1, 2001, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.922, would be in effect on February 5, 2001: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2001. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska, 99503-7167.
On January 4, 2003, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.922, would be in effect on January 1, 2003: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2003. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska, 99503-7167.
As of Register 165 (April 2003), the regulations attorney made a technical revision under AS 44.62.125 (b)(6) and AS 44.62.245 (d), to 7 AAC 43.922(c) , to set out the full title of the Healthcare Common Procedure Coding System (HCPCS), and to reflect a change in the name in the federal agency that issues the document, from the Healthcare Financing Administration (HCFA) to the Centers for Medicare and Medicaid Services (CMS).
On December 5, 2003, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.922, would be in effect on January 1, 2004: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2004. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage Alaska, 99503-7167.
On December 1, 2004, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.922, would be in effect on January 1, 2005: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2005. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
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Last modified 7/05/2006