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History: Eff. 2/1/2010, Register 193

Authority: AS 47.05.010

AS 47.07.040

AS 47.07.055

7 AAC 160.250. Exemptions from estate recovery

(a) A special low-income Medicare beneficiary under 7 AAC 100.754 who receives assistance from the department only in the form of payment for the beneficiary's Medicare co-payments or deductibles is exempt from estate recovery.

(b) A Medicaid expenditure made for services that a recipient would not have been required to pay for if the recipient was not eligible for Medicaid is exempt from estate recovery.

(c) American Indian and Alaska Native income and resources, including rents, leases, royalties, usage rights, or income from them, are exempt from estate recovery if that income is or those resources are

(1) located on, near, or within the most recent boundaries of a current or prior federally recognized or designated reservation;

(2) derived from the passing of land described in (1) of this subsection from an American Indian or an Alaska Native or descendant of an American Indian or Alaska Native to

(A) one or more relatives, by blood, adoption, or marriage;

(B) another American Indian or Alaska Native; or

(C) an American Indian or Alaska Native group;

(3) derived from the exercise of a federally protected right to extract or harvest natural resources from land described in (1) of this subsection;

(4) held in trust or restricted status or are judgment funds that are exempt from recovery by state law, including the following distributions or conveyances by an Alaska Native corporation organized under to 43 U.S.C. 1601 - 1629h (Alaska Native Claims Settlement Act (ANCSA)) to an Alaska Native or descendant of an Alaska Native:

(A) stock, including stock issued or distributed as a dividend or distribution on stock, or bonds issued by that corporation;

(B) land or an interest land, including land or an interest in land received as a dividend or distribution on stock;

(C) a shareholder homesite conveyed under 43 U.S.C. 1620(j);

(D) an interest in a settlement trust; and

(E) any other property interest that is conveyed, or deemed to be conveyed, under 43 U.S.C. 1601 - 1629h;

(5) originally protected assets and ownership interests that have been inherited, if the protected source can be clearly traced; or

(6) ownership interest in or usage rights to items not included in this subsection, with unique religious, spiritual, traditional, or cultural significance or usage rights that support subsistence or a traditional lifestyle in accordance with applicable tribal law or custom.

(d) In this section,

(1) "Alaska Native group" has the meaning given "Native group" in 43 U.S.C. 1602(d);

(2) "settlement trust" means a trust

(A) established and registered

(i) by an Alaska Native corporation organized under 43 U.S.C. 1601 - 1629h; and

(ii) under the laws of the state and under a resolution of its shareholders; and

(B) operated for the benefit of shareholders, Alaska Natives, and descendants of Alaska Natives, in accordance with 43 U.S.C. 1629e (sec. 39 of the Alaska Native Claims Settlement Act) and the laws of the state.

History: Eff. 2/1/2010, Register 193

Authority: AS 47.05.010

AS 47.07.040

AS 47.07.055

覧覧覧覧覧

Article 3
General Provisions

Section

900. Requirements adopted by reference.

990. Definitions.

7 AAC 160.900. Requirements adopted by reference

(a) The following documents referenced in 7 AAC 105 - 7 AAC 160 are adopted by reference:

(1) American Medical Association, Current Procedural Terminology, Professional Edition, as revised for 2010 ("CPT 2010"), as amended from time to time;

(2) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Healthcare Common Procedure Coding System (HCPCS) 2010, as amended from time to time, and published by the American Medical Association;

(3) International Classification of Diseases - 10th Revision, Clinical Modification (ICD-10-CM), 2016 revision, as amended from time to time;

(4) American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, June 2013 (DSM-5), as amended from time to time;

(5) United States Department of Health and Human Services, National Institutes of Health, Glossary of Terms for Human Subjects Protection and Inclusion Issues, dated April 25, 2001;

(6) Indian Health Service encounter rates, published in 74 Fed. Reg. 27554 - 27555 (June 10, 2009), as amended from time to time;

(7) American Society of Anesthesiologists, Relative Value Guide, 2006, as amended from time to time;

(8) the nonfacility individual relative value units (RVUs) for the Medicare program for each medical procedure, including the geographic practice cost indices (GPCI) for this state, as published in 74 Fed. Reg. 62014 - 62146 and 62148 (Addenda A, B, C, and E) (November 25, 2009), as amended from time to time;

(9) Drug Facts and Comparisons, 2007 edition, published by Wolters Kluwer Health, Inc.;

(10) Overview of the Chart of Accounts, pages 55 - 64 of the publication entitled Chart of Accounts for Hospitals, by L. Vann Seawell, 1994 Edition, ISBN 1-55738-619-6;

(11) Alternative Link, ABC Coding Manual for Integrative Healthcare, 9th edition, 2007 first release;

(12) Inventory for Client and Agency Planning (ICAP), as revised as of 1986;

(13) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), DMEPOS Fee Schedule 2006 1st Quarter;

(14) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Ambulatory Surgical Centers (ACS) Approved HCPCS Codes and Payment Rates spreadsheet, revised as of February 26, 2007;

(15) United States Department of Health and Human Services, Public Health Service, Quick Reference Guide for Clinicians: Treating Tobacco Use and Dependence, dated October 2000, pages 9 - 11;

(16) the optional standard mileage rate for medical purposes published in the United States Internal Revenue Service announcement IR-2008-82, published June 23, 2008;

(17) repealed 11/3/2012;

(18) repealed 11/3/2012;

(19) the federal Medicare ambulatory surgical center payment rates for federal fiscal year 2000, as set out in 65 Fed. Reg. 6380 - 6383 (February 9, 2000);

(20) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.10 (Cardiac Rehabilitation Programs), Revision 98, revised as of December 24, 2008;

(21) Comptroller General of the United States, Government Auditing Standards, December 2011 revision;

(22) repealed 5/18/2014;

(23) Consumer Price Index for All Urban Consumers (CPI-U), all items, for Anchorage Alaska, as revised for calendar year 2012 by the United States Department of Labor, Bureau of Labor Statistics, and as amended from time to time;

(24) the Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care, revised as of October 2015, as amended from time to time;

(25) the American Academy of Pediatric Dentistry's Recommendations for Pediatric Oral Health Assessment, Preventive Services, and Anticipatory Guidance/Counseling, revised as of March 11, 2016 and appearing in the American Academy of Pediatric Dentistry's 2015-16 Definitions, Oral Health Policies, and Clinical Practice Guidelines;

(26) the American Academy of Pediatric Dentistry's Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents, revised as of 2013 and appearing in the American Academy of Pediatric Dentistry's 2015-16 Definitions, Oral Health Policies, and Clinical Practice Guidelines;

(27) Zero to Three: National Center for Infants, Toddlers, and Families, Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R), revised as of 2005.

(b) The following provisions of federal statutes and regulations are adopted by reference:

(1) 42 U.S.C. 1396a(bb)(1) - (6), revised as of December 29, 2007;

(2) 42 U.S.C. 1396r-8(k)(6) (definition of "medically accepted indication"), revised as of October 1, 2008;

(3) 42 C.F.R. 405.515 (reimbursement for clinical laboratory services billed by physicians), revised as of October 1, 2008;

(4) 42 C.F.R. 405.2400 - 405.2472 (rural health clinic and federally qualified health clinic services), revised as of October 1, 2008;

(5) 42 C.F.R. Part 418 (hospice care), revised as of October 1, 2008;

(6) 42 C.F.R. Part 442 (standards for payment to nursing facilities and intermediate care facilities for the mentally retarded), revised as of October 1, 2008;

(7) 42 C.F.R. 447.280 (hospital providers of NF services (swing-bed hospitals)), revised as of October 1, 2008;

(8) 42 C.F.R. 447.300 - 447.371 (payment methods for other institutional and noninstitutional services), revised as of October 1, 2008;

(9) 42 C.F.R. 447.512 (drugs: aggregate upper limits of payment), revised as of October 1, 2008;

(10) repealed 5/18/2014;

(11) 42 C.F.R. Part 456 (utilization control), revised as of October 1, 2008;

(12) 42 C.F.R. Part 483 (requirements for states and long term care facilities), revised as of October 1, 2008;

(13) 42 C.F.R. 485.701 - 485.729 (conditions of participation for clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services), revised as of October 1, 2008;

(14) 42 C.F.R. 486.100 - 486.110 (conditions for coverage: portable x-ray services), revised as of October 1, 2008;

(15) 42 C.F.R. 488.11 (state survey agency functions) and 42 C.F.R. 488.26 (determining compliance), revised as of October 1, 2008;

(16) 42 C.F.R. Part 491 (certification of certain health care facilities), revised as of October 1, 2008;

(17) repealed 1/1/2013;

(18) 42 C.F.R. Part 494 (conditions for coverage for end-stage renal disease facilities), revised as of October 1, 2011;

(19) 42 C.F.R. 410.50 (institutional dialysis services and supplies: scope and conditions), revised as of October 1, 2011;

(20) 42 C.F.R. 410.52 (home dialysis services, supplies, and equipment: scope and conditions), revised as of October 1, 2011;

(21) 42 C.F.R. 447.26(b) and (c) (prohibition on payment for provider-preventable conditions), revised as of October 1, 2013.

(c) Repealed 11/3/2012.

(d) The following department documents are adopted by reference:

(1) the Alaska Medicaid Preferred Drug List, revised as of August 8, 2014;

(2) the Alaska Medicaid Prior-Authorization Medications List, dated May 8, 2013;

(3) the description of diagnoses and procedures included in the Select Diagnoses and Procedures Pre-certification List, revised as of January 2008;

(4) the Durable Medical Equipment Prior Authorization List, dated August 2005;

(5) the Table of ICAP Broad Independence Scores by Age, revised as of April 5, 2004;

(6) the Consumer Assessment Tool (CAT), revised as of January 29, 2009;

(7) repealed 1/26/2012;

(8) the Home and Community-Based Waiver Services Provider Certification Application, dated April 4, 2014;

(9) repealed 7/22/2017;

(10) the Chart of Personal Care Attendant and Waiver Services Rates, dated April 24, 2013, for providers of personal care services under 7 AAC 125.010 - 7 AAC 125.199 and home and community-based waiver services under 7 AAC 130;

(11) Alaska Commission on Aging, Alaska State Plan for Senior Services, New Funding Formula for Title III and Title V Programs table, page 106, revised for FY 2010 - 2011;

(12) repealed 12/2/2012;

(13) repealed 5/11/2012;

(14) the Addresses for Second Level Provider Appeals list, revised August 2006;

(15) the Revenue Codes: Inpatient Hospitals and Revenue Codes: Outpatient Hospitals tables listed in the Alaska Provider Billing Manual, revised as of October 30, 2013;

(16) the Covered Revenue Codes for Tribal Outpatient Hospitals table and the Covered Revenue Codes for Tribal Inpatient Hospitals table listed in the Alaska Provider Billing Manual , revised as of June 4, 2013;

(17) Table I-1, Procedure Codes: Mental Health Services of the Federally Qualified Health Center/Rural Health Clinic Services section of the Alaska Provider Billing Manual, revised as of January 2003;

(18) the Specialized Medical Equipment Fee Schedule, dated August 16, 2013, for home and community-based waiver services;

(19) the State of Alaska, Department of Health and Social Services, Behavioral Health Inpatient Psychiatric Review Provider Manual, revised as of October 2015;

(20) Medicaid Hospital and Long-Term Care Facility Reporting Manual, dated September 2005;

(21) Medicaid Log of Uninsured Care Reporting Form, dated February 26, 2002;

(22) the Handicapping Labiolingual Deviation (HLD) Index Report, revised as of October 2010;

(23) the Orthodontic Services Statement of Coverage, dated July 1, 2015;

(24) the Alaska Geographic Differential Study 2008, Table I-1, dated April 30, 2009;

(25) the Cost Survey and Cost Survey 2016 Instructions, dated February 8, 2017, for providers of personal care services under 7 AAC 125.010 - 7 AAC 125.199 and home and community-based waiver services under 7 AAC 130;

(26) the Residential Behavioral Rehabilitation Services Handbook, 2013 Edition, revised as of August 7, 2013;

(27) the Alaska Screening Tool, revised as of June 21, 2010;

(28) the Client Status Review form, revised as of June 21, 2010;

(29) the Personal Care Services: Service Level Computation, revised as of June 2, 2017;

(30) the Certificate to Request Funds for Abortion, revised as of December 2013;

(31) the Application for Alaskans Living Independently Waiver and Adults with Physical and Developmental Disabilities Waiver, dated May 13, 2013;

(32) the Adult Day Services Conditions of Participation, dated September 5, 2017;

(33) the Care Coordinator Certification Application, dated May 2, 2013;

(34) the Care Coordination Services Conditions of Participation, dated September 5, 2017;

(35) the Chore Services Conditions of Participation, dated September 5, 2017;

(36) the Day Habilitation Services Conditions of Participation, dated September 5, 2017;

(37) the Intellectual & Developmental Disabilities Registration and Review form, dated May 15, 2013;

(38) the Material Improvement Reporting for ALI/APDD Waivers, dated May 2, 2013;

(39) the Material Improvement Reporting for CCMC Waivers, dated May 2, 2013;

(40) the Material Improvement Reporting for IDD Participants Age Three or Over, dated May 2, 2013;

(41) the Material Improvement Reporting for IDD Participants Under The Age of Three, dated May 2, 2013;

(42) the Meal Services Conditions of Participation, dated September 5, 2017;

(43) the Nursing Facility Level of Care Assessment Form for Children, dated March 22, 2011;

(44) the Home and Community-Based Waiver Services Provider Conditions of Participation, dated September 5, 2017;

(45) the Residential Habilitation Services Conditions of Participation, dated September 5, 2017;

(46) the Residential Supported-Living Services Conditions of Participation, dated September 5, 2017;

(47) the Screening Tool for Children with Complex Medical Conditions (CCMC) Waiver Program, dated March 22, 2011;

(48) the Respite Care Services Conditions of Participation, dated September 5, 2017;

(49) the Supported Employment Services Conditions of Participation, dated September 5, 2017;

(50) the Transportation Services Conditions of Participation, dated September 5, 2017;

(51) the Alaska Medicaid 90 Day Generic Prescription Medication List, dated June 27, 2013;

(52) Information About Your Prescription Drug Benefits and Prior Authorization, dated May 2014;

(53) the Environmental Modification Services Conditions of Participation, dated September 5, 2017;

(54) the Orthodontic Referral Oral Health and Hygiene Assessment, revised as of July 2015;

(55) the Personal Care Services Provider Conditions of Participation, dated June 9, 2017.

(56) the Personal Care Attendant and Waiver Rate-Setting Methodology, dated February 8, 2017, for providers of personal care services under 7 AAC 125.010 - 7 AAC 125.199 and home and community-based waiver services under 7 AAC 130.

(e) The following department fee schedules are adopted by reference:

(1) State Fiscal Year 2014 CPT Fee Schedule for Chiropractic Services, revised as of July 12, 2013;

(2) State Fiscal Year 2014 CDT Fee Schedule: Dental Services for Children, revised as of July 9, 2013, State Fiscal Year 2014 CDT Fee Schedule: Emergent Adult Dental Services, revised as of August 1, 2013, State Fiscal Year 2014 CDT Fee Schedule: Prosthodontic Adult Dental Services, revised as of July 9, 2013, and State Fiscal Year 2014 CDT Fee Schedule: Enhanced Adult Dental Services, revised as of July 16, 2013;

(3) State Fiscal Year 2014 CPT Fee Schedule for Direct Entry Midwife Services, and State Fiscal Year 2014 HCPC Fee Schedule for Direct Entry Midwife Services, revised as of July 29, 2013;

(4) State Fiscal Year 2013 CPT Fee Schedule for Audiology Services, Table I-2(a), State Fiscal Year 2013 HCPC Fee Schedule for Audiology Services, Table I-2(b), and State Fiscal Year 2013 HCPC Fee Schedule for Hearing Aid Dealer Services, Table I-3, revised as of September 5, 2012;

(5) 2010 CPT Fee Schedule for Home Infusion Therapy Services, Table I-3(a), revised as of March 4, 2010, and 2010 HCPC Fee Schedule for Home Infusion Therapy Services, Table I-3(b), revised as of March 4, 2010;

(6) 2010 HCPC Fee Schedule for Incontinence Supplies, Table I-1, revised as of March 4, 2010;

(7) State Fiscal Year 2014 CPT Fee Schedule for Occupational Therapy Services, revised as of August 30, 2013, and State Fiscal Year 2014 HCPC Fee Schedule for Occupational Therapy Services, revised as of July 26, 2013;

(8) State Fiscal Year 2014 CPT Fee Schedule for Outpatient Therapy Services, revised as of August 30, 2013, and State Fiscal Year 2014 HCPC Fee Schedule for Outpatient Therapy Services, revised as of July 26, 2013;

(9) State Fiscal Year 2014 CPT Fee Schedule for Independent Physical Therapists, revised as of August 30, 2013, and State Fiscal Year 2014 HCPC Fee Schedule for Independent Physical Therapists, revised as of July 26, 2013;

(10) State Fiscal Year 2014 CPT Fee Schedule for Podiatry Services, and State Fiscal Year 2014 HCPC Fee Schedule for Podiatry Services, revised as of July 30, 2013;

(11) State Fiscal Year 2014 CPT Fee Schedule for School-Based Services, and State Fiscal Year 2014 HCPC Fee Schedule for School-Based Services, revised as of July 25, 2013;

(12) State Fiscal Year 2014 CPT Fee Schedule for Speech Pathologists, revised as of August 30, 2013, and State Fiscal Year 2014 HCPC Fee Schedule for Speech Pathologists, revised as of July 26, 2013;

(13) Transportation/Accommodation Fee Schedule, revised as of August 2012;

(14) State Fiscal Year 2014 CPT Fee Schedule for Vision Services, and State Fiscal Year 2014 HCPC Fee Schedule for Vision Services, revised as of July 31, 2013.

(f) The United States Department of Health and Human Services federal poverty guidelines for this state, established in 73 Fed. Reg. 3971 - 3972, revised as of January 23, 2008, and as amended from time to time, are adopted by reference.

History: Eff. 2/1/2010, Register 193; am 8/25/2010, Register 195; am 12/1/2010, Register 196; am 1/1/2011, Register 196; am 1/15/2011, Register 197; am 2/9/2011, Register 197; am 3/1/2011, Register 197; am 10/1/2011, Register 199; am 12/1/2011, Register 200; am 1/26/2012, Register 201; am 3/8/2012, Register 201; am 4/1/2012, Register 201; add'l am 4/1/2012, Register 201; am 5/11/2012, Register 202; am 10/16/2012, Register 204; am 11/3/2012, Register 204; am 12/1/2012, Register 204; am 12/2/2012, Register 204; am 1/1/2013, Register 204; am 1/16/2013, Register 205; am 7/1/2013, Register 206; add'l am 7/1/2013, Register 206; am 11/3/2013, Register 208; am 1/1/2014, Register 208; am 2/2/2014, Register 209; am 3/19/2014, Register 209; am 3/22/2014, Register 209; am 5/18/2014, Register 210; am 2/26/2015, Register 213; am 3/15/2015, Register 213; am 7/1/2015, Register 214; am 5/1/2016, Register 218; am 6/16/2016, Register 218; am 6/16/2016, Register 218; am 7/22/2017, Register 223; am 11/5/2017, Register 224; am 3/1/2018, Register 225

Authority: AS 47.05.010

AS 47.05.012

AS 47.07.030

AS 47.07.040

Editor's note: The department's Handicapping Labiolingual Deviation (HLD) Index Report adopted by reference in 7 AAC 160.900(d) , may be obtained from Xerox Business Services, LLC web site at http://www.medicaidalaska.com/provi- ders/forms.html, the department's Internet site at http://dhss.alaska.gov/ Pages/default.aspx or at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167.

The American Medical Association's Current Procedural Terminology (CPT), Professional Edition; the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS), the International Classification of Diseases - 10th Revision, Clinical Modification (ICD-10-CM), and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), all adopted by reference in 7 AAC 160.900, may be obtained by contacting the Order Department, American Medical Association, P.O. Box 930876, Atlanta, Georgia 31193-0876, or by visiting the AMA Bookstore at Internet address: https://catalog. ama-assn.org/Catalog/home.jsp. These publications may also be available at other retail book sellers. A copy of each of these publications 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 or the Office of the Commissioner, 350 Main Street, Juneau, Alaska 99801.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 160.900, may also be obtained from American Psychiatric Association - Publishing, Inc., 1000 Wilson Boulevard, Suite 1825, Arlington, Virginia 22209-3901, telephone (703) 907-7322 or (800) 368-5777; or from the American Psychiatric Association - Publishing, Inc. at the following Internet address: https://appi.org.

The United States Department of Health and Human Services, National Institutes of Health's Glossary of Terms for Human Subjects Protection and Inclusion Issues, adopted by reference in 7 AAC 160.900, 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 or at the National Institutes of Health Internet address: http://grants.nih.gov/grants/peer
/tree=hrzglossary.pdf.

The Federal Register may be obtained through the nearest public library. If the Federal Register is not available at your nearest library, the material can be obtained by the library through the interlibrary loan system. It may also be obtained at http://www.gpo.gov/fdsys/.

The American Society of Anesthesiologists' Relative Value Guide, adopted by reference in 7 AAC 160.900, may be obtained by contacting American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, Illinois 60068-2573, Internet address: http://www.asahq.org/shop-asa/billing-coding.

The nonfacility individual relative value units (RVUs) for the Medicare program, and the geographic practice cost indices (GCPI) for this state, adopted by reference in 7 AAC 160.900, 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.

Drug Facts and Comparisons, adopted by reference in 7 AAC 160.900, may be obtained from the publisher, Wolters Kluwer Health, Inc., by telephone at (855) 633-0577. The book may also be ordered from the publisher at http://www.wolterskluwercdi.com/drug-facts-and-comparisons-bound/ or by writing to the following address: Wolters Kluwer Health, Inc., 77 Westport Plaza, Suite 450, St. Louis, Missouri 63146. A copy of this document 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.

Alternative Link's ABC Coding Manual for Integrative Healthcare, adopted by reference in 7 AAC 160.900, may be obtained from Alternative Link, 6121 Indian School Road NE, Suite 131, Albuquerque, New Mexico 87110; telephone: (505) 503-1336; or the following Internet address: http://abccodes.com. A copy of this document 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.

The Inventory for Client and Agency Planning, adopted by reference in 7 AAC 160.900, is available for inspection at the Department of Health and Social Services, Division of Senior and Disabilities Services, Court Plaza Building, 240 Main Street, Suite 602, Juneau, Alaska.

A copy of the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) DMEPOS Fee Schedule, adopted by reference in 7 AAC 160.900, 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' (CMS) Ambulatory Surgical Centers (ACS) Approved HCPCS Codes and Payment Rates spreadsheet, adopted by reference in 7 AAC 160.900, may be obtained by contacting the Superintendent of Documents, United States Government Printing Office, Washington, D.C. 20402. A copy of this spreadsheet is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167 or may be found at the following CMS Internet address: http://www.cms.hhs.gov/ASC Payment/01=hrzOverview.asp.

The United States Department of Health and Human Services, Public Health Service's Quick Reference Guide for Clinicians: Treating Tobacco Use and Dependence, adopted by reference in 7 AAC 160.900, may be obtained by contacting any of the following Public Health Service clearinghouse telephone numbers: Agency for Healthcare Research and Quality (AHRQ), (800) 358-9295; Centers for Disease Control and Prevention (CDC), (800) CDC-1311 ((800) 232-1311); National Cancer Institute (NCI), (800) 4-CANCER ((800) 422-6237). The publication may also be obtained at the following Internet address: http://www.ahrq.gov/professionals/ clinicians-providers/guidelines-recom- mendations/tobacco/clinicians/presenta- tions/2008update-overview/index.htm.

The United States Internal Revenue Service optional standard mileage rate for medical purposes announcement IR-2008-82, published June 23, 2008, and adopted by reference in 7 AAC 160.900, may be obtained from the Internal Revenue Service at the following Internet address: http://www.irs.gov/uas/LatestNews.

The department's Alaska Medicaid Preferred Drug List, Alaska Medicaid Prior-Authorized Medications List, and Select Diagnoses and Procedures Pre-certification List, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167; or may be obtained at the department's Internet site at http:// dhss.alaska.gov/dhcs/Pages/default.aspx.

The Durable Medical Equipment Prior Authorization List, adopted by reference in 7 AAC 160.900, 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 Table of ICAP Scores by Age and Consumer Assessment Tool (CAT), adopted by reference in 7 AAC 160.900, are available for inspection at the Department of Health and Social Services, Division of Senior and Disabilities Services, Court Plaza Building, 240 Main Street, Suite 602, Juneau, Alaska.

The FY 2010 - 2011 New Funding Formula for Title III and Title V Programs table, page 106, of the Alaska Commission on Aging Alaska State Plan for Senior Services, FY 2008 - FY 2011, adopted by reference in 7 AAC 160.900, may be obtained by contacting the Department of Health and Social Services, Division of Senior and Disabilities Services, P.O. Box 110680, Juneau, Alaska 99811-0680. The Alaska Commission on Aging Alaska State Plan for Senior Services, FY 2008 - FY 2011 is also posted on the Department of Health and Social Services, Alaska Commission on Aging's Internet site at http://dhss.alaska.gov/acoa/Pages
/stateplan.aspx.

The Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care, adopted by reference in 7 AAC 160.900, is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167.

The Addresses for Second Level Provider Appeals list, adopted by reference in 7 AAC 160.900, 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.

Sections of the Alaska Provider Billing Manual, adopted by reference in 7 AAC 160.900(d) , may be obtained at the following Xerox Business Services, LLC Internet site: http://manuals.medicaidalaska.com/, or 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 Specialized Medical Equipment Fee Schedule, adopted by reference in 7 AAC 160.900, may be obtained by contacting the Department of Health and Social Services, Division of Senior and Disabilities Services, 3601 C Street, Suite 310, Anchorage, Alaska 99503-5684.

The State of Alaska, Department of Health and Social Services, Behavioral Health Inpatient Psychiatric Review Provider Manual, adopted by reference in 7 AAC 160.900, may be obtained by contacting Qualis Health, PO Box 243609, Anchorage, AK 99524-3609, or may be obtained at the following Qualis Health Internet site: http://www.qualishealth.org/healthcare-professionals/alaska-medicaid- behavioral-health/provider-resources. This manual is also available for inspection at the Department of Health and Social Services, Division of Behavioral Health, 3601 C Street, Suite 878, Anchorage, Alaska 99503.

The Medicaid Hospital and Long-Term Care Facility Reporting Manual, and the relevant pages from the Chart of Accounts for Hospitals, adopted by reference in 7 AAC 160.900, are available from the Office of Rate Review, Department of Health and Social Services, 3601 C Street, Ste 978, Anchorage, Alaska 99503.

The Medicaid Log of Uninsured Care Reporting Form, adopted by reference in 7 AAC 160.900, is available from the Department of Health and Social Services, DSH Program, P.O. Box 110660, Juneau, Alaska 99811-0660.

The department fee schedules, adopted by reference in 7 AAC 160.900(e) , 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, or may be obtained at the following Xerox Business Services, LLC's Internet site http://manuals.medicaid alaska.com/.

The department's Orthodontic Services Statement of Coverage, adopted by reference in 7 AAC 160.900, may be obtained from the department's Internet website at: http://dhss.alaska.gov/dhcs/Pages
/default.aspx or at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167.

The department's Orthodontic Referral Oral Health and Hygiene Assessment, adopted by reference in 7 AAC 160.900, may be obtained from the department's Internet website at: http://dhss.alaska.gov/dhcs/Pages
/default.aspx or at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167.

On December 7, 2010, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a) , would be in effect on January 1, 2011: the Current Procedural Terminology, 4th edition as revised for 2011 ("CPT 2011 "), and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2011. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska 99503-7167.

The Chart of Personal Care Attendant and Waiver Services Rates, adopted by reference in 7 AAC 160.900, may be obtained by contacting the Department of Health and Social Services, Division of Senior and Disabilities Services, P.O. Box 110680, Juneau, Alaska 99811-0680. The Chart of Personal Care Attendant and Waiver Services Rates is also posted on the Department of Health and Social Services, Division of Senior and Disabilities Services' website at http://dhss.alaska.gov/ dsds/Pages/info/costsurvey.aspx.

The Cost Survey and Cost Survey 2016 Instructions, adopted by reference in 7 AAC 160.900, may be obtained by contacting the Department of Health and Social Services, Division of Senior and Disabilities Services, P.O. Box 110680, Juneau, Alaska 99811-0680. The materials are also posted on the Department of Health and Social Services, Division of Senior and Disabilities Services' website at http:// dhss.alaska.gov/dsds/Pages/info/cost survey.aspx.

On January 26, 2011, 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 160.900, would be in effect on March 1, 2011: the United States Department of Health and Human Services poverty guidelines established in 76 Fed. Reg. 3637 - 3638 (January 20, 2011). The Federal Register with the amended version may be obtained through the nearest public library. If the Federal Register is not available at that library site, the material can be obtained by that library through the interlibrary loan system. It may also be obtained at http://www.gpo.gov/fdsys.

The department's Residential Behavioral Rehabilitation Services Handbook, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Behavioral Health, P.O. Box 110620, Juneau, Alaska 99811-0620.

The department's Alaska Screening Tool, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Behavioral Health, Policy and Planning Section, 3601 C Street, Suite 878, Anchorage, AK 99503.

The department's Client Status Review form, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Behavioral Health, Policy and Planning Section, 3601 C Street, Suite 878, Anchorage, AK 99503.

The Consumer Price Index for All Urban Consumers (CPI-U), all items, for Anchorage, Alaska published annually by the United States Department of Labor, Bureau of Labor Statistics, adopted by reference in 7 AAC 160.900, 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 or at the United States Department of Labor, Bureau of Labor Statistics' Internet website at http://bls.gov/cpi/.

The Personal Care Services: Service Level Computation, adopted by reference in 7 AAC 160.900, is available for inspection at the Department of Health and Social Services, Division of Senior and Disabilities Services, Court Plaza Building, 240 Main Street, Suite 602, Juneau, Alaska.

On December 7, 2011, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a) , would be in effect on January 1, 2012: the Current Procedural Terminology, 4th edition, as revised for 2012 ("CPT 2012") and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2012. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska, 99503-7167.

The Certificate to Request Funds for Abortion, adopted by reference in 7 AAC 160.990, is available for inspection at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167.

On December 13, 2012, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a) , would be in effect on January 1, 2013: the Current Procedural Terminology, 4th edition, as revised for 2013 ("CPT 2013" ) and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2013. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska 99503-7167.

The Application for Alaskans Living Independently Waiver and Adults with Physical and Developmental Disabilities Waiver, Adult Day Services Condition of Participation, Care Coordinator Certification Application, Care Coordination Services Conditions of Participation, Chore Services Conditions of Participation, Day Habilitation Services Conditions of Participation, Intellectual & Developmental Disabilities Registration and Review form, Material Improvement Reporting for ALI/APDD Waivers, Material Improvement Reporting for CCMC Waivers, Material Improvement Reporting for IDD Participants Age Three or Over, Material Improvement Reporting for IDD Participants Under the Age of Three, Home and Community-Based Waiver Services Provider Certification Application, Meal Services Conditions of Participation, Nursing Facility Level of Care Assessment Form for Children, Home and Community-Based Waiver Services Provider Conditions of Participation, Residential Habilitation Services Conditions of Participation, Residential Supported-Living Services Conditions of Participation, Screening Tool for Children with Complex Medical Conditions (CCMC) Waiver Program, Supported Employment Services Conditions of Participation, Transportation Services Conditions of Participation, and Environmental Modification Services Conditions of Participation, adopted by reference in 7 AAC 160.900(d) , may be obtained by contacting the Department of Health and Social Services, Division of Senior and Disabilities Services, P.O. Box 110680, Juneau, Alaska, 99811-0680 and are posted on the Department of Health and Social Services, Division of Senior and Disabilities Services Internet website at http://dhss.alaska.gov/dsds.

On December 25, 2013, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a) , would be in effect on January 1, 2014: the Current Procedural Terminology, 4th edition, as revised for 2014 ("CPT 2014 ") and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2014. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska 99503-7167.

The department's Alaska Medicaid 90 Day Generic Prescription Medication List, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167, or may be obtained at the department's Internet site at http:// dhss.alaska.gov/dhcs/Pages/pharmacy/ medpriorauthoriz.aspx.

The department's Information About Your Prescription Drug Benefits and Prior Authorization, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167; or may be obtained at the department's Internet site at http://dhss.alaska.gov/dhcs/Pages/phar- macy/medpriorauthoriz.aspx.

On June 2, 2015, as required under 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 160.900, would be in effect on January 22, 2015: the United States Department of Health and Human Services poverty guidelines established in 80 Fed. Reg. 3236 - 3237 (January 22, 2015). The Federal Register with the amended version may be obtained through the nearest public library. If the Federal Register is not available at that library site, the material can be obtained by that library through the interlibrary loan system. It may also be obtained at http://www.gpo.gov/fdsys.

On January 29, 2016, 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 160.900, would be in effect on October 1, 2015: the 2016 version of the American Medical Association's International Classification of Diseases - 10th Revision, Clinical Modification, (ICD-10-CM). 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 February 2, 2016, 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 160.900, would be in effect on January 25, 2016: the United States Department of Health and Human Services poverty guidelines established in 81 Fed. Reg. 4036 - 4037 (January 25, 2016). The Federal Register with the amended version may be obtained through the nearest public library. If the Federal Register is not available at that library site, the material can be obtained by that library through the interlibrary loan system. It may also be obtained at http://www.gpo.gov/fdsys/.

On February 2, 2016, 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 160.900, would be in effect in June 2013: the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, June 2013 (DSM-5). The amended version may be reviewed at the Department of Health and Social Services, Division of Behavioral Health, 3601 C Street, Anchorage, Alaska, 99503. The DSM-5 may also be obtained from the American Psychiatric Association - Publishing, Inc., 1000 Wilson Boulevard, Suite 1825, Arlington, Virginia 22209-3901, telephone (703) 907-7322 or (800) 368-5777; or from the American Psychiatric Association - Publishing, Inc. at the following Internet address: https://appi.org.

On January 29, 2016, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a) , would be in effect on January 1, 2016: the Current Procedural Terminology, 4th edition, as revised for 2016 ("CPT 2016") and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2016. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska 99503-7167.

A copy of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R), adopted by reference in 7 AAC 160.900, is available for examination at the Department of Health and Social Services, Division of Behavioral Health, 3601 C Street, Suite 878, Anchorage, Alaska 99503-7167.

On February 22, 2017, 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 160.900, would be in effect on January 31, 2017: the United States Department of Health and Human Services poverty guidelines established in 82 .Fed. Reg. 8831 - 8832 (January 31, 2017). The Federal Register with the amended version may be obtained through the nearest public library. If the Federal Register is not available at that library site, the material can be obtained by that library through the interlibrary loan system. It may also be obtained at http://www.gpo.gov/fdsys.

On March 1, 2017, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a) , would be in effect on January 1, 2017: the Current Procedural Terminology, 4th edition, as revised for 2017 ("CPT 2017") and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2017. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage Alaska, 99503-7167.

On March 1, 2017, 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 160.900, would be in effect on January 1, 2017: the 2017 version of the American Medical Association's International Classification of Diseases - 10th Revision, Clinical Modification, (ICD-10-CM). 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.

The Personal Care Services Provider Conditions of Participation, adopted by reference in 7 AAC 160.900, is available for inspection at the Department of Health and Social Services, Division of Senior and Disabilities Services, Court Plaza Building, 240 Main Street, Suite 602, Juneau, Alaska.

The Personal Care Attendant and Waiver Rate-Setting Methodology, adopted by reference in 7 AAC 160.900, may be obtained by contacting the Department of Health and Social Services, Office of Rate Review, 3601 C Street, Suite 978, Anchorage, Alaska 99503.

7 AAC 160.990. Definitions

(a) In the definition of "health facility" in AS 47.07.900 , "outpatient surgical clinic" means an ambulatory surgical center.

(b) In 7 AAC 105 - 7 AAC 160, unless the context requires otherwise,

(1) "Alaska Native" has the meaning given "Native" in 43 U.S.C. 1602(b);

(2) "ambulatory surgical center" has the meaning given in AS 47.32.900 ;

(3) "American Indian" has the meaning given "Indian" in 25 U.S.C. 479;

(4) "claim" means a request for payment submitted to the department, on paper or electronically, by a Medicaid provider who has provided a service to a recipient under 7 AAC 105 - 7 AAC 160;

(5) "clinical social worker" means an individual licensed as a clinical social worker under AS 08.95;

(6) "CMS" means the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services;

(7) "community mental health clinic" means a program

(A) headed by a

(i) physician, who may be a psychiatrist; or

(ii) psychologist or mental health professional clinician working under the general direction of a physician;

(B) that provides mental health services; and

(C) operates

(i) under 7 AAC 71; or

(ii) as a state-operated community mental health clinic;

(8) "continued stay" mean a stay in a facility that is uninterrupted by a discharge and readmission;

(9) "covered" or "coverage" means the department pays for all or part of that service as a Medicaid service under AS 47.07.030 and 7 AAC 105 - 7 AAC 160;

(10) repealed 6/29/2017;

(11) "crisis intervention" means short-term mental health services provided to a recipient during an acute episode of a mental, emotional, or behavioral disorder, that are intended to reduce the symptoms of the disorder, prevent harm to the recipient or others, prevent further relapse or deterioration of the recipient's condition, or stabilize the recipient;

(12) "department" means the Department of Health and Social Services;

(13) "dispensing provider" means one of the following entities, if that entity dispenses drugs as part of a medical practice, does not employ a pharmacist to dispense drugs, and is not enrolled with Medicaid as an outpatient pharmacy:

(A) a physician;

(B) a podiatrist;

(C) a physician assistant;

(D) an advanced nurse practitioner;

(E) a rural health clinic that meets the requirements of 7 AAC 140.210;

(F) a federally qualified health center that meets the requirements of 7 AAC 140.205;

(G) a tribal health program;

(14) "EPSDT" means the early periodic screening, diagnosis, and treatment program under Medicaid;

(15) "estate" has the meaning given in AS 13.06.050 ;

(16) "facility" means

(A) a general acute care hospital;

(B) a specialty hospital; in this subparagraph, "specialty hospital" has the meaning given in 7 AAC 150.990;

(C) a nursing facility;

(D) an intermediate care facility for individuals with an intellectual disability or related condition;

(E) an inpatient psychiatric hospital;

(F) a rural health clinic;

(G) a federally qualified health center;

(H) an ambulatory surgical center;

(I) a home health agency, except that in 7 AAC 150, "facility" does not include a home health agency; or

(J) a residential psychiatric treatment center, except that in 7 AAC 150, "facility" does not include a residential psychiatric treatment center;

(K) an end-stage renal disease facility;

(17) "family psychotherapy" means a form of therapy in which members of a family or any two or more individuals sharing a household, one of whom is a Medicaid recipient, attend psychotherapy sessions together for the treatment of relationships within the family or household to achieve better emotional, behavioral, or social adjustments of all the individuals within the family or household;

(18) "federal and state laws" means laws of the United States government and laws of a jurisdiction of the United States;

(19) "federally qualified health center" means a facility that has filed an agreement with the department to provide federally qualified health center services under Medicaid;

(20) "fiscal agent" means an organization that processes and pays provider claims on behalf of the department;

(21) "freestanding facility" means a facility that is individually licensed and enrolled to provide health care services independent from administrative or financial control of another facility;

(22) "functional assessment" means a systematic evaluation of a recipient to assess that recipient's functioning level in the areas of living skills, learning, education, work, interpersonal skills, and other life skills necessary for independent living, in order to develop an individualized written treatment plan;

(23) "general acute care hospital" has the meaning given in 7 AAC 12.990;

(24) "group practice" means a legally organized partnership, professional corporation, foundation, nonprofit corporation, or similar association comprised of one or more health care providers;

(25) "group skill development services" means face-to-face therapeutic skill instruction, skill practice, and skill monitoring, offered in a group setting, designed to help the recipient develop or improve specific self-care, self-direction, communication, or social-interaction skills necessary for successful community adjustment and interaction with persons in the recipient's home, school, work, or community environment;

(26) "home and community-based waiver services" means services provided under AS 47.07.045 and 7 AAC 130;

(27) "home and community-based waiver services provider" means a provider that the department has certified under 7 AAC 130.220 to provide one or more home and community-based waiver services;

(28) "hospice care" has the meaning given in AS 47.07.900 ;

(29) "hospital" means a facility licensed by the department under 7 AAC 12 to provide inpatient and outpatient hospital services;

(30) "ICF" means an intermediate care facility;

(31) "ICF/IID" means an intermediate care facility for individuals with an intellectual disability or related condition;

(32) "individual psychotherapy" means any form of treatment for mental illness, behavioral maladaptation, or other problems that are assumed to be of an emotional nature, in which a trained individual deliberately establishes a professional relationship with an individual for the purpose of removing, modifying, or retarding existing symptoms, attenuating or reversing disturbed patterns of behavior, and promoting positive personality growth and development;

(33) "individual skill development services" means face-to-face therapeutic self-care and life skill instruction, skill practice, and skill monitoring, provided to an individual, and designed to help the recipient develop or improve specific self-care skills, engage in age-appropriate social behavior, maintain the recipient's household, and develop the ability to be independent within the recipient's community;

(34) "inpatient interdisciplinary team" means a team composed of physicians and other personnel who are employed by an inpatient psychiatric hospital facility, a residential psychiatric treatment center, or an individual who renders services to recipients in either facility;

(35) "inpatient psychiatric hospital" means a hospital or part of a hospital, other than a residential psychiatric treatment center, that delivers medical and inpatient psychiatric services described in 7 AAC 12.215;

(36) "inpatient psychiatric services" means diagnostic and treatment services for mental, behavioral, and emotional disorders provided in an inpatient psychiatric hospital that meets the conditions for payment under 7 AAC 140.350, or provided in a residential psychiatric treatment center that meets the conditions for payment under 7 AAC 140.400;

(37) "intake assessment" means a systematic evaluation of a recipient upon admission to services, and periodically during the course of treatment, to assess and document mental status, social and medical history, the presenting problems and related symptoms, the recipient's strengths and resources, and service needs of the recipient for the purposes of establishing a diagnosis and developing an individualized treatment plan;

(38) "intermediate care facility" means a nursing facility that provides intermediate care services described in 7 AAC 140.510; "intermediate care facility" does not include an intermediate care facility for individuals with an intellectual disability or related condition;

(39) "intermediate care facility for individuals with an intellectual disability or related condition" means a facility, or a distinct part of one, that

(A) is licensed under AS 47.32;

(B) is primarily for the diagnosis, treatment, or rehabilitation of individuals with intellectual or developmental disabilities or individuals with related conditions; and

(C) has met the conditions for payment under 7 AAC 140.600;

(40) "jurisdiction" means a state or territory of the United States and the District of Columbia;

(41) "legend drug" has the meaning given in AS 08.80.480 ;

(42) "long-term care" means

(A) services provided in a nursing facility;

(B) services provided in an intermediate care facility for individuals with an intellectual disability or related condition;

(C) home and community-based waiver services; or

(D) any other services received in a medical institution by a recipient who is an institutionalized individual required to pay a portion of that individual's income toward the cost of care under 7 AAC 100.550 - 7 AAC 100.579;

(43) "long-term care facility" means an intermediate care facility for individuals with an intellectual disability or related condition or a nursing facility;

(44) "Medicaid" means the medical assistance program administered by the department under 42 U.S.C. 1396 - 1396v and AS 47.07, including those eligibility groups and services for which additional federal financial participation is available under 42 U.S.C. 1397aa;

(45) "medical institution" has the meaning given in 7 AAC 100.990;

(46) "Medicare" means the medical assistance program administered by the federal government through private health insurance companies under 42 U.S.C. 1395 - 1395iii;

(47) "Medicare cost report" means the uniform cost report that a facility must prepare under 42 C.F.R. 413.20 - 413.24;

(48) repealed 10/1/2011;

(49) "mental health professional clinician" means

(A) an individual who

(i) is working for an enrolled community behavioral health services provider;

(ii) is performing community behavioral health services that are within that individual's field of expertise;

(iii) is not working in a capacity that requires the individual to be licensed under AS 08; and

(iv) has a master's degree or more advanced degree in psychology, counseling, child guidance, community mental health, marriage and family therapy, social work, or nursing;

(B) a nurse who

(i) has a master's degree in nursing;

(ii) has received special training or experience in mental health;

(iii) has an active license to practice nursing issued by the jurisdiction in which the nurse provides services, or if services are provided in this state, holds an active license under AS 08.68; and

(iv) is working in the individual's field of expertise;

(C) a marital and family therapist who

(i) has an active license to practice marital and family therapy issued by the jurisdiction in which the marital and family therapist provides services, or if services are provided in this state, holds an active license under AS 08.63; and

(ii) is working in the individual's field of expertise;

(D) a professional counselor who

(i) has an active license to practice as a professional counselor issued by the jurisdiction in which the professional counselor provides services, or if services are provided in this state, holds an active license under AS 08.29; and

(ii) is working in the individual's field of expertise;

(E) a social worker who

(i) has a master's degree in social work;

(ii) has an active license to practice as a social worker issued by the jurisdiction in which the social worker provides services, or if services are provided in this state, holds an active license under AS 08.95; and

(iii) is working in the individual's field of expertise; or

(F) a psychologist or psychological associate who

(i) has an active license to practice as a psychologist or psychological associate issued by the jurisdiction in which the psychologist or psychological associate provides services, or if services are provided in this state, holds an active license under AS 08.86; and

(ii) is working in the individual's field of expertise;

(50) "nursing facility" has the meaning given in AS 18.20.390 ; "nursing facility" includes a skilled nursing facility and an intermediate care facility;

(51) "part A of Medicare" means that portion of the Medicare program providing coverage for hospital care under 42 U.S.C. 1395c - 1395i-5;

(52) "patient" means an individual who receives medical attention, care, or treatment;

(53) "person" has the meaning given in AS 01.10.060 ; "person" includes a municipality and the state;

(54) repealed 10/1/2011;

(55) "physiatrist" means a physician who specializes in that branch of medicine using physical therapy, physical agents, such as light, heat, water, and electricity, and mechanical apparatus, in the diagnosis, prevention, and treatment of bodily disorders known as physiatrics;

(56) "prescription drug" has the meaning given in AS 08.80.480 ;

(57) "primary care" means the provision of professional comprehensive health services that includes health education and disease prevention, initial assessment of health problems, treatment of acute and chronic health problems, and the overall management of an individual's or family's health care services;

(58) "prior authorization" means approval by the department, in accordance with 7 AAC 105.130 and service-specific requirements in 7 AAC 105 - 7 AAC 160, of a certain type and number of units of Medicaid-covered services before those services are provided;

(59) "provider" means an individual, firm, corporation, association, or institution that provides, medical assistance to a recipient under Medicaid;

(60) "psychiatric assessment" means a systematic evaluation of a recipient to determine symptomatology, establish a diagnosis, and prescribe needed treatment;

(61) "psychiatric facility" means a licensed hospital facility or part of a licensed hospital facility that is primarily for the diagnosis and treatment of mental, emotional, or behavioral disorders;

(62) "psychiatrist" means a physician licensed to practice medicine in the jurisdiction in which services are provided, and who has completed a fully qualified residency in psychiatry;

(63) "psychological associate" means an individual licensed in the jurisdiction in which services are provided, who renders specific mental health services in association with a licensed psychologist within the scope of practice identified in 12 AAC 60.185;

(64) repealed 10/1/2011;

(65) "psychologist" means an individual who is licensed to practice psychology in the jurisdiction in which services are provided;

(66) "psychosocial assessment" has the meaning given in this section for "functional assessment";

(67) "quality improvement organization" or "QIO" means an organization that has a contract with the Department of Health and Human Services, Centers for Medicare and Medicaid Services, under part B of title XI of the Social Security Act, 42 U.S.C. 1320c - 1320c-12, to perform utilization and quality control review of the health care furnished, or to be furnished, to Medicare beneficiaries, and operates under a contract with the state to provide preadmission screening and utilization review services;

(68) "RBRVS" means resource-based relative value scale;

(69) "recipient" means an individual who has been determined eligible for Medicaid in this state, including home and community-based waiver services, and who is receiving, is authorized to receive, or has received a Medicaid-covered service from a provider enrolled in the Medicaid program in this state;

(70) "recipient's representative" means a parent, guardian, or other individual with legal authority to act on the recipient's behalf;

(71) "recoupment" means an action by the department to recover an overpayment by reducing future payments to the provider until the amount of the overpayment has been offset;

(72) "rendering provider" means a provider whose direct services are paid through a health care provider enrolled under 7 AAC 105.200(a) ;

(73) "residential care" means a residential living arrangement that provides a structured setting with supervision and care where the needs of the residents are largely social; a facility providing residential care is one that offers

(A) shelter, food, household maintenance, encouragement, and assistance to the residents;

(B) guidance as necessary in activities of daily living;

(C) social and recreational activities and opportunities; and

(D) arrangements made to secure medical services when the need is indicated;

(74) "residential psychiatric treatment center" means a freestanding facility that

(A) provides residential child care and inpatient psychiatric services for the diagnosis and treatment of child and adolescent mental, emotional, or behavioral disorders;

(B) is licensed under AS 47.32;

(C) meets the requirements of 7 AAC 140.400; and

(D) is not a provider eligible for payment under 7 AAC 150;

(75) "respite care" means care provided to an individual for the purpose of relief of family members or other regular care providers in the home, except for personal care assistants;

(76) "rural health clinic" means a facility that has filed an agreement with the department to provide rural health clinic services under Medicaid;

(77) "RVU" means relative value unit;

(78) "service" means a medical evaluation or procedure, drug, medical supply, item, equipment, transportation, or other benefit related to an individual's health or delivery of health care;

(79) "skilled nursing facility" has the meaning given in 42 U.S.C. 1395i-3(a);

(80) "SNF" means a skilled nursing facility;

(81) "tribal health program" means a hospital, clinic, or other type of health care facility or program operated by

(A) the United States Department of Health and Human Services, Indian Health Service;

(B) an Indian tribe as defined in 25 U.S.C. 450b(e) and 458aaa(b);

(C) a tribal organization as defined in 25 U.S.C. 450b(l); or

(D) an inter-tribal consortium as defined in 25 U.S.C. 458aaa(a)(5) or established by federal law;

(82) "utilization review" means the process of evaluating the appropriateness and efficient use of medical services and facilities, including admission criteria, length of stay, and discharge practices;

(83) "skilled nursing visit" means a personal visit by a nurse to perform a level of care or treatment that requires the nurse to be licensed in the jurisdiction in which services are provided;

(84) "national drug code" or "NDC" means the code assigned by the United States Food and Drug Administration under 21 C.F.R. Part 207 (registration of producers of drugs and listing of drugs in commercial distribution);

(85) repealed 6/16/2016;

(86) "behavioral health clinical associate" means an individual

(A) who has less than a master's degree in psychology, social work, counseling, or a related field with specialization or experience in providing rehabilitation services to recipients with severe behavioral health conditions;

(B) whose responsibilities may include provision of psychosocial evaluation, education related to a recipient's behavioral health condition, encouraging and coaching, counseling, and teaching of needed life skills; and

(C) who works within the scope of the individual's training, experience, and education;

(87) "behavioral health services" means the behavioral health clinic services identified in 7 AAC 135.010(b) and the behavioral health rehabilitation services identified in 7 AAC 135.010(c) ;

(88) repealed 6/16/2016;

(89) "community behavioral health services provider" has the meaning given in 7 AAC 70.990;

(90) "counseling" means an exchange of information, opinions, and ideas between the recipient and the recipient's provider about the recipient's life choices and behaviors for the purpose of helping the recipient make positive changes in the recipient's behavior;

(91) "detoxification" means the immediate physiological stabilization, diagnosis, and treatment of a recipient who is intoxicated, incapacitated, or experiencing withdrawal from using alcohol or drugs;

(92) "functional impairment"

(A) means a disorder that substantially interferes with or prevents a recipient from achieving or maintaining one or more developmentally appropriate social, behavioral, cognitive, communicative, or adaptive skills;

(B) includes disorders of episodic, recurrent, or continuous duration;

(C) does not include temporary, expected responses to stressful events in the recipient's environment;

(93) "group psychotherapy" means a form of psychotherapy in which two or more individuals participate together in the presence of one or more psychotherapists;

(94) "mental, emotional, or behavioral disorder" means a disorder identified by a provider listed in 7 AAC 135.030 and in accordance with the

(A) Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 160.900;

(B) International Classification of Diseases, adopted by reference in 7 AAC 160.900; or

(C) Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R), adopted by reference in 7 AAC 160.900;

(95) "mental health physician clinic" means a clinic, operated by one or more psychiatrists, that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more of the professionals identified in 7 AAC 135.030(d) (2);

(96) repealed 4/9/2017;

(97) "neuropsychological testing" means the administration of specific psychological tests that are designed to measure and identify cognitive impairments that may be the result of brain damage;

(98) "psychotherapy" means the treatment of a mental, emotional, or behavioral disorder through the use of psychological techniques;

(99) "recipient's residence"

(A) means the physical location where the recipient conducts the daily activities of sleeping and storage of personal possessions, whether temporary or permanent, regardless of recipient ownership;

(B) includes a dwelling maintained by a public or private support organization or an assisted living home;

(100) "severe behavioral health disorder" means an individual

(A) has a substance use disorder;

(B) is a child experiencing a severe emotional disturbance; or

(C) is an adult experiencing a serious mental illness;

(101) "substance abuse" means a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances;

(102) "substance use disorder" means a disorder that is identified by a diagnostic code found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 160.900, and that is related to

(A) alcohol, amphetamine, or similar acting sympathomimetics;

(B) cannabis, cocaine, hallucinogens, inhalants, nicotine, or opioids;

(C) analogs of phencyclidine (PCP) or similar arylcyclohexylamines; or

(D) sedatives, hypnotics, or anxiolytics;

(103) "urinalysis" means laboratory testing of a recipient's urine performed by a laboratory accredited under 42 C.F.R. Part 493;

(104) "Medicare Part B" means that portion of the Medicare program providing coverage for physician and outpatient care under 42 U.S.C. 1395j - 1395w-5;

(105) "FDA" means the United States Food and Drug Administration;

(106) "opioid use disorder treatment program" means an individual or entity that

(A) administers or dispenses a narcotic drug to a narcotic addict for withdrawal or maintenance treatment;

(B) provides to individuals when appropriate or necessary a comprehensive range of medical and behavioral health clinical and rehabilitative services; and

(C) is approved under 7 AAC 70.

(107) "background check" means the processing of an individual's fingerprints, name, social security number, and other identifying information as described in 7 AAC 10.915.

History: Eff. 2/1/2010, Register 193; am 7/7/2010, Register 195; am 1/1/2011, Register 196; am 10/1/2011, Register 199; am 4/1/2012, Register 201; am 7/1/2013, Register 206; am 5/18/2014, Register 210; am 6/16/2016, Register 218; am 4/9/2017, Register 222; am 6/29/2017, Register 222

Authority: AS 47.05.010

AS 47.07.040

AS 47.07.055

Editor's note: As of Register 197 (April 2011), the regulations attorney made a technical revision under AS 44.62.125 (b)(6), to the definition of "Medicaid" in 7 AAC 160.990(b) .

As of Register 207 (October 2013), and acting under AS 44.62.125 (b)(6) and sec. 29, ch. 42, SLA 2013, the regulations attorney made technical changes to 7 AAC 160.990, to change "intermediate care facility for the mentally retarded" to "intermediate care facility for individuals with an intellectual disability or related condition" and to change "the mentally retarded" to "individuals with intellectual or developmental disabilities." Chapter 42, SLA 2013 amended terminology in the Alaska Statutes to replace references to "mental retardation" and "mentally retarded" with more current terms. Section 29, ch. 42, SLA 2013 instructed that similar changes be made in the Alaska Administrative Code.

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Part 9
Medicaid Electronic Health Record Incentive Program; Electronic Health Care Information Exchanges

Chapter

165. Alaska Medicaid Electronic Health Record Incentive Program. (7 AAC 165.001 - 7 AAC 165.900)

166. Statewide Electronic Health Information Exchange System. (7 AAC 166.010 - 7 AAC 166.900)

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Chapter 165
Alaska Medicaid Electronic Health Record Incentive Program

Section

1. Purpose.

20. Provider registration and attestation.

30. Participation and payment determinations.

40. Incentive payments.

50. Program standards for continuing participation.

80. Appeals.

900. Definitions.

7 AAC 165.001. Purpose

The purpose of this chapter is to encourage selected Medicaid providers to deploy and use electronic health record technology and the electronic health information exchange system created under AS 18.23.300 - 18.23.325.

History: Eff. 6/1/2011, Register 198

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