This Alaska Medicaid chapter establishes the conditions under which the department will reimburse behavioral health services, including eligibility criteria for recipients (children and adults with emotional disturbances, serious mental illness, substance use disorders, and autism spectrum disorder), provider enrollment requirements for community behavioral health services providers and mental health physician clinics, and prior authorization rules. Covered services span behavioral health clinic services (psychotherapy, psychiatric assessments, pharmacologic management), rehabilitation services (case management, withdrawal management, residential SUD treatment, crisis stabilization, day treatment for children, opioid use disorder treatment), and autism/ABA services. Providers must meet staffing, documentation, and treatment planning standards to bill Medicaid for these services.
View official source7 AAC 135.010. Scope of Medicaid behavioral health services. (a) The department will pay for a behavioral health service under 7 AAC 135.010 - 7 AAC 135.370 if (1) the recipient meets the criteria for services under 7 AAC 135.020 ; (2) the provider meets the criteria for payment under 7 AAC 135.030 ; (3) the service is identified as a treatment need in (A) a professional behavioral health assessment under 7 AAC 135.110 or a reassessment conducted while the recipient is receiving behavioral health services; and (B) a behavioral health treatment plan; (4) screening and brief intervention services are provided in accordance with 7 AAC 135.240 ; (5) the department has given prior authorization for the service under 7 AAC 105.130 and 7 AAC 135.040 ; (6) the service is medically necessary and clinically appropriate; (7) the service is provided as active treatment; (8) the service, if it is a behavioral health clinic service, is provided under the general direction of a physician; (9) the service is provided by a member of the provider's staff who is performing that service as a regular duty within the scope of that staff member's knowledge, experience, and education; (10) the clinical record requirements of 7 AAC 105.230 and 7 AAC 135.130 are met; and (11) the provider meets the criteria for payment under 7 AAC 135.300 , if the provider is providing autism services. (b) A provider may not bill the department for the following behavioral health clinic services unless the service is provided in accordance with this chapter by (1) a mental health professional clinician within the meaning given under 7 AAC 160.990 (b), a physician licensed as required under 7 AAC 110.400 , a physician assistant licensed as required under 7 AAC 110.455 , an advanced practice registered nurse licensed and certified as required under 7 AAC 110.100 , a psychologist licensed as required under 7 AAC 110.550 , a clinical social worker licensed as required under 7 AAC 110.565 , a marital and family therapist licensed as required under 7 AAC 110.575 , or a professional counselor licensed as required under 7 AAC 110.585 , if the provider is working within the scope of the provider's education, training, and experience: (A) the following professional behavioral health assessments conducted in accordance with 7 AAC 135.110 : (i) a mental health intake assessment; (ii) an integrated mental health and substance use intake assessment; (iii) psychological testing and evaluation; (B) psychotherapy conducted in accordance with 7 AAC 135.150 ; (C) short-term crisis intervention services conducted in accordance with 7 AAC 135.160 ; (D) screening and brief intervention services in accordance with 7 AAC 135.240 ; (2) a physician licensed as required under 7 AAC 110.400 , a physician assistant licensed as required under 7 AAC 110.455 , or an advanced nurse practitioner licensed and certified as required under 7 AAC 110.100 , if the provider is working within the scope of the provider's education, training, and experience, if the provider has prescriptive authority, and if the provider is enrolled under 7 AAC 120.100 (c) as a dispensing provider: (A) the following professional behavioral health assessments conducted in accordance with 7 AAC 135.110 : (i) a psychiatric assessment interview; (ii) an interactive psychiatric assessment using equipment and devices; (B) pharmacologic management services conducted in accordance with 7 AAC 135.140 . (c) A provider may not bill the department for the following behavioral health rehabilitation services unless the service is provided in accordance with this chapter by a member of the provider's staff who is qualified to perform that service as a regular duty within the scope of that staff member's knowledge, experience, and education: (1) behavioral health screening under 7 AAC 135.100 ; (2) a substance use intake assessment under 7 AAC 135.110 (c); (3) case management under 7 AAC 135.180 ; (4) withdrawal management services under 7 AAC 135.190 ; (5) repealed 6/30/2021; (6) therapeutic behavioral health services for children under 7 AAC 135.220 ; (7) repealed 6/30/2021; (8) medication administration services under 7 AAC 135.260 , from an individual listed in the definition of "medication administration services" in 7 AAC 70.990 ; (9) medical evaluation provided by a physician, physician assistant, or advanced practice registered nurse; (10) methadone, buprenorphine, buprenorphine-naloxone combination, or naltrexone administration or administration of any other drug approved by the United States Food and Drug Administration for the treatment of opioid addiction if administered in an opioid use disorder treatment program under 7 AAC 70.125 and provided by an individual listed in the definition of "medication administration services" in 7 AAC 70.990 ; (11) behavioral health treatment plan review for a recipient in an opioid use disorder treatment program; (12) day treatment services for children under 7 AAC 135.250 ; (13) repealed 6/30/2021; (14) residential substance use disorder treatment services under 7 AAC 135.280 ; (15) short-term crisis stabilization services under 7 AAC 135.170 ; (16) autism services under 7 AAC 135.350 ; (17) short-term crisis intervention services conducted in accordance with 7 AAC 135.160 provided by an individual listed in the definition of "mental health professional clinician" in 7 AAC 160.990 ; (18) psychotherapy services under 7 AAC 135.150 provided by an individual listed in the definition of "mental health professional clinician" in 7 AAC 160.990 . (d) The department will not pay for any of the following services as a Medicaid covered service under this chapter: (1) outpatient mental health services provided by a hospital or psychiatric facility, unless the outpatient program is a mental health physician clinic that is enrolled in accordance with 7 AAC 105.210 ; (2) experimental therapy; (3) consultation or coordination by means of a telehealth modality with another service provider other than case management; (4) preparation of reports as a separate service; (5) narcosynthesis; (6) socializing; (7) recreation therapy; (8) primal therapy; (9) rage reduction or holding therapy; (10) marathon group therapy; (11) megavitamin therapy; (12) pastoral counseling; (13) explanation of an examination to a family member or other responsible individual that is provided outside of a family therapy session; (14) therapy or evaluation if the documentation required by 7 AAC 105.230 , 7 AAC 135.120 , and 7 AAC 135.130 is inadequate or is absent from the recipient's clinical record or behavioral health treatment plan; (15) room and board costs as a part of a behavioral health clinic service or rehabilitation service; (16) transportation or travel time as a part of a behavioral health clinic service or rehabilitation service, except as provided under 7 AAC 135.180 ; (17) a behavioral health clinic service not provided on the premises or by means of a telehealth modality under 7 AAC 110.620 - 7 AAC 110.639 , unless the service is provided to a person experiencing homelessness. 7 AAC 135.020. Recipient eligibility for Medicaid behavioral health services. (a) The department will pay for behavioral health clinic services for the following individuals only: (1) a child experiencing an emotional disturbance; (2) a child experiencing a severe emotional disturbance; (3) an adult experiencing an emotional disturbance; (4) an adult experiencing a serious mental illness. (b) The department will pay for behavioral health rehabilitation services for the following individuals only: (1) an individual experiencing a substance use disorder characterized by (A) a maladaptive pattern of substance use; or (B) cognitive, behavioral, or physiological symptoms indicating that the individual will continue to use a substance despite significant substance-related problems associated with its use; (2) a child experiencing a severe emotional disturbance; (3) except as provided in (d) of this section, an adult experiencing a serious mental illness; (4) an individual under 21 years of age who meets the criteria in (e) or (f) of this section. (c) If, during the assessment, evaluation, or treatment of a child experiencing an emotional disturbance, a provider determines that the recipient may have a severe behavioral health disorder and that the recipient is in need of behavioral health rehabilitation services, that provider shall refer the recipient to a provider that provides behavioral health rehabilitation services in the community. (d) repealed 6/30/2021. (e) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for autism services, a recipient must (1) be under 21 years of age; (2) have a qualifying diagnosis of autism spectrum disorder, as determined by either a mental health professional as defined in AS 47.30.915 or a health care professional who is qualified based on that individual's scope of practice, training, education, and experience to assess and diagnose autism spectrum disorders in children; and (3) provide documentation, completed by a licensed behavior analyst who meets the requirements of 7 AAC 135.300 , that includes a recipient assessment conducted under 7 AAC 135.350 and that (A) establishes the presence of (i) functional impairments; (ii) delays in communication, behavior, or social interaction; or (iii) repetitive or stereotyped behaviors; (B) establishes that the recipient's identified impairments, delays, or behaviors adversely affect normal child growth and development, communication, or both, such that (i) the recipient cannot adequately participate in home, school, or community activities because the behaviors or social skill deficits interfere or impede access with these activities; or (ii) the recipient's behaviors endanger either the recipient or another person; and (C) indicates that the requested autism services are expected to result in measurable improvement in either the recipient's behaviors, skills, or both. (f) In addition to those individuals who are eligible under (e) of this section, an individual who is eligible for home and community-based waiver services under 7 AAC 130.205 (d)(1) and (3) and who received prior authorization from the department to receive, and was receiving, applied behavioral analysis services through intensive active treatment under 7 AAC 130.275 as of June 30, 2018, remains eligible for autism services under this section as of July 1, 2018. 7 AAC 135.030. Behavioral health provider enrollment and organization. (a) To be eligible for payment under 7 AAC 135.010 - 7 AAC 135.370 for providing Medicaid behavioral health services, a provider must be enrolled in Medicaid under 7 AAC 105.210 and must be either (1) a community behavioral health services provider; (2) a mental health physician clinic that meets the requirements of (d) of this section; (3) a psychologist who (A) meets the requirements of 7 AAC 110.550 ; and (B) provides psychological testing and evaluation under 7 AAC 135.110 (g); (4) a licensed behavior analyst who (A) meets the requirements of 7 AAC 135.300 ; and (B) provides autism services under 7 AAC 135.350 ; or (5) a licensed behavior analyst group practice that (A) meets the requirements of 7 AAC 135.300 ; and (B) provides autism services under 7 AAC 135.350 . (6) a licensed mental health professional who meets the requirements of 7 AAC 135.910 . (b) If a community behavioral health services provider is administratively, organizationally, financially, or otherwise connected to a health facility, as defined in AS 47.07.900 , the community behavioral health services provider must account for income and expenses separately from the health facility to verify that the cost used by the department to determine the health facility's prospective payment rate under 7 AAC 150 is excluded from the operating cost of the community behavioral health services provider. (c) If a community behavioral health services provider is operated by a governmental or corporate entity that concurrently operates a health facility, the health facility may provide administrative and other support services to the community behavioral health services provider. However, the department will not include the cost of providing those behavioral health services in determining the health facility's prospective payment rate under 7 AAC 150 . If a physician or other health professional is employed by the health facility and by the community behavioral health services provider, the physician or other health professional must be employed under a separate written agreement with the community behavioral health services provider that requires that the cost of services provided by the physician or other health care professional be (1) separately accounted for by the community behavioral health services provider; and (2) excluded from the costs considered by the department in determining the health facility's prospective payment rate under 7 AAC 150 . (d) The department will pay for behavioral health clinic services provided by a mental health physician clinic only if the (1) mental health physician clinic is operated by one or more physicians licensed under AS 08.64 who provide direct supervision under AS 47.07.030 (g) to all clinic employees and to individuals on contract with the clinic to provide behavioral health clinic services; (2) services are for treatment of a diagnosable mental health disorder; (3) services are provided by one of the physicians operating the clinic or by one of the following individuals who work under the direct supervision of those physicians: (A) a psychologist who is licensed under 7 AAC 110.550 ; (B) a psychological associate who is licensed under AS 08.86 or in the jurisdiction where services are provided, and who renders the services within the scope of practice identified in 12 AAC 60 ; (C) a clinical social worker who is licensed under AS 08.95 ; (D) a physician assistant who is licensed under 7 AAC 110.455 ; (E) an advanced practice registered nurse who is licensed and certified as required under 7 AAC 110.100 ; (F) a psychiatric nursing clinical specialist who is licensed under AS 08.68 or in the jurisdiction where services are provided; (G) a marital and family therapist who is licensed under AS 08.63 or in a jurisdiction with requirements substantially similar to the requirements of AS 08.63 where services are provided; or (H) a professional counselor who is licensed under AS 08.29 or in a jurisdiction with requirements substantially similar to the requirements of AS 08.29 where services are provided; (4) services are provided on the premises of the mental health physician clinic or by means of a telehealth modality under 7 AAC 110.620 - 7 AAC 110.639 , unless the service is provided to a person experiencing homelessness. (e) Repealed 11/10/2019. 7 AAC 135.040. Service authorization and limitation. (a) Except as provided in (b) and (c) of this section and 7 AAC 105.130 (d), the department will not pay for behavioral health services unless the department has given prior authorization for those services. (b) A community behavioral health services provider or mental health physician clinic may provide the following behavioral health clinic services without prior authorization from the department: (1) any combination of individual, group, and family psychotherapy under 7 AAC 135.150 ; (2) psychiatric assessments under 7 AAC 135.110 (e); (3) psychological and neuropsychological testing and evaluation under 7 AAC 135.110 (g); (4) pharmacologic management services under 7 AAC 135.140 ; (5) an integrated mental health and substance use intake assessment under 7 AAC 135.110 , or a combination of a mental health intake assessment and a substance use intake assessment under 7 AAC 135.110 ; the assessment or combination of assessments must consist of (A) one or more face-to-face sessions; and (B) a review of collaterally connected information; (6) repealed 7/1/2025; (7) short-term crisis intervention services under 7 AAC 135.160 , or a combination of behavioral health clinic service, rehabilitation service, and intervention service under 7 AAC 135.010 that are included in the crisis plan that do not exceed 22 consecutive hours in a single encounter; (8) screening and brief intervention services under 7 AAC 135.240 . (c) A community behavioral health services provider may provide the following behavioral health rehabilitation services without prior authorization by the department: (1) case management services under 7 AAC 135.180 ; a directing clinician may bill not more than one hour each week for service monitoring for a recipient of case management services; (2) individual therapeutic behavioral health services for children under 7 AAC 135.220 , or a combination of individual therapeutic behavioral health services for children and peer support services under 7 AAC 135.210 and 7 AAC 135.220 ; (3) group therapeutic behavioral health services for children under 7 AAC 135.220 ; (4) family therapeutic behavioral health services for children under 7 AAC 135.220 , or a combination of family therapeutic behavioral health services for children and peer support services under 7 AAC 135.210 and 7 AAC 135.220 ; (5) repealed 6/30/2021; (6) repealed 6/30/2021; (7) repealed 6/30/2021; (8) medication administration services under 7 AAC 135.260 , limited to one billable service each day; (9) medical evaluation of a recipient receiving opioid use disorder treatment services, including (A) consultation and referral; and (B) establishing dosage for medication for the treatment of opioid use disorder; (10) medication administration services of medication for the treatment of an opioid use disorder or alcohol use disorder; (11) withdrawal management services under 7 AAC 135.190 , not to exceed one withdrawal management service episode each day; in this paragraph, "service episode" means the completion of services identified in this paragraph for which a single payment is made in accordance with 7 AAC 145.580 ; (12) behavioral health screening in accordance with 7 AAC 135.100 to determine eligibility for admission to a treatment program; (13) medical evaluation for a recipient prior to providing withdrawal management services; (14) behavioral health treatment plan review for a recipient in an opioid treatment program; (15) day treatment services for children under 7 AAC 135.250 , not to exceed six hours each school day; (16) repealed 11/10/2019; (17) residential substance use disorder treatment services under 7 AAC 135.280 , not to exceed one billable service each day; (18) short-term crisis stabilization services under 7 AAC 135.170 that do not exceed 22 consecutive hours in a single encounter; and (19) autism services provided in accordance with 7 AAC 135.350 . (d) A provider request for prior authorization of an extension of a service beyond service limitations or a provider request for a change in the level of the service that a recipient previously received must be made in writing on a form approved by the department. The request must (1) be documented in the clinical record prepared under 7 AAC 105.230 and 7 AAC 135.130 ; (2) include a listing of all Medicaid reimbursable services and the expected duration of these services as set out in the recipient's behavioral health treatment plan; and (3) affirm that the recipient's treatment team for a recipient under 18 years of age, in accordance with 7 AAC 135.120 , has reviewed the behavioral health treatment plan and recommended the requested services as medically necessary and clinically appropriate. (e) An extension made under (d) of this section is valid through the date set by the director of the division responsible within the department for behavioral health services, or the director's designee. (f) Repealed 7/1/2025. (g) After considering the area of the state where the service is provided, the provider's location, and whether other providers are available to a recipient, the director of the division responsible within the department for behavioral health services, or the director's designee, shall extend a behavioral health clinic service limitation under 7 AAC 135.010 - 7 AAC 135.280 if the director or director's designee determines that (1) the recipient's circumstances are exceptional; and (2) the extension is necessary to protect the recipient's health. (h) Repealed 7/1/2025. 7 AAC 135.050. Adult experiencing an emotional disturbance. An adult experiencing an emotional disturbance is an individual 21 years of age or older who is experiencing a nonpersistent mental, emotional, or behavioral disorder that (1) is identified and diagnosed during a professional behavioral health assessment under 7 AAC 135.110 ; and (2) is not the result of intellectual, physical, or sensory deficits. 7 AAC 135.055. Adult experiencing a serious mental illness. (a) An adult experiencing a serious mental illness is an individual 21 years of age or older who currently has or at any time during the past year has had a diagnosable mental, emotional, or behavioral disorder of sufficient duration to meet diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 160.900 , or the International Classification of Diseases, adopted by reference in 7 AAC 160.900 , and that (1) has consistently resulted in (A) impaired thinking and judgment that may include the presence of delusions or hallucinations; (B) socially disruptive behavior that may include an emotional response that is inappropriate to the situation; or (C) conduct that is illegal or outside socially accepted rules and mores; (2) has resulted in serious functional impairment that interferes with the individual's ability to participate in two or more of the following life domains within a culturally appropriate context: (A) the ability to fulfill social responsibilities, including the ability to engage in work, school, parenting, maintaining a household, or other meaningful, productive activity; (B) the ability to meaningfully interact with others, including the ability to actively communicate with others, maintain a supportive social network, avoid isolation, and control disruptive behaviors; (C) the capacity for self-care of the individual's physical health, personal hygiene and grooming, and nutritional needs; (D) the capacity to maintain mental health, including the ability to problem-solve issues, to maintain the individual's independence and personal safety, and to use available community resources for those purposes; or (3) has resulted in current hospitalization or the imminent risk of hospitalization. (b) In addition to the impairments described in (a)(1) and (2) of this section, for individuals with cognitive impairments or organic brain syndrome, there must be documented evidence showing the ability of the individual to benefit from rehabilitative services that would enable the individual to self-regulate behavior, modulate emotional reactivity, and improve functioning in major life domains. 7 AAC 135.060. Child experiencing an emotional disturbance. A child experiencing an emotional disturbance is an individual under 21 years of age who is experiencing a nonpersistent mental, emotional, or behavioral disorder that (1) is identified and diagnosed during a professional behavioral health assessment under 7 AAC 135.110 ; and (2) is not the result of intellectual, physical, or sensory deficits. 7 AAC 135.065. Child experiencing a severe emotional disturbance. (a) A child experiencing a severe emotional disturbance is an individual under 21 years of age who currently has or at any time during the past year has had a diagnosable mental, emotional, or behavioral disorder of sufficient duration to meet diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 160.900 , the International Classification of Diseases, adopted by reference in 7 AAC 160.900 , or 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 , and that (1) has resulted in a severe functional impairment that significantly interferes with the child's ability to participate in one or more life domains at a developmentally appropriate level and within a culturally appropriate context; or (2) has resulted in the individual exhibiting one or more of the following: (A) persistent symptoms of distress or diminished affect that do not readily respond to encouragement, reassurance, or instructional control; (B) impeded development or inappropriate attachment as a result of exposure to traumatic life events or impaired relationships; (C) pervasive behavior that is disruptive, aggressive, or risk-taking and that places the individual at serious risk of physical harm to self or to another person or results in serious property damage; (D) consistent inability to participate appropriately in a community setting, including family, school, work, or child care; (E) imminent risk for out-of-home placement; (F) imminent risk for being placed in the custody of the department under AS 47.12.120 or as a result of exposure to maltreatment under AS 47.10.011 ; (G) current hospitalization or the imminent risk of hospitalization. (b) In addition to the impairments described in (a)(1) and (2) of this section, for individuals with cognitive impairments or organic brain syndrome, there must be documented evidence showing that the individual has the ability to benefit from rehabilitative services that would enable the individual to self-regulate behavior, modulate emotional reactivity, and improve developmentally appropriate functioning in major life domains. 7 AAC 135.100. Behavioral health screening. (a) The department will pay a provider listed in 7 AAC 70.010 (a) and an eligible provider under 7 AAC 105.200 for conducting a behavioral health screening with a new or returning request using a screening tool recommended by the department or identified by the provider as appropriate for use with the recipient. (b) A provider under this section shall include the results of the screening in the recipient's clinical record including any action taken or recommended based on the recipient's responses. 7 AAC 135.110. Professional behavioral health assessments. (a) If an individual requests treatment, or is referred by a court or other agency, as an individual who is suspected of having a behavioral health disorder that could require behavioral health services, the department will pay (1) a community behavioral health services provider for the following services: (A) one of the following behavioral health intake assessments: (i) a mental health intake assessment under (b) of this section; (ii) a substance use intake assessment under (c) of this section; (iii) an integrated mental health and substance use intake assessment under (d) of this section; (B) a psychiatric assessment under (e) of this section; (C) psychological testing and evaluation under (g) of this section; (2) a mental health physician clinic for (A) a mental health intake assessment under (b) of this section; (B) a psychiatric assessment under (e) of this section; (C) psychological testing and evaluation under (g) of this section; (D) an integrated mental health and substance use intake assessment under (d) of this section. (b) To qualify for payment, a mental health intake assessment must be (1) documented in the recipient's clinical record in accordance with 7 AAC 105.230 and 7 AAC 135.130 ; (2) conducted in accordance with (A) the requirements of 7 AAC 135.010 (b)(1), if the provider is a community behavioral health services provider; (B) the requirements of 7 AAC 135.030 (d), if the provider is a mental health physician clinic; (3) conducted upon admission to services and during the course of active treatment as necessary, for the purpose of determining and documenting (A) the recipient's mental status and social and medical history; (B) the nature and severity of any identified mental health disorder; (C) a diagnosis consistent with the (i) Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 160.900 ; (ii) International Classification of Diseases, adopted by reference in 7 AAC 160.900 ; or (iii) 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 ; (D) treatment recommendations that form the basis of a subsequent behavioral health treatment plan; and (E) functional impairment; and (4) updated as new information becomes available. (c) To qualify for payment, a substance use intake assessment must be (1) documented in the recipient's clinical record in accordance with 7 AAC 105.230 and 7 AAC 135.130 ; (2) conducted at a minimum by a substance use disorder counselor, behavioral health clinical associate, or other qualified program staff member performing duties regularly within the scope of the individual's training, experience, and education; however, if the substance use intake assessment is conducted as part of withdrawal management services subject to 7 AAC 70.110 and 7 AAC 135.190 , the assessment must be conducted by an individual identified in 7 AAC 70.110 for the type of withdrawal management service provided; (3) conducted upon admission to services and during the course of active treatment as necessary, for the purpose of determining and documenting (A) if the recipient has a substance use disorder; (B) the nature and severity of any identified substance use disorder; (C) the correct diagnosis; (D) treatment recommendations that form the basis of a subsequent behavioral health treatment plan; and (E) functional impairment; and (4) updated as new information becomes available. (d) To qualify for payment, an integrated mental health and substance use intake assessment must (1) be documented in the recipient's clinical record in accordance with 7 AAC 105.230 and 7 AAC 135.130 ; (2) be conducted in accordance with (A) the requirements of 7 AAC 135.010 (b)(1), if the provider is a community behavioral health services provider; (B) the requirements of 7 AAC 135.030 (d), if the provider is a mental health physician clinic; (3) meet the requirements of (b)(3) and (c)(3) of this section; and (4) be updated as new information becomes available. (e) The department will pay a community behavioral health services provider or mental health physician clinic for a psychiatric assessment interview, that is to serve as the professional behavioral health assessment under this section, if the recipient's condition indicates the need for a more intensive assessment, including an assessment to evaluate the need for medication. A psychiatric assessment interview must (1) be conducted by a professional described in 7 AAC 135.010 (b)(2); (2) include a review of any general medical and psychiatric history or problem the recipient is presenting; (3) include a relevant recipient history; (4) include a mental status examination; (5) result in a diagnosis consistent 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 ; and (6) include a listing of any identified psychiatric problems, including functional impairments, with treatment recommendations. (f) Repealed 11/10/2019. (g) The department will pay a community behavioral health services provider, mental health physician clinic, or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disorders. Psychological testing and evaluation includes the assessment of functional capabilities, the administration of standardized psychological tests, and the interpretation of findings, and must be conducted in accordance with (1) the requirements of 7 AAC 135.010 (b)(1), if the provider is a community behavioral health services provider; (2) the requirements of 7 AAC 135.030 (d) and (e), if the provider is a mental health physician clinic; (3) the requirements of 7 AAC 135.030 (a), if the provider is a psychologist. (h) Repealed 4/24/2020. 7 AAC 135.120. Behavioral health treatment plan. (a) The department will pay a community behavioral health services provider or a mental health physician clinic for services provided to a recipient only if (1) those services are provided under an individualized behavioral health treatment plan that meets the requirements of 7 AAC 135.130 ; (2) the plan is based on a professional behavioral health assessment under 7 AAC 135.110 ; (3) the plan is signed and monitored by the directing clinician; and (4) if the recipient is 18 years of age or younger, the plan is developed with the recipient or the recipient's representative and is based upon the input of a treatment team that meets the requirements of (c) of this section. (b) By signing a behavioral health treatment plan, a directing clinician attests that in the directing clinician's professional judgment the services called for in the behavioral health treatment plan are (1) appropriate to the recipient's needs; (2) delivered at an adequate skill level; and (3) achieving the treatment goals. (c) A behavioral health treatment team for a recipient under 18 years of age (1) must include (A) the recipient; (B) the recipient's family members, including parents, guardians, and others similarly involved in providing general oversight of the recipient; (C) a staff member of the subunit of the Department of Family and Community Services responsible for children's services, if the recipient is in the state's protective custody or supervision; (D) a staff member of the division in the Department of Family and Community Services responsible for juvenile justice, if the recipient is in that agency's custody or care; (E) the directing clinician; and (F) the case manager, if the recipient is a child experiencing a severe emotional disturbance; and (2) may include (A) if the recipient currently resides within an alternative living arrangement, including foster care, residential child care, or an institution, a representative of that facility; (B) if the recipient is currently unable to succeed in a school, a representative from the recipient's public, private, or home educational system, including a teacher, special education consultant, speech therapist, or other representative involved in the recipient's education. (d) All members of the behavioral health treatment team shall attend meetings of the team in person or by means of a telehealth modality and be involved in team decisions unless the clinical record documents that (1) the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipient's well-being; (2) family members, school district employees, or government agency employees refuse to or are unable to participate after the provider's responsible efforts to encourage participation; or (3) weather, illness, or other circumstances beyond the member's control prohibits that member from participating. (e) If a provision of this chapter requires the approval, concurrence, or recommendation of the treatment team, the treatment team may issue that approval, concurrence, or recommendation only upon the concurrence of (1) the directing clinician; and (2) the recipient or the recipient's representative. (f) The directing clinician must review a recipient's plan for treatment in person or by means of a telehealth modality with the recipient at least every 90 days to confirm that the identified problems and treatment services are current and relevant, and to identify any need for continuing assessment or treatment services to address new problems identified by the provider or the recipient. If the recipient is 18 years of age or younger, the review must be conducted in accordance with (c) of this section. The directing clinician shall document in the recipient's clinical record the date that the review was conducted. 7 AAC 135.130. Clinical record. (a) To be eligible for payment under this chapter, a community behavioral health services provider or a mental health physician clinic must maintain, for each recipient served, a clinical record in accordance with 7 AAC 105.230 that also must include a (1) written report that documents the results of a professional behavioral health assessment conducted in accordance with 7 AAC 135.110 that also identifies the (A) recipient's presenting problems, diagnosed conditions, and functional deficits that require treatment; and (B) treatment recommendations for the recipient's presenting problems, diagnosed conditions, and functional impairments; and (2) behavioral health treatment plan that meets the requirements of 7 AAC 135.120 and includes (A) the recipient's identifying information; (B) the date implementation of the behavioral health treatment plan will begin; (C) treatment goals based on the presenting problems, assessed conditions, and functional deficits that are the current focus of treatment; and (D) the services that will be used to address the written goals. (b) The clinical record must include all the changes made to a recipient's behavioral health treatment plan and updates to the professional behavioral health assessment. 7 AAC 135.140. Pharmacologic management services. (a) The department will pay a community behavioral health services provider or mental health physician clinic for a pharmacologic management service if that service is provided directly by a professional described in 7 AAC 135.010 (b)(2). (b) To qualify for payment under this section, a provider must monitor a recipient for the purposes of (1) assessing a recipient's need for pharmacotherapy; (2) prescribing appropriate medications to meet the recipient's need; and (3) monitoring the recipient's response to medication, including (A) documenting medication compliance; (B) assessing and documenting side effects; and (C) evaluating and documenting the effectiveness of the medication. 7 AAC 135.150. Psychotherapy. (a) The department will pay a community behavioral health services provider or mental health physician clinic for one or more of the following forms of psychotherapy, as coded in Current Procedural Terminology (CPT), adopted by reference in 7 AAC 160.900 : (1) insight-oriented individual psychotherapy; (2) interactive individual psychotherapy; (3) group psychotherapy; (4) family psychotherapy - without recipient; (5) family psychotherapy - with recipient; (6) multi-family group psychotherapy. (b) Biofeedback or relaxation therapy may be provided as an element of insight-oriented individual psychotherapy and interactive individual psychotherapy if that biofeedback or relaxation therapy is (1) prescribed by a psychiatrist, if provided in a mental health physician clinic; (2) prescribed by a physician or ordered by a mental health professional clinician, if provided at a community behavioral health services provider; and (3) included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions: (A) chronic pain syndrome; (B) panic disorders; (C) phobias. (c) Family psychotherapy, with or without recipient involvement, may be provided by means of a telehealth modality. 7 AAC 135.160. Short-term crisis intervention services. (a) The department will pay a community behavioral health services provider or mental health physician clinic for short-term crisis intervention services, provided by a mental health professional clinician to a recipient, if that mental health professional clinician provides an initial assessment of the (1) nature of the short-term crisis; (2) recipient's mental, emotional, and behavioral status; and (3) recipient's overall functioning in relation to the short-term crisis. (b) The mental health professional clinician may order and deliver, as a crisis intervention service, a medically necessary and clinically appropriate behavioral health clinic service, rehabilitation service, or intervention service in accordance with 7 AAC 135.010 that (1) is included in the crisis plan to (A) reduce the symptoms of the acute mental, emotional, or behavioral disorder; (B) prevent harm to the recipient or others; (C) prevent further relapse or deterioration of the recipient's condition; or (D) stabilize the recipient within the family system, if one exists; and (2) does not exceed 22 hours of the total short-term crisis intervention services provided to a recipient. (c) Short-term crisis intervention includes the following treatment and supports: (1) individual or family psychotherapy needed in response to the short-term crisis; (2) individual or family training and education related to resolving the existing short-term crisis and preventing a future crisis; (3) monitoring the recipient for safety purposes. (d) The mental health professional clinician is responsible for (1) planning all behavioral health services needed to respond to the short-term crisis; (2) writing the short-term crisis intervention plan that contains (A) treatment goals derived from the assessment performed under (a) of this section of the crisis; and (B) a description of the medically necessary and clinically appropriate services provided under this chapter that the recipient requires to resolve the existing short-term crisis; and (3) directing all services that are ordered in the short-term crisis intervention plan except for pharmacologic management services. (e) The department will separately pay a community behavioral health services provider for pharmacologic management services provided in accordance with 7 AAC 135.010 (b)(2) and for the behavioral health clinic and rehabilitation services and interventions ordered and delivered under a short-term crisis intervention plan developed under (b) of this section if the bill for each service is separately submitted to the department. (f) Notwithstanding any behavioral health treatment plan in effect for the recipient at the onset of a short-term crisis, if a recipient is receiving short-term crisis intervention services, the department will only pay for the behavioral health services identified in the short-term crisis intervention plan for the duration of the short-term crisis intervention service. (g) Short-term crisis intervention must be documented in a progress note in accordance with 7 AAC 105.230 and include an evidence-based risk assessment and follow-up disposition. The services that are ordered by the mental health professional clinician in the short-term crisis intervention plan, but provided by others, must be documented by the individual who provided the service. All documentation under this subsection must be filed in the recipient's clinical record. (h) Short-term crisis intervention may be provided in any appropriate outpatient or community setting, including (1) a hospital emergency room, if the recipient has not been admitted to the hospital; (2) a facility designated for crisis respite purposes; and (3) the recipient's place of residence, workplace, or school. (i) Repealed 2/2/2024. 7 AAC 135.170. Short-term crisis stabilization services. (a) The department will pay a community behavioral health services provider for short-term crisis stabilization services, provided by a substance use disorder counselor or a behavioral health clinical associate to a recipient, if that substance use disorder counselor or behavioral health clinical associate (1) provides an initial assessment of the recipient's overall functioning in relation to the short-term crisis; (2) develops a short-term crisis stabilization plan; and (3) documents, on a form provided by the department, the assessment, a short-term crisis stabilization plan, and the services that are provided. (b) The substance use disorder counselor or behavioral health clinical associate may provide, as part of the short-term crisis stabilization plan, any medically necessary and clinically appropriate behavioral health rehabilitation services necessary to return the recipient to the recipient's mental, emotional, and behavioral level of functioning before the short-term crisis occurred. (c) Short-term crisis stabilization includes the following treatment and supports: (1) individual or family counseling needed in response to the short-term crisis; (2) individual or family training and education related to resolving the existing short-term crisis and preventing a future crisis; (3) monitoring the recipient for safety purposes; (4) any behavioral health rehabilitation services. (d) Notwithstanding any behavioral health treatment plan in effect for the recipient at the onset of a short-term crisis, if a recipient is receiving short-term crisis stabilization services, the department will only pay for the behavioral health services identified in the short-term crisis stabilization plan for the duration of the short-term crisis stabilization. (e) Short-term crisis stabilization must be documented in a progress note in accordance with 7 AAC 105.230 and include an evidence-based risk assessment and follow-up disposition. Documentation under this section must be filed in the recipient's clinical record. (f) If the substance use disorder counselor or behavioral health clinical associate is unable to resolve the short-term crisis, a mental health professional clinician may assume responsibility for the case and begin providing short-term crisis intervention services under 7 AAC 135.160 . (g) Short-term crisis stabilization services may be provided in any appropriate outpatient or community setting, including (1) the premises of the community behavioral health services provider; (2) a facility designated for crisis respite purposes; and (3) the recipient's place of residence, workplace, or school. 7 AAC 135.180. Case management. (a) The department will pay a community behavioral health services provider for case management provided to a recipient or recipient's family for one or more of the following purposes only: (1) coordinating assessments, treatment planning, and service delivery; (2) providing linkage between the recipient and other needed services; (3) monitoring, by direct observation by the directing clinician, the delivery of behavioral health services other than case management as those services are provided to the recipient to ensure that interventions and techniques are (A) appropriate to the recipient's needs; (B) delivered at an adequate skill level; and (C) achieving the treatment goals; (4) providing advocacy and support to the parents and the foster parents of a child in foster care to preserve the placement; (5) providing overall advocacy and support for the recipient's social, educational, legal, and treatment needs. (b) The department will pay only one case manager of a child experiencing a severe emotional disturbance for time setting up, traveling to or from, and attending a treatment team meeting conducted under 7 AAC 135.120 for that recipient. (c) Except as provided in (b) of this section, the department will not pay a member of a treatment team for (1) travel to or from a meeting; (2) time spent in or preparing for a meeting; (3) serving as a member of a treatment team; or (4) writing or monitoring a behavioral health treatment plan. (d) The department will not pay for case management if it is provided by a family member or foster parent of the recipient. (e) Case management may be provided within the home, workplace, school, or any other appropriate community setting. (f) Case management does not require the recipient to be present and may be provided at the same time the recipient is being provided another service. 7 AAC 135.190. Withdrawl management services. (a) A community behavioral health services provider may only bill the department for the following alcohol and drug withdrawal management services delivered face-to-face to the recipient if the services are provided in accordance with this section: (1) level 1 withdrawal management: ambulatory withdrawal management services without extended on-site monitoring, provided in accordance with 7 AAC 70.110 ; (2) level 2 withdrawal management: ambulatory withdrawal management services with extended on-site monitoring, provided in accordance with 7 AAC 70.110 ; (3) level 3.2 withdrawal management: clinically managed residential withdrawal management services, provided in accordance with 7 AAC 70.110 ; (4) level 3.7 withdrawal management: medically monitored inpatient withdrawal management services, provided in accordance with 7 AAC 70.110 . (b) The only behavioral health services that the department will pay for when provided on the same day as withdrawal management services are (1) behavioral health screening under 7 AAC 135.100 ; (2) needed professional behavioral health assessments under 7 AAC 135.110 ; (3) case management services under 7 AAC 135.180 ; (4) needed behavioral health clinic services under 7 AAC 135.010 ; (5) a medical evaluation. 7 AAC 135.200. Comprehensive community support services for adults. Repealed. 7 AAC 135.210. Peer support services. (a) A community behavioral health services provider may only bill the department for peer support services if those services (1) include (A) one-on-one, family, or group activities designed to assist the recipient attain identified treatment goals; (B) assisting the recipient or recipient's family in regaining balance and control of their lives; (C) enhancing the recipient's community living skills; and (D) supporting a self-directed recovery and independence; (2) are based on the unique therapeutic relationship between the provider, the recipient, and the recipient's family; (3) are included in the recipient's behavioral health treatment plan; and (4) are focused on the current presenting problems, diagnosed conditions, and functional impairments included in the recipient's treatment plans. (b) Peer support services must be provided by a person who has lived experience and who (1) maintains frequent in-person or telephonic contact with the recipient to achieve all the objectives listed in (a) of this section; and (2) meets the requirements of 7 AAC 138.400 . (c) Peer support services may be offered as a standalone service or in combination with (1) individual therapeutic behavioral health services for children under 7 AAC 135.220 ; or (2) family therapeutic behavioral health services for children under 7 AAC 135.220 ; 7 AAC 135.220. Therapeutic behavioral health services for children. (a) The department will pay a community behavioral health services provider for therapeutic behavioral health services, for a recipient under 21 years of age with a severe behavioral disorder, if those services (1) improve the recipient's overall functioning and reduce the likelihood of (A) removal from a school setting; (B) placement out of the family home; or (C) referral to institutional care; (2) help the recipient's family to develop or improve specific child behavior management skills; (3) promote wellness, recovery, and resiliency; (4) help the recipient (A) develop or improve specific age-appropriate social behavior; (B) develop or improve self-management skills that will support academic success; and (C) make better behavioral choices within their family, school, and community overall; or (5) assist the recipient in developing more functional coping strategies. (b) Therapeutic behavioral health services for children may be provided (1) on the premises of the community behavioral health services provider, the recipient's home, the recipient's school, or any other appropriate community setting; (2) to an individual, family, or group. (c) Therapeutic behavioral health services for children are limited to the following: (1) teaching of life skills designed to restore the recipient's functioning; (2) counseling focused on functional improvement, recovery, and relapse prevention; (3) encouraging and coaching. (d) Except as provided in (e) of this section, the department will not pay for therapeutic behavioral health services delivered in a classroom setting if those services are delivered by the teacher providing the academic program. (e) The department will pay for therapeutic behavioral health services for children, when provided in a classroom setting, as a group session only if (1) all group participants have similar treatment needs; and (2) the individual rendering the services facilitates a group session outside the regular academic class at least twice per week for the purpose of (A) creating a clear awareness among recipients of the specific in-class behaviors that are the focus of treatment; (B) reviewing by means of the group process each recipient's strategies for success; (C) facilitating the group's assessment of individual progress; and (D) preparing each recipient in the group for the classroom. 7 AAC 135.230. Recipient support services. Repealed. 7 AAC 135.240. Screening and brief intervention services. (a) A community behavioral health services provider, a mental health physician clinic, or an individual identified in 7 AAC 135.910 may only bill the department for screening and brief intervention services if that provider conducts the screening component and, if needed, the brief intervention component in accordance with this section. (b) A provider under (a) of this section shall provide a screening through self-report questionnaires, structured interviews, or similar screening techniques to detect substance use problems and to identify the appropriate level of intervention. If the screening is positive for substance use problems, the provider may provide brief intervention services that involve motivational discussion focused on raising the recipient's awareness of their substance use, the potential harmful effects of that substance use, and encouraging positive change. Brief intervention services may include (1) feedback; (2) goal setting; (3) coping strategies; (4) identification of risk factors; (5) information; and (6) advice. (c) A provider under (a) of this section shall refer the recipient to a behavioral health treatment program that provides services that will meet the recipient's need if (1) the screening reveals that the recipient is at severe risk of substance use problems; (2) the recipient is already substance dependent; or (3) the recipient has already received brief intervention or treatment for substance use and was non-responsive. (d) A provider listed in (a) of this section shall document screening and brief intervention services in a case note in accordance with 7 AAC 105.230 . (e) Delivery of screening and brief intervention services does not require an intake assessment or behavioral health treatment plan. (f) Screening and brief intervention services must be provided by a person that qualifies as a substance use disorder counselor or higher level clinician. 7 AAC 135.250. Day treatment services for children. (a) The department will pay a community behavioral health services provider for day treatment services for children provided in the school setting if those services (1) are provided to a recipient who is a child experiencing a severe emotional disturbance; (2) promote the recipient's ability to be successful, independent of behavioral health services, in the community-based school environment; and (3) assist the recipient in developing self-management skills consistent with academic progress. (b) Day treatment services for children are provided (1) on the school premises; (2) on days that the recipient's school is in session; (3) as group treatment; and (4) by an individual who delivers rehabilitation services within the educational setting led by a teacher. (c) Day treatment services for children are limited to the following forms of active treatment: (1) teaching self-management skills designed to improve the recipient's academic and behavioral functioning; (2) counseling focused on overall functional improvement in the school setting; (3) encouraging and coaching to achieve academic and behavioral success in school. (d) The community behavioral health services provider providing day treatment services must establish with the local school district a written agreement that specifies the overall goals of the collaborative effort, guidelines for meeting the criteria for services, roles and responsibilities of the parties to the agreement, and the resources, including personnel, contributed by each of the parties to the agreement. (e) The department will not pay for day treatment services if those services are delivered by the teacher providing the academic program. 7 AAC 135.260. Medication administration services. (a) The department will pay a community behavioral health services provider for on-premises medication administration services provided to a recipient on the premises of the community behavioral health services provider. (b) The department will pay a community behavioral health services provider for off-premises medication administration services provided to a recipient at home, school, or any other appropriate community setting. 7 AAC 135.270. Daily behavioral rehabilitation services. Repealed. 7 AAC 135.280. Residential substance use treatment services. (a) The department will pay a community behavioral health services provider for residential substance use disorder treatment services if the provider is operating a structured residential program to treat substance use disorders in accordance with 7 AAC 70.120 . (b) To qualify for payment for providing residential substance use disorder treatment services, a community behavioral health services provider must provide the following active treatment each day the recipient is in treatment: (1) teaching of life skills designed to restore or improve the recipient's overall functioning relative to their substance use disorder; (2) counseling focused on functional improvement, recovery, and relapse prevention; (3) encouraging and coaching. (c) Residential substance use disorder treatment services may be provided within the structured residential program as individual, group, or family services. (d) The only behavioral health services that the department will pay for on the same day as residential substance use disorder treatment services are (1) behavioral health screening under 7 AAC 135.100 ; (2) needed professional behavioral health assessments under 7 AAC 135.110 ; (3) case management services under 7 AAC 135.180 ; (4) needed behavioral health clinic services under 7 AAC 135.010 ; (5) a medical evaluation. 7 AAC 135.290. Facilitation of a telemedicine session. Repealed. 7 AAC 135.300. Autism services; provider qualifications. (a) To qualify for payment for autism services, a provider must be a community behavioral health services provider, a behavior analyst who meets the requirements in (c) of this section, or a behavior analyst group practice enrolled under 7 AAC 105.210 . If the provider is (1) a community health behavioral services provider, the provider must (A) meet the qualifications in 7 AAC 70.100 and 7 AAC 135.030 ; (B) employ at least one behavior analyst licensed under AS 08 . 15.020(a); the provider may, subject to (D) of this paragraph, employ an assistant behavior analyst licensed under AS 08.15.020 (b), or employ an autism behavior technician under (i) of this section who meets the requirements in (c)(3) of this section; (C) repealed 7/1/2025; (D) ensure that each individual rendering autism services is supervised in accordance with (d) of this section, and separately enrolled under 7 AAC 105.210 ; and (E) provide autism services in accordance with 7 AAC 135.350 ; (2) a behavior analyst, the provider must (A) be enrolled as an independent provider in accordance with 7 AAC 105.200 (a) and 7 AAC 105.210 ; (B) repealed 7/1/2025; (C) provide autism services in accordance with 7 AAC 135.350 ; (3) a behavior analyst group practice, the provider must (A) be enrolled under 7 AAC 105.210 as a behavior analyst group practice; (B) be comprised of at least one licensed behavior analyst; (C) ensure that each individual providing autism services is supervised in accordance with (d) of this section, and separately enrolled as a provider in accordance with 7 AAC 105.210 ; (D) repealed 7/1/2025; (E) provide services in accordance with 7 AAC 135.350 . (b) A provider may only provide autism services to a recipient listed in 7 AAC 135.020 (e) or (f). (c) Autism services may only be provided by (1) a behavior analyst who (A) is enrolled as a behavior analyst and an independent provider under 7 AAC 105.200 (a) and 7 AAC 105.210 ; (B) has an active license to practice behavior analysis issued (i) by the jurisdiction in which the behavior analyst provides services, if the behavior analyst provides services outside this state; or (ii) under AS 08.15.020 (a), if the behavior analyst provides services in this state; and (C) is currently certified by the Behavior Analyst Certification Board, Inc., or another certifying entity approved under AS 08.15.020 (a)(4); (2) an assistant behavior analyst who (A) is enrolled as an assistant behavior analyst and a rendering provider under 7 AAC 105.200 (b) and 7 AAC 105.210 ; (B) has an active license to practice as an assistant behavior analyst issued (i) by the jurisdiction in which the assistant behavior analyst provides services, if the assistant behavior analyst provides services outside this state; or (ii) under AS 08.15.020 (b), if the assistant behavior analyst provides services in this state; and (C) is currently certified by the Behavior Analyst Certification Board, Inc., or another certifying entity approved under AS 08.15.020 (b)(4); or (3) an autism behavior technician who is (A) enrolled as an autism behavior technician and a rendering provider under 7 AAC 105.200 (b) and 7 AAC 105.210 ; and (B) currently registered by the Behavior Analyst Certification Board, Inc., currently certified by the Behavior Intervention Certification Council, or currently registered or certified by a similar organization approved by the department, except that an autism behavior technician who is not yet registered or certified on July 1, 2018 may continue to provide autism services in accordance with (i) of this section, but must become registered or certified not later than June 30, 2019. (d) A licensed behavior analyst who wishes to supervise an assistant behavior analyst or an autism behavior technician, and a licensed assistant behavior analyst who wishes to supervise an autism behavior technician, must first complete the supervisory training required by the Behavior Analyst Certification Board, Inc., or another certifying entity approved under AS 08.15.020 . (e) To be enrolled with the department, a licensed behavior analyst, licensed assistant behavior analyst, and autism behavior technician may not have been denied a health care provider license, certification, or registration for a reason related to patient services described in 7 AAC 105 - 7 AAC 160 , or ever had a license, certification, or registration revoked. A licensed behavior analyst, licensed assistant behavior analyst, and autism behavior technician are subject to the applicable requirements of AS 47.05.300 - 47.05.390 and 7 AAC 10.900 - 7 AAC 10.990 (barrier crimes, criminal history checks, and centralized registry), and shall submit to the department a request for a criminal history check as required under 7 AAC 10.910 . (f) The department will not pay for services provided by a licensed behavior analyst, licensed assistant behavior analyst, or autism behavior technician for whom a criminal history check was not requested as required under 7 AAC 10.910 or who does not pass a criminal history check under 7 AAC 10.900 - 7 AAC 10.990 . However, except as restricted by applicable federal law, the department will not withhold payment if it grants a provisional valid criminal history check under 7 AAC 10.920 or a variance under 7 AAC 10.935 . (g) A licensed behavior analyst with the training required under (d) of this section may supervise the work of an assistant behavior analyst and an autism behavior technician. (h) A licensed assistant behavior analyst must be supervised by a licensed behavior analyst with the training required under (d) of this section. A licensed assistant behavior analyst with the training required under (d) of this section may supervise the work of an autism behavior technician. (i) An autism behavior technician is an individual who is primarily responsible for the direct implementation of behavior analysis services. For purposes of the exemption under AS 08.15.070 (3) from licensure, an autism behavior technician must be supervised by a licensed behavior analyst or licensed assistant behavior analyst with the training required under (d) of this section. An autism behavior technician may not design intervention or assessment plans. An autism behavior technician is responsible for implementing interventions developed by the supervisory behavior analyst or assistant behavior analyst, including (1) providing instruction; (2) introducing behavior protocols; (3) providing direct assistance to the behavior analyst or assistant behavior analyst; (4) engaging in data collection procedures; (5) providing behavioral intervention in home, community, and school settings; (6) using applied behavior analysis interventions to teach communication, social, and daily living skills and reduce problematic behaviors; and (7) providing applied behavior analysis interventions that encourage socially acceptable replacement behaviors so an individual can build and improve the individual's communication, social interaction, and problem-solving skills. 7 AAC 135.350. Autism services. (a) The department will pay for the following rehabilitative autism services provided to a recipient listed in 7 AAC 135.020 (e) or (f) if provided by a provider identified in 7 AAC 135.300 : (1) initial behavior identification assessment; (2) behavior identification reassessment; (3) adaptive behavior treatment by protocol; (4) group adaptive behavior treatment by protocol; (5) family adaptive behavior treatment guidance; (6) adaptive behavior treatment by protocol modification. (b) The department will pay for an initial behavior identification assessment for a new or returning patient if the assessment is conducted by a licensed behavior analyst or licensed assistant behavior analyst, and if the assessment (1) interprets information from multiple informants and data sources, including (A) a referral from a mental health professional, as defined in AS 47.30.915 , or a health care professional who is qualified based on that individual's training, education, experience and scope of practice to assess and diagnose autism spectrum disorders in children; (B) direct observation of the recipient in different settings and situations; (C) information on the recipient's skill deficits, deficient adaptive behaviors, or maladaptive behaviors from the following sources: (i) in-person observation of the recipient; (ii) structured interviews with the guardian or caregiver; (iii) administration of standardized and nonstandardized tests; (iv) a detailed behavioral history; (v) interpretation of test results; and (D) additional information, if it exists, from the following collateral sources: (i) intellectual and achievement tests; (ii) developmental assessments; (iii) assessments of comorbid mental health conditions; (iv) evaluations of family functioning and needs; (v) results of neuropsychological testing; (vi) results of other standardized psychometric tests, including measures of general psychopathology; and (2) results in a written report that (A) identifies the skill deficits and deficient adaptive behaviors or maladaptive behaviors that should be the focus of treatment; (B) indicates if the recipient's behavior and level of functioning interferes with the recipient's ability to adequately participate in age appropriate home, school, or community activities; (C) indicates if the recipient's behavior poses a danger to the recipient or others; (D) indicates that the treatment goals and treatment targets, in the professional judgment of the behavior analyst, is expected to result in measurable improvement in either the recipient's behaviors or level of functioning or both; (E) identifies the potential functional relationship between behavior and environmental factors; (F) identifies motivational and contextual factors that may be used in the course of treatment to assist with modification and reinforcement of behavior; (G) recommends services and protocols that form the basis for an individualized treatment plan; and (H) avoids duplication of services by ensuring that a listing of all current services being delivered to the recipient is provided, including (i) home and community-based waiver services through plans of care developed under 7 AAC 130 ; (ii) behavioral health treatment plans; (iii) individualized education plans offered through school-based services under 7 AAC 115.600 ; (iv) individualized family service plans under AS 47.20.100 ; (v) services covered under third-party insurance payers; and (vi) any privately funded services that families seek through private foundations and private donation campaigns. (c) The department will pay for a behavior identification reassessment if the reassessment is conducted by a licensed behavior analyst or licensed assistant behavior analyst. The reassessment must establish (1) the recipient's measured progress over the course of treatment; (2) an adjusted baseline in the areas of social skills, communication skills, language skills, adaptive behaviors, and maladaptive behaviors that are the focus of treatment; (3) recommended updates to the recipient's treatment plan; and (4) an estimated timeline and number of treatment hours necessary to achieve each of the recipient's treatment goals. (d) The department will pay for adaptive behavior treatment by protocol conducted by a provider identified in 7 AAC 135.300 (a) if the (1) treatment adheres to the protocols identified by a licensed behavior analyst; and (2) service is used to introduce and reinforce incremental change in recipient skills and behavior. (e) The department will pay for group adaptive behavior treatment by protocol conducted by a provider listed in 7 AAC 135.300 (a) if the service is provided (1) to a group with at least two and not more than eight recipients; (2) according to the protocols identified in the treatment plan created by a licensed behavior analyst; and (3) to assist with the development of individually identified social skills. (f) The department will pay for family adaptive behavior treatment guidance provided by a licensed behavior analyst or assistant behavior analyst, or by an autism behavior technician, to (1) instruct a recipient's guardian and caregivers on the recipient's identified problem behaviors and deficit skills; and (2) teach a recipient's guardian and caregivers to use planned treatment protocols to intervene with the recipient to reinforce change and to maintain treatment progress. (g) Repealed 7/1/2025. (h) To receive payment for autism services a provider must develop and update as needed an individual treatment plan that includes (1) recommended protocols for service provision; (2) objective, measurable, and developmentally appropriate treatment goals related to skills development, improvement in adaptive functioning and modification of problem behavior, and other relevant diagnostic criteria for autism spectrum disorder as listed in the Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 160.900 ; (3) the anticipated timeline for improvement based on the initial behavior identification assessment and subsequent behavior identification reassessments conducted over the duration of treatment; and (4) interventions with a recipient's guardian and caregivers designed to reinforce treatment and treatment progress. (i) To receive payment for autism services provided under this section, a provider must maintain a clinical record in accordance with 7 AAC 135.130 . The clinical record also must include (1) verification of a diagnosis of autism spectrum disorder from a mental health professional as defined in AS 47.30.915 , or a health care professional who is qualified based on that individual's scope of practice, training, education, and experience to assess and diagnose autism spectrum disorders in children; (2) an initial behavior identification assessment under (b) of this section; and (3) any behavior identification reassessment under (c) of this section. (j) Except as set out in (k)(9)(C) of this section, autism services may be provided in the following settings; (1) the recipient's home, school, and community; (2) a behavior analyst's office; (3) an outpatient clinic; (4) another appropriate community setting. (k) The department will not pay for any of the following services or interventions as a Medicaid covered service under this section: (1) a service listed under 7 AAC 105.110 or 7 AAC 135.010 (d); (2) respite for the family; (3) increasing the recipient's social activity; (4) addressing a recipient's antisocial behavior or legal problems; (5) autism services provided by a recipient's immediate family member, foster parent, or legal guardian, unless a court has authorized that legal guardian to provide those services under AS 13.26.316 ; (6) repealed 5/25/2022; (7) a behavioral health rehabilitation service under 7 AAC 135.010 (c) provided concurrently with an autism service; (8) when a licensed behavior analyst, licensed assistant behavior analyst, or autism behavior technician acts as a different kind of paid treatment provider or caregiver at the same time; (9) claims by a licensed behavior analyst, licensed assistant behavior analyst, or autism behavior technician that include time spent (A) assisting a recipient with school work for the sole purpose of education in the home, school, or community; (B) providing leisure or social activities solely for the purpose of entertainment, play, or recreation; or (C) providing autism services to a patient in an outpatient hospital, general acute care hospital, inpatient psychiatric hospital, residential psychiatric treatment center, intermediate care facility, skilled nursing facility, or intermediate care facility for individuals with an intellectual disability or related condition, except for services for which the department gives prior authorization to specifically assist the recipient with discharge planning from these care facilities. (l) Notwithstanding any other provision of this section, the department will pay for authorized behavioral health clinic services under 7 AAC 135.010 (b), any service listed in 7 AAC 110.210 (b), or any required medical service on the same day a recipient receives approved autism services under this chapter. (m) To avoid a break in treatment, a provider of autism services shall submit a request for additional authorized periods of autism services 14 days before the end of the previously authorized period of treatment. The prior authorization request must include a behavior identification reassessment under (c) of this section, and an updated treatment plan under (g) and (h) of this section. (n) The department will pay for the following autism services provided during the same 15-minute time increment as a Medicaid covered service under this section: (1) adaptive behavioral health treatment by protocol; (2) adaptive behavioral health treatment by protocol modification. 7 AAC 135.360. Payment for qualified addiction professional or peer support specialist crisis services. (a) The department will pay a community behavioral health services provider for 1115 waiver peer-based crisis services provided by a qualified addiction professional (QAP) or peer support specialist (PSS) to a recipient if that QAP or PSS (1) provides an initial assessment of the recipient's overall functioning in relation to the short-term crisis; (2) develops a short-term crisis stabilization plan; and (3) documents the assessment, a short-term crisis stabilization plan, follow-up disposition, and the services that are provided. (b) The department will pay a community behavioral health services provider for 1115 waiver mobile outreach and crisis response services provided by a qualified addiction professional (QAP) or peer support specialist (PSS) to a recipient if that QAP or PSS (1) provides an initial assessment of the recipient's overall functioning in relation to the short-term crisis; (2) develops a short-term crisis stabilization plan; and (3) documents the assessment, a short-term crisis stabilization plan, follow-up disposition, and the services that are provided. (c) The department will pay a community behavioral health services provider for 1115 waiver crisis observation and stabilization services provided by a qualified addiction professional (QAP) or peer support specialist (PSS) to a recipient if that QAP or PSS (1) provides an initial assessment of the recipient's overall functioning in relation to the short-term crisis; (2) develops a short-term crisis stabilization plan; and (3) documents the assessment, a short-term crisis stabilization plan, follow-up disposition, and the services that are provided. (d) The department will pay a community behavioral health services provider for 1115 waiver crisis residential and stabilization services provided by a qualified addiction professional (QAP) or peer support specialist (PSS) to a recipient if that QAP or PSS (1) provides an individualized crisis assessment using an evidence-based risk assessment tool; (2) develops an individualized crisis treatment plan; and (3) daily documents the recipient's progress toward resolution of the crisis. (e) In this section, a peer support specialist must meet the requirements of 7 AAC 138.400 . 7 AAC 135.370. Payment for qualified behavioral health professional crisis services. (a) The department will pay a community behavioral health services provider for 1115 waiver peer-based crisis services provided by a qualified behavioral health professional (QBHP) if that QBHP (1) provides an initial assessment of the recipient's overall functioning in relation to the short-term crisis; (2) develops a short-term crisis stabilization plan; and (3) documents the assessment, a short-term crisis stabilization plan, follow-up disposition, and the services that are provided. (b) The department will pay a community behavioral health services provider for 1115 waiver mobile outreach and crisis response services provided by a qualified behavioral health professional (QBHP) if that QBHP (1) provides an initial assessment of the recipient's overall functioning in relation to the short-term crisis; (2) develops a short-term crisis stabilization plan; and (3) documents the assessment, a short-term crisis stabilization plan, follow-up disposition, and the services that are provided. (c) The department will pay a community behavioral health services provider for 1115 waiver crisis observation and stabilization services provided by a qualified behavioral health professional (QBHP) if that QBHP (1) provides an initial assessment of the recipient's overall functioning in relation to the short-term crisis; (2) develops a short-term crisis stabilization plan; and (3) documents the assessment, a short-term crisis stabilization plan, follow-up disposition, and the services that are provided. (d) The department will pay a community behavioral health services provider for 1115 waiver crisis residential and stabilization services provided by a qualified behavioral health professional (QBHP) if that QBHP (1) provides an individualized crisis assessment using an evidence-based risk assessment tool; (2) develops an individualized crisis treatment plan; and (3) daily documents the recipient's progress toward resolution of the crisis. 7 AAC 135.800. Residential behavioral rehabilitation services. Repealed. 7 AAC 135.900. Physicians providing behavioral health clinic services. (a) If a physician provides behavioral health clinic services in a community behavioral health services provider organization, the physician may request payment for those services by submitting a claim for payment (1) using the community behavioral health services provider's medical assistance provider identification number; payment for services under this paragraph is subject to the same requirements and restrictions placed on a community behavioral health services provider under this chapter; or (2) using the physician's medical assistance provider identification number; payment for services under this paragraph is subject to the same requirements and restrictions placed upon a physician under this chapter; the department will pay a physician for medically necessary and clinically appropriate mental health services only if the physician renders those services directly. (b) If a physician provides behavioral health clinic services in a mental health physician clinic, the physician may request payment for those services by submitting a claim for payment (1) using the mental health physician clinic medical assistance provider identification number; payment for services under this paragraph is subject to the same requirements and restrictions placed on a mental health physician clinic under this chapter; or (2) using the physician's medical assistance provider identification number; payment for services under this paragraph is subject to the same requirements and restrictions placed upon a physician under this chapter; the department will pay a physician for medically necessary and clinically appropriate mental health services only if the physician renders those services directly. 7 AAC 135.910. Licensed mental health professionals providing behavioral health services. (a) A mental health professional enrolled under 7 AAC 105.210 and licensed as required in AS 08 who provides behavioral health services under this chapter may only request payment for those services by submitting a claim for payment using the (1) community behavioral health services provider's claims processing procedures if the mental health professional is an employee or volunteer of that organization; payment for services under this paragraph is subject to the same requirements and restrictions placed on a behavioral health services organization under this chapter; (2) mental health physician clinic claims processing procedures if the mental health professional is an employee of the clinic; payment for services under this paragraph is subject to the same requirements and restrictions placed on a mental health physician clinic under this chapter; or (3) mental health professional's National Provider Identifier (NPI) number if providing the service as an independent practitioner; payment for services under this paragraph must be medically necessary and clinically appropriate, must be directly rendered by the licensed mental health professional, and must meet the service criteria set out in this chapter. (b) If, during an assessment, evaluation, or treatment of a recipient under 21 years of age, the provider determines that the recipient may meet the criteria in 7 AAC 135.065 for a child experiencing a severe emotional disturbance, the provider shall refer the recipient to a community behavioral health services provider that provides behavioral health rehabilitation services in the community. (c) If, during an assessment, evaluation, or treatment of a recipient 21 years of age or older, the provider determines that the recipient may meet the criteria in 7 AAC 135.055 for an adult experiencing a serious mental illness, the provider shall refer the recipient to a community behavioral health services provider that provides behavioral health rehabilitation services in the community. (d) If, during an assessment, evaluation, or treatment of a recipient, the provider discovers that the recipient meets the criteria in 7 AAC 135.020 (b)(1) for an individual experiencing a substance use disorder, the provider shall refer the recipient to a community behavioral health services provider that provides substance use disorder treatment services in the community. (e) If a provider covered under this section refers a recipient to a community behavioral health services provider for rehabilitation services in accordance with (b) - (d) of this section, the provider may still continue to provide other services to the recipient that the provider is eligible to provide under 7 AAC 110 . (f) A service provided under 7 AAC 140.215 by a psychologist, clinical social worker, marital and family therapist, or professional counselor enrolled under 7 AAC 105.210 must be billed by the federally qualified health center and may not be billed separately by the psychologist, clinical social worker, marital and family therapist, or professional counselor. 7 AAC 135.990. Definitions. In this chapter, unless the context requires otherwise, (1) "active treatment" means that the individual who renders the services actively engages the recipient and provides pre-planned specific interventions, supports, or other actions that assist the recipient in achieving the goals written in the behavioral health treatment plan; (2) "adjunctive treatment" means a treatment that is associated with another treatment in a subordinate or auxiliary capacity; (3) "adult experiencing an emotional disturbance" means an individual described in 7 AAC 135.050 ; (4) "behavioral health clinic services" means services provided under 7 AAC 135.010 (b); (5) "behavioral health rehabilitation services" means services provided under 7 AAC 135.010 (c); (6) "behavioral health screening" means administering and interpreting a screening tool described in 7 AAC 135.100 , at the point of entry to a behavioral health program to determine the appropriate assessments needed to identify the recipient's treatment needs; (7) "behavioral health treatment plan" means (A) a written individualized treatment plan that details (i) the goals, objectives, services, and interventions selected to address a recipient's behavioral health needs identified by a professional behavioral health assessment under 7 AAC 135.110 ; and (ii) with respect to selected services and interventions, their frequency and duration; or (B) a short-term crisis intervention plan under 7 AAC 135.160 , or short-term crisis stabilization plan under 7 AAC 135.170 ; (8) "case management" means assistance to the recipient and the recipient's family in accessing and coordinating high-quality needed services, including (A) medical, psychiatric, and mental health services; (B) substance use disorder treatment; (C) educational, vocational, and social supports; and (D) community-based services, related assessments, and post-discharge follow-up activities; (9) "child experiencing an emotional disturbance" means an individual described in 7 AAC 135.060 ; (10) repealed 4/24/2020; (11) "co-occurring disorder" means a diagnosable substance use disorder and a diagnosable mental health disorder that the recipient experiences at the same time; (12) repealed 4/24/2020; (13) "directing clinician" means a substance use disorder counselor or a mental health professional clinician who, by virtue of that individual's education, training, and experience, and with respect to the recipient's behavioral health treatment plan, (A) develops or oversees the development of the plan; (B) periodically reviews and revises the plan as needed; (C) signs the plan each time a change is made to the plan; and (D) monitors and directs the delivery of all services identified in the plan; (14) "general direction" means, in a community behavioral health services provider, a physician provides general program and clinical consultative services when needed; (15) "Medicaid 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); (16) "medical evaluation" means a physical examination that includes appropriate testing, the ordering of other appropriate tests, a review of medical history and present problems, face-to-face consultation, and medical decision-making; (17) "medication administration services" means the administration, by medical personnel, of injectable or oral medications to a recipient, documentation of medication compliance, assessment and documentation of side effects, and evaluation and documentation regarding the effectiveness of the medication; in this paragraph, "medical personnel" means (A) a physician; (B) a physician assistant; (C) an advanced practice registered nurse; (D) a registered nurse supervised by a physician or advanced practice registered nurse; or (E) a licensed practical nurse supervised by a physician or advanced practice registered nurse; (18) "mental status examination" means the process of assessing an individual's thoughts, moods, self-identity, insight or judgment, memory, speech, intellectual functioning, time-and-place orientation, and reasoning or problem-solving ability to assist in establishing a diagnosis and case formulation; (19) repealed 6/30/2021; (20) "screening and brief intervention" means nonmandatory screening by a provider under 7 AAC 135.240 (a) for the purposes of (A) early identification of a developing substance use problem, or identification of a previously unknown substance use disorder; and (B) providing brief interventions or referral to a substance use disorder treatment program; (21) "short-term crisis" means an acute episode of a mental, emotional, behavioral, or psychiatric disorder; (22) "substance use disorder counselor" means an individual who (A) has completed a course of study, training, or education, or who has documented evidence of experience, that has resulted in demonstrated competency to assist with or to independently conduct screening, assessment, treatment planning, case management, and provision of rehabilitative services for the treatment of substance use disorders; and who (i) works within the scope of the individual's education, training, and experience; (ii) adheres to a code of professional ethics; and (iii) participates in continuing education to enhance relevant knowledge skills, abilities, and professional characteristics; or (B) holds any current, valid certificate from the National Association for Alcoholism and Drug Abuse Counselors, the International Certification and Reciprocity Consortium, the Alaska Commission for Behavioral Health Certification, or the Alaska Native Tribal Health Consortium Behavioral Health Aid Program; (23) "adult experiencing a serious mental illness" means an individual described in 7 AAC 135.055 ; (24) "child experiencing a severe emotional disturbance" means an individual described in 7 AAC 135.065 . (25) "adaptive behavior treatment" means services to treat a recipient's deficient adaptive behaviors or maladaptive behaviors, a recipient's impaired social skills and communication, or the recipient's destructive behaviors that impair, delay or adversely affect normal childhood growth, development, or communication; (26) "adaptive behavior treatment by protocol" (A) means adaptive behavior treatment that adheres to the protocols that the behavior analyst has designed; (B) includes skills training delivered to a recipient by introducing small, incremental changes to the recipient's expected routine along one or more stimulus dimensions, and delivering reinforcement each time the recipient appropriately tolerates a given stimulus change; (27) "adaptive behavior treatment by protocol modification" means a licensed behavior analyst directly demonstrates a recipient's individualized new or modified protocol with the recipient to a recipient's licensed assistant behavior analyst, autism behavior technician, guardian, or parent; (28) "autism services" (A) means the (i) design, implementation, and evaluation of instructional and environmental modifications to produce socially significant improvements in human behavior; (ii) empirical identification of functional relations between behavior and environmental factors, and the utilization of contextual factors, motivating operations, antecedent stimuli, positive reinforcement, and other consequences to help people develop new behaviors, increase or decrease existing behaviors, and engage in behaviors under specific environmental conditions; and (iii) application of adaptive behavior treatment by protocol, group adaptive behavior treatment by protocol, adaptive behavior treatment by protocol modification, or family adaptive behavior treatment guidance; (B) does not include (i) psychological testing; (ii) diagnosis of a mental or behavioral disorder; or (iii) the practice of neuropsychology, psychotherapy, cognitive therapy, sex therapy, psychoanalysis, hypnotherapy, or long-term counseling; (29) "family adaptive behavior treatment guidance" means guidance provided to the family by a licensed behavior analyst, a licensed assistant behavior analyst, or an autism behavior technician, with or without the recipient present, that identifies recipient problem behaviors and deficits and teaches guardians and caregivers to use treatment protocols in order to support the services provided to the recipient by a behavior analyst, assistant behavior analyst, or autism behavior technician; (30) "group adaptive behavior treatment by protocol" means adaptive behavior treatment by protocol provided in a group of at least two recipients and not more than eight recipients; (31) "recipient's immediate family member" means (A) a recipient's parent, spouse, or sibling living in the same residence as the recipient; or (B) an adult relative or nonrelative caregiver who is acting in the place of a parent. (32) "licensed mental health professional" means (A) a psychiatrist or physician who is licensed by the State Medical Board to practice in this state or is employed by the federal government; (B) a clinical psychologist licensed by the Board of Psychologist and Psychological Associate Examiners; (C) a psychological associate trained in clinical psychology and licensed by the Board of Psychologist and Psychological Associate Examiners; (D) an advanced practice registered nurse or a registered nurse with a master's degree in psychiatric nursing, licensed by the Board of Nursing; (E) a marital and family therapist licensed by the Board of Marital and Family Therapy; (F) a professional counselor licensed by the Board of Professional Counselors; (G) a clinical social worker licensed by the Board of Social Work Examiners; (33) "withdrawal management" means the process to safely and effectively provide the immediate physiological stabilization and treatment of a recipient who is intoxicated, incapacitated, or experiencing withdrawal from a specific psychoactive substance; (34) "withdrawal management services" means those services under 7 AAC 135.190 provided by a community behavioral health services provider; (35) "experiencing homelessness" means an individual who is in a state of being "homeless," as defined in 42 U.S.C. 11302(a). Chapter 136 Alaska Substance Use Disorder and Behavioral Health Program: 1115 Demonstration Waiver Article 1 Administration 7 AAC 136.010. Purpose. 7 AAC 136.010 was effective as an emergency regulation July 1, 2019. In reviewing the permanent amendment in accordance with AS 44.62.060 and 44.62.125, the regulations attorney made technical corrections to the emergency regulation made permanent. The technical changes appear in 7 AAC 136.010 as published in Register 232. The purpose of this chapter is to offer individuals who meet the eligibility criteria of this chapter services offered by the Substance Use Disorder and Behavioral Health Program under the 1115 waiver approved by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS). To meet the purpose of this chapter, the department will (1) establish recipient eligibility; (2) establish department approval criteria for providers of 1115 waiver services; (3) ensure that all 1115 waiver services are provided according to the Special Terms and Conditions for Section 1115(a) Demonstration: Alaska Substance Use Disorder and Behavioral Health Program, adopted by reference in 7 AAC 160.900 , and according to service criteria established under 7 AAC 138 and 7 AAC 139 ; (4) establish service standards and administrative procedures for providers of 1115 waiver services; (5) conduct utilization reviews of the 1115 waiver project and 1115 waiver services; (6) collect and report data to Centers for Medicare and Medicaid Services (CMS) for project monitoring and evaluation; and (7) establish definitions and service criteria for 1115 waiver services. 7 AAC 136.020. Provider requirements. 7 AAC 136.020 was effective as an emergency regulation July 1, 2019. In reviewing the permanent amendment in accordance with AS 44.62.060 and 44.62.125, the regulations attorney made technical corrections to the emergency regulation made permanent. The technical changes appear in 7 AAC 136.020 as published in Register 232. In addition to the requirements of 7 AAC 70 , 7 AAC 105 , and 7 AAC 135 , to qualify as a provider of 1115 waiver services, a provider must (1) obtain department certification as an 1115 waiver services provider and identify the 1115 waiver services the provider will provide before delivering 1115 waiver services if the provider is a community behavioral health services provider; (2) collaborate with the department or its contractor to (A) establish recipient eligibility and coordinate recipient care and benefit management; (B) report data required by the department; and (C) participate in quality management, improvement, and assurance process; and (3) comply with the additional requirements listed in the (A) Alaska Behavioral Health Provider Service Standards & Administrative Procedures for SUD Provider Services, adopted by reference in 7 AAC 160.900 , for substance use disorder treatment providers, and including the documentation guidelines for 1115 waiver services; and (B) Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 , for community behavioral health services providers, and including the documentation guidelines for 1115 waiver services. 7 AAC 136.990. Definitions. In this chapter, unless the context requires otherwise, (1) "1115 waiver" has the meaning given in 7 AAC 160.990 (b); (2) "community behavioral health services provider" has the meaning given in 7 AAC 70.990 ; (3) "substance use disorder treatment provider" has the meaning given in 7 AAC 70.990 . Chapter 138 1115 Substance Use Disorder Waiver Services Article 1 Scope; Eligibility; Service Provision Rates and Authorization 7 AAC 138.010. Recipient eligibility. The following Medicaid-eligible recipients may receive services under this chapter: (1) a child at least 12 years of age and under 18 years of age who may have a substance use disorder or may be at risk to develop a substance use disorder as determined through a screening conducted according to 7 AAC 135.100 ; (2) a youth at least 18 years of age and under 22 years of age who may have a substance use disorder or may be at risk to develop a substance use disorder as determined through a screening conducted according to 7 AAC 135.100 ; (3) an adult who is diagnosed with a substance use disorder or is at risk of developing a substance use disorder as determined through a screening conducted according to 7 AAC 135.100 . 7 AAC 138.020. Provision of 1115 substance use disorder waiver services. The department will pay for substance use disorder 1115 waiver services if the (1) recipient is eligible under 7 AAC 138.010 ; (2) provider meets the requirements in 7 AAC 136.020 ; (3) repealed 11/10/2019; (4) provider meets, in addition to the requirements of this chapter, the requirements in 7 AAC 70.125 if providing opioid use disorder treatment services; (5) provider provides a recipient substance use disorder 1115 waiver services listed in 7 AAC 138.250 - 7 AAC 138.400 based on an assessment under 7 AAC 135.110 and according to the assessment criteria outlined in the ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, adopted by reference in 7 AAC 70.910 , and that results in a diagnosis according to the (A) Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 70.910 ; or (B) International Classification of Diseases, adopted by reference in 7 AAC 70.910 ; and (6) substance use disorder 1115 waiver services listed in 7 AAC 138.250 - 7 AAC 138.350 are provided according to the treatment criteria listed in the ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, adopted by reference in 7 AAC 70.910 . 7 AAC 138.030. Provision of Medicaid state plan services. 7 AAC 138.030 was effective as an emergency regulation July 1, 2019. In reviewing the permanent amendments in accordance with AS 44.62.060 and 44.62.125, the regulations attorney made technical corrections to the emergency regulation made permanent. The technical changes appear in 7 AAC 138.030 as published in Register 232. (a) Except as provided in (b) of this section, the department will pay for a behavioral health Medicaid state plan service provided to an eligible recipient even if the recipient is also receiving services under this chapter. (b) Repealed 6/30/2021. 7 AAC 138.040. Service rates, service limits, and service authorization. (a) Substance use disorder 1115 waiver services rates are established in the department's Chart of 1115 Waiver Services, adopted by reference in 7 AAC 160.900 . (b) The department will not pay for substance use disorder 1115 waiver services beyond the limits listed in the Alaska Behavioral Health Provider Service Standards & Administrative Procedures for SUD Provider Services, adopted by reference in 7 AAC 160.900 , without prior authorization from the department. (c) A provider of substance use disorder 1115 waiver services must file a request for prior authorization of an extension of a substance use disorder 1115 waiver service beyond service limitations using a form approved by the department. The request must (1) be documented in the clinical record; (2) include the expected duration of the service; and (3) include an explanation for the need to extend the service. (d) A provider that meets the requirements of 7 AAC 136.020 may provide any substance use disorder 1115 waiver service without prior authorization from the department. (e) The department may review a provider's clinical record to confirm the need for an extension of substance use disorder 1115 waiver services. Article 2 Medicaid Substance Use Disorder 1115 Waiver Services 7 AAC 138.100. Assessment and treatment plan services. 7 AAC 138.100 was effective as an emergency regulation July 1, 2019. In reviewing the permanent amendments in accordance with AS 44.62.060 and 44.62.125, the regulations attorney made technical corrections to the emergency regulation made permanent. The technical changes appear in 7 AAC 138.100 as published in Register 232. The department will pay a provider to (1) conduct an assessment according to 7 AAC 138.020 (5) for each recipient receiving substance use disorder services under this chapter; (2) develop an initial treatment plan for each recipient in accordance with 7 AAC 135.120 ; and (3) review the treatment plan and revise the plan as necessary at least every 90 days; document the results of the treatment plan review in the clinical record; and include the name, signature, and credentials of the individual who conducted the review. 7 AAC 138.200. Prevention and engagement services. (a) The department will pay for a screening conducted by a provider under this chapter if the provider uses (1) one of the department-approved screening tools listed in the Alaska Behavioral Health Provider Service Standards & Adminis- trative Procedures for SUD Provider Services, adopted by reference in 7 AAC 160.900 ; and (2) the results of the screening to identify an individual who is at risk for a substance use disorder and to identify the need for further assessment. (b) A provider of prevention and engagement services under the 1115 waiver is not required to conduct an assessment with a recipient or to develop a treatment plan under 7 AAC 135.120 . (c) Prevention and engagement services under the 1115 waiver must be documented according to the requirements established in 7 AAC 105.230 . 7 AAC 138.250. Outpatient substance use disorder treatment services. (a) The department will pay for the following outpatient substance use disorder treatment services under the 1115 waiver if the service is provided according to this chapter: (1) intensive outpatient services; (2) partial hospitalization services; (3) outpatient services. (b) Providers may administer pharmacological treatment in conjunction with the outpatient substance use disorder treatment services in (a) of this section if the pharmacological treatment is provided by an individual listed in 7 AAC 135.010 (b)(2). 7 AAC 138.300. Inpatient residential substance use disorder treatment services. (a) The department will pay for the following inpatient residential substance use disorder treatment services under the 1115 waiver if the service is provided according to 7 AAC 138.030 : (1) clinically managed low-intensity residential services; (2) repealed 11/10/2019; (3) clinically managed population-specific high-intensity services for adults; (4) clinically managed medium-intensity residential services for adolescents; (5) clinically managed high-intensity residential services for adults; (6) medically monitored high-intensity inpatient services for adolescents; (7) medically monitored high-intensity inpatient services for adults; (8) medically managed intensive inpatient services; (9) repealed 11/10/2019. (b) A provider of inpatient residential substance use disorder treatment services under this chapter is exempt from the requirements of the Medicaid Institutions for Mental Diseases exclusion under 42 U.S.C. 1396d(a)(29)(B) (section 1905(a)(B) of the Social Security Act). (c) A provider may administer pharmacological treatment under the 1115 waiver in conjunction with inpatient residential substance use disorder treatment services in (a) of this section if the pharmacological treatment is provided by an individual listed in 7 AAC 135.010 (b)(2). (d) Inpatient residential substance use disorder treatment services under the 1115 waiver that are delivered during regular business hours must also be delivered during evening hours and on weekends and holidays based on provider staffing patterns and provider treatment services. 7 AAC 138.350. Alcohol and drug withdrawal management services. (a) The department will pay for the following alcohol and drug withdrawal management services under the 1115 waiver for an adolescent or adult if the service is provided according to 7 AAC 138.020 : (1) ambulatory withdrawal management without extended on-site monitoring; (2) ambulatory withdrawal management services with extended on-site monitoring; (3) clinically managed residential withdrawal management; (4) medically monitored inpatient withdrawal management; (5) medically managed intensive inpatient withdrawal management. (b) A provider of alcohol and drug withdrawal management services under (a)(3) - (5) of this section is exempt from the requirements of the Medicaid Institutions for Mental Diseases exclusion under 42 U.S.C. 1396d(a)(29)(B) (section 1905(a)(B) of the Social Security Act). (c) The department will pay for pharmacological treatment under the 1115 waiver in conjunction with alcohol and drug withdrawal management services under (a) of this section if the pharmacological treatment is provided by an individual listed in 7 AAC 135.010 (b)(2). (d) If an individual is determined to need alcohol or drug withdrawal services after an assessment under 7 AAC 138.020 (5), the provider must conduct an evaluation of the individual using the: (1) Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWAAr), adopted by reference in 7 AAC 70.910 ; and (2) Clinical Opiate Withdrawal Scale, adopted by reference in 7 AAC 70.910 . 7 AAC 138.400. Community-based support services and payment conditions. (a) The department will pay a provider who meets the requirements of 7 AAC 138.020 for one or more of the following substance use disorder 1115 waiver community-based support services provided to an eligible recipient under this chapter: (1) community recovery support services that are provided to promote recipient recovery through skill building and counseling, and provided to (A) assist the recipient to build social, cognitive, daily living, employment, and self-management skills; (B) educate and train the recipient and the recipient's family on behavioral health topics related to the recipient's treatment and recovery; (C) help the recipient access necessary treatment and social support services; (D) help the recipient participate in traditional healing or spiritual activities; (E) facilitate level-of-care transitions; or (F) assist the recipient with recovery through support, mentoring, or coaching, and the services listed in (A) - (E) of this paragraph provided by a peer support specialist who (i) must have lived experience of a substance use disorder or co-occurring mental health disorder or is a family member of an individual with lived experience; (ii) must work under the supervision of a mental health professional clinician or a substance use disorder counselor; and (iii) is competent to provide services through supervised experience or formal training; (2) substance use disorder care coordination services that must be provided to a recipient receiving medication-assisted treatment in an outpatient care setting or an inpatient residential care setting, and are provided to (A) integrate a recipient's behavioral health treatment with primary care and specialty medical services through interdisciplinary care planning and monitoring of treatment progress and outcomes; (B) connect the recipient with appropriate community resources and social support services; (C) help the recipient with level-of-care transition; and (D) help the recipient develop skills needed for the self-management of treatment needs and the self-maintenance of long-term social supports; (3) intensive case management services that are used to establish, organize, integrate, and modify the treatment and social support services and resources required to meet recipient needs, and are provided in collaboration with the recipient to (A) facilitate provision of community-based social, educational, vocational, legal, and financial resources; (B) obtain medical, behavioral health, or other specialized treatment services and social support services; (C) monitor the safety and stability of the recipient and connect the recipient with crisis intervention services; (D) coordinate the provision of services and exchange of information between treatment providers and social services agencies to help achieve the goals listed in the recipient's treatment plan; (E) help the recipient engage in social relationships and natural community-based supports that enhance the recipient's quality of life; and (F) help the recipient resolve conflicts and mediate solutions to problems with treatment providers, social support agencies, or natural community-based supports. (b) Services provided under (a)(1) of this section may be provided concurrently with: (1) any 1115 waiver listed in 7 AAC 138.250 ; (2) ambulatory withdrawal management services under the 1115 waiver listed in 7 AAC 138.350 (a); and (3) a community-based support service listed in (a)(2) and (a)(3) of this section if the recipient is receiving services listed in (1) and (2) of this subsection. (c) Substance use disorder care coordination services may be provided concurrently with any 1115 waiver service listed in 7 AAC 138.250 - 7 AAC 138.350 . (d) Intensive case management services may be provided concurrently with any service under the 1115 waiver listed in 7 AAC 138.250 - 7 AAC 138.350 . (e) In this section, "lived experience" means that an individual has experienced or was treated for a substance use related disorder or a co-occurring mental health disorder, or is a family member who lived with a person with such a condition. In this section, "family member" means a parent, step-parent, sibling, step-sibling, spouse, grandparent, aunt or uncle. 7 AAC 138.410. Requirement to pay substance use disorder care coordination services. An eligible individual under this chapter who is receiving medication-assisted treatment in an outpatient or inpatient care setting must also receive substance use disorder care coordination services under the 1115 waiver. 7 AAC 138.450. Crisis response services. (a) The following services may be provided to an eligible recipient under this chapter, as set out in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 , in any appropriate community setting: (1) peer-based crisis services, provided by a peer support specialist under 7 AAC 138.400 , to help an individual avoid the need for hospital emergency department services or the need for psychiatric hospitalization through services identified in a crisis plan by a mental health professional clinician that may include (A) a summary of crisis intervention needs; (B) facilitation of transition to other community-based resources or natural supports; and (C) advocacy for client needs with other service providers; (2) mobile outreach and crisis response services, (A) only if provided by (i) a mental health professional clinician; and (ii) a qualified behavioral health professional, as defined in the Alaska Behavioral Health Provider Service Standards & Administrative Procedures for SUD Provider Services, adopted by reference in 7 AAC 160.900 ; and (B) provided to (i) prevent a substance use disorder or mental health crisis from escalating; (ii) stabilize an individual during or after a mental health crisis or crisis involving a substance use disorder; or (iii) refer and connect to other appropriate services that may be needed to resolve the crisis; (3) 23-hour crisis observation and stabilization services, that are provided for up to 23 hours and 59 minutes in a secure environment to an individual presenting with acute symptoms of mental or emotional distress, and that must (A) be provided by a multidisciplinary team supervised by a physician, a physician assistant, or an advanced practice registered nurse; (B) result in prompt evaluation and stabilization of the individual's condition; and (C) ensure that the individual is safe from self-harm, including suicidal behavior. (b) Peer-based crisis services, mobile outreach and crisis response, and 23-hour crisis observation and stabilization services must be documented in a progress note in accordance with 7 AAC 105.230 and include an evidence-based risk assessment and follow-up disposition. (c) The crisis residential and stabilization services provided to an eligible individual under this chapter presenting with acute mental or emotional disorders requiring psychiatric stabilization and care may be provided in a licensed general acute care hospital, a licensed psychiatric hospital, a United States Indian Health Service facility, a licensed critical access hospital, a community behavioral health services provider approved by the department under 7 AAC 136.020 , or a licensed crisis stabilization center. The crisis residential and stabilization services must be (1) provided (A) as a short-term residential program with 16 or fewer beds; (B) as a medically monitored stabilization service designed to restore the individual to a level of functioning that does not require inpatient hospitalization; and (C) to assess the need for medication services and other post-discharge treatment and support services; and (2) supported by documentation that includes (A) an individualized crisis assessment based on an evidence-based risk assessment tool; (B) an individualized crisis treatment plan; and (C) daily documentation in the clinical record of the recipient's progress toward resolution of crisis. (d) A peer support specialist in this section is subject to the qualifications listed in 7 AAC 138.400 . (e) In this section, "secure environment" means a level of security that will reasonably ensure that if a recipient leaves without permission, the recipient's act of leaving will be immediately noticed. (f) In this section, "short-term" means not more than seven days, and may be extended through a service authorization. (g) In this section, "follow-up disposition" includes the diagnosis and treatment given, condition of the recipient on discharge or transfer, and instructions given to the recipient, or the recipient's family regarding necessary follow-up care. Article 3 General Provisions 7 AAC 138.900. Transition to 1115 waiver services. (a) A provider may only provide the 1115 waiver services listed in this chapter upon approval by the department in accordance with 7 AAC 136.020 . (b) A provider must update a recipient treatment plan in accordance with 7 AAC 135.130 before providing a new service listed in this chapter for a recipient that is currently receiving services under 7 AAC 70 and 7 AAC 135 . Chapter 139 Behavioral Health 1115 Waiver Services Article 1 Scope; Eligibility; Service Provision Rates and Authorization 7 AAC 139.010. Recipient eligibility. The following individuals may receive services under this chapter: (1) an individual under 21 years of age who (A) is diagnosed with a mental, emotional, or behavioral disorder or substance use disorder; (B) is at risk of developing a mental, emotional, or behavioral disorder or substance use disorder based upon a screening conducted under 7 AAC 135.100 ; (C) is at risk of out-of-home placement; (D) is currently in the custody of the state; or (E) has been detained in a juvenile justice facility or treated in a residential treatment program or psychiatric hospital within the past year; (2) an individual who meets the criteria under 7 AAC 135.055 for an adult experiencing a serious mental illness; (3) an individual 21 years of age or older who is experiencing a mental, emotional, or behavioral disorder who meets the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 70.910 , or the International Classification of Diseases - 10th Revision, Clinical Modification, (ICD-10-CM), adopted by reference in 7 AAC 70.910 . 7 AAC 139.020. Provision of behavioral health 1115 waiver services. The department will pay for behavioral health 1115 waiver services if the (1) recipient is eligible under 7 AAC 139.010 ; (2) provider meets the requirements in 7 AAC 136.020 ; (3) services are provided under this chapter; and (4) services are based upon an assessment conducted under 7 AAC 135.110 , except for (A) individuals described in 7 AAC 139.150 (a)(1); and (B) individuals described in 7 AAC 139.350 (a)(1) 7 AAC 139.030. Provision of Medicaid state plan services. Repealed. 7 AAC 139.040. Service rates, limits, and authorization. (a) The behavioral health 1115 waiver services rates are found in the department's Chart of 1115 Medicaid Waiver Services, adopted by reference in 7 AAC 160.900 . (b) The department will not pay for a behavioral health 1115 waiver service beyond the limits listed in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 , without prior authorization from the department. (c) A provider of behavioral health 1115 waiver services must file a request for prior authorization of an extension for a behavioral health 1115 waiver service beyond service limits under (b) of this section using a form approved by the department. The request must (1) be documented in the clinical record; (2) include the expected duration of the service; and (3) include an explanation for the need to extend the service. (d) Except as provided in (b) of this section, a provider that meets the requirements of 7 AAC 136.020 may provide any behavioral health 1115 waiver service without prior authorization from the department. (e) The department may review a provider's clinical record to confirm the need for an extension of a behavioral health 1115 waiver service. Article 2 Medicaid Behavioral Health 1115 Waiver Services 7 AAC 139.100. Assessment and treatment plan services. The department will pay a provider to (1) conduct an assessment according to 7 AAC 135.110 for each recipient receiving services under this chapter; (2) develop an initial treatment plan for each recipient under 7 AAC 135.120 ; and (3) review the treatment plan and revise the plan as necessary at least every 90 days; document the results of the treatment plan review in the clinical record; and include the name, signature, and credentials of the individual who conducted the review. 7 AAC 139.150. Home-based family treatment services. (a) The department will pay for home-based family treatment services according to the following criteria to prevent inpatient hospitalization and residential services for an individual under 21 years of age listed in 7 AAC 139.010 (1) if a combination of less intensive outpatient services under 7 AAC 135 has not been effective or is determined likely to not be effective: (1) level 1: for an individual at risk of out-of-home placement or diagnosed with or at risk to develop a mental, emotional, or behavioral disorder or substance use disorder as determined by a screening conducted under 7 AAC 135.100 ; (2) level 2: for an individual at high risk of out-of-home placement; (3) level 3: for an individual who is at imminent risk of out-of-home placement or who has been discharged from a residential treatment program, psychiatric hospital, or juvenile detention facility. (b) A provider may only provide level 1 home-based family treatment services if the screening is conducted under 7 AAC 135.100 using a screening tool listed in the Alaska Behavioral Health Provider Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 , that is designed to identify recipient problems with one or more social determinants of health. (c) A provider must provide level 1 home-based family treatment services according to a family services plan developed by the provider in collaboration with the family. (d) A provider may only provide level 2 and level 3 home-based family treatment services if the assessment is conducted under 7 AAC 139.100 and also addresses how family relationships and family dynamics affect the recipient's identified problems. (e) All levels of home-based family treatment services must include direct access to the component services described in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 . A provider that cannot provide one or more of the component services under this subsection must arrange for another provider to provide those services. (f) In this section, (1) "high risk" means a person who may have at least one or more adverse childhood experiences based on the clinical assessment; (2) "imminent risk" means a person who has been out of home placement, or is at risk of being out of home placement in state or tribal custody for issues that could lead to out of home placement. 7 AAC 139.200. Community-based care management services. (a) The following community-based care management services may be provided to any eligible recipient under this chapter: (1) intensive case management services, that must be provided according to the criteria listed in 7 AAC 138.400 (a)(3); (2) community recovery support services, that must be provided according to the criteria listed in 7 AAC 138.400 (a)(1). (b) If community-based care management services consist of assertive community treatment services, those services may be provided to an individual listed in 7 AAC 139.010 (2) who meets admission criteria set out in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 , and whose needs have not otherwise been adequately met through behavioral health services offered under 7 AAC 135 . Assertive community treatment services must be (1) available 24 hours a day, seven days a week, according to recipient need; and (2) provided according to the evidence-based practice criteria established for assertive community treatment, as documented in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 . (c) Notwithstanding (b) of this section, an individual may receive assertive community treatment services, without being an adult experiencing a serious mental illness as required under 7 AAC 139.010 (2), if (1) the individual is 18 years of age or older but under 21 years of age; and (2) the department determines that the individual is eligible for the services under 7 AAC 100 and 7 AAC 110.200 - 7 AAC 110.210 (EPSDT services). 7 AAC 139.250. Structured treatment services. Structured treatment services under this section may be provided to a recipient listed in 7 AAC 139.010 if the services are provided according to the following criteria: (1) partial hospitalization program services provided to treat a recipient's assessed psychiatric disorder to prevent relapse or the need for higher level of hospitalized care; partial hospitalization program services must (A) be provided in a therapeutic environment that maintains daily scheduled treatment activities by providers qualified to treat individuals with significant mental health and co-occurring disorders; (B) include direct access to psychiatric and medical consultation and treatment, including medication services; and (C) provide the range of component services identified for partial hospitalization program services in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 ; (2) intensive outpatient services provided to a recipient experiencing significant functional impairment that interferes with the individual's ability to participate in one or more life domains, including home, work, school, and community; intensive outpatient services must (A) be provided as a therapeutic outpatient program that maintains daily scheduled treatment activities; and (B) provide the range of component services identified for intensive outpatient services in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 . 7 AAC 139.300. Adult mental health residential services. (a) Adult mental health residential services in this section must be provided in a facility that is approved by the department and that maintains a therapeutically structured and supervised environment according to the criteria listed in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 . (b) Adult mental health residential services must be provided in a facility with 16 or fewer beds by an interdisciplinary treatment team for an individual under 7 AAC 139.010 (2) according to the following criteria: (1) level 1: for an individual (A) diagnosed with a mental, emotional, or behavioral disorder or co-occurring mental, emotional, or behavioral disorder and substance use disorder; and (B) with a prior history of continuous high service needs, or who presents with behaviors or symptoms that require a facility to provide intensive rehabilitative services, stabilization, and maintain safety; (2) level 2: for an individual diagnosed with a mental, emotional, or behavioral disorder or substance use disorder who presents with behaviors or symptoms that require a level of care, supervision, or monitoring that is higher than that required for other adult residents in assisted living home care as set out in AS 47.33 and 7 AAC 75 , and who has (A) not responded to outpatient treatment; and (B) a history of treatment needs for chronic mental, emotional, or behavioral disorders or substance use disorders that cannot be met in a less restrictive setting. (c) A psychiatric or psychological assessment must be conducted for an individual receiving adult mental health residential services before the department will approve a provider request for a service authorization. (d) In this section, "high service needs" means a person who, in the past 12-month period, has (1) accessed or been in contact with (A) acute psychiatric hospitalization; (B) psychiatric emergency services; or (C) the criminal justice system; or (2) has been unable to maintain safe and stable housing because of behaviors or symptoms. (e) Notwithstanding (b) of this section, an individual may receive adult mental health residential services without being an adult experiencing a serious mental illness as required under 7 AAC 139.010 (2), if (1) the individual is 18 years of age or older but under 21 years of age; and (2) the department determines that the individual is eligible for the services under 7 AAC 100 and 7 AAC 110.200 - 7 AAC 110.210 (EPSDT services). 7 AAC 139.325. Children's residential treatment. (a) Children's residential treatment in this section must be provided in a facility approved by the department and that maintains a therapeutically structured and supervised environment according to the criteria listed in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 . (b) Children's residential treatment must be provided by an interdisciplinary treatment team for an individual under 7 AAC 139.010 (1) according to the following criteria: (1) level 1: for children and adolescents in need of stabilization and assessment who do not require the intensive services of medical personnel and who have (A) not responded to outpatient treatment; and (B) treatment needs that cannot be met in a less restrictive setting; (2) level 2: for children and adolescents who need intensive treatment and recovery services, and who have (A) treatment needs that cannot be met in a less restrictive setting; (B) demonstrated an inability to adjust and progress in a family setting, therapeutic treatment home, or outpatient or other structured treatment placement in the past 12-month period; or (C) completed a higher level of care and require a step-down level of care before returning to a community setting. 7 AAC 139.350. Crisis response services. (a) The following services may be provided to an eligible recipient under this chapter, as set out in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 , in any appropriate community setting: (1) peer-based crisis services, provided by a peer support specialist under 7 AAC 138.400 to help an individual avoid the need for hospital emergency department services or the need for psychiatric hospitalization through (A) a summary of crisis intervention needs; (B) facilitation of transition to other community-based resources or natural supports; and (C) advocacy for client needs with other service providers; (2) mobile outreach and crisis response services, (A) only if provided by (i) a mental health professional clinician; and (ii) a qualified behavioral health professional, as defined in Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 ; and (B) provided to (i) prevent a substance use disorder or mental health crisis from escalating; (ii) stabilize an individual during or after a mental health crisis or crisis involving a substance use disorder; or (iii) refer and connect to other appropriate services that may be needed to resolve the crisis; (3) 23-hour crisis observation and stabilization services, that are provided for up to 23 hours and 59 minutes in a secure environment to an individual presenting with acute symptoms of mental or emotional distress, and that must (A) be provided by a multidisciplinary team supervised by a physician, a physician assistant, or an advanced practice registered nurse; (B) result in prompt evaluation and stabilization of the individual's condition; and (C) ensure that the individual is safe from self-harm, including suicidal behavior. (b) Peer-based crisis services, mobile outreach and crisis response, and 23-hour crisis observation and stabilization services must be documented in a progress note in accordance with 7 AAC 105.230 , and include an evidence-based risk assessment and follow-up disposition. (c) The crisis residential and stabilization services provided to an eligible individual presenting with acute mental or emotional disorders requiring psychiatric stabilization and care may be provided in a licensed general acute care hospital, a licensed psychiatric hospital, a United States Indian Health Service facility, a licensed critical access hospital, a community behavioral health services provider approved by the department under 7 AAC 136.020 , or a licensed crisis stabilization center. The crisis residential and stabilization services must be (1) provided (A) as a short-term residential program with 16 or fewer beds; (B) as a medically monitored stabilization service designed to restore the individual to a level of functioning that does not require inpatient hospitalization; and (C) to assess the need for medication services and other post-discharge treatment and support services; and (2) supported by documentation that includes (A) an individualized crisis assessment based on an evidence-based risk assessment tool; (B) an individualized crisis treatment plan; and (C) daily documentation in the clinical record of the recipient's progress toward resolution of crisis. (d) A peer support specialist in this section is subject to the qualifications listed in 7 AAC 138.400 . (e) In this section, "secure environment" means a level of security that will reasonably ensure that if a recipient leaves without permission, the recipient's act of leaving will be immediately noticed. (f) In this section, "short-term" means not more than seven days, and may be extended through a service authorization. (g) In this section, "follow-up disposition" includes the diagnosis and treatment given, the condition of the recipient on discharge or transfer, and instructions given to the recipient or the recipient's family regarding necessary follow-up care. 7 AAC 139.400. Therapeutic treatment home services. The department will pay for therapeutic treatment home services that are provided to an eligible child or adolescent under 7 AAC 139.010 (1), who experiences severe mental, emotional, or behavioral health needs that cannot be stabilized in a less intensive home setting. Theraputic treatment home services must (1) be provided in a licensed foster home under 7 AAC 50 by at least one licensed foster parent; (2) include trauma-informed care by licensed foster parents and other providers listed in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 , who have received documented training or education in principles of trauma-informed care; (3) include the component services for therapeutic treatment homes listed in the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, adopted by reference in 7 AAC 160.900 ; and (4) be provided under the direction and supervision of a community behavioral health services provider approved under 7 AAC 136.020 . Article 3 General Provisions 7 AAC 139.900. Transition to behavioral health 1115 waiver services. (a) A provider may only provide the 1115 waiver services listed in this chapter upon approval by the department under 7 AAC 136.020 . (b) A provider must update a recipient treatment plan under 7 AAC 135.130 before providing a new service listed in this chapter for a recipient who is currently receiving services under 7 AAC 70 and 7 AAC 135 . Chapter 140 Medicaid Coverage; Facility and Facility-Based Services Article 1 Ambulatory Surgical Center Services 7 AAC 140.100. Ambulatory surgical center enrollment requirements. To be eligible for payment under 7 AAC 105 - 7 AAC 160 for ambulatory surgical center services, an ambulatory surgical center must (1) be enrolled in the Medicaid program under 7 AAC 105.210 ; (2) have a system to transfer recipients requiring emergency admittance or overnight care to a licensed, Medicaid-enrolled facility following any surgical procedure performed at the ambulatory surgical center; (3) have a department-approved utilization review plan under 7 AAC 160.140 ; and (4) except for ambulatory surgical centers operated by a tribal health program under 7 AAC 155.010 , comply with the requirements of 7 AAC 150 . 7 AAC 140.105. Ambulatory surgical center services. (a) To be covered under 7 AAC 105 - 7 AAC 160 , ambulatory surgical center services must be (1) preventive, diagnostic, therapeutic, rehabilitative, or palliative; (2) directly related to a surgical procedure provided to an outpatient by or under the direction of a physician or dentist; (3) provided in an ambulatory surgical center; and (4) listed in the Ambulatory Surgical Centers (ACS) Approved HCPCS Codes and Payment Rates, adopted by reference in 7 AAC 160.900 . (b) The department will pay for use of the ambulatory surgical center to perform dental services covered by the department under 7 AAC 110.145 - 7 AAC 110.155 , if use of the center is medically necessary. (c) An ambulatory surgical center may not provide overnight services. (d) An ambulatory surgical center must submit a claim to the department for services provided by the ambulatory surgical center separately from submitting a claim to the department for the services of physicians, anesthesiologists, radiologists, and dentists. 7 AAC 140.110. Ambulatory surgical center reports. The department may request a copy of a full operative report, an interpretation of any film, or a pathologist's report on tissue that is removed. When a procedure requires an operative or pathologist's report or particular explanation or interpretation before payment, payment to the ambulatory surgical center is subject to receipt of the report, explanation, or interpretation for evaluation by the department. Article 2 Health Clinic Services; Federally Qualified Health Centers and Rural Health Clinics 7 AAC 140.200. Health clinic enrollment and reporting. (a) The department will pay a health clinic for services provided to a recipient if the health clinic (1) meets the enrollment and reporting requirements of 42 C.F.R. 405.2400 - 405.2444, adopted by reference in 7 AAC 160.900 ; (2) is a federally qualified health center that meets the requirements of 7 AAC 140.205 or a rural health clinic that meets the requirements of 7 AAC 140.210 ; (3) is enrolled as a Medicare provider; (4) is enrolled as a federally qualified health center or rural health clinic in accordance with 7 AAC 105.210 ; (5) is not enrolled as another type of Medicaid provider of primary care or ambulatory services provided by the health clinic; (6) employs staff who meet the individual provider enrollment requirements for each service that the clinic provides if enrollment is required for that type of provider under 7 AAC 105 - AAC 160; and (7) is enrolled as follows if the health clinic is providing those services: (A) as a dental provider under 7 AAC 110.140 ; (B) as a dispensing pharmacy provider under 7 AAC 120.100 ; (C) as a nurse midwife under 7 AAC 110.100 or direct-entry midwife under 7 AAC 110.180 , if providing professional services associated with labor and delivery. (b) Each permanent site operated by a health clinic must be separately enrolled and meet the requirements of this section. In this subsection, "permanent site"; (1) means a fixed, brick-and-mortar location; (2) does not include a temporary location where services are provided on a onetime or occasional basis, such as a health fair, school, or fish camp. (c) For each site where it operates, a health clinic shall maintain sufficient financial records and statistical data to allow the department to identify and verify the costs and charges associated with providing services at each site. (d) On or before the last day of the fifth month after the close of its fiscal year, a health clinic shall file an annual year-end report, even if the clinic did not provide medical services to recipients during that fiscal year. The annual year-end report must contain the items listed in the definition of "year-end report" in 7 AAC 150.990 , except that (1) worksheet A of the Medicare cost report must include separate cost centers for licensed marital and family therapists and for licensed professional counselors; (2) Medicare home office cost statements are not required; (3) the required reconciliation of the post-audit working trial balance must be to the Medicare cost report worksheets A, A-1, and A-2; reconciliation may not be made to the Medicare cost report worksheets A-8, C, and G series; (4) the report must also include a worksheet detailing the total number of visits for the clinic's fiscal year; the worksheet must include visits for dental, licensed marital and family therapist, licensed professional counselor, and other ambulatory services; (5) full-time-equivalent numbers must be reported separately for a licensed marital and family therapist or licensed professional counselor following the same calculation requirements as other rendering providers on Worksheet S-3 Part Ill of the Medicare cost report; and (6) rural health clinics may provide reviewed financial statements meeting the requirements of 7 AAC 150.190 (j)(3)(A) and (B) instead of audited financial statements. (e) If no change in the scope of services occurred during the health clinic fiscal year, and the health clinic does not intend to request a change, the health clinic shall submit to the department, on or before the last day of the fifth of the month after the close of that fiscal year, a written statement indicating that no change in the scope of services occurred or is being requested. (f) If a change in scope of services occurred during the health clinic fiscal year, the health clinic shall submit to the department the additional reports listed in this subsection. The data contained in these reports will be used to evaluate the change in scope of service request made under 7 AAC 145.700 (f), to adjust the health clinic payment rates in accordance with that subsection, and to ensure, in accordance with 7 AAC 145.700 (c)(4), that the prospective payment rate does not exceed upper payment limits. The reports must be submitted on or before the last day of the fifth month after the close of the health clinic fiscal year during which the change in the scope of services occurred, and on or before the last day of the fifth month after 12 continuous months of operation with the change. The reports must include the following: (1) a worksheet detailing the total number by which visits increased or decreased for the clinic's fiscal year due to the change in the scope of services; (2) a narrative report that (A) identifies the date the change in the scope of services occurred; and (B) describes the type of change in the scope of services; (3) a spreadsheet that details the costs that are associated with the change in the scope of services and reported on the Medicare cost report; the spreadsheet must (A) identify the working trial balance, account numbers, and cost centers; and (B) list all expense amounts associated with the change in the scope of services. (g) If the facility receives an extension for filing the Medicare cost report from the Medicare intermediary, the facility must forward a copy of the intermediary's letter that grants the extension to the facility to the department. The department will then grant an extension for the year-end report and the change-in-scope report to coincide with the due date given by the Medicare intermediary. Otherwise, for good cause shown to the department's satisfaction, the department will grant a 30-day extension of the due date for submitting the information required under (d) - (f) of this section. In order to receive an extension from the department, a health clinic must submit to the department an extension request in writing before the due date. For purposes of this subsection, "good cause" (1) means circumstances beyond the control of the health clinic that cause the reporting due date to be missed by several days; and (2) includes natural disasters, hazardous weather, illness of the individual making the request, or specific medical emergencies that preclude timely submission. (h) The department will withhold 20 percent of the payment due to a health clinic if the clinic fails to submit complete information as required in (d) - (f) of this section. The department will restore, without interest, a payment withheld under this subsection, if the health clinic submits complete information as required in (d) - (f) of this section. (i) The department may conduct audits, perform special analysis, and review the records of a health clinic to verify compliance with Medicare and Medicaid laws, audit claims for payment submitted or paid, and make adjustments based on audits to a health clinic's payment rate. A health clinic shall provide to the department financial and all other information regarding Medicaid claims for services provided to eligible recipients, shall provide Medicare cost reports upon request, and shall provide access to all facilities and records. (j) A health clinic may terminate its agreement to participate as a rural health clinic or a federally qualified health center by submitting a written notice to the department and identifying a termination date not less than 30 days after submitting the notice of termination. (k) In this section, (a)(1) and (3) and (d) - (i) of this section do not apply to a federally qualified health center that elects to be reimbursed under 7 AAC 155.010 (1). 7 AAC 140.205. Federally qualified health centers. (a) To qualify as a federally qualified health center under 7 AAC 140.200 and this section and for payment under 7 AAC 145.700 , a provider must meet at least one of the following eligibility requirements for the entire period for which Medicaid services are rendered: (1) a provider is receiving a grant under 42 U.S.C. 254b; (2) a provider is receiving money from a grant under (1) of this subsection under a contract with the grant recipient, and the provider also meets the requirements to receive that type of grant; (3) a provider is determined by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), to meet the requirements for receiving a grant under (1) of this subsection; (4) a provider is a tribal health program. (b) In addition to the requirements of 7 AAC 140.200 , to enroll with the department, a federally qualified health center that is enrolled (1) under (a)(1), (2), or (3) of this section must (A) participate as a federally qualified health center in accordance with this section and 7 AAC 145.700 , 42 C.F.R. 405.2430 - 405.2452, and 42 C.F.R. Part 491, adopted by reference in 7 AAC 160.900 ; and (B) provide the department with a letter from CMS, certifying the entity as a federally qualified health center provider, and must provide a copy of its grant notice; (2) under (a)(4) of this section must participate as a federally qualified health center in accordance with this section and 7 AAC 145.700 and 42 C.F.R. 405.2446 - 405.2452, adopted by reference in 7 AAC 160.900 . 7 AAC 140.210. Rural health clinics. To qualify as a rural health clinic under 7 AAC 140.200 and this section and for payment under 7 AAC 145.700 , a provider must be an entity that the department has certified under 42 C.F.R. Part 491 as being in compliance with 42 C.F.R. 405.2400 - 405.2417, adopted by reference in 7 AAC 160.900 . 7 AAC 140.215. Health clinic services and payment conditions. (a) The department will pay a health clinic for providing services under (b) - (e) of this section rendered to a patient of the clinic by an employee or a contract worker of the clinic. Except as otherwise provided in this section, the department will pay a provider for services under this section in accordance with the payment rate established in 7 AAC 145.700 , or 7 AAC 155.010 , as applicable. (b) The department will pay for primary care services provided by a physician, a physician assistant, or an advanced practice registered nurse acting within the scope of that individual's license to practice. The department will not pay a federally qualified health center under the rate methodology established in 7 AAC 145.700 for services that the department determines to be incidental to primary care services, including laboratory services, x-ray services, and supplies. (c) The department will pay for ambulatory services under 7 AAC 105 - 7 AAC 160 , including (1) vision services under 7 AAC 110.705 ; (2) speech-language pathology services under 7 AAC 115.410 ; (3) hearing services under 7 AAC 115.520 and 7 AAC 115.530 ; (4) EPSDT screening and EPSDT services under 7 AAC 110.205 and 7 AAC 110.210 ; (5) podiatry services under 7 AAC 110.505 ; (6) nutrition services under 7 AAC 110.275 and 7 AAC 110.280 ; (7) private-duty nursing services under 7 AAC 110.525 ; (8) hospice services under 7 AAC 140.275 and 7 AAC 140.280 ; (9) family planning services under 7 AAC 110.230 ; (10) physical therapy services under 7 AAC 115.310 ; (11) occupational therapy services under 7 AAC 115.110 ; (12) chiropractic services under 7 AAC 110.120 ; and (13) nonprimary care services that are provided in a hospital by a rural health clinic physician, physician assistant, or advanced practice registered nurse acting within the scope of that individual's license to practice. (d) The department will separately pay a health clinic for dental services covered under 7 AAC 110.145 - 7 AAC 110.155 provided by a dentist who is enrolled separately under 7 AAC 110.140 . (e) The department will pay the established encounter rate to a health clinic for the behavioral health services identified in Table 1-1. Procedure Codes: Mental Health Services of the Federally Qualified Health Center/Rural Health Clinic Services section of the Alaska Provider Billing Manual, adopted by reference in 7 AAC 160.900 , if those services are provided to a recipient by a psychologist, clinical social worker, marital and family therapist, or professional counselor acting within the scope of that individual's license to practice. Behavioral health services covered under this subsection include (1) psychiatric diagnostic interview procedures; (2) psychological testing and examination services; (3) individual psychotherapy; (4) group psychotherapy; (5) family psychotherapy; and (6) health and behavior assessment and intervention services. (7) screening and brief intervention services. (f) In accordance with the relevant fee schedule established under 7 AAC 145.050 , the department will separately pay a health clinic eligible under 7 AAC 140.205 (a)(1), (2), or (3) for labor and delivery services provided by a physician, a physician assistant, or an advanced practice registered nurse, including a nurse midwife, who has separately enrolled under 7 AAC 105 - 7 AAC 160 . The department will pay a health clinic eligible under 7 AAC 140.205 (a)(4) in accordance with 7 AAC 155.010 . (g) The department will separately pay a health clinic for pharmacy services and for prescription drugs provided by the health clinic under 7 AAC 120.110 if the health clinic is enrolled as a dispensing provider in accordance with 7 AAC 120.100 . The department will pay a provider under this subsection in accordance with the rates established in 7 AAC 145.400 and 7 AAC 145.410 . (h) The department will not pay a health clinic eligible under 7 AAC 140.205 (a)(1), (2), or (3) for (1) services or supplies that a health clinic routinely provides to individuals other than Medicaid-eligible recipients; (2) services or supplies that the health clinic routinely furnishes for free or without regard to the recipient's ability to pay; or (3) services provided off-site of the health clinic, except as provided in 7 AAC 140.220 ; this paragraph does not apply to a federally qualified health center. 7 AAC 140.220. Health clinic services provided off-site. (a) The department will not pay a health clinic for services provided off-site unless (1) the health clinic patient is homebound as determined under (b) of this section and if all of the following conditions are met: (A) the United States Department of Health and Human Services has determined that a shortage of home health agencies exists in the area; (B) services are furnished by a registered nurse, a licensed practical nurse, or a licensed vocational nurse who is employed by, or receives compensation for the services from, the clinic; (C) the services are furnished under a written plan of treatment that is (i) established and reviewed at least every 60 days by a supervising physician of the health clinic or established by an advanced practice registered nurse or a physician assistant and reviewed at least every 60 days by a supervising physician; and (ii) signed by the advanced practice registered nurse, the physician assistant, or the supervising physician of the health clinic; (D) the nursing care coverage is limited as specified in 42 C.F.R. 405.2416(b) and (c), adopted by reference in 7 AAC 160.900 ; (2) a rural health clinic physician, acting within the scope of the physician's license to practice, provides the services in a hospital or nursing facility; (3) a rural health clinic physician assistant or rural health clinic advanced practice registered nurse, acting within the scope of that individual's license to practice, provides the services in a hospital; or (4) a federally qualified health center physician, physician assistant, or advanced practice registered nurse, acting within the scope of the individual's license to practice, provides the services in a nursing facility. (b) A health clinic patient is homebound if, due to the individual's medical or health condition, the individual is confined to the individual's residence, or cannot leave the residence without considerable effort. The department will not disqualify an individual from being considered homebound for infrequent absences of short duration from the residence, including absences to attend religious services, or for absences from the residence in order to receive health care treatment, including participation in therapeutic or medical treatment as part of adult day services provided under 7 AAC 130.250 by a provider that is certified under 7 AAC 130.220 . The department will not consider an individual to be homebound if the individual's residence is a hospital or long-term care facility. (c) This section does not apply to a federally qualified health center. 7 AAC 140.229. Definitions. In 7 AAC 140.200 - 7 AAC 140.229 , (1) "ambulatory services" means noninstitutional services that are payable under Medicaid and provided in accordance with this chapter; "ambulatory services" includes (A) visual care; (B) speech; (C) hearing; (D) language; (E) EPSDT; (F) podiatry; (G) nutrition; (H) private duty nursing; (I) hospice care; (J) family planning; (K) physical therapy; (L) occupational therapy; (M) chiropractic; and (N) services that are not primary care services, that are provided by a physician, physician assistant, or advanced practice registered nurse, that are within the scope of that individual's license to practice, and that are (i) provided in or by a hospital; or (ii) laboratory or x-ray services only; (2) "change in the scope of service" has the meaning given in 7 AAC 145.700 (k); (3) "cost center" has the meaning given in 7 AAC 150.990 ; (4) "health clinic" (A) means a federally qualified health center or a rural health clinic; (B) does not include a private or nonprofit medical practice or clinic that is not a federally qualified health center or rural health clinic; (5) "visit" has the meaning given in 7 AAC 145.739 . Article 3 Hospice Care Services 7 AAC 140.270. Hospice care provider enrollment. (a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing hospice care services, the provider must (1) be enrolled in the Medicaid program under 7 AAC 105.210 ; (2) be a public or private organization that the department has certified as a hospice for the purposes of the Medicare program under 42 C.F.R. Part 418, adopted by reference in 7 AAC 160.900 ; and (3) provide hospice care services for periods of at least 210 days. (b) If the hospice care provider enrolled under (a) of this section employs individuals to provide professional or specialized services, those employees must individually meet any applicable state licensing requirements. (c) The department will not enroll a hospice care organization that is located out of state. 7 AAC 140.275. Hospice care services. (a) Before the department will give prior authorization to and pay for hospice care services provided to a recipient in the recipient's place of residence, the department must receive, no more than eight days after hospice care begins, (1) a certification, signed by the recipient's attending physician and the medical director of the hospice, that the recipient's medical prognosis is a life expectancy of six months or less if the illness runs its normal course; (2) a copy of the recipient's care plan described in (d) of this section; and (3) an election statement, signed by the recipient or the recipient's representative, that includes (A) the name of the designated hospice; (B) an acknowledgment by the recipient, or the recipient's representative, of an understanding of hospice care; (C) the effective date of the election; (D) an acknowledgment by the recipient, or the recipient's representative, that for the duration of care, the recipient waives the recipient's rights to hospice care by any other hospice unless arranged through the designated hospice, and waives the recipient's rights to any other Medicaid-covered services related to the recipient's terminal illness except for those provided by the designated hospice, an alternative hospice under arrangement with the designated hospice, or the recipient's attending physician; (E) an acknowledgment of the recipient's option to revoke the election of hospice care at any time; and (F) an acknowledgment of the recipient's option to elect to change the designation of the hospice by submitting to both hospices a signed statement indicating the hospice from which care has been received, the newly designated hospice, and the date the change is effective; the recipient may only elect to change the designation of the hospice once in each election period as described in 42 C.F.R. 418.21 and 418.30, adopted by reference in 7 AAC 160.900 . (b) A recipient eligible for Medicare and Medicaid must make an election of a hospice, a designation of change of a hospice, or a revocation of a hospice simultaneously for both programs. (c) The following hospice care services are not paid separately from payments made for routine home care, continuous home care, inpatient respite care, or general inpatient care, as provided in 7 AAC 145.690 : (1) preparation of a written plan of care that meets the requirements of (d) of this section; (2) a service rendered that is consistent with the written plan of care; (3) nursing care provided under the direction of a registered nurse; nursing care must be routinely provided by employees of the hospice; (4) medical social services rendered by a social worker under the direction of a physician; medical social services rendered by a social worker under the direction of a physician must be routinely provided by employees of the hospice; (5) physical, occupational, and speech therapy; (6) durable medical equipment, medical supplies, and biologicals and drugs that are used primarily for the relief of pain and symptom control of the terminal illness; (7) home health aide and homemaker services provided in the recipient's home under the direction of a registered nurse; (8) counseling services provided to the recipient, family members, or caregiver for the purpose of enabling the family or caregiver to provide care, or aiding in adjustment to the recipient's approaching death, and up to one year following the death of the recipient; counseling services described in this paragraph must be routinely provided by employees of the hospice. (d) A hospice care provider shall prepare a written plan of care that contains an initial plan of care expanded to a comprehensive plan of care. Before hospice service begins, a written initial plan of care must be completed by a registered nurse or physician in cooperation with at least one member of the interdisciplinary group. A comprehensive plan of care must be reviewed and updated at intervals, specified in the plan, by the hospice medical director or the recipient's attending physician, and by the interdisciplinary group. The plan must include an assessment of the recipient's needs and state in detail the scope and frequency of services needed to meet the recipient's and family's needs. (e) Nursing care, physician services, medical social services, and counseling are core hospice services and must be routinely provided by hospice employees. Physician services provided by the hospice must also meet the general medical needs of the recipient to the extent that the needs are not met by the recipient's attending physician. (f) Continuous home care is to be provided only during a period of crisis in which a recipient requires constant care to reduce or manage acute medical symptoms as necessary to maintain a recipient at home. To be paid as continuous home care, a minimum of eight hours of care described in 42 C.F.R. 418.204, adopted by reference in 7 AAC 160.900 , must be provided in each 24-hour period, and may be supplemented with homemaker and home health aide services; more than half of the continuous home care hours must be nursing care. If care less skilled than nursing services is required on a continuous basis to maintain the recipient at home, that care will be paid as routine home care. (g) The interdisciplinary group required by (d) of this section must include a doctor of medicine or osteopathy, a registered nurse, a social worker, and a counselor. 7 AAC 140.280. Hospice care for individuals under 21 years of age. (a) Except as otherwise provided in this section, the department may enroll a hospice care provider and pay for hospice care services for a recipient under 21 years of age in the same manner as in 7 AAC 140.270 - 7 AAC 140.275 and 7 AAC 145.690 . In addition to satisfying the requirements in 7 AAC 140.275 , and no earlier than 12 months before hospice care services begin, the recipient must have had an EPSDT screening that meets the requirements in 7 AAC 110.205 for coverage. (b) In addition to the hospice care services eligible for payment under 7 AAC 140.275 (c), a recipient under 21 years of age may receive private-duty nursing services rendered by or under the supervision of a registered nurse in a recipient's home. The department will pay for those private-duty nursing services provided in a recipient's home at the in-state rate established under 7 AAC 145.250 . The department will not pay for out-of-state private-duty nursing services under this section. 7 AAC 140.289. Definitions. In 7 AAC 140.200 - 7 AAC 140.289 , (1) "continuous home care" means care provided during a period of crisis in which a recipient requires constant care to reduce or manage acute medical symptoms as necessary to maintain a recipient at home; (2) "general inpatient care" means care provided in a participating hospice inpatient unit or a participating general acute care hospital or nursing facility that meets the standards for staffing and recipient areas in 42 C.F.R. 418.98 or 42 C.F.R. 418.100, adopted by reference in 7 AAC 160.900 , for procedures necessary for pain control or acute or chronic symptom management that cannot feasibly be provided in another setting; (3) "inpatient respite care" means a short-term admission of no more than five days for inpatient care in a facility that meets the standards in 42 C.F.R. 418.98(b), adopted by reference in 7 AAC 160.900 , in order to provide relief to the caregiver; "inpatient respite care" does not include care provided to a recipient residing in a long-term care facility; (4) "interdisciplinary group" means a group of individuals designated by a hospice who provide or supervise the care and services offered by the hospice; (5) "routine home care" means any combination of the services listed in 7 AAC 140.275 (c)(1) - (8) provided to a recipient electing hospice care that are not provided at the level and intensity of continuous home care. Article 4 Hospital Services 7 AAC 140.300. Hospital provider requirements. (a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing hospital services, a provider must (1) be enrolled as a hospital in accordance with 7 AAC 105.210 ; (2) if located in the state, (A) be licensed under AS 47.32 , except for a hospital operated by a tribal health program; and (B) comply with the requirements of 7 AAC 150 ; (3) if located out of state, meet all applicable licensing and accreditation requirements of the jurisdiction in which the hospital is located; (4) have a department-approved plan of utilization review; and (5) comply with all prior authorization requirements established under 7 AAC 105 - 7 AAC 160 . (b) The provisions of 7 AAC 140.300 - 7 AAC 140.325 apply to all general acute care hospital services, including inpatient, outpatient, and emergency room services. Except as otherwise provided in 7 AAC 105 - 7 AAC 160 , 7 AAC 140.300 - 7 AAC 140.325 do not apply to inpatient or outpatient psychiatric facility or residential psychiatric treatment center services. 7 AAC 140.305. Admission to a hospital. The department will pay for inpatient hospital services only if the (1) recipient is admitted to the hospital by the written order of a physician or other licensed health care professional authorized to admit a patient to a hospital; (2) recipient requires a general acute care hospital level of care or meets the requirements for administrative-wait bed or swing-bed status; and (3) department gives prior authorization for admission as required under 7 AAC 105 - 7 AAC 160 . 7 AAC 140.310. Covered hospital services. (a) The department will pay for those hospital services for which a revenue code is listed in Section I of the Inpatient/Outpatient Hospital Services section of the Alaska Provider Billing Manual, adopted by reference in 7 AAC 160.900 , and in the Covered Revenue Codes for Outpatient Hospitals and the Covered Revenue Codes for Inpatient Hospitals of the Indian Health Service (IHS)/Tribal Facility Services section of the Alaska Provider Billing Manual, adopted by reference in 7 AAC 160.900 . Some revenue codes are for services that are limited based on recipient age, gender, and eligibility category as otherwise provided in AS 47.07 , 7 AAC 100 , or 7 AAC 105 - 7 AAC 160 . (b) The department will pay for the standard daily hospital service, which includes room, linen service, meals, special diets, general nursing service, medical records and admitting service, use of ordinary hospital equipment and instruments, routine treatments, routine drugs, and routine supplies. (c) The department will pay for the central hospital service, which includes supplies and preparing, handling, and storing supplies. (d) The department will pay a hospital for drugs prescribed by the attending physician or other dispensing provider only if the drugs are administered to the recipient while the patient is receiving care in the hospital. (e) The department will pay for outpatient hospital observation services, not to exceed 48 hours, only if a recipient's condition warrants evaluation. 7 AAC 140.315. Noncovered hospital services. (a) Except as otherwise provided in 7 AAC 105 - 7 AAC 160 , the department will not pay for services (1) identified as noncovered services in 7 AAC 105.110 ; or (2) for which a revenue code is not listed as described in 7 AAC 140.310 (a). (b) Except as otherwise provided in 7 AAC 105 - 7 AAC 160 , the department will not pay a hospital for the following services and procedures: (1) a service that is not within the scope of the facility's licensure, certification, or accreditation; (2) the following services, unless the department gives prior authorization specifically for the service: (A) the dispensing of antabuse; (B) methadone treatment, including the dispensing of methadone; (C) alcohol or drug detoxification or rehabilitation; (3) tobacco cessation therapy and services; however, the department will pay for tobacco cessation products; (4) leaves of absence, including charges for holding a recipient's room or bed, except as described under 7 AAC 140.585 when a recipient is in a hospital's long-term care facility; (5) services and procedures that do not require hospital care, including (A) outpatient special residence charges, rest cures, daily respite care under 7 AAC 130.280 , adult day services, or day care for children; (B) room and board for individuals other than the patient, unless the department gives prior authorization specifically for the service; (C) admission solely for the purpose of medical and dental services, surgical procedures, or diagnostic testing that can be performed on an outpatient basis or in an ambulatory surgical center; however, the department will give prior authorization specifically for a service, procedure, or test if the recipient's (i) current medical condition or physical or mental disabilities are sufficiently severe that performing that service, procedure, or test on an outpatient basis or in an ambulatory surgical center would seriously endanger the recipient's health; or (ii) recent medical history indicates that performing that service, procedure, or test on an outpatient basis or in an ambulatory surgical center would seriously endanger the recipient's health; (D) recipients who do not require or who no longer require acute inpatient care; however, the department will make a payment to the hospital for accommodation when no long-term care bed is available, if the department has approved the level of care appropriate for the recipient in situations involving a swing bed or administrative-wait bed; (E) custodial care related to court commitments; patients confined to a hospital under a court commitment for any reason will be covered for payment only to the extent medical necessity exists for inpatient hospital care; (F) recipients remaining beyond the length of stay authorized under 7 AAC 140.320 ; (G) recipients pending discharge when hospital care is no longer required; (H) days of care due to failure to promptly request or perform necessary diagnostic studies, medical-surgical procedures, or consultations; (I) disability examinations, except that the department will pay for outpatient tests ordered by a physician as part of (i) an initial disability examination in accordance with 7 AAC 40.180 ; or (ii) a review of a disability determination in accordance with 7 AAC 40.190 ; (J) evaluative or periodic checkups, examinations, or immunizations that are connected with the participation in, enrollment in, attendance at, or accomplishment of a program or activity unrelated to the recipient's physical or mental health or rehabilitation, except mammograms; (6) organ transplants and related services, and dental implants, except that the department will make payment for organ transplants and requisite related medical care for (A) kidney and corneal transplants; prior authorization is not required; (B) skin and bone transplants for which the department has given prior authorization; (C) bone marrow transplants for which the department has given prior authorization; (D) liver transplants for which the department has given prior authorization, for persons with biliary atresia or other forms of end-stage liver disease; and (E) heart, lung, and heart-lung transplants for which the department has given prior authorization; (7) weekend stays if admission was made on Friday or Saturday for surgery scheduled on Monday, except for an emergency or situation where the physical or mental condition of the patient necessitates extensive preoperative preparation or therapy; (8) professional fees in addition to those typically charged within specific cost centers, including osteopathic services, and except registered nurse anesthetist services; (9) separately identifiable preventive care services, clinic services, medical social services, and trauma team response activation charges; (10) nursing services and incremental nursing charges assessed in addition to accommodation charges, including private-duty nursing charges; (11) take-home drugs, oxygen, and supplies not otherwise classified; (12) home infusion therapy; (13) miscellaneous home dialysis charges; (14) educational services and supplies; (15) cardiac rehabilitation that exceeds the guidelines in the Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.10 (Cardiac Rehabilitation Programs), adopted by reference in 7 AAC 160.900 ; (16) recreational therapy and medical rehabilitation day programs; (17) charges for services or items normally considered part of routine services and optional or special services not directly related to medical care, including (A) private accommodation charges, unless medically necessary; (B) deluxe accommodation charges; (C) patient convenience items; and (D) routine service charges for accommodations that cannot be included in more specific revenue codes; (18) personal services not normally associated with hospital care, including long-distance telephone calls, television rental, guest meals, and personal items. (c) The department will not pay for a service or inpatient stay for which prior authorization is denied, or is required but not obtained, including nonemergency out-of-state services for which prior authorization is not obtained under 7 AAC 105.130 . (d) Repealed 3/19/2014. (e) Except as provided in (f) of this section, the department will not pay a hospital for the following provider-preventable conditions: (1) services and procedures related to a health care-acquired condition as defined in 42 C.F.R. 447.26(b), adopted by reference in 7 AAC 160.900 ; (2) a wrong surgical or other invasive procedure performed on a patient; (3) a surgical or other invasive procedure performed on the wrong body part; (4) a surgical or other invasive procedure performed on the wrong patient. (f) A reduction in payment resulting from a provider-preventable condition identified in (e) of this section will be abrogated in accordance with 42 C.F.R. 447.26(c)(2) or limited in accordance with 42 C.F.R. 447.26(c)(3). The provisions of 42 C.F.R. 447.26(c) are adopted by reference in 7 AAC 160.900 . (g) In this section, "cost center" has the meaning given in 7 AAC 150.990 . 7 AAC 140.320. Length of hospitalization. (a) Except as provided in (b) and (d) of this section, the department will not pay for more than three days of hospitalization for any single admission, except that, for a maternal and newborn hospital stay related to childbirth, the department will not pay for more than 48 hours of inpatient hospitalization for a single recipient following a normal vaginal delivery and no more than 96 hours of inpatient hospitalization for a single recipient following a cesarean delivery. (b) The department will not pay for coverage beyond the days or hours of hospitalization specified in (a) of this section unless the department has given prior authorization for those days or hours under 7 AAC 105.130 . (c) If the department reimburses a provider under the Diagnosis Related Groups (DRG) methodology, the department will use the method specified in 7 AAC 150.250 (a)(4) to calculate the amount that will be reimbursed for the length of stay. (d) If the department reimburses a hospital under the Diagnosis Related Groups (DRG) methodology, the hospital is exempt from the requirements of (b) of this section. 7 AAC 140.325. Billing for hospital services. (a) The quality improvement organization (QIO) certification of necessity for hospital stays over three days or for stays for treatment or procedures on the Select Diagnoses and Procedures Pre-certification List, adopted by reference in 7 AAC 160.900 , must appear on the invoice submitted by the hospital in order to receive payment. The department will pay only for days that are medically necessary and within the scope of Medicaid coverage. If a recipient refuses to leave the hospital at the end of a covered stay, the hospital may bill the recipient for days beyond the noncovered or noncertified portion of the hospital stay. Payment by the department for covered services is considered by the department to be payment in full for those covered services. (b) When a health care-acquired condition or provider-preventable condition described in 7 AAC 140.315 (e) is not present on admission, but is reported as a diagnosis associated with the hospitalization, the hospital must submit a claim identifying the condition, even if the hospital does not seek reimbursement for the hospitalization. Article 5 Inpatient Psychiatric Hospital Services 7 AAC 140.350. Inpatient psychiatric hospital provider requirements. (a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing inpatient psychiatric hospital services, a provider must (1) be enrolled as an inpatient psychiatric hospital in accordance with 7 AAC 105.210 ; (2) if located in this state, (A) be licensed under AS 47.32 and accredited by the Joint Commission; (B) comply with the requirements of 7 AAC 150 ; (3) if located out of state, meet all applicable licensing and accreditation requirements of the jurisdiction in which the inpatient psychiatric hospital is located; and (4) meet the requirements of 7 AAC 140.350 - 7 AAC 140.365 . (b) An inpatient psychiatric hospital provider shall record the results of each required screening, assessment, evaluation, and certification in a written report and include that report in the recipient's medical record. (c) An inpatient psychiatric hospital provider shall provide an accounting for any funds accepted from a patient for safekeeping and shall make that accounting available for inspection by designated department staff and for audit by the department. 7 AAC 140.355. Inpatient psychiatric hospital services. (a) Subject to the admission and prior authorization requirements of 7 AAC 140.360 and plan-of-care requirements of 7 AAC 140.365 , the department will pay for therapeutically appropriate, medically necessary diagnostic and treatment services for recipients who are admitted to an inpatient psychiatric hospital, including the following services: (1) intake assessment; (2) admitting history and physical examination; (3) individual psychotherapy; (4) group psychotherapy; (5) family psychotherapy; (6) pharmacologic management; (7) crisis intervention; (8) medication administration. (b) Psychiatric services provided in an inpatient psychiatric hospital must be provided (1) under the supervision of a psychiatrist licensed under AS 08.64 ; and (2) in a manner consistent with an individual plan of care that meets the requirements of 7 AAC 140.365 and is signed by the supervising psychiatrist. (c) Payment for inpatient psychiatric hospital services is limited to services provided to an individual under 21 years of age or an individual 65 years of age and older. (d) in this section, "admitting history and physical examination" means a comprehensive review and examination of a recipient upon admission to an inpatient psychiatric hospital to determine and record the recipient's (1) medical history; (2) developmental history; (3) social history; (4) present illness or illnesses; (5) basic physical health by means of a complete physical examination; (6) medication history; and (7) allergies, if any. 7 AAC 140.360. Inpatient psychiatric hospital admission. (a) The department will not pay for inpatient psychiatric hospital services unless the department has authorized the recipient's admission. Before the department will authorize admission, the department will verify that the requirements of (b) and (c) of this section are met. (b) Upon admission, an inpatient interdisciplinary team that meets the requirements of (d) of this section must (1) complete a diagnostic evaluation that (A) includes a psychiatric assessment; (B) is performed no more than 60 days before admission or no more than 72 hours after admission; and (C) indicates the need for inpatient psychiatric services; (2) certify in the recipient's medical record that (A) available alternate community resources for ambulatory care do not meet the treatment needs of the recipient, if the recipient is under 21 years of age; (B) proper treatment of the recipient's psychiatric condition requires services on an inpatient basis, as appropriate; and (C) inpatient psychiatric services can reasonably be expected to improve the recipient's condition or prevent further regression; (3) provide to the department (A) the results of the diagnostic evaluation required in (1) of this subsection; (B) the results of a functional assessment; (C) the results of any direct patient observations and assessments obtained following the recipient's referral; and (D) other information from referral sources, other community agencies, and the family, that is relevant to the recipient's condition; and (4) develop a plan of care based upon the information provided under this subsection that meets the requirements of 7 AAC 140.365 . (c) Based on the information received under (b)(3) of this section, the department will determine if the proposed treatment and other services are consistent with the recipient's clinical diagnosis and if they appropriately address the recipient's needs. (d) An inpatient interdisciplinary team that provides the services required in (b) of this section must, by virtue of education and experience, have the capability of assessing the recipient's immediate and long-range therapeutic requirements, developmental priorities, personal strengths, liabilities, and the potential resources of the recipient's family. Except as provided in (f) of this section, an inpatient interdisciplinary team must include (1) either a (A) psychiatrist licensed under AS 08.64 ; (B) psychologist licensed under AS 08.86 who has a doctorate degree in clinical psychology and a physician licensed under AS 08.64 to practice medicine or osteopathy; or (C) physician licensed under AS 08.64 to practice medicine who has specialized training and experience in the diagnosis and treatment of mental diseases and a psychological associate licensed under AS 08.86 ; (2) a representative of the office of the Department of Family and Community Services responsible for children's services if the child is in that subunit's custody, or a representative of the division of the Department of Family and Community Services responsible for juvenile justice if the child is in that division's custody; (3) a clinical social worker licensed under AS 08.95 ; (4) a registered nurse licensed under AS 08.68 who has specialized training or one year's experience in treating mentally ill patients; and (5) depending upon the needs of the recipient, either (A) an occupational therapist licensed under AS 08.84 who has specialized training or one year's experience in treating mentally ill patients; or (B) a psychological associate licensed under AS 08.86 who has a master's degree in clinical psychology. (e) Upon the admission of a recipient under 21 years of age to an inpatient psychiatric hospital, the provider shall arrange for appropriate EPSDT screening services, in accordance with 7 AAC 110.200 - 7 AAC 110.210 . The provider shall ensure that a child has received EPSDT screening (1) no more than the 60 days immediately preceding the date of admission; or (2) no more than five days after the date of admission. (f) Members of the interdisciplinary team of an out-of-state inpatient psychiatric hospital must be licensed by the jurisdiction in which the inpatient psychiatric hospital is located. (g) The department will issue a prior authorization required under this section in accordance with the State of Alaska, Department of Health, Behavioral Health Inpatient Psychiatric Review Provider Manual, adopted by reference in 7 AAC 160.900 . 7 AAC 140.365. Inpatient psychiatric hospital plan of care. (a) The individual plan-of-care established by the inpatient interdisciplinary team in accordance with 7 AAC 140.360 (b)(4), and a subsequent plan of care review, must (1) be comprehensive and in writing; (2) be developed based upon a diagnostic evaluation as required in 7 AAC 140.360 (b)(1); (3) be formulated in consultation with the recipient and the recipient's family, guardian, or other individual into whose care or custody the recipient will be released following discharge; (4) document individualized treatment objectives and prescribe an integrated program of appropriate therapies, activities, and experiences designed to develop the recipient's ability to function independently in the recipient's own environment; (5) include appropriate treatments that are reasonably expected to improve the recipient's condition to the extent that inpatient psychiatric services will become unnecessary; for a recipient under 21 years of age, the treatment plan must include family psychotherapy unless family psychotherapy is contraindicated; and (6) include a discharge plan prepared at the time of admission and updated during the recipient's inpatient stay as the recipient's mental health service needs change, that specifies the approximate date for discharge, the recipient's anticipated post-discharge service needs, the recipient's prospective community-based service providers, and other provisions necessary for the transition to a less restrictive environment. (b) The department will review a recipient's plan of care every 30 days to determine whether the inpatient psychiatric hospital services provided are or were required. The department may make recommendations as to necessary adjustments in a plan of care based on the recipient's response to treatment. Article 6 Residential Psychiatric Treatment Center (RPTC) Services 7 AAC 140.400. Residential psychiatric treatment center provider requirements. (a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing residential psychiatric treatment center (RPTC) services, a provider must (1) be enrolled as an RPTC in accordance with 7 AAC 105.210 ; (2) if located in this state, be licensed by the department under AS 47.32 ; (3) if located out of state, meet the licensing and accreditation requirements of the jurisdiction in which the RPTC is located; (4) be accredited by The Joint Commission, the Commission on Accreditation of Rehabilitation Facilities, or the Council on Accreditation of Services for Families and Children as a residential psychiatric treatment center for care of children under 21 years of age; (5) comply with the requirements of 7 AAC 140.400 - 7 AAC 140.415 ; (6) comply with 42 C.F.R. 483.350 - 483.376, adopted by reference in 7 AAC 160.900 , governing the use of restraint and seclusion; and (7) provide basic residential care and services that include (A) dwelling space provided in separate buildings or units with no more than 60 residential beds per building and no more than 30 beds provided for sleeping accommodation per unit; if the residential unit is part of a larger facility, the residential unit must be a separate and distinct area from other designated psychiatric or treatment units; and (B) equipment, supplies, maintenance, and insurance used by residents for program activities and case-specific services. (b) The results of required screenings, assessments, evaluations, and certifications must be recorded separately in a written report and included in the recipient's medical record. (c) An RPTC shall provide an accounting for any funds accepted from the patient for safekeeping. This accounting must be available for inspection by designated department staff and for audit by the department. (d) The department may (1) deny payment to, deny enrollment to, or disenroll a residential psychiatric treatment center in the Medicaid program if the department determines that the facility used a service under 7 AAC 140.415 (d); (2) deny enrollment to or disenroll a residential psychiatric treatment center in the Medicaid program if the department determines that the facility (A) is under investigation, or has been disciplined, by another state for a violation that is substantially similar to a violation under 7 AAC 105.400 ; (B) is no longer accredited by an organization listed in (a)(4) of this section; or (C) does not meet the applicable requirements under 7 AAC 105.120 (b)(2) and (3), if the facility is located out of state. 7 AAC 140.405. Residential psychiatric treatment center admission.