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(a) Notwithstanding any other provisions contained in this chapter or 7 AAC 43, a payment may not be made under the General Relief Medical program for any expense
(1) that is for major medical care not determined necessary by the professional review organization on contract with the division of medical assistance;
(2) that is for nursing home care not approved by the division of medical assistance;
(3) for items and services not properly prescribed or determined necessary by a health care practitioner;
(4) for more than 12 outpatient physician visits by a recipient in a calendar year;
(5) for outpatient physician visits that are not for a recipient with a diagnosis as described in 7 AAC 47.271(b) ;
(6) if persons are in the care and custody of penal facilities, including juveniles in detention facilities;
(7) for an elective procedure, including an elective abortion;
(8) if the expense is for the first $50 of each day of hospital stay up to a maximum of $200 per hospital admission for major medical care;
(9) if the expense is for a prescription drug or prescribed medical supply for a recipient who does not have a diagnosis specified in 7 AAC 47.271(b) ;
(10) repealed 7/1/87;
(11) for room, board or ancillary services provided in a hospital beyond the length of hospitalization stay authorized in 7 AAC 47.245;
(12) for a service provided on or after August 1, 1998.
(b) Notwithstanding any other provisions contained in this chapter or 7 AAC 43, the General Relief Medical program will not pay for any service provided by an Indian Health Service or Indian Health Service funded facility that is provided to an Indian Health Service beneficiary and for which there is no charge to the individual.
History: Eff. 3/23/78, Register 65; am 5/2/79, Register 70; am 4/15/82, Register 82; am 5/25/82, Register 84; am 8/1/86, Register 99; am 11/28/86, Register 100; am 7/1/87, Register 103; am 2/19/93, Register 125; am 11/20/94, Register 132; am 8/8/97, Register 143; am 8/1/98, Register 147
Authority: AS 47.05.010
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Last modified 7/05/2006