(a) The department shall offer all mandatory services required under 42 U.S.C. 1396 — 1396p (Title XIX of the Social Security Act).
(b) In addition to the mandatory services specified in (a) of this section and the services provided under (d) of this section, the department may offer only the following optional services: case management services for traumatic or acquired brain injury; case management and nutrition services for pregnant women; personal care services in a recipient’s home; emergency hospital services; long-term care noninstitutional services; medical supplies and equipment; advanced practice registered nurse services; clinic services; rehabilitative services for children eligible for services under AS 47.07.063, substance abusers, and emotionally disturbed or chronically mentally ill adults; targeted case management services; inpatient psychiatric facility services for individuals 65 years of age or older and individuals under 21 years of age; psychologists’ services; clinical social workers’ services; marital and family therapy services; midwife services; prescribed drugs; physical therapy; occupational therapy; chiropractic services; low-dose mammography screening, as defined in AS 21.42.375(e); hospice care; treatment of speech, hearing, and language disorders; adult dental services; prosthetic devices and eyeglasses; optometrists’ services; intermediate care facility services, including intermediate care facility services for persons with intellectual and developmental disabilities; skilled nursing facility services for individuals under 21 years of age; and reasonable transportation to and from the point of medical care.
(c) Notwithstanding (b) of this section, the department may offer a service for which the department has received a waiver from the federal government if the department was authorized, directed, or requested to apply for the waiver by law or by a concurrent or joint resolution of the legislature.
(d) The department shall establish as optional services a primary care case management system or a managed care organization contract in which certain eligible individuals are required to enroll and seek approval from a case manager or the managed care organization before receiving certain services. The purpose of a primary care case management system or managed care organization contract is to increase the use of appropriate primary and preventive care by medical assistance recipients while decreasing the unnecessary use of specialty care and hospital emergency department services. The department shall
(1) establish enrollment criteria and determine eligibility for services consistent with federal and state law; the department shall require recipients with multiple hospitalizations to enroll in a primary care case management system or with a managed care organization under this subsection, except that the department may exempt recipients with chronic, acute, or terminal medical conditions from the requirement under this paragraph;
(2) define the coordinated care services and the provider types eligible to participate as primary care providers;
(3) create a performance and quality reporting system; and
(4) integrate the coordinated care demonstration projects described under AS 47.07.039 and the demonstration projects described under AS 47.07.036(e) with the primary care case management system or managed care organization contract established under this subsection.
(e) The department shall provide the services set out in (a) and (b) of this section to an eligible person, notwithstanding the person’s participation in an approved clinical trial. In this subsection, “approved clinical trial” has the meaning given in AS 21.42.415.
(f) When the department authorizes the purchase of durable medical equipment under this section, the department may require a recipient of medical assistance services to purchase used or refurbished durable medical equipment if used or refurbished durable medical equipment
(1) is available;
(2) is less expensive, including shipping, than new durable medical equipment of the same type;
(3) is able to withstand at least three years of use; and
(4) equally meets the needs of the recipient.
(g) For purposes of medical assistance coverage, the department may require behavioral health clinic services to be provided by or under the direct supervision of a physician licensed under AS 08.64. In this subsection, “direct supervision” means that a physician licensed under AS 08.64 is available, either in person or by a communication device, to
(1) provide clinical consultation or oversight to the supervisee;
(2) approve behavioral health treatment plans;
(3) review each case to determine the need for continued care;
(4) ensure that the services provided to recipients of behavioral health clinic services are medically necessary and clinically appropriate; and
(5) assume professional responsibility for the services provided.
(h) In this section,
(1) “case management services for traumatic or acquired brain injury” means services furnished to assist individuals who reside in a community setting or who are transitioning to a community setting to gain access to needed medical, social, educational, and other available services;
(2) “durable medical equipment” means equipment that
(A) can withstand repeated use;
(B) is primarily and customarily used to serve a medical purpose;
(C) generally is not useful to an individual in the absence of an illness or injury; and
(D) is appropriate for use in the home, school, or community.
(3) “traumatic or acquired brain injury” has the meaning given in AS 47.80.529.
Other Sections in this Chapter:
- Sec. 47.07.010. Purpose.
- Sec. 47.07.020. Eligible persons. Repealed
- Sec. 47.07.025. Assignment of medical support rights.
- Sec. 47.07.032. Inpatient psychiatric services for persons under 21 years of age.
- Sec. 47.07.035. Priority of medical assistance. [Repealed, § 4 ch 106 SLA 2003.] Repealed
- Sec. 47.07.036. Cost containment measures authorized.
- Sec. 47.07.038. Collaborative, hospital-based project to reduce use of emergency department services.
- Sec. 47.07.039. Coordinated care demonstration projects.
- Sec. 47.07.040. State plan for provision of medical assistance.
- Sec. 47.07.042. Recipient cost-sharing. Repealed
- Sec. 47.07.045. Home and community-based services.
- Sec. 47.07.046. Traumatic or acquired brain injury services.
- Sec. 47.07.050. Implementation of the medical assistance program.
- Sec. 47.07.055. Recovery of medical assistance from estates.
- Sec. 47.07.060. Receipt of federal money.
- Sec. 47.07.063. Payment for certain services furnished or paid for by a school district.
- Sec. 47.07.065. Payment for prescribed drugs.
- Sec. 47.07.067. Payment for adult dental services.
- Sec. 47.07.068. Payment for abortions.
- Sec. 47.07.070. Payment rates for health facilities.
- Sec. 47.07.071. Reports by health facilities.
- Sec. 47.07.072. Report by the department. [Repealed, § 35 ch 126 SLA 1994.] Repealed
- Sec. 47.07.073. Uniform accounting, budgeting, and reporting. Repealed
- Sec. 47.07.074. Audits and inspections.
- Sec. 47.07.075. Administrative procedure.
- Sec. 47.07.076. Reports to legislature.
- Sec. 47.07.080. [Renumbered as AS 47.07.900 Renumbered
- Sec. 47.07.085. Supplemental reimbursement for emergency medical transportation services.
- Secs. 47.07.110 — 47.07.190. Medicaid Rate Advisory Commission. [Repealed, § 6 ch 28 SLA 2003.] Repealed
- Sec. 47.07.900. Definitions. Repealed