This chapter establishes Alaska Medicaid program integrity requirements applicable to all enrolled Medicaid providers, including fiscal audit procedures, self-identified overpayment reporting and repayment obligations, statistical sampling methodologies, appeal rights for audit findings, and quality assurance program reviews. Providers must maintain records, allow department access, conduct biennial self-audits, and repay identified overpayments within specified timeframes. Non-compliance may result in sanctions, termination from the Medicaid program, or referral to law enforcement. These are general Medicaid administrative provisions, not facility-type-specific licensing or operating standards.
View official source7 AAC 160.100. Program integrity.
The department or its designee shall provide for and operate program integrity activities designed to promote the economical and effective administration of the department's Medicaid program. These activities may include the following:
(1) operation of a surveillance, utilization, and review subsystem within the department's system to manage Medicaid information;
(2) audit activities designed to investigate fraud, abuse, over-utilization or Medicaid program compliance by providers;
(3) utilization review under
7 AAC 160.140
;
(4) coordination with the Department of Law, the United States Department of Justice, and the United States Office of Inspector General.
7 AAC 160.110. Fiscal audit.
(a) The department or its designee shall conduct fiscal audits of Medicaid providers, their subcontractors, and their grantees. A provider that bills the department is responsible for ensuring that records related to the services billed are kept by employees, subcontractors, and grantees, are maintained in accordance with
7 AAC 105.230
, and are made available when requested by the department.
(b) For purposes of this section, a fiscal audit may include a desk audit, a field audit, or both, to determine the provider's compliance with the requirements of 42 U.S.C. 1396,
AS 47.05
,
AS 47.07
, 42 C.F.R. Part 430 - 42 C.F.R. Part 498, and
7 AAC 105
-
7 AAC 160
.
(c) For purposes of conducting an audit under this section, the provider must allow the department or its designee, the federal government, or the Department of Law access to original financial, clinical, and other records documenting care provided to Medicaid recipients.
(d) Except as provided in (e) of this section, the department or its designee will give a provider 30 days' advance notice of an audit to be conducted under this section. The notice will
(1) advise the provider that the department or its designee intends to conduct an audit of the provider's records;
(2) specify the place where the audit is to be conducted;
(3) specify the records that the provider must produce for purposes of the audit;
(4) specify the date by which the provider must produce the records and the address to which the records are to be delivered or inspected; and
(5) advise the provider that the provisions of
7 AAC 105.240
apply to the production of the records requested.
(e) The department or its designee may request and receive immediate access to records and perform an audit of those records without advance notice if the department or its designee has reason to believe, based on credible evidence, that the provider is engaging in a course of conduct or performing an act in violation of the requirements specified in (b) of this section. Notwithstanding the provisions of
7 AAC 105.240
, the provider shall produce the requested records for an immediate audit under this subsection at the provider's place of business or other location as specified by the department or its designee. To provide immediate access to records under this subsection, the provider must make the records available not later than 24 hours after the request. If the provider is unable to produce the records in that timeframe, the provider shall notify the department, not later than 24 hours after the request, of the reason for the delay together with the estimated timeframe to comply.
(f) Following the department's or its designee's audit of a provider's records, the department or its designee will give the provider the written preliminary findings of the audit. The preliminary findings will identify claim-line inaccuracies. The provider has 30 days after the date of the letter informing the provider of the preliminary findings to submit additional documentation or respond to the preliminary findings.
(g) The department will issue the final audit report to the provider no more than 60 days after it has considered any documentation or response submitted under (f) of this section and the audit is complete. The final audit report will include audit or review findings and overpayment amounts identified as a result of the audit.
(h) If the department finds in the final audit report under (g) of this section that the provider has not complied with the requirements specified in (b) of this section,
(1) the department
(A) will recoup or require repayment of any identified overpayment amount from the provider; and
(B) may require that the provider pay interest on applicable overpayments; interest on overpayments will be calculated in accordance with
AS 47.05.200
(b); and
(2) in addition to actions under (1) of this subsection, the department may take one or more of the following actions:
(A) impose sanctions against the provider under
7 AAC 105.400
-
7 AAC 105.490
;
(B) initiate other administrative or civil actions;
(C) refer the matter to another state, federal, or local agency.
(i) For purposes of this section,
(1) "audit" means the process of obtaining competent evidentiary material about a provider through inspection, observation, inquiry, and confirmation sufficient to support a reasonable basis for determining the provider's compliance with the legal requirements of the Medicaid program;
(2) "desk audit" means an audit of a provider conducted by the department or its designee based upon an examination of a provider's records without a visit to the provider's place of business or site where the provider maintains business records;
(3) "field audit" means an audit of a provider conducted by the department or its designee based upon an examination of a provider's records with at least one on-site visit to conduct audit procedures at the provider's place of business or site where the provider maintains business records.
7 AAC 160.115. Duty of a provider to identify and repay self-identified overpayments.
(a) An enrolled provider who bills the department for services rendered during a calendar year shall conduct, once every two years, a review or audit of a statistically valid random sample of claims submitted to the department for reimbursement, unless the provider is being audited under
AS 47.05.200
(a). The universe of claims from which the random sample is drawn must be all claims that are billed with dates of service during the calendar year for the provider and that may be identified at the taxpayer identification level. As part of the self-review or self-audit, a provider shall establish appropriate corrective actions for any deficiencies identified.
(b) A biennial review or audit conducted under this section shall be conducted not earlier than one year following the end of the calendar year to allow for timely filing of all claims.
(c) The provider may use any widely accepted statistical software, such as RAT-STATS, developed by the United States Department of Health and Human Services, Office of Inspector General, to assist in sample size determination, and sample selection, using a minimum of a 90-percent confidence interval.
(d) If a provider identifies overpayments through the biennial review or audit, the provider shall report each overpayment to the department not later than 10 business days after identification of that overpayment. Overpayment reports shall be submitted to the Department of Health, Office of the Commissioner, Medicaid Program Integrity. In this subsection, "business day" means a day other than Saturday, Sunday, or a legal holiday under
AS 44.12.010
.
(e) A provider who was reimbursed
(1) $30,000 or greater for services during the year shall submit a report to the department detailing the claims audited or reviewed together with the results of that review or audit;
(2) $10,000 or greater but less than $30,000 is not required to submit the report to the department but must have the report available for review by the department;
(3) less than $10,000 is not required to produce a report but shall have an attestation form on file and available for review by the department.
(f) The reimbursement values referenced in (e) of this section are based upon the reimbursement values reported in each United States Internal Revenue Service form 1099 that the department issues to the provider by calendar year.
(g) The report or attestation required under this section must be made in writing on a form approved by the department and submitted, if required, to the Department of Health, Office of the Commissioner, Medicaid Program Integrity. The report must include
(1) the method used to sample the claims;
(2) the sampled claims Medicaid assigned transaction control number (TCN);
(3) the outcome of the individual claim audit;
(4) the identified amount of overpayment back to the department; and
(5) if appropriate, a corrective action plan.
(h) A provider shall retain all audit documents, reports, and attestations created as a result of the review for at least seven calendar years following completion.
(i) Not later than 60 days after identification of the overpayment, the provider shall repay the department unless the provider has a repayment agreement with the department. The department may, in the repayment agreement, authorize repayment through one of the following means:
(1) a lump sum payable not later than two months after the date of the discovery of the overpayment;
(2) a payment plan not to exceed two years in length; the department may extend the payment plan beyond two years based on the following factors:
(A) the provider's history of compliance with the Medicaid program generally, including prior payment agreements;
(B) the amount of the overpayment;
(C) the amount of revenue the provider is receiving from Medicaid;
(D) any other factors that would impact repayment, such as type of services being provided;
(3) by offsetting future billings by the provider; if a provider chooses to offset future billings, the amount offset must be repaid not later than two years from the date of the agreement.
(j) If a provider defaults on a repayment under (i) of this section, the department may require immediate payment of the total amount due. If a provider defaults on paying the total amount, the provider is subject to sanctions under
7 AAC 105.400
-
7 AAC 105.490
. Sanctions may include termination from the Medicaid program in accordance with
7 AAC 105.410
.
(k) Under this section, an overpayment is identified when the provider has, through the exercise of reasonable diligence, determined that the provider has received an overpayment and quantified the amount of the overpayment.
(l) The department may review the results of a provider-conducted self-review for accuracy. If the provider does not provide an opportunity for department review under this subsection or obstructs the review, or if the department determines that the provider's self-review is inaccurate, the department may impose sanctions under
7 AAC 105.400
-
7 AAC 105.490
.
(m) For purposes of this section,
(1) "default" means any default that results in written notice from the department;
(2) "immediate repayment" means a payment that is made not later than 30 days after written notice is provided under (m)(1) of this section.
7 AAC 160.120. Use of statistical sampling.
The department, its designee, or a provider may use statistically valid sampling methodologies to
(1) select Medicaid claims for review or audit; and
(2) calculate overpayment amounts to providers that are subject to a provider self-review or self-audit under
AS 47.05.235
and
7 AAC 160.115
, a fiscal audit under
7 AAC 160.110
, or a quality assurance program review under
7 AAC 160.140
.
7 AAC 160.130. Appeal.
(a) A provider may appeal the findings of a final audit conducted under
7 AAC 160.110
and determinations of overpayment amount under the audit. A provider may request reconsideration of the audit findings before a formal appeal. If a provider requests reconsideration, the provider may still request a formal appeal under this section by requesting the appeal not later than 30 days after the date of the notice of decision on reconsideration.
(b) An appeal under this section must
(1) be made in writing and submitted to the Commissioner's Office, Department of Health, P.O. Box 110601, Juneau, Alaska 99811-0601;
(2) be submitted to the commissioner no more than 30 days after the date of the letter transmitting the provider's final audit report;
(3) contain a description of the finding or determination being appealed, a copy of the determination, and the basis upon which the final audit report is challenged; and
(4) include all information and materials, including any new information that the provider requests the commissioner to consider in resolving the appeal.
(c) The department will refer an appeal received under this section to the Department of Administration, office of administrative hearings (
AS 44.64.010
). At the hearing under
AS 44.64.060
, the department must prove by a preponderance of the evidence to the administrative law judge that overpayments were properly identified and that the amount is correctly calculated. The commissioner will render a decision on an appeal after reviewing, under
AS 04.64.060
(e), the record and the proposed decision submitted under
AS 44.64.060
(d) by the administrative law judge.
(d) The commissioner's decision under this section is a final administrative decision. The department will notify the provider of the provider's right to appeal the final administrative decision to the superior court under the Alaska Rules of Appellate Procedure.
7 AAC 160.140. Quality assurance program.
(a) The department, through each division responsible for the administration of the Medicaid program, will establish a quality assurance program to ensure provider compliance with
AS 47.05
,
AS 47.07
, and
7 AAC 105
-
7 AAC 160
.
(b) Under the quality assurance program, the department will conduct program reviews of providers. If the department proposes adverse action as a result of the review, the department will issue a written report of the findings to the provider.
(c) If the department finds in the written report under (b) of this section that the provider has not complied with
AS 47.05
,
AS 47.07
, or
7 AAC 105
-
7 AAC 160
, the department may take one or more of the following actions:
(1) give the provider notice under
7 AAC 105.440
that the department proposes to immediately suspend a provider's participation in the Medicaid program;
(2) find grounds under
7 AAC 105.400
to sanction the provider under
7 AAC 105.410
;
(3) require that the provider be subject to a financial audit if there is a reasonable basis to conclude that the provider has received payments in excess of what is authorized under the Medicaid program;
(4) require the provider to issue a corrective action plan to address a written report of findings issued under (b) of this section;
(5) initiate other administrative or other civil actions;
(6) refer the matter to
(A) another state, federal, or local agency; and
(B) applicable certifying and accrediting agencies.
(d) As a condition for participation in the Medicaid program, an ambulatory surgical center or a hospital, including an inpatient hospital, must have in effect a utilization review plan approved by the United States Department of Health and Human Services if utilization review is performed by a federally contracted Quality Improvement Organization (QIO). The written plan submitted by the hospital or the QIO on behalf of the hospital must include the detailed provisions described in 42 C.F.R. 456.50 - 456.145, adopted by reference in
7 AAC 160.900
.
(e) The approved utilization review plan described in (d) of this section must be implemented through the QIO or a hospital that has been delegated review authority by the QIO.
(f) As a condition for participation in the Medicaid program, a hospital must participate in a review of health care services to Medicaid recipients. The department or its designee will conduct an annual on-site hospital review under this subsection. The review will be planned in advance and in coordination with the hospital.
7 AAC 160.200. Third-party resources.
(a) The department will pay for a service, prescription drug, or supply only to the extent it is a covered service under
AS 47.07.030
and
7 AAC 105
-
7 AAC 160
and only after the recipient has made full use of any other third-party resources available to pay for that service, prescription drug, or supply. A third-party resource includes
(1) workers' compensation under a law or plan of the United States or a particular jurisdiction;
(2) private, employer-based, or public health insurance;
(3) a prepaid health plan;
(4) a program or health plan of the federal government, including
(A) Veterans Administration benefits,
(B) the TRICARE military health plan under 10 U.S.C. 1071 - 1110 for active duty military personnel, reservists, dependents, and retirees, or other military health plan; and
(C) Medicare;
(5) the fishermen's fund (
AS 23.35.060
);
(6) automobile insurance, including uninsured or underinsured motorist insurance;
(7) an indemnity policy; and
(8) another jurisdiction's Medicaid or other medical assistance program.
(b) If a provider treats a recipient for an injury that the provider has reason to believe may have been caused by another individual, institution, corporation, business, or public or private agency, the provider shall notify the department of that belief at the time of billing. The department will evaluate this information to determine if there is potential for legal action, recovery from a settlement, or payment from a third-party resource. The department will not delay payment to the provider pending an evaluation.
(c) If a third-party resource makes a demand for the refund of a claim previously paid by the third-party resource and the billing deadline in
7 AAC 145.005
(c) has expired, the provider has 60 days after the date of demand to bill Medicaid or adjust the original claim. The provider shall include a copy of the third-party resource's demand letter and proof of the refund that the provider made to the third-party resource with the claim.
(d) For purposes of this section, a tribal health program is not a third-party resource.
(e) In this section, "has made full use of" means the recipient has applied for, reasonably cooperated with, and to the extent possible has maintained eligibility for, a third party that will pay for a service, prescription drug, or supply otherwise covered under
AS 47.07.030
and
7 AAC 105
-
7 AAC 160
.
7 AAC 160.210. Estate recovery.
(a) At the time of application, the department will notify each applicant for medical assistance that the estate of an individual who received medical assistance benefits may be subject to a claim for recovery under
AS 47.07.055
and
7 AAC 160.210
-
7 AAC 160.250
.
(b) When the state determines under
7 AAC 160.220
that a recipient who is subject to estate recovery under
AS 47.07.055
cannot be expected to return home or has died, the department will determine
(1) the estimated value of the estate;
(2) if there is a surviving spouse or other estate beneficiaries; and
(3) if proceeding with recovery in accordance with (c) of this section will be permissible and cost effective.
(c) The department will pursue a claim only if it determines that the potential recovery amount would result in twice the administrative and legal cost of pursuing the claim, with a minimum pursuable net amount of $10,000. In assessing the value of an estate, the department will consider allowances and all other claims against the estate having precedence under state statute. For the purposes of this subsection "administrative and legal costs" include the costs of
(1) advertising, filing, and exercising a lien;
(2) legal representation of the state;
(3) tracking property with potential for a lien and then tracking its subsequent recovery;
(4) repair of the property to bring it into saleable condition;
(5) insurance to protect the asset; and
(6) advertising, listing, and selling the home including all applicable closing fees.
(d) When making a claim for reimbursement under
AS 47.07.055
(e), the department will include in that claim any hospital and prescription drug services provided to a recipient while the recipient was receiving services identified in
AS 47.07.055
(e)(1) or (2).
7 AAC 160.220. Liens.
(a) For purposes of
AS 47.07.055
(a)(3), if a recipient resides in a medical institution for at least 120 consecutive days, the department will give the recipient
(1) notice of its intent to determine that the recipient is not reasonably expected to be discharged from the institution and return home; and
(2) an opportunity for a hearing regarding that determination.
(b) A transfer from one medical institution to another does not interrupt the 120-day period for the purposes of (a) of this section. A discharge from a medical institution to a community setting terminates the 120-day period. Re-admission to a medical institution starts a new 120-day period.
(c) The department will not pursue recovery under a lien filed under
AS 47.07.055
(a) against a recipient's home while the recipient's child 21 years of age or older is lawfully residing in the home and can provide documentation that
(1) the child resided with the recipient in the recipient's home for at least 24 months immediately preceding the recipient's admission into a medical institution;
(2) the child has continued to reside in the recipient's home continuously since the institutionalization began; and
(3) the care the child provided enabled the recipient to stay at home rather than move to a medical institution.
(d) Documentation under (c) of this section must include
(1) written evidence that the child used the recipient's address as the child's mailing address on the child's driver's license or voter registration, and that the child's address remained unchanged throughout this entire time period; and
(2) a written statement from the recipient residing in a medical institution or the recipient's treating physician that the child's presence in the home had enabled the recipient to live in the community longer, postponing the need to move to the medical institution.
(e) If the department has decided to place a lien on real property of a recipient, the department shall notify the recipient of the department's intent to place a lien on the real property and to proceed with recovery on the lien after the death of the recipient's surviving spouse, if any. In the notice, the department will include
(1) the recipient's name, date of birth, and date of death, if deceased;
(2) the definition of the term "lien";
(3) an explanation that estate beneficiaries will not lose ownership of the real property if the lien is imposed;
(4) the amount of recoverable Medicaid benefits correctly paid on behalf of the recipient;
(5) the department's intent to file a lien against the recipient's real property to recover the applicable Medicaid benefits paid on behalf of the recipient; and
(6) how to request a hardship waiver and how to appeal the department's decision to proceed with recovery.
7 AAC 160.230. Appealing a lien.
(a) After receiving a notice under
7 AAC 160.220
(e) from the department, the recipient, legal representative of the recipient, or estate beneficiary may file an appeal with the department to
(1) contest the amount of recoverable medical assistance identified by the department;
(2) contest whether the real property is a part of the recipient's estate; or
(3) request a waiver of recovery for undue hardship.
(b) An appeal is timely if the department receives it no more than 30 days after the date on the notice. The department will accept an appeal received more than 30 days after, and no more than 60 days after the date on the notice if the individual demonstrates good cause for the late application.
(c) An appeal must
(1) be submitted in writing;
(2) be signed by the recipient, legal representative of the recipient, or estate beneficiary;
(3) be submitted in person or by mail to the division of the department that administers the estate recovery provisions of the Medicaid program;
(4) include a statement of the reason for contesting the department's action or explaining the reason why recovery will cause undue hardship; and
(5) include contact information for the person contesting the action.
(d) The department will make a decision on a request for waiver for undue hardship no more than 30 days after receipt of the request.
7 AAC 160.240. Waiving estate recovery.
(a) After considering the information gathered in accordance with
7 AAC 160.210
, or after considering an appeal based on
7 AAC 160.230
, the department may waive all or part of the department's claim for recovery.
(b) The department will waive recovery for undue hardship if the department determines that recovery would impoverish the estate beneficiary. To determine if estate recovery would impoverish the estate beneficiary, the department will consider whether
(1) the estate's only asset produces income, and recovery would cause an estate beneficiary's loss of livelihood;
(2) recovery would deprive the beneficiary of food, clothing, shelter, other necessities of life, or medical care, thereby endangering the beneficiary's health and safety;
(3) an estate beneficiary's primary residence is the estate's only significant asset and recovery would cause impoverishment of the estate beneficiary as follows:
(A) recovery of the asset would make the beneficiary eligible for public assistance;
(B) a beneficiary could discontinue eligibility for public assistance if the beneficiary was to receive the asset; or
(4) a beneficiary's primary residence is a home of modest value as determined on the date of the recipient's death; in this paragraph, "modest value" means 50 percent or less of the average price of homes in the community, based on Department of Labor and Workforce Development statistics, and as determined as of the date of the recipient's death.
7 AAC 160.250. Exemptions from estate recovery.
(a) A special low-income Medicare beneficiary under
7 AAC 100.754
who receives assistance from the department only in the form of payment for the beneficiary's Medicare co-payments or deductibles is exempt from estate recovery.
(b) A Medicaid expenditure made for services that a recipient would not have been required to pay for if the recipient was not eligible for Medicaid is exempt from estate recovery.
(c) American Indian and Alaska Native income and resources, including rents, leases, royalties, usage rights, or income from them, are exempt from estate recovery if that income is or those resources are
(1) located on, near, or within the most recent boundaries of a current or prior federally recognized or designated reservation;
(2) derived from the passing of land described in (1) of this subsection from an American Indian or an Alaska Native or descendant of an American Indian or Alaska Native to
(A) one or more relatives, by blood, adoption, or marriage;
(B) another American Indian or Alaska Native; or
(C) an American Indian or Alaska Native group;
(3) derived from the exercise of a federally protected right to extract or harvest natural resources from land described in (1) of this subsection;
(4) held in trust or restricted status or are judgment funds that are exempt from recovery by state law, including the following distributions or conveyances by an Alaska Native corporation organized under to 43 U.S.C. 1601 - 1629h (Alaska Native Claims Settlement Act (ANCSA)) to an Alaska Native or descendant of an Alaska Native:
(A) stock, including stock issued or distributed as a dividend or distribution on stock, or bonds issued by that corporation;
(B) land or an interest land, including land or an interest in land received as a dividend or distribution on stock;
(C) a shareholder homesite conveyed under 43 U.S.C. 1620(j);
(D) an interest in a settlement trust; and
(E) any other property interest that is conveyed, or deemed to be conveyed, under 43 U.S.C. 1601 - 1629h;
(5) originally protected assets and ownership interests that have been inherited, if the protected source can be clearly traced; or
(6) ownership interest in or usage rights to items not included in this subsection, with unique religious, spiritual, traditional, or cultural significance or usage rights that support subsistence or a traditional lifestyle in accordance with applicable tribal law or custom.
(d) In this section,
(1) "Alaska Native group" has the meaning given "Native group" in 43 U.S.C. 1602(d);
(2) "settlement trust" means a trust
(A) established and registered
(i) by an Alaska Native corporation organized under 43 U.S.C. 1601 - 1629h; and
(ii) under the laws of the state and under a resolution of its shareholders; and
(B) operated for the benefit of shareholders, Alaska Natives, and descendants of Alaska Natives, in accordance with 43 U.S.C. 1629e (sec. 39 of the Alaska Native Claims Settlement Act) and the laws of the state.
7 AAC 160.900. Requirements adopted by reference.
(a) The following documents referenced in
7 AAC 105
-
7 AAC 160
are adopted by reference:
(1) American Medical Association, Current Procedural Terminology, Professional Edition, as revised for 2010 ("CPT 2010"), as amended from time to time;
(2) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Healthcare Common Procedure Coding System (HCPCS) 2010, as amended from time to time, and published by the American Medical Association;
(3) International Classification of Diseases - 10th Revision, Clinical Modification (ICD-10-CM), 2016 revision, as amended from time to time;
(4) American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, June 2013 (DSM-5), as amended from time to time;
(5) United States Department of Health and Human Services, National Institutes of Health, Glossary of Terms for Human Subjects Protection and Inclusion Issues, dated April 25, 2001;
(6) Indian Health Service encounter rates, published in 74 Fed. Reg. 27554 - 27555 (June 10, 2009), as amended from time to time;
(7) American Society of Anesthesiologists, Relative Value Guide, 2006, as amended from time to time;
(8) the nonfacility individual relative value units (RVUs) for the Medicare program for each medical procedure, including the geographic practice cost indices (GPCI) for this state, as published in 74 Fed. Reg. 62014 - 62146 and 62148 (Addenda A, B, C, and E) (November 25, 2009), as amended from time to time;
(9) Drug Facts and Comparisons, 2007 edition, published by Wolters Kluwer Health, Inc.;
(10) Overview of the Chart of Accounts, pages 55 - 64 of the publication entitled Chart of Accounts for Hospitals, by L. Vann Seawell, 1994 Edition, ISBN 1-55738-619-6;
(11) repealed 5/19/2023;
(12) Inventory for Client and Agency Planning (ICAP), as revised as of 1986;
(13) repealed 6/2/2019;
(14) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Ambulatory Surgical Centers (ACS) Approved HCPCS Codes and Payment Rates spreadsheet, revised as of February 26, 2007;
(15) United States Department of Health and Human Services, Public Health Service, Quick Reference Guide for Clinicians: Treating Tobacco Use and Dependence, dated October 2000, pages 9 - 11;
(16) the optional standard mileage rate for medical purposes published in the United States Internal Revenue Service announcement IR-2008-82, published June 23, 2008;
(17) repealed 11/3/2012;
(18) repealed 11/3/2012;
(19) the federal Medicare ambulatory surgical center payment rates for federal fiscal year 2000, as set out in 65 Fed. Reg. 6380 - 6383 (February 9, 2000);
(20) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.10 (Cardiac Rehabilitation Programs), Revision 98, revised as of December 24, 2008;
(21) Comptroller General of the United States, Government Auditing Standards, December 2011 revision;
(22) repealed 5/18/2014;
(23) Consumer Price Index for All Urban Consumers (CPI-U), all items, for Anchorage Alaska, as revised for calendar year 2012 by the United States Department of Labor, Bureau of Labor Statistics, and as amended from time to time;
(24) the Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care, revised as of October 2015, as amended from time to time;
(25) the American Academy of Pediatric Dentistry's Recommendations for Pediatric Oral Health Assessment, Preventive Services, and Anticipatory Guidance/Counseling, revised as of 2018;
(26) the American Academy of Pediatric Dentistry's guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents, revised as of 2018;
(27) Zero to Three: National Center for Infants, Toddlers, and Families, Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R), revised as of 2005.
(28) United States Preventive Services Task Force (USPSTF), A & B Recommendations for Adults, revised as of September 2021;
(29) Centers for Disease Control and Prevention (CDC), Immunization Schedules, revised as of February 17, 2022;
(30) Health Resources and Services Administration (HRSA), Women's Preventive Services Guidelines, revised as of January 2022;
(31) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), The Provider Reimbursement Manual - Part 1, Publication Number 15-1, Chapter 21 (Costs Related to Patient Care), published December 30, 2020 as a .pdf document, as indicated on the United States Department of Health and Human Services guidance portal website.
(b) The following provisions of federal statutes and regulations are adopted by reference:
(1) 42 U.S.C. 1396a(bb)(1) - (6), revised as of December 29, 2007;
(2) 42 U.S.C. 1396r-8(k)(6) (definition of "medically accepted indication"), revised as of October 1, 2008;
(3) 42 C.F.R. 405.515 (reimbursement for clinical laboratory services billed by physicians), revised as of October 1, 2008;
(4) 42 C.F.R. 405.2400 - 405.2452 (rural health clinic and federally qualified health clinic services), revised as of October 1, 2020;
(5) 42 C.F.R. Part 418 (hospice care), revised as of October 1, 2008;
(6) 42 C.F.R. Part 442 (standards for payment to nursing facilities and intermediate care facilities for the mentally retarded), revised as of October 1, 2008;
(7) 42 C.F.R. 447.280 (hospital providers of NF services (swing-bed hospitals), revised as of October 1, 2008;
(8) 42 C.F.R. 447.300 - 447.371 (payment methods for other institutional and noninstitutional services), revised as of October 1, 2008;
(9) 42 C.F.R. 447.512 (drugs: aggregate upper limits of payment), revised as of October 1, 2008;
(10) repealed 5/18/2014;
(11) 42 C.F.R. Part 456 (utilization control), revised as of October 1, 2008;
(12) 42 C.F.R. Part 483 (requirements for states and long term care facilities), revised as of October 1, 2008;
(13) 42 C.F.R. 485.701 - 485.729 (conditions of participation for clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services), revised as of October 1, 2008;
(14) 42 C.F.R. 486.100 - 486.110 (conditions for coverage: portable x-ray services), revised as of October 1, 2008;
(15) 42 C.F.R. 488.11 (state survey agency functions) and 42 C.F.R. 488.26 (determining compliance), revised as of October 1, 2008;
(16) 42 C.F.R. Part 491 (certification of certain health care facilities), revised as of October 1, 2020;
(17) repealed 1/1/2013;
(18) 42 C.F.R. Part 494 (conditions for coverage for end-stage renal disease facilities), revised as of October 1, 2011;
(19) 42 C.F.R. 410.50 (institutional dialysis services and supplies: scope and conditions), revised as of October 1, 2011;
(20) 42 C.F.R. 410.52 (home dialysis services, supplies, and equipment: scope and conditions), revised as of October 1, 2011;
(21) 42 C.F.R. 447.26(b) and (c) (prohibition on payment for provider-preventable conditions), revised as of October 1, 2013.
(22) 42 C.F.R. 424.57(c) (Special payment rules for items furnished by DMEPOS suppliers and issuance of DMEPOS supplier billing privileges: Application certification standards), revised as of November 24, 2014;
(23) 42 C.F.R. 447.502 (definitions; covered outpatient drug), revised as of November 25, 2019;
(24) 42 U.S.C. 1396d(gg)(l) (routine patient costs), revised as of March 15, 2022;
(25) 42 U.S.C. 1396d(gg)(2) (qualifying clinical trial defined), revised as of March 15, 2022;
(26) 42 C.F.R. 413.1 - 413.157 (principles of reasonable cost reimbursement), revised as of October 1, 2024.
(c) Repealed 11/3/2012.
(d) The following department documents are adopted by reference:
(1) the Alaska Medicaid Preferred Drug List, as amended from time to time;
(2) the Alaska Medicaid Prior-Authorization Medications List, as amended from time to time;
(3) the description of diagnoses and procedures included in the Select Diagnoses and Procedures Pre-certification List, revised as of January 2008;
(4) repealed 6/2/2019;
(5) the Table of ICAP Broad Independence Scores by Age, revised as of April 5, 2004;
(6) the Consumer Assessment Tool (CAT), revised as of January 29, 2009;
(7) repealed 1/26/2012;
(8) repealed 6/13/2019;
(9) repealed 7/22/2017;
(10) the Chart of Personal Care Services and Community First Choice Services Rates, dated May 1, 2023, for providers of personal care services under
7 AAC 125.010
-
7 AAC 125.199
and Community First Choice services under
7 AAC 127
;
(11) Alaska Commission on Aging, Alaska State Plan for Senior Services, New Funding Formula for Title III and Title V Programs table, page 106, revised for FY 2010 - 2011;
(12) repealed 12/2/2012;
(13) repealed 5/11/2012;
(14) the Addresses for Second Level Provider Appeals list, revised August 2006;
(15) the Revenue Codes: Inpatient Hospitals and Revenue Codes: Outpatient Hospitals tables listed in the Alaska Provider Billing Manual, revised as of October 30, 2013;
(16) the Covered Revenue Codes for Tribal Outpatient Hospitals table and the Covered Revenue Codes for Tribal Inpatient Hospitals table listed in the Alaska Provider Billing Manual, revised as of June 4, 2013;
(17) Table I-1, Procedure Codes: Mental Health Services of the Federally Qualified Health Center/Rural Health Clinic Services section of the Alaska Provider Billing Manual, revised as of January 2003;
(18) the Specialized Medical Equipment Fee Schedule, dated January 25, 2019, for home and community-based waiver services and Community First Choice Services;
(19) the State of Alaska, Department of Health, Behavioral Health Inpatient Psychiatric Review Provider Manual, revised as of October 2015;
(20) Medicaid Hospital and Long-Term Care Facility Reporting Manual, dated August 22, 2022;
(21) Medicaid Log of Uninsured Care Reporting Form, dated February 26, 2002;
(22) the Handicapping Labiolingual Deviation (HLD) Index Report, revised as of October 2010;
(23) repealed 12/1/2022;
(24) the Alaska Geographic Differential Study 2008, Table I-1, dated April 30, 2009;
(25) the Cost Survey andCost Survey Instructions, dated August 18, 2022, for providers of personal care services under
7 AAC 125.010
-
7 AAC 125.199
and home and community-based waiver services under
7 AAC 130
;
(26) repealed 6/30/2021;
(27) repealed 4/24/2020;
(28) repealed 4/24/2020;
(29) the Personal Care Services: Service Level Computation, revised as of June 2, 2017;
(30) the Certificate to Request Funds for Abortion, revised as of December 2013;
(31) repealed 3/31/2021;
(32) the Adult Day Services Conditions of Participation, dated September 5, 2017;
(33) the Care Coordinator Certification Application, dated May 2, 2013;
(34) the Care Coordination Services and Long Term Services and Supports Targeted Case Management Conditions of Participation, dated July 1, 2022;
(35) the Community First Choice Chore Services Conditions of Participation, effective January 1, 2021;
(36) the Day Habilitation Services Conditions of Participation, dated July 1, 2022;
(37) the Developmental Disabilities (DD) Registration and Review form, dated January 4, 2018;
(38) the Material Improvement Reporting for ALI/APDD Waivers, dated May 2, 2013;
(39) the Material Improvement Reporting for CCMC Waivers, dated May 2, 2013;
(40) the Material Improvement Reporting for IDD Participants Age Three or Over, dated May 2, 2013;
(41) the Material Improvement Reporting for IDD Participants Under The Age of Three, dated May 2, 2013;
(42) the Meal Services Conditions of Participation, dated September 5, 2017;
(43) the Nursing Facility Level of Care Assessment Form for Children, dated March 22, 2011;
(44) the Provider Conditions of Participation for Home and Community-Based Waiver Services and Community First Choice Chore Services, effective September 1, 2022;
(45) the Residential Habilitation Services Conditions of Participation, dated September 5, 2017;
(46) the Residential Supported-Living Services Conditions of Participation, dated September 5, 2017;
(47) repealed 10/1/2018;
(48) the Respite Care Services Conditions of Participation, dated July 1, 2022;
(49) the Employment Services Conditions of Participation, dated November 15, 2024;
(50) the Transportation Services Conditions of Participation, dated September 5, 2017;
(51) the Alaska Medicaid 90 Day Generic Prescription Medication List, dated June 27, 2013;
(52) Information About Your Prescription Drug Benefits and Prior Authorization, dated May 2014;
(53) the Environmental Modification Services Conditions of Participation, dated September 5, 2017;
(54) the Orthodontic Referral Oral Health and Hygiene Assessment, revised as of July 2015;
(55) the Personal Care Services and Community First Choice Personal Care Services Provider Conditions of Participation, dated September 1, 2022;
(56) the Rate-Setting Methodology for Personal Care Services, Community First Choice Services, Long-Term Services and Supports Targeted Case Management Services, and Waiver Services, dated August 18, 2022, for providers of personal care services under
7 AAC 125.010
-
7 AAC 125.199
, Community First Choice services under
7 AAC 127
, long term services and supports targeted case management services under
7 AAC 128
, and home and community-based waiver services under
7 AAC 130
;
(57) the Community First Choice Personal Care Services: Service Level Computation, dated August 2, 2018;
(58) the Chart of Long Term Services and Supports Targeted Case Management Services Rates, dated May 1, 2023;
(59) the Chart of Community Behavioral Health and Mental Health Physician Clinic Medicaid Covered Services Rates, dated February 12, 2026;
(60) Medicaid Form E-1, dated July 2018;
(61) the Nursing Oversight and Care Management Services Conditions of Participation, dated January 25, 2019.
(62) the Chart of Waiver Services Rates, dated May 1, 2023, for providers of home and community-based waiver services under
7 AAC 130
;
(63) repealed 5/21/2020;
(64) repealed 2/2/2024;
(65) Chart of Behavioral Health Reform 1115 Medicaid Services Rates, dated April 28, 2026;
(66) the Adverse Childhood Experiences Questionnaires, dated May 27, 2020;
(67) the Alaska Behavioral Health Provider Service Standards & Administrative Procedures for SUD Provider Services, dated October 9, 2023;
(68) the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, dated October 9, 2023;
(69) Chart of Psychiatric Residential Treatment Facility Rates, dated November 31, 2021;
(70) the Supplemental Emergency Medical Transportation (SEMT) Cost Report, dated February 24, 2021;
(71) the Supplemental Emergency Medical Transportation (SEMT) Cost Report Instructions, dated April 1, 2021;
(72) the Supplemental Emergency Medical Transportation (SEMT) Provider Participation Agreement, dated April 1, 2021;
(73) Medicaid Procedure Codes and Rates - Autism Services, dated February 12, 2026;
(74) Chart of Justice-Involved Youth Targeted Case Management Services Rate, dated April 16, 2025.
(e) The following department fee schedules are adopted by reference:
(1) State Fiscal Year 2019 CPT Fee Schedule for Chiropractic Services, revised as of August 24, 2018;
(2) State Fiscal Year 2024 Fee Schedule: Dental Services for Children, revised as of September 11, 2023, State Fiscal Year 2024 Fee Schedule: Emergent Adult Dental Services, revised as of September 11, 2023, State Fiscal Year 2024 Fee Schedule: Prosthodontic Adult Dental Services, revised as of September 11, 2023, and State Fiscal Year 2024 Fee Schedule: Enhanced Adult Dental Services, revised as of September 11, 2023, and State Fiscal Year 2024 Fee Schedule: Advanced Practice Dental Hygienist Services, dated September 11, 2023;
(3) State Fiscal Year 2024 Fee Schedule for Direct-Entry Midwife Services, revised as of August 11, 2023;
(4) State Fiscal Year 2019 CPT Fee Schedule for Audiology Services, Table I-2(a), State Fiscal Year 2019 HCPC Fee Schedule for Audiology Services, Table I-2(b), and State Fiscal Year 2019 HCPC Fee Schedule for Hearing Aid Dealer Services, Table I-3, revised as of January 15, 2019;
(5) 2019 CPT Fee Schedule for Home Infusion Therapy Services, Table I-3(a), revised as of September 10, 2018, and 2019 HCPC Fee Schedule for Home Infusion Therapy Services, Table I-3(b), revised as of September 10, 2018;
(6) repealed 7/1/2019;
(7) State Fiscal Year 2022 Fee Schedule for Therapy Services, revised as of November 2, 2021;
(8) repealed 3/3/2023;
(9) repealed 3/3/2023;
(10) State Fiscal Year 2019 CPT Fee Schedule for Podiatry Services, and State Fiscal Year 2019 HCPC Fee Schedule for Podiatry Services, revised as of August 24, 2018;
(11) State Fiscal Year 2019 CPT Fee Schedule for School-Based Services, and State Fiscal Year 2019 HCPC Fee Schedule for School-Based Services, revised as of January 22, 2019;
(12) repealed 3/3/2023;
(13) Transportation/Accommodation Fee Schedule, revised as of June 29, 2018;
(14) State Fiscal Year 2022 Fee Schedule for Vision Services, revised as of November 4, 2021;
(15) Alaska Medicaid DMEPOS Fee Schedule, Table I-5, revised as of March 30, 2018;
(16) Alaska Medicaid DMEPOS Fee Schedule, Table I-6, revised as of March 30, 2018;
(17) Alaska Medicaid DMEPOS Fee Schedule, Table I-7, revised as of March 30, 2018;
(18) Alaska Medicaid DMEPOS Fee Schedule, Table I-8, revised as of March 30, 2018;
(19) Alaska Medicaid DMEPOS Fee Schedule, Table I-9, revised as of March 30, 2018.
(20) Fee Schedule for Independent Licensed Professional Counselors (LPC), dated July 1, 2022;
(21) Fee Schedule for Independent Licensed Marital and Family Therapists (LMFT), dated July 1, 2022;
(22) Fee Schedule for Independent Licensed Clinical Social Workers (LCSW), dated July 1, 2022.
(23) State Fiscal Year 2023 Fee Schedule for Pharmacist Renderer, revised as of February 14, 2022.
(f) The United States Department of Health and Human Services federal poverty guidelines for this state, established in 73 Fed. Reg. 3971 - 3972, revised as of January 23, 2008, and as amended from time to time, are adopted by reference.
7 AAC 160.990. Definitions.
7 AAC 160.990(110) and (111) were effective as an emergency regulation July 1, 2019. 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 160.990 as published in Register 232.
Effective July 1, 2022, Executive Order 121 split the former Department of Health and Social Services into the Department of Health and the Department of Family and Community Services. As of Register 242 (July 2022), the regulations attorney made a conforming technical revision under sec. 138, E.O. 121 and
AS 44.62.125
(b)(6), to the definition of "department" in
7 AAC 160.990(b).
(a) In the definition of "health facility" in
AS 47.07.900
, "outpatient surgical clinic" means an ambulatory surgical center.
(b) In
7 AAC 105
-
7 AAC 160
, unless the context requires otherwise,
(1) "Alaska Native" has the meaning given "Native" in 43 U.S.C. 1602(b);
(2) "ambulatory surgical center" has the meaning given in
AS 47.32.900
;
(3) "American Indian" has the meaning given "Indian" in 25 U.S.C. 479;
(4) "claim" means a request for payment submitted to the department, on paper or electronically, by a Medicaid provider who has provided a service to a recipient under
7 AAC 105
-
7 AAC 160
;
(5) "clinical social worker" means an individual licensed as a clinical social worker under
AS 08.95
;
(6) "CMS" means the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services;
(7) "community mental health clinic" means a program
(A) headed by a
(i) physician, who may be a psychiatrist; or
(ii) psychologist or mental health professional clinician working under the general direction of a physician;
(B) that provides mental health services; and
(C) operates
(i) under
7 AAC 71
; or
(ii) as a state-operated community mental health clinic;
(8) "continued stay" mean a stay in a facility that is uninterrupted by a discharge and readmission;
(9) "covered" or "coverage" means the department pays for all or part of that service as a Medicaid service under
AS 47.07.030
and
7 AAC 105
-
7 AAC 160
;
(10) repealed 6/29/2017;
(11) "crisis intervention" means short-term mental health services provided to a recipient during an acute episode of a mental, emotional, or behavioral disorder, that are intended to reduce the symptoms of the disorder, prevent harm to the recipient or others, prevent further relapse or deterioration of the recipient's condition, or stabilize the recipient;
(12) "department" means the Department of Health;
(13) "dispensing provider" means one of the following entities, if that entity dispenses drugs as part of a medical practice, does not employ a pharmacist to dispense drugs, and is not enrolled with Medicaid as an outpatient pharmacy:
(A) a physician;
(B) a podiatrist;
(C) a physician assistant;
(D) an advanced practice registered nurse;
(E) a rural health clinic that meets the requirements of
7 AAC 140.210
;
(F) a federally qualified health center that meets the requirements of
7 AAC 140.205
;
(G) a tribal health program;
(14) "EPSDT" means the early periodic screening, diagnosis, and treatment program under Medicaid;
(15) "estate" has the meaning given in
AS 13.06.050
;
(16) "facility" means
(A) a general acute care hospital;
(B) a specialty hospital; in this subparagraph, "specialty hospital" has the meaning given in
7 AAC 150.990
;
(C) a nursing facility;
(D) an intermediate care facility for individuals with an intellectual disability or related condition;
(E) an inpatient psychiatric hospital;
(F) a rural health clinic;
(G) a federally qualified health center;
(H) an ambulatory surgical center;
(I) a home health agency, except that in
7 AAC 150
, "facility" does not include a home health agency; or
(J) a residential psychiatric treatment center, except that in
7 AAC 150
, "facility" does not include a residential psychiatric treatment center;
(K) an end-stage renal disease facility;
(17) "family psychotherapy" means a form of therapy in which members of a family or any two or more individuals sharing a household, one of whom is a Medicaid recipient, attend psychotherapy sessions together for the treatment of relationships within the family or household to achieve better emotional, behavioral, or social adjustments of all the individuals within the family or household;
(18) "federal and state laws" means laws of the United States government and laws of a jurisdiction of the United States;
(19) "federally qualified health center" means a facility that has filed an agreement with the department to provide federally qualified health center services under Medicaid;
(20) "fiscal agent" means an organization that processes and pays provider claims on behalf of the department;
(21) "freestanding facility" means a facility that is individually licensed and enrolled to provide health care services independent from administrative or financial control of another facility;
(22) "functional assessment" means a systematic evaluation of a recipient to assess that recipient's functioning level in the areas of living skills, learning, education, work, interpersonal skills, and other life skills necessary for independent living, in order to develop an individualized written treatment plan;
(23) "general acute care hospital" has the meaning given in
7 AAC 12.990
;
(24) "group practice" means a legally organized partnership, professional corporation, foundation, nonprofit corporation, or similar association comprised of one or more health care providers;
(25) "group skill development services" means face-to-face therapeutic skill instruction, skill practice, and skill monitoring, offered in a group setting, designed to help the recipient develop or improve specific self-care, self-direction, communication, or social-interaction skills necessary for successful community adjustment and interaction with persons in the recipient's home, school, work, or community environment;
(26) "home and community-based waiver services" means services provided under
AS 47.07.045
and
7 AAC 130
;
(27) "home and community-based waiver services provider" means a provider that the department has certified under
7 AAC 130.220
to provide one or more home and community-based waiver services;
(28) "hospice care" has the meaning given in
AS 47.07.900
;
(29) "hospital" means a facility licensed by the department under
7 AAC 12
to provide inpatient and outpatient hospital services;
(30) "ICF" means an intermediate care facility;
(31) "ICF/IID" means an intermediate care facility for individuals with an intellectual disability or related condition;
(32) "individual psychotherapy" means any form of treatment for mental illness, behavioral maladaptation, or other problems that are assumed to be of an emotional nature, in which a trained individual deliberately establishes a professional relationship with an individual for the purpose of removing, modifying, or retarding existing symptoms, attenuating or reversing disturbed patterns of behavior, and promoting positive personality growth and development;
(33) "individual skill development services" means face-to-face therapeutic self-care and life skill instruction, skill practice, and skill monitoring, provided to an individual, and designed to help the recipient develop or improve specific self-care skills, engage in age-appropriate social behavior, maintain the recipient's household, and develop the ability to be independent within the recipient's community;
(34) "inpatient interdisciplinary team" means a team composed of physicians and other personnel who are employed by an inpatient psychiatric hospital facility, a residential psychiatric treatment center, or an individual who renders services to recipients in either facility;
(35) "inpatient psychiatric hospital" means a hospital or part of a hospital, other than a residential psychiatric treatment center, that delivers medical and inpatient psychiatric services described in
7 AAC 12.215
;
(36) "inpatient psychiatric services" means diagnostic and treatment services for mental, behavioral, and emotional disorders provided in an inpatient psychiatric hospital that meets the conditions for payment under
7 AAC 140.350
, or provided in a residential psychiatric treatment center that meets the conditions for payment under
7 AAC 140.400
;
(37) "intake assessment" means a systematic evaluation of a recipient upon admission to services, and periodically during the course of treatment, to assess and document mental status, social and medical history, the presenting problems and related symptoms, the recipient's strengths and resources, and service needs of the recipient for the purposes of establishing a diagnosis and developing an individualized treatment plan;
(38) "intermediate care facility" means a nursing facility that provides intermediate care services described in
7 AAC 140.510
; "intermediate care facility" does not include an intermediate care facility for individuals with an intellectual disability or related condition;
(39) "intermediate care facility for individuals with an intellectual disability or related condition" means a facility, or a distinct part of one, that
(A) is licensed under
AS 47.32
;
(B) is primarily for the diagnosis, treatment, or rehabilitation of individuals with intellectual or developmental disabilities or individuals with related conditions; and
(C) has met the conditions for payment under
7 AAC 140.600
;
(40) "jurisdiction" means a state or territory of the United States and the District of Columbia;
(41) "legend drug" has the meaning given in
AS 08.80.480
;
(42) "long-term care" means
(A) services provided in a nursing facility;
(B) services provided in an intermediate care facility for individuals with an intellectual disability or related condition;
(C) home and community-based waiver services; or
(D) any other services received in a medical institution by a recipient who is an institutionalized individual required to pay a portion of that individual's income toward the cost of care under
7 AAC 100.550
-
7 AAC 100.579
;
(43) "long-term care facility" means an intermediate care facility for individuals with an intellectual disability or related condition or a nursing facility;
(44) "Medicaid" means the medical assistance program administered by the department under 42 U.S.C. 1396 - 1396v and
AS 47.07
, including those eligibility groups and services for which additional federal financial participation is available under 42 U.S.C. 1397aa;
(45) "medical institution" has the meaning given in
7 AAC 100.990
;
(46) "Medicare" means the medical assistance program administered by the federal government through private health insurance companies under 42 U.S.C. 1395 - 1395iii;
(47) "Medicare cost report" means the uniform cost report that a facility must prepare under 42 C.F.R. 413.20 - 413.24;
(48) repealed 10/1/2011;
(49) "mental health professional clinician" means
(A) an individual who
(i) is working for an enrolled community behavioral health services provider;
(ii) is performing community behavioral health services that are within that individual's field of expertise;
(iii) is not working in a capacity that requires the individual to be licensed under
AS 08
; and
(iv) has a master's degree or more advanced degree in psychology, counseling, child guidance, community mental health, marriage and family therapy, social work, or nursing;
(B) a nurse who
(i) has a master's degree in nursing;
(ii) has received special training or experience in mental health;
(iii) has an active license to practice nursing issued by the jurisdiction in which the nurse provides services, or if services are provided in this state, holds an active license under
AS 08.68
; and
(iv) is working in the individual's field of expertise;
(C) a marital and family therapist who
(i) has an active license to practice marital and family therapy issued by the jurisdiction in which the marital and family therapist provides services, or if services are provided in this state, holds an active license under
AS 08.63
; and
(ii) is working in the individual's field of expertise;
(D) a professional counselor who
(i) has an active license to practice as a professional counselor issued by the jurisdiction in which the professional counselor provides services, or if services are provided in this state, holds an active license under
AS 08.29
; and
(ii) is working in the individual's field of expertise;
(E) a social worker who
(i) has a master's degree in social work;
(ii) has an active license to practice as a social worker issued by the jurisdiction in which the social worker provides services, or if services are provided in this state, holds an active license under
AS 08.95
; and
(iii) is working in the individual's field of expertise; or
(F) a psychologist or psychological associate who
(i) has an active license to practice as a psychologist or psychological associate issued by the jurisdiction in which the psychologist or psychological associate provides services, or if services are provided in this state, holds an active license under
AS 08.86
; and
(ii) is working in the individual's field of expertise;
(50) "nursing facility" has the meaning given in
AS 18.20.390
; "nursing facility" includes a skilled nursing facility and an intermediate care facility;
(51) "part A of Medicare" means that portion of the Medicare program providing coverage for hospital care under 42 U.S.C. 1395c - 1395i-5;
(52) "patient" means an individual who receives medical attention, care, or treatment;
(53) "person" has the meaning given in
AS 01.10.060
; "person" includes a municipality and the state;
(54) repealed 10/1/2011;
(55) "physiatrist" means a physician who specializes in that branch of medicine using physical therapy, physical agents, such as light, heat, water, and electricity, and mechanical apparatus, in the diagnosis, prevention, and treatment of bodily disorders known as physiatrics;
(56) "prescription drug" has the meaning given in
AS 08.80.480
;
(57) "primary care" means the provision of professional comprehensive health services that includes health education and disease prevention, initial assessment of health problems, treatment of acute and chronic health problems, and the overall management of an individual's or family's health care services;
(58) "prior authorization" means approval by the department, in accordance with
7 AAC 105.130
and service-specific requirements in
7 AAC 105
-
7 AAC 160
, of a certain type and number of units of Medicaid-covered services before those services are provided;
(59) "provider" means an individual, firm, corporation, association, or institution that provides, medical assistance to a recipient under Medicaid;
(60) "psychiatric assessment" means a systematic evaluation of a recipient to determine symptomatology, establish a diagnosis, and prescribe needed treatment;
(61) "psychiatric facility" means a licensed hospital facility or part of a licensed hospital facility that is primarily for the diagnosis and treatment of mental, emotional, or behavioral disorders;
(62) "psychiatrist" means a physician licensed to practice medicine in the jurisdiction in which services are provided, and who has completed a fully qualified residency in psychiatry;
(63) "psychological associate" means an individual licensed in the jurisdiction in which services are provided, who renders specific mental health services in association with a licensed psychologist within the scope of practice identified in
12 AAC 60.185
;
(64) repealed 10/1/2011;
(65) "psychologist" means an individual who is licensed to practice psychology in the jurisdiction in which services are provided;
(66) "psychosocial assessment" has the meaning given in this section for "functional assessment";
(67) "quality improvement organization" or "QIO" means an organization that has a contract with the Department of Health and Human Services, Centers for Medicare and Medicaid Services, under part B of title XI of the Social Security Act, 42 U.S.C. 1320c - 1320c-12, to perform utilization and quality control review of the health care furnished, or to be furnished, to Medicare beneficiaries, and operates under a contract with the state to provide preadmission screening and utilization review services;
(68) "RBRVS" means resource-based relative value scale;
(69) "recipient" means an individual who has been determined eligible for Medicaid in this state, including home and community-based waiver services, and who is receiving, is authorized to receive, or has received a Medicaid-covered service from a provider enrolled in the Medicaid program in this state;
(70) "recipient's representative" means a parent, guardian, or other individual with legal authority to act on the recipient's behalf;
(71) "recoupment" means an action by the department to recover an overpayment by reducing future payments to the provider until the amount of the overpayment has been offset;
(72) "rendering provider" means a provider whose direct services are paid through a health care provider enrolled under
7 AAC 105.200
(a);
(73) "residential care" means a residential living arrangement that provides a structured setting with supervision and care where the needs of the residents are largely social; a facility providing residential care is one that offers
(A) shelter, food, household maintenance, encouragement, and assistance to the residents;
(B) guidance as necessary in activities of daily living;
(C) social and recreational activities and opportunities; and
(D) arrangements made to secure medical services when the need is indicated;
(74) "residential psychiatric treatment center" means a freestanding facility that
(A) provides residential child care and inpatient psychiatric services for the diagnosis and treatment of child and adolescent mental, emotional, or behavioral disorders;
(B) is licensed under
AS 47.32
;
(C) meets the requirements of
7 AAC 140.400
; and
(D) is not a provider eligible for payment under
7 AAC 150
;
(75) "respite care" means care provided to an individual for the purpose of relief of family members or other regular care providers in the home, except for personal care assistants;
(76) "rural health clinic" means a facility that has filed an agreement with the department to provide rural health clinic services under Medicaid;
(77) "RVU" means relative value unit;
(78) "service" means a medical evaluation or procedure, drug, medical supply, item, equipment, transportation, or other benefit related to an individual's health or delivery of health care;
(79) "skilled nursing facility" has the meaning given in 42 U.S.C. 1395i-3(a);
(80) "SNF" means a skilled nursing facility;
(81) "tribal health program" means a hospital, clinic, or other type of health care facility or program operated by
(A) the United States Department of Health and Human Services, Indian Health Service;
(B) an Indian tribe as defined in 25 U.S.C. 450b(e) and 458aaa(b);
(C) a tribal organization as defined in 25 U.S.C. 450b( l); or
(D) an inter-tribal consortium as defined in 25 U.S.C. 458aaa(a)(5) or established by federal law;
(82) "utilization review" means the process of evaluating the appropriateness and efficient use of medical services and facilities, including admission criteria, length of stay, and discharge practices;
(83) "skilled nursing visit" means a personal visit by a nurse to perform a level of care or treatment that requires the nurse to be licensed in the jurisdiction in which services are provided;
(84) "national drug code" or "NDC" means the code assigned by the United States Food and Drug Administration under 21 C.F.R. Part 207 (registration of producers of drugs and listing of drugs in commercial distribution);
(85) repealed 6/16/2016;
(86) "behavioral health clinical associate" means an individual
(A) who has less than a master's degree in psychology, social work, counseling, or a related field with specialization or experience in providing rehabilitation services to recipients with severe behavioral health conditions;
(B) whose responsibilities may include provision of psychosocial evaluation, education related to a recipient's behavioral health condition, encouraging and coaching, counseling, and teaching of needed life skills; and
(C) who works within the scope of the individual's training, experience, and education;
(87) "behavioral health services" means the behavioral health clinic services identified in
7 AAC 135.010
(b) and the behavioral health rehabilitation services identified in
7 AAC 135.010
(c);
(88) repealed 6/16/2016;
(89) "community behavioral health services provider" has the meaning given in
7 AAC 70.990
;
(90) "counseling" means an exchange of information, opinions, and ideas between the recipient and the recipient's provider about the recipient's life choices and behaviors for the purpose of helping the recipient make positive changes in the recipient's behavior;
(91) "detoxification" means the immediate physiological stabilization, diagnosis, and treatment of a recipient who is intoxicated, incapacitated, or experiencing withdrawal from using alcohol or drugs;
(92) "functional impairment"
(A) means a disorder that substantially interferes with or prevents a recipient from achieving or maintaining one or more developmentally appropriate social, behavioral, cognitive, communicative, or adaptive skills;
(B) includes disorders of episodic, recurrent, or continuous duration;
(C) does not include temporary, expected responses to stressful events in the recipient's environment;
(93) "group psychotherapy" means a form of psychotherapy in which two or more individuals participate together in the presence of one or more psychotherapists;
(94) "mental, emotional, or behavioral disorder" means a disorder identified by a provider listed in
7 AAC 135.030
and in accordance with the
(A) Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in
7 AAC 160.900
;
(B) International Classification of Diseases, adopted by reference in
7 AAC 160.900
; or
(C) Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R), adopted by reference in
7 AAC 160.900
;
(95) "mental health physician clinic" means a clinic, operated by one or more psychiatrists, that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more of the professionals identified in
7 AAC 135.030
(d)(2);
(96) repealed 4/9/2017;
(97) "neuropsychological testing" means the administration of specific psychological tests that are designed to measure and identify cognitive impairments that may be the result of brain damage;
(98) "psychotherapy" means the treatment of a mental, emotional, or behavioral disorder through the use of psychological techniques;
(99) "recipient's residence"
(A) means the physical location where the recipient conducts the daily activities of sleeping and storage of personal possessions, whether temporary or permanent, regardless of recipient ownership;
(B) includes a dwelling maintained by a public or private support organization or an assisted living home;
(100) "severe behavioral health disorder" means an individual
(A) has a substance use disorder;
(B) is a child experiencing a severe emotional disturbance; or
(C) is an adult experiencing a serious mental illness;
(101) "substance abuse" means a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances;
(102) "substance use disorder" means a disorder that is identified by a diagnostic code found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in
7 AAC 160.900
, and that is related to
(A) alcohol, amphetamine, or similar acting sympathomimetics;
(B) cannabis, cocaine, hallucinogens, inhalants, nicotine, or opioids;
(C) analogs of phencyclidine (PCP) or similar arylcyclohexylamines; or
(D) sedatives, hypnotics, or anxiolytics;
(103) "urinalysis" means laboratory testing of a recipient's urine performed by a laboratory accredited under 42 C.F.R. Part 493;
(104) "Medicare Part B" means that portion of the Medicare program providing coverage for physician and outpatient care under 42 U.S.C. 1395j - 1395w-5;
(105) "FDA" means the United States Food and Drug Administration;
(106) "opioid use disorder treatment program" means an individual or entity that
(A) administers or dispenses a narcotic drug to a narcotic addict for withdrawal or maintenance treatment;
(B) provides to individuals when appropriate or necessary a comprehensive range of medical and behavioral health clinical and rehabilitative services; and
(C) is approved under
7 AAC 70
.
(107) "background check" means the processing of an individual's fingerprints, name, social security number, and other identifying information as described in
7 AAC 10.915
;
(108) "Community First Choice personal care services" means personal care services provided under
7 AAC 127
;
(109) "Community First Choice services" means personal care services and other services provided under
7 AAC 127
;
(110) repealed 11/10/2019;
(111) "1115 waiver" means the Substance Use Disorder and Behavioral Health Program demonstration approved by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services as a section 1115 waiver under 42 U.S.C. 1315(a);
(112) "inmate of a public institution" has the meaning given in 42 C.F.R. 435.1010;
(113) "justice-involved youth" has the meaning given "eligible juvenile" in 42 U.S.C. 1396a(nn); for purposes of this paragraph, "juvenile" has the meaning given in 42 U.S.C. 1396a(nn).
Chapter 165
Alaska Medicaid Electronic Health Record Incentive Program
7 AAC 165.001. Purpose.
The purpose of this chapter is to encourage selected Medicaid providers to deploy and use electronic health record technology and the electronic health information exchange system created under
AS 18.23.300
- 18.23.325.
7 AAC 165.020. Provider registration and attestation.
(a) To participate in the Alaska Medicaid electronic health record incentive program a provider must electronically register using the
(1) Medicare and Medicaid electronic health record incentive program registration and attestation system; and
(2) Alaska Medicaid state-level registry for provider incentive payments.
(b) To complete the registration, a provider must submit to the department the provider's
(1) state Medicaid enrollment number;
(2) state professional or facility licensing information;
(3) Medicaid patient volume or needy individual patient volume that meets the minimum requirements of
7 AAC 165.010
;
(4) federal taxpayer identification number that the provider is using to identify the individual or group who will receive the incentive payment;
(5) national provider identifier number under 45 C.F.R. 162.402 - 162.414 that the provider will use to participate in the Alaska Medicaid electronic health record incentive program;
(6) attestation that meets the requirements of (c) or (d) of this section; and
(7) electronic mail address to be used for official correspondence between the department and provider.
(c) If registering to participate in the Alaska Medicaid electronic health record incentive program for the first time, a provider must attest
(1) to meeting the annual Medicaid patient volume or needy individual patient volume requirements of
7 AAC 165.010
;
(2) to adopting, implementing, or upgrading of electronic health records technology used in the provider's practice, or to meeting, with respect to that technology, the meaningful use objectives and measures applicable to the type of provider that are established in 42 C.F.R. 495.6, revised as of November 12, 2012, and adopted by reference;
(3) that the electronic health records technology used is certified by the national coordinator for health information technology under 45 C.F.R. 170.102 - 170.306;
(4) to the accuracy of the electronic health record certification number provided;
(5) to any voluntary assignment made by the provider; and
(6) to the accuracy of the data used to determine the incentive payment calculations, if the provider is a hospital provider; the data used must be available for inspection under
7 AAC 105
.
(d) If registering for any participation year after the provider's initial year of participation in the Alaska Medicaid electronic health records incentive program, the provider must attest to
(1) meeting the applicable annual Medicaid patient volume or needy individual patient volume requirements of
7 AAC 165.010
;
(2) using the data in a manner that meets the meaningful use objectives and measures applicable to the type of provider that are established in 42 C.F.R. 495.6, adopted by reference in (c)(2) of this section;
(3) the accuracy of the electronic health record certification number provided;
(4) any voluntary assignment made by the provider; and
(5) the accuracy of the data used to determine the incentive payment calculations, if the provider is a hospital provider; the data used must be available for inspection under
7 AAC 105
.
(e) The electronic registration process is not complete until
(1) the provider sends the attestation and all supporting documentation to the department as an electronic document through the Alaska Medicaid state-level registry for provider incentive payments; and
(2) the department has received the material submitted under (1) of this subsection.
(f) Before determining if the provider meets the requirements of this chapter, the department may request any missing or additional information from the provider. If missing or additional information is required, the department will notify the provider by electronic mail of the specific information needed. A provider must submit the additional information to the department no later than 30 days after the date of the electronic mail notice. If the provider fails to submit the required information during that period, the department will determine the registration incomplete.
(g) Before determining if the provider meets the requirements of this chapter, the department will evaluate the facts to which the provider has attested and may request additional information from sources other than the provider to validate the provider's attestation submitted under this section.
7 AAC 165.030. Participation and payment determinations.
(a) If the department determines that a provider meets the requirements of
7 AAC 165.010
and
7 AAC 165.020
, the department will
(1) send to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), an electronic request for validation, through CMS's automated national level registry, that the provider is not
(A) deceased;
(B) federally sanctioned; or
(C) paid, in the same year, an incentive payment from Medicare or another jurisdiction, unless the provider is a hospital provider; and
(2) upon receiving validation through the CMS registry, notify the provider of the approval.
(b) If the department determines that a provider does not meet the requirements of
7 AAC 165.010
and
7 AAC 165.020
, or if the department does not receive validation from CMS, the department will notify the provider of the
(1) reason for denial; and
(2) the provider's right to request an appeal under
7 AAC 165.080
.
(c) If a change occurs in the information that the department used to deny participation, or that previously resulted in a failure to receive CMS validation, the provider may submit a new or updated attestation at any time during that payment year.
7 AAC 165.040. Incentive payments.
(a) The department will make an incentive payment to a provider under this chapter in accordance with
(1) the requirements of 42 C.F.R. 495.308 - 495.312, revised as of September 4, 2012, and adopted by reference; and
(2) if a hospital provider, the payment schedule identified in (b) of this section.
(b) If a hospital provider continues to be eligible for participation in the Alaska Medicaid electronic health record incentive program each payment year, the department will pay, as follows, the aggregate amount determined under this chapter and 42 C.F.R. 495.310, adopted by reference in (a)(1) of this section, to that provider:
(1) in the first year of participation, 50 percent of the aggregate amount;
(2) in second year of participation, 40 percent of the aggregate amount;
(3) in the third year of participation, 10 percent of the aggregate amount.
(c) Before making a payment under this chapter, the department will verify that the federal taxpayer identification number to which the provider attested under
7 AAC 165.020
is the federal taxpayer identification number of a Medicaid-enrolled provider under
7 AAC 105
-
7 AAC 160
.
7 AAC 165.050. Program standards for continuing participation.
(a) A provider who has received an incentive payment under this chapter must continue to meet the eligibility standards for that payment through the entire payment year.
(b) The department may investigate a provider and audit the provider's records to verify that the provider
(1) continues to be enrolled and in compliance with the Medicaid program under
7 AAC 105
-
7 AAC 160
;
(2) continues to meet the requirements of this chapter, including
(A) the accurate calculation and reporting of Medicaid patient volume, needy individual patient volume, and total patient volume for the type of provider, in accordance with 42 C.F.R. 495.302 - 495.306, adopted by reference in
7 AAC 165.010
(b)(1); and
(B) in each participation year after the provider's initial year of participation, meaningful use objectives and measures applicable to the type of provider that are established in 42 C.F.R. 495.6, adopted by reference in
7 AAC 165.020
(c)(2);
(3) received accurate payments; and
(4) is not subject to any sanctions under
7 AAC 105.400
-
7 AAC 105.490
.
(c) An investigation or audit conducted under (b) of this section may include any information the provider used to justify payment under this chapter, including the results of any Medicaid claim or payment information generated under
7 AAC 105
-
7 AAC 160
.
(d) If the department finds that a provider is deficient for any reason listed in (b) of this section, the department may take any of the following actions:
(1) suspend an incentive payment until the provider has removed the deficiency to the satisfaction of the department;
(2) require full repayment of all or a portion of an incentive payment;
(3) terminate participation in the Alaska Medicaid electronic health record incentive program;
(4) terminate or suspend participation in the Medicaid program in this state.
(e) Any action taken by the department under (d) of this section may be appealed by the provider under
7 AAC 165.080
.
7 AAC 165.080. Appeals.
(a) A provider may appeal the department's decision to do any of the following:
(1) deny participation in the Alaska Medicaid electronic health records incentive program under
7 AAC 165.030
;
(2) suspend an incentive payment under
7 AAC 165.050
;
(3) require repayment of all or a portion of an incentive payment under
7 AAC 165.050
;
(4) terminate participation in the Alaska Medicaid electronic health record incentive program under
7 AAC 165.050
;
(5) terminate or suspend participation in the Medicaid program in this state under
7 AAC 105.490
.
(b) To appeal a decision by the department a provider must submit a written request for a first-level appeal to the department no later than 30 days after the date of the department's letter denying participation. The request for a first-level appeal must specify the basis upon which the department's decision is challenged and include any supporting documentation. A first-level appeal will be conducted by the supervisor who oversees the health information technology program in the department.
(c) Upon receipt of a request for a first-level appeal, if the department has suspended an incentive payment, the department may continue suspending the payment until a final determination is made regarding the appropriateness of the suspension.
(d) The department will notify the provider in writing of the department's first-level appeal decision.
(e) A provider who is not satisfied with the first-level appeal decision under (d) of this section may request a second-level appeal by submitting a written request to the commissioner no later than 30 days after the date of the first-level appeal decision. The request for second-level appeal must include
(1) a copy of the department's first-level appeal decision;
(2) a description of the basis upon which the decision is being appealed;
(3) a copy of the first-level appeal submitted by the provider; and
(4) any additional supporting documentation that supports the basis upon which the provider is making the appeal.
(f) The commissioner's review of the original appeal record, decision, and any additional material submitted by the provider and the department constitutes the second-level appeal. A decision by the commissioner under this subsection is the final administrative decision of the department. The department will notify the provider of the provider's right to appeal to the superior court under the Alaska Rules of Appellate Procedure.
7 AAC 165.900. Definitions.
In this chapter,
(1) "CMS" means the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services;
(2) "hospital provider" means a hospital enrolled under
7 AAC 140.300
that is
(A) an acute care hospital as defined in 42 C.F.R. 495.302, revised as of September 4, 2012, and adopted by reference;
(B) a children's hospital as defined in 42 C.F.R. 495.302, revised as of September 4, 2012, and adopted by reference;
(3) "Medicaid patient"
(A) means an individual who has been determined eligible for Medicaid in this state under 42 U.S.C. 1396 - 1396w-5 (Title XIX of the Social Security Act) and who is receiving or has received services from a provider enrolled in the Medicaid program in this state;
(B) does not include an individual who has been determined eligible under 42 U.S.C. 1397aa;
(4) "needy individual patient" means
(A) an individual who is
(i) a Medicaid patient or who has been determined eligible for Medicaid services in this state under 42 U.S.C. 1397aa; and
(ii) receiving or has received services from a provider enrolled in the Medicaid program in this state;
(B) an individual who received uncompensated medical care by the provider; or
(C) an individual who received medical care by the provider at no cost to the individual or at reduced cost to the individual based on a sliding scale determined by the individual's ability to pay;
(5) "payment year" has the meaning given in 42 C.F.R. 495.4, revised as of October 1, 2010, and adopted by reference;
(6) "provider" means a type of provider identified in
7 AAC 165.010
(a)(1).
Chapter 166
Statewide Electronic Health Information Exchange System
7 AAC 166.010. Creation of statewide electronic health information exchange system.
(a) A statewide electronic health information exchange (HIE) system is established.
(b) The purpose of the HIE system is to facilitate
(1) public and private uses and disclosures of electronic health information permissible under
AS 18.23.300
- 18.23.325 and this chapter; and
(2) the intrastate and interstate exchange of information for treatment and billing purposes.
7 AAC 166.020. Governing body; membership.
(a) The voting members of the governing body of the designee under
AS 18.23.300
shall be nominated as follows:
(1) the hospital and nursing home facility representative shall be nominated by the Alaska State Hospital and Nursing Home Association;
(2) the private medical care providers' representative shall be nominated by the Alaska State Medical Association;
(3) the community-based primary care providers' representative shall be nominated by the Alaska Primary Care Association;
(4) the federal health care providers' representative shall be nominated by the Alaska Federal Health Care Partnership;
(5) the Alaska tribal health organizations' representative shall be nominated by the Alaska Native Health Board;
(6) the health insurers' representative shall be nominated by the Alaska Comprehensive Health Insurance Association;
(7) the healthcare consumers' representative shall be nominated by at least one of the following groups:
(A) the Alaska chapter of AARP;
(B) the Alaska chapter of the American Civil Liberties Union;
(C) the Alaska Mental Health Board within the department;
(D) the American Cancer Society Alaska;
(E) the United Way of Alaska;
(8) the employers' or business representative shall be nominated by the Alaska Chamber.
(b) A member of the public may nominate an individual in any category under (a) of this section upon proof of the individual's membership in that category.
(c) The two nonvoting liaison members shall serve three-year terms and shall be selected as follows:
(1) the nonvoting liaison member representing the Board of Regents of the University of Alaska shall be nominated by that board;
(2) the nonvoting liaison member representing the commission established in the governor's office to review health care policy shall be nominated by that commission.
(d) HIE participants shall elect the voting members of the governing body at the annual meeting. Members of the governing body shall elect the officers of the governing body.
(e) The commissioner will appoint the nonvoting members of the governing body.
(f) Voting members of the governing body shall serve three-year terms so that one-third of the total number of members will change each year. A member may not serve more than two full consecutive terms. The commissioner and the two nonvoting liaison members are not subject to the two-consecutive term limit.
(g) A member of the governing body shall represent the interests of the group that member was elected or appointed to represent, not the specific interests of the member's individual organization or employer.
(h) Meetings of the governing body are subject to
AS 44.62.310
- 44.62.319 (Open Meetings Act), and shall be conducted in accordance with the current edition of Robert's Rules of Order Newly Revised.
7 AAC 166.030. Duties of the governing body.
The governing body shall
(1) subject to approval by the department, set the user fee at an amount that attains self-sustainability for the HIE system;
(2) inform the public by means of print and electronic media at least twice per year about the benefits and risks of participation in an HIE; and
(3) develop policies and procedures that comply with
AS 18.23.300
- 18.23.325 and this chapter, including policies and procedures regarding
(A) HIE patient information submitted in error;
(B) opting out of and opting back into an HIE;
(C) notification required by law of a breach of information by an HIE;
(D) audit reports;
(E) protecting the privacy and security of electronic health information;
(F) access to and use and disclosure of electronic health information;
(G) amendment and storage of electronic health information; and
(H) sanctions.
7 AAC 166.040. Privacy and security.
(a) An individual owns the individual's individually identifiable health information. An HIE participant owns the medical record that includes the individually identifiable health information.
(b) Individually identifiable health information located on an HIE is confidential, is protected under
AS 40.25.120
from disclosure, and is not public information subject to the public records requirements of
AS 40.25.110
.
(c) An HIE shall comply with the applicable requirements of
AS 45.48
(Alaska Personal Information Protection Act), P.L. 104-191 (Health Insurance Portability and Accountability Act of 1996 (HIPAA)), P.L. 111-5, div. A, title XIII (Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009), 42 C.F.R. Part 2, and 45 C.F.R. Parts 160 and 164.
(d) An HIE may not allow an HIE participant to alter the electronic health information of another HIE participant within the HIE. Nothing in this subsection prohibits an HIE participant from remedying an error made in a previous transmission of electronic health information, or amending the HIE participant's own records.
(e) An HIE may only disclose electronic health information for treatment and billing.
(f) An HIE shall annually have an independent third party perform an assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic health information on the HIE, as required under 45 C.F.R. 164.308(a)(1)(ii)(A). The assessment must include the HIE's compliance with the privacy and security requirements of 45 C.F .R. 164.302 - 164.318 and 45 C.F.R. 164.500 - 164.534. The HIE shall provide the risk assessment to the department and the governing body, not later than 10 business days after receipt from the third party that performed the assessment. The HIE shall provide recommendations for acceptance or mitigation of each high- and medium-level risk identified in the assessment to the governing body and to the department not later than 30 days after receipt from the third party that performed the assessment. The HIE shall provide to an HIE participant, upon request, a summary of the risk assessment and actions taken to accept or mitigate risk.
(g) A valid release of an individual's electronic health information or a court order is required for any disclosure not otherwise authorized under this section.
7 AAC 166.050. Opt-out provisions.
(a) An individual may opt out of an HIE. If an individual opts out of an HIE, the HIE shall remove all of that individual's electronic health information from the HIE.
(b) The HIE system's procedures for opting out of an HIE must include procedures for
(1) preventing storage of an individual's electronic health information after the date the individual opts out, except as required by law;
(2) allowing disclosure of individually identifiable health information for emergency treatment purposes in the case of a medical emergency, if an individual has opted out but authorized disclosure for treatment purposes in a medical emergency;
(3) destroying, or securing against unauthorized access to, an individual's electronic health information once an individual opts out;
(4) training health care workers and HIE staff responsible for processing an individual's request to opt out;
(5) notifying an individual if an HIE discloses an individual's electronic health information after that individual opts out of an HIE; and
(6) including authorizations and opt-out elections on an HIE.
(c) The governing body shall ensure that the following information is easily accessible on the governing body's Internet website:
(1) a description of how and where to opt out of an HIE;
(2) a description of how and where to opt back into an HIE after an individual has opted out of that HIE.
(d) An HIE participant shall document an individual's request to opt out and forward that request to the governing body. The governing body shall ensure that the request is processed. An HIE shall make any patient opt-out required under this section available on the HIE. Electronic health information may be stored on an HIE before the HIE obtains an opt-out request from an individual but may not be disclosed after an individual opts out, except as required by law.
(e) A health care provider may not deny an individual treatment and a health plan may not deny an individual an insurance benefit based solely on the provider's or individual's decision not to participate in an HIE.
7 AAC 166.900. Definitions.
In
AS 18.23.300
- 18.23.325 and this chapter, unless the context requires otherwise,
(1) "billing" has the meaning given "payment" in 45 C.F.R. 164.501;
(2) "department" means the Department of Health;
(3) "electronic health information" means an individual's information located on an HIE, including an individual's individually identifiable health information;
(4) "governing body" means the governing body of the designee under
AS 18.23.300
;
(5) "health care provider" has the meaning given in 45 C.F.R. 160.103;
(6) "health plan" has the meaning given in 45 C.F.R. 160.103;
(7) "HIE" means an electronic health information exchange;
(8) "HIE participant" means an entity or facility that has paid a participation fee to an HIE and signed a participation agreement with the HIE;
(9) "HIE system" means the system of statewide electronic HIEs established under
AS 18.23.300
;
(10) "individually identifiable health information" means information, including demographic information collected from an individual, that
(A) is created or received by a health care provider or health plan; and
(B) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and
(i) that identifies the individual; or
(ii) with respect to which there is a reasonable basis to believe the information can be used to identify the individual;
(11) "treatment" means
(A) the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party, consultation between health care providers relating to a patient, or the referral of a patient for health care from one health care provider to another;
(B) health care operations related to patient care and safety, to be limited to the following:
(i) case management and care coordination;
(ii) an HIE participant contacting health care providers and the HIE participant's own patients with information about treatment alternatives; and
(iii) resolution of HIE-related grievances;
(C) reporting on clinical quality measures or other measures related to demonstrating meaningful use under 45 C.F.R. Part 170 to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS); and
(D) public health reporting required by law.
Title 8
Labor and Workforce Development
Part 1
Industrial Welfare
Part 1
ndustrial Welfare
Chapter 05
Child Labor
Article 1
Employment of Minors 14 and 15 Years of Age
8 AAC 05.010. Prohibited occupations.
Employment of minors 14 and 15 years of age is prohibited in the following occupations:
(1) manufacturing, mining, or processing occupations, including occupations requiring the performance of any duties in work rooms or work places where goods are manufactured, mined, or otherwise processed;
(2) occupations which involve the operation or tending of hoisting apparatus or of any power-driven machinery other than office machines;
(3) the operation of motor vehicles or service as helpers on such vehicles;
(4) repealed 4/23/77;
(5) public messenger service;
(6) occupations in or about canneries or other seafood processing plants or establishments involving cutting, slicing, or butchering; work involved in the operation of any floating plant, which includes the loading and unloading of boats, barges, or scows;
(7) work performed in or about boiler or engine rooms or retorts;
(8) work in connection with maintenance or repair of the establishments, machines, or equipment;
(9) outside window washing that involves working from windowsills, and all work requiring the use of ladders or scaffolds or their substitutes;
(10) occupations which involve operating, setting up, adjusting, cleaning, oiling, or repairing power-driven food slicers and grinders, food choppers and cutters, and bakery-type mixers;
(11) work in freezers and meat coolers and all work in the preparation of meats for sale;
(12) loading and unloading goods to or from trucks, railroad cars, or conveyors;
(13) all occupations in warehouses except office and clerical work;
(14) occupations involving the use of sharpened tools;
(15) except for office or sales work in connection with these occupations, which work is permitted, occupations in connection with
(A) transportation of persons or property by rail, highway, air, water, pipeline, or other means;
(B) warehousing and storage;
(C) communications and public utilities;
(D) construction (including demolition and repair).
8 AAC 05.020. Permissible occupations.
Employment of minors 14 and 15 years of age is permitted in the following:
(1) office and clerical work, including the operation of office machines;
(2) cashiering, selling, modeling, art work, work in advertising departments, window trimming, and comparative shopping;
(3) price marking and tagging by hand or by machine, assembling orders, packing, and shelving;
(4) bagging and carrying out customer orders;
(5) errand and delivery work by foot, bicycle, and public transportation;
(6) cleanup work, including the use of vacuum cleaners and floor waxers, and maintenance of grounds including the use of power-driven monofilament cutters, but not including the use of power-driven mowers or power-driven cutters with metal blades;
(7) work in connection with cars and trucks if confined to the following: dispensing gasoline and oil, courtesy service, car cleaning, washing and polishing, and other occupations permitted by this section, but not including work involving
(A) the use of a pit, rack, or power-operated lifting apparatus;
(B) the operation of a pneumatic tire machine;
(C) the inflation of any tire mounted on a rim equipped with a removable retaining ring; or
(D) dispensing propane;
(8) cleaning vegetables and fruits, and wrapping, sealing, labeling, weighing, pricing, and stocking goods.
8 AAC 05.030. Periods and conditions of employment.
(a) Except for enrollees in work training, apprenticeship, vocational education and other programs approved by the commissioner, employment of minors aged 14 or 15 must be confined to the periods and limitations set forth in
AS 23.10.340
.
(b) Work training during school hours will be permitted for minors aged 14 through 17 if the employer has on file an unrevoked written statement from the minor's school coordinator or the coordinator's representative setting out the periods during which the minor may work and certifying that the employment will be confined to those periods and will not interfere with the health and well-being of the minor. The writing must also contain a statement signed by the principal of the minor's school stating that the employment will not interfere with the minor's schooling.
Article 2
Employment of Minors Under 18 Years of Age
8 AAC 05.040. General.
(a) Nothing in this section authorizes noncompliance with any federal or state law or regulation, or municipal ordinance establishing a higher standard. If more than one standard within this section applies to a single activity the higher standard is applicable.
(b) An exception for apprentices applies only when
(1) the apprentice is employed in a craft recognized as an apprenticeable trade;
(2) the work of the apprentice in the occupations declared particularly hazardous is incidental to the training;
(3) that work is intermittent and for short periods of time and is under the direct and close supervision of a journeyman as a necessary part of such apprentice training; and
(4) the apprentice is registered by the United States Department of Labor, Office of Apprenticeship, or is registered by a state agency as employed in accordance with the standards of state apprenticeship and training approved by the commissioner of labor and workforce development, or is employed under a written apprenticeship agreement and conditions that are found by the commissioner of labor and workforce development to conform substantially with those federal or state standards.
(c) An exemption for student-learners applies when
(1) the student-learner is enrolled in a course of study and training in a cooperative vocational training program under a recognized state or local educational authority or in a course of study in a substantially similar program conducted by a private school; and
(2) the student-learner is employed under a written agreement which provides that
(A) the work of the student-learner in the occupations declared particularly hazardous will be incidental to the training;
(B) the work will be intermittent and for short periods of time, and under the direct and close supervision of a qualified and experienced person;
(C) safety instructions will be given by the school and correlated by the employer with on-the-job training; and
(D) a schedule of organized and progressive work processes to be performed on the job will have been prepared; and
(3) each written agreement contains the name of the student-learner, and is signed by the employer and the school coordinator or principal.
(d) Copies of each agreement covered by (c) of this section must be kept on file by both the school and the employer. This exemption for the employment of student-learners will, in the department's discretion, be revoked in any individual case if it is found that reasonable precautions have not been observed for the safety of minors employed under the agreement. A high school graduate who has completed training as provided in (c) of this section as a student-learner, may be employed in that occupation in which the student-learner training was completed, even though the graduate is not yet 18 years of age.
(e) The state, political subdivisions of the state, and employers who only employ minors enrolled in work-training apprenticeship, vocational education, and other programs approved by the commissioner are exempt from the requirements of
AS 23.10.332
.
(f) Minors who have been emancipated for general purposes under
AS 09.55.590
are exempt from the requirements of
AS 23.10.332
.
(g) The wage prescribed for minors who work less than 30 hours in a workweek may not be less than the prevailing federal minimum wage. This provision, however, is not applicable to those exemptions otherwise provided for in
AS 23.10.055
(1) - (10).
8 AAC 05.045. Work permits.
(a) Except as provided in
AS 23.10.332
(c), and in (b) and (c) of this section, a minor under 17 years of age may not be employed until a work permit has been issued to the minor by the commissioner under this section. An applicant for a work permit under this subsection must submit
(1) a completed application on a form provided by the department;
(2) repealed 11/16/2012;
(3) proof of legal guardianship if the form is signed by a person other than the minor's parent.
(b) Under
AS 23.10.332
(c), instead of complying with (a) of this section an employer may submit a request, on a form provided by the department, to the commissioner for a written authorization of the commissioner for specific job duties to be performed by a minor who is at least 14 years of age, but under 17 years of age. The request must include
(1) a description of the job, including tools, equipment, or machinery to be used by the minor;
(2) a list of specific duties to be performed by the minor;
(3) a declaration of the age groups to be employed by the employer;
(4) a description of the hours during which a minor may be employed by the employer; and
(5) any other applicable information required by the commissioner to determine that the proposed job duties are permitted.
(c) If specific job duties are authorized by the commissioner under (b) of this section, the employer may hire a minor in the age group for which the duties have been authorized without the minor obtaining a work permit under (a) of this section if
(1) before the minor begins work, the employer obtains a written consent from the minor's parent or guardian on a form provided by the department; the written consent must include proof of legal guardianship if it is signed by a person other than the minor's parent;
(2) within seven calendar days after hiring the minor, the employer submits to the department a copy of the written consent of the parent or guardian; the employer must maintain a copy of the written consent at the physical location where the minor is employed; and
(3) the duties are not changed unless prior written authorization has been obtained from the commissioner.
(d) Under this section, proof of legal guardianship includes a
(1) general power of attorney appointing guardianship of the minor to an individual;
(2) power of attorney to an individual that specifically includes authorization regarding employment of the minor;
(3) marriage license and proof that the spouse of the minor is at least 18 years of age;
(4) state court award of guardianship of the minor to an individual;
(5) court order making the minor a ward of the state.
8 AAC 05.050. Occupations in or about plants or establishments manufacturing or storing explosives or articles containing explosive components.
(a) Occupations, including sales, in or about plants or establishments manufacturing, selling, or storing fireworks, explosives, ammunition, or articles containing explosive components are dangerous and prohibited to minors.
(b) Notwithstanding (a) of this section, minors may be employed on the premises of a retail establishment that sells ammunition or articles containing explosive components if the employment does not involve the handling, stocking, or sales of these items.
8 AAC 05.060. Motor vehicle driver and outside helper.
(a) The occupations of motor vehicle driver and outside helper are dangerous and prohibited to minors. Minors may not, in the course of their employment, drive automobiles or trucks on public roadways, in or about any
(1) mine, including an open pit or quarry;
(2) place where logging or sawmill operations are located; or
(3) excavation.
(b) Notwithstanding (a) of this section, minors who are 17 years of age may drive automobiles or trucks on public roadways in the course of their employment only if the
(1) driving is restricted to daylight hours;
(2) minor holds a state license valid for the type of driving involved in the job performed and has no records of a violation of traffic laws, excluding equipment violations, at the time of hire or during the period of employment;
(3) the minor has successfully completed a driver education course approved by the state under
AS 28.17
;
(4) automobile or truck is equipped with seat belts for the driver and passengers and the minor's employer has instructed the minor that the seat belts must be used by the driver and passengers when driving the automobile or truck in the course of employment;
(5) the minor's automobile or truck does not exceed 6,000 pounds of gross vehicle weight;
(6) driving does not involve
(A) the towing of vehicles;
(B) route deliveries or route sales;
(C) the transportation for hire of
(i) property, including goods; or
(ii) passengers;
(D) urgent, time-sensitive deliveries;
(E) except for transporting of employees of the employer, more than two trips away from the minor's primary place of employment in a single day for each of the following purposes of
(i) delivering property, including goods, of the minor's employer to a customer that are not urgent time-sensitive deliveries; or
(ii) transporting passengers, if the transportation is not for hire;
(F) transporting more than three passengers, including employees of the employer; or
(G) driving beyond a 30-mile radius from the minor's place of employment; and
(7) driving is only occasional and incidental to the minor's employment.
(c) In this section, unless the context requires otherwise
(1) "occasional and incidental" means no more than one-third of a minor's work time in a workday and no more than 20 percent of a minor's work time in a workweek;
(2) "traffic laws" means statutes, regulations, and municipal ordinances governing the driving or movement of vehicles.
8 AAC 05.070. All occupations in connection with mining.
All occupations in connection with mining are considered dangerous and prohibited to minors, except the following:
(1) work in offices, in the warehouse or supply house, in the change house, in the laboratory, and in repair or maintenance shops not located underground;
(2) work in the operation and maintenance of living quarters;
(3) work outside the mine in surveying, in the repair and maintenance of roads, and in general cleanup about the mine property such as clearing brush and digging drainage ditches.
8 AAC 05.080. Logging occupations.
All occupations in logging are dangerous and prohibited to minors, except the following:
(1) work in offices or in repair or maintenance shops;
(2) work in the construction, operation, repair, or maintenance of living and administrative quarters of logging camps;
(3) work in timber cruising, surveying, or logging-engineering parties; work in the repair or maintenance of roads, railroads, or flumes; work in forest protection, such as clearing fire trails or roads, piling and burning trash, maintaining fire-fighting equipment, constructing and maintaining telephone lines, or acting as fire lookout or fire patrol. The provisions of this paragraph shall not apply to the felling or bucking of timber, the collecting or transplanting of logs, the operation of power-driven machinery, the handling or use of explosives, and work on trestles.
8 AAC 05.090. Occupations in the operation of a sawmill, lath mill, shingle mill, or cooperage-stock mill.
(a) All occupations in the operation of a sawmill, lath mill, shingle mill, or cooperage-stock mill are dangerous and prohibited to minors, except the following:
(1) work in office or in repair or maintenance shops;
(2) straightening, marking, or tallying lumber on the dry chain or the dry shop sorter;
(3) pulling lumber from the dry chain;
(4) cleanup in the lumberyard;
(5) piling, handling, or shipping of cooperage-stock in yards or storage sheds other than operating or assisting in the operation of power-driven equipment;
(6) clerical work in yards or shipping sheds, such as done by ordermen, tallymen, and shipping clerks;
(7) cleanup work outside shake and shingle mills, except when the mills are in operation;
(8) splitting shakes manually from pre-cut and split blocks with a froe and mallet, except inside the mill building or cover;
(9) packing shakes into bundles when done in conjunction with splitting shakes manually with a froe and mallet, except inside the building or cover;
(10) manual loading of bundles of shingles or shakes into trucks or railroad cars, if the employer has on file a statement from a licensed doctor of medicine or osteopathy certifying the minor capable of performing this work without injury.
(b) The exceptions in this section do not apply to a portable sawmill the lumberyard of which is used only for the temporary storage of green lumber and in connection with which no office or repair or maintenance shop is ordinarily maintained.
8 AAC 05.100. Occupations involved in the operation of power-driven woodworking machines.
The following occupations involving the operation of power-driven woodworking machines are dangerous and prohibited to minors:
(1) the occupation of operating power-driven woodworking machines, including supervising or controlling the operation of these machines, feeding material into these machines, and helping the operator to feed material into these machines, but not including the placing of material on a moving chain or in a hopper or slide for automatic feeding;
(2) the occupations of setting up, adjusting, repairing, oiling, or cleaning power-driven woodworking machines;
(3) the occupations of off-bearing from circular saws and from guillotine-action veneer clippers.
8 AAC 05.110. Exposure to radioactive substances and to ionizing radiations.
Occupations involving exposure to radioactive substances and to ionizing radiations are dangerous and prohibited to minors.
8 AAC 05.115. Occupations involving exposure to bloodborne pathogens.
Occupations in hospitals, clinics, dental, orthodontic, or other medical or dental offices that involve exposure to bloodborne pathogens are hazardous and prohibited to minors, unless the minor is
(1) at least 16 years of age and is enrolled in or has successfully completed a state-certified nursing training course or a health care career program in conjunction with a high school, either as part of the curriculum or through a school-to-work partnership between the school district and an employer or group of employers; or
(2) 17 years of age and is enrolled in or has successfully completed a health care career program approved by the commissioner that is offered by a training facility other than a school.
8 AAC 05.120. Occupations involved in the operation of power-driven hoisting apparatus.
The following occupations involved in the operation of power-driven hoisting apparatus are dangerous and prohibited to minors:
(1) operating an elevator, crane, derricks, hoist, or high-lift truck, except operating an unattended automatic passenger elevator or an electric or air-operated hoist not exceeding one ton capacity;
(2) work which involves riding on a manlift or on a freight elevator, except a freight elevator operated by an assigned operator;
(3) assisting in the operation of a crane, derrick, or hoist performed by crane hookers, crane chasers, hookers-on, riggers, rigger helpers, and like occupations.
8 AAC 05.130. Occupations involved in the operations of power-driven metal forming, punching and shearing machine.
The following occupations are dangerous and prohibited to minors:
(1) the occupations of operator of or helper on the following power-driven metal forming, punching, and shearing machines
(A) all rolling machines, such as beading, straightening, corrugating, flanging, or bending rolls, and hot or cold rolling mills;
(B) all pressing or punching machines, such as punch presses except those provided with full automatic feed and ejection and with a fixed barrier guard to prevent the hands or finger of the operator from entering the area between the dies, power presses, and plate punches;
(C) all bending machines, such as apron brakes and press brakes;
(D) all hammering machines, such as drop hammers and power hammers;
(E) all shearing machines, such as guillotine or squaring shears, alligator shears, or rotary shears; and
(F) in welding, brazing or the operation of abrasive wheels.
(2) the occupations of setting-up, adjusting, repairing, oiling, or cleaning these machines including those with automatic feed and ejection.
8 AAC 05.140. Occupations involving slaughtering, meat packing or processing, or rendering.
Occupations in or about slaughtering and meat packing establishments, rendering plants, or wholesale, retail or service establishments are dangerous and prohibited to minors.
8 AAC 05.150. Occupations involved in the operation of bakery machines.
The following occupations involved in the operation of power-driven bakery machines are dangerous and prohibited to minors:
(1) the occupations of operating, assisting to operate, or setting-up, adjusting, repairing, oiling, or cleaning any horizontal or vertical dough mixer, batter mixer, bread dividing, rounding, or molding machine, dough brake, dough sheeter; combination bread slicing and wrapping machine or cake cutting band saw;
(2) the occupation of setting up or adjusting a cookie or cracker machine.
8 AAC 05.160. Occupations involved in the operation of paper-products machines.
The following occupations are dangerous and prohibited to minors:
(1) the occupations of operating or assisting to operate any of the following power-driven paper-products machines:
(A) arm-type wire stitcher or stapler, circular or band saw, corner cutter or mitering machine, corrugating and single-or-double-facing machine, envelope die-cutting press, guillotine paper cutter or shear, horizontal bar scorer, laminating or combining machine, sheeting machine, scrap-paper baler, or vertical slotter;
(B) platen die-cutting press, platen printing press, or punch press which involves hand feeding of the machine;
(2) the occupations of setting-up, adjusting, repairing, oiling, or cleaning these machines including those which do not involve hand feeding.
8 AAC 05.170. Occupations involved in the manufacture of brick, tile and kindred products.
Occupations involved in the manufacture of clay construction products and of silica refractory products are dangerous and prohibited to minors.
8 AAC 05.180. Occupations involved in the operations of circular saws, band saws, and guillotine shears.
The following occupations are dangerous and prohibited to minors:
(1) the occupations of operator of or helper on the following power-driven fixed or portable machines except machines equipped with full automatic feed and ejection:
(A) circular saws;
(B) band saws;
(C) guillotine shears;
(2) the occupations of setting-up, adjusting, repairing, oiling, or cleaning circular saws, band saws, and guillotine shears.
8 AAC 05.190. Occupations involved in wrecking, demolition, and shipbreaking operations.
All occupations in wrecking, demolition, and shipbreaking operations are dangerous and prohibited to minors.
8 AAC 05.200. Occupations in roofing operations.
All occupations in roofing operations are dangerous and prohibited to minors.
8 AAC 05.210. Occupations in excavation operations.
The following occupations in excavation operations are dangerous and prohibited to minors:
(1) excavating, working in, or backfilling (refilling) trenches except
(A) manually excavating or manually backfilling trenches that do not exceed four feet in depth at any point; or
(B) working in trenches that do not exceed four feet in depth at any point;
(2) excavating for buildings or other structures or working in such excavations, except
(A) manually excavating to a depth not exceeding four feet below any ground surface adjoining the excavation; or
(B) working in an excavation not exceeding such depth; or
(C) working in an excavation where the side walls are shored or sloped to the angle of repose;
(3) working within tunnels prior to the completion of all driving, and shoring operations;
(4) working within shafts prior to the completion of all sinking and shoring operations.
8 AAC 05.220.
Repealed 4/23/77.
8 AAC 05.230. Occupations in connection with the installation, operation or maintenance of electrical equipment, outside erection and repair of electrical wires, and meter testing.
Work in connection with the installation, operation or maintenance of electrical equipment energized at voltages exceeding 220, the outside erection and repair of any electrical wires including telegraph and telephone lines, and meter testing is dangerous and prohibited to minors.
8 AAC 05.240. Occupations in any pool or billiard room or other premises prohibited to minors by statute or ordinance.
Repealed 6/4/82.
8 AAC 05.250. Occupations in any industry where a strike or lockout is in progress.
Repealed 6/4/82.
8 AAC 05.260. Permissible occupations on fishing boats.
Employment of minors between 16 and 17 years of age is permitted aboard fishing boats unless otherwise prohibited under this chapter or
AS 23.10.350
.
8 AAC 05.265. Occupations involved in canvassing, peddling, door-to-door solicitation or sales.
Occupations involved in canvassing, peddling, solicitation of door-to-door contributions, or acting as an "outside salesman" as defined in
8 AAC 15.910
, from house to house are dangerous and prohibited to minors.
Article 3
Certificates of Age
8 AAC 05.270. Application for exemption.
Repealed 6/4/82.
8 AAC 05.280. Certificates of age.
Every person employing a minor shall obtain and have on file proof of the minor's age acceptable to the commissioner. Examples of acceptable proof of age include, but are not limited to, a copy of
(1) birth certificate;
(2) Bureau of Indian Affairs census record;
(3) passport;
(4) driver's license;
(5) authenticated school records;
(6) federal age certificate;
(7) baptismal certificate;
(8) military dependent identification;
(9) family court records;
(10) affidavit of physician.
Article 4
Authorization for Minors Under 17 Years of Age to Work
Repealed 6/4/82
Article 5
Entertainment Industry
8 AAC 05.300. Permits to work.
(a) Except as provided in (d) of this section, an employer in the entertainment industry desiring to employ children must obtain a permit from the department to employ children. In order to obtain a permit, a parent or guardian and the employer must complete an application for each job on a form provided by the department. A talent or casting agency may obtain a provisional permit as the employer or record by submitting the information listed in (b)(1) - (5) of this section. Within 72 hours of sending the child to a specific job call, the talent or casting agency, as employer of record, shall submit to the department the information required in (b)(6) - (10) of this section. If the talent or casting agency has obtained a provisional permit and sent the child to a job, the agency is responsible for compliance with this section.
(b) An application to employ a child shall contain
(1) the legal and professional name of the child;
(2) the date of birth of the child;
(3) the written consent of the parent or guardian;
(4) the name and permanent address of the parent or guardian and the name of the parent, guardian, or representative who will accompany the child to rehearsals and performances;
(5) if the child has a legal guardian, proof of guardianship;
(6) the nature, time, duration, dates, and number of rehearsals and performances involving the child, with identification of the location and nature of those rehearsals and performances;
(7) the maximum combined rehearsal and performance times per day and per week involving the child;
(8) the rate of pay the child will receive for performing;
(9) a detailed description of the child's role, including each activity to be performed; the description shall include an excerpt from the script that contains the child's dialogue and action; and
(10) any other information the department may request for clarification of items listed in (1) - (10) of this subsection.
(c) The application must be accompanied by adequate proof of age for the child as indicated in
8 AAC 05.280
and proof of workers' compensation coverage valid in this state as required by
AS 23.30.075
.
(d) An appearance of a child in any of the following activities for no compensation is not considered employment as a performer in the entertainment industry under
AS 23.10.330
:
(1) church, school, or community entertainment;
(2) entertainment for charity or for children for which no admission is charged; or
(3) radio or television broadcasting exhibition consisting of a single performance by the child lasting not more than one hour and for which no admission fee is charged; an exhibition includes an appearance in a concert or choral presentation or as a member of an audience, panel, or gallery.
(e) Under this section, proof of legal guardianship includes a
(1) general power of attorney appointing guardianship of the minor to an individual;
(2) power of attorney to an individual that specifically includes authorization regarding employment of the minor;
(3) marriage license and proof that the spouse of the minor is at least 18 years of age;
(4) state court award of guardianship of the minor to an individual;
(5) court order making the minor a ward of the state.
8 AAC 05.305. Denial of permit.
The department will, in its discretion, deny a permit under
8 AAC 05.300
if the department finds that the denial serves the best interests of the health, development, education, or welfare of the child. The department will keep a record of denials of permits, including its findings supporting the denials. A denial under this section may be appealed in writing to the commissioner within 30 days of the date of the issuance of the denial.
8 AAC 05.310. Revocation.
No child may perform in the entertainment industry except as provided in law and the permit. No permit may be issued for the exhibition, rehearsal, or performance of a child that is harmful to the health, development, education, or welfare of the child. The department will, in its discretion, revoke a permit for violation of law or a term or condition specified in the permit, if that violation endangers the health, development, education, or welfare of the child. If a parent or guardian withdraws consent for the child to perform and informs the department of the withdrawal, the department will revoke the permit. Revocation of a permit will take effect immediately upon service in person or through the mail to the employer who requested the permit. A revocation of a permit issued under
8 AAC 05.300
may be appealed in writing to the commissioner within 30 days of the date of issuance of the revocation.
8 AAC 05.315. Supervision by studio teachers.
(a) Except as provided in (f) of this section, as a condition of receiving a permit under
8 AAC 05.300
, an employer must provide a studio teacher for a child from the age of birth to 16 years of age, and for a child from 16 to 18 years of age when required for the education of the child. Except as provided in (d) and (e) of this section, a studio teacher must possess an appropriate endorsement on a valid and current Type A Alaska teaching certificate to instruct the age level of the children in the teacher's care and exhibit a working knowledge of the child labor laws of this state. One studio teacher must supervise each group of 10 or fewer children, from the age of birth to 16 years of age, except that on Saturdays, Sundays, holidays, or during school vacation periods, one studio teacher may supervise each group of 20 or fewer of those aged children.
(b) Notwithstanding (a) of this section, if babies between the ages of birth to six weeks are employed, one nurse and one studio teacher must be provided for each group of three or fewer babies. If infants from age six weeks to six months are employed, one nurse and one studio teacher must be provided for each group of 10 or fewer infants. One studio teacher who also possesses a license or certification as a registered nurse, advanced nurse practitioner, physician assistant, emergency medical technician, or mobile intensive care paramedic, or who meets the requirements of a primary community health aide as set out at
AS 18.28.100
(5), may fulfill both requirements.
(c) In addition to teaching, the studio teacher shall also have responsibility for the health, development, and welfare of children under 16 years of age while the children are at the place of employment in the entertainment industry. The studio teacher will ensure compliance with the law and the permit. The studio teacher may refuse to allow a child to work on a set or location and may remove the child from the set or location if, in the judgment of the studio teacher, conditions present a danger to the health, development, education, or welfare of the child.
(d) If the teacher does not hold a valid and current Type A Alaska teaching certificate, a studio teacher accompanying one or more non-resident children must satisfy the studio teacher requirements in the state of origin of the children and have a working knowledge of child labor laws of this state. If the state of origin of the children does not have studio teacher requirements, the studio teacher must have a valid and current teaching certificate from the state of origin of the children to instruct the age level of the child, and have a working knowledge of child labor laws in this state.
(e) If the commissioner finds that a studio teacher who meets the requirements of (a) of this section is not available in the geographic location of the child's employment in this state, the commissioner will, in the commissioner's discretion, waive the requirement of the studio teacher exhibiting a working knowledge of the child labor laws of this state so long as the child's health, development and welfare are not jeopardized and the studio teacher holds a valid and current Type A Alaska teaching certificate. A waiver granted under this section expires when the employment of the child ends or at the close of 90 day calendar days from the date that the waiver was granted, whichever occurs first.
(f) A studio teacher is not required if the employment of a minor in the entertainment industry does not conflict with the schooling of the minor, the employment occurs in or near the minor's home, school, or from a fixed location used by the employer in the employer's regular course of business, and the employment does not pose recognized serious hazards to the minor, such as employment in
(1) dinner shows;
(2) cultural dance exhibitions;
(3) theatrical productions; and
(4) television, film, and photography productions where the total time of the minor's employment is less than 24 hours.
(g) For the purposes of (f) of this section, to ensure that the employment of a minor in the entertainment industry will not conflict with the schooling of the minor, the department may require written authorization from school officials if the employment occurs during school hours.
8 AAC 05.320. Hours of work.
(a) A child under 18 years may not be permitted to work in the entertainment industry before 5 a.m. or after 10 p.m. on any day preceding a school day. A child under 18 years may not work later than 12:30 a.m. on any other day.
(b) If the consent of the commissioner is first obtained, a child between 8 and 18 years of age may be permitted to work as an actor or a performer after 10 p.m. but not later than midnight on a night preceding a school day if the performance begins before 10 p.m.
(c) The amount of time that a child is permitted at the place of employment in the entertainment industry within a 24-hour period is limited by age as follows:
(1) babies and infants from birth to six months are limited to two hours per day, with actual work time not to exceed 20 minutes per day;
(2) infants and children age from six months to two years are limited to four hours per day, with actual work time not to exceed two hours;
(3) children age from two years to six years are limited to six hours per day, with actual work time not to exceed three hours;
(4) children age from six years to nine years are limited to eight hours per day, with actual work time not to exceed four hours, except that when school is not in session, actual work time may be increased to six hours; when school is in session, an eight-hour day must include at least three hours of schooling;
(5) children age from nine years to 16 years are limited to nine hours per day, with actual work time not to exceed five hours, except that when school is not in session, work time may be increased to seven hours; when school is in session, a nine-hour day must include at least three hours of schooling;
(6) children age from 16 years to 17 years are limited to 10 hours per day, with actual work time not to exceed six hours, except that when school is not in session, work time may be increased to eight hours; when school is in session, children age 16 through 17 years who are enrolled in school must receive at least three hours of schooling in a 10-hour day.
(d) The hours listed in (c)(1) - (c)(6) of this section that a child may work at the place of employment do not include a meal period. The working day for the child may be extended by no more than one-half hour for a meal period.
(e) For the purposes of computing total time at the place of employment, travel time to and from a location will be included as time at the place of employment.
(f) The time spent in make-up or hairdressing with the assistance of studio personnel in the child's home is considered work time for the child. Twelve hours must elapse between the time the child is dismissed on one day and the time make-up or hairdressing begins on the following day.
(g) Twelve hours must elapse between the child's time of dismissal and time of call on the following day. If the child's regular school starts less than 12 hours after the child's dismissal time, the child must be schooled the following day at the employer's place of business.
(h) The commissioner or the commissioner's designee may alter or waive a provision of this section if the provision makes it impossible to legally employ the child. An employer may request, in writing, an alteration or a waiver from the commissioner or the commissioner's designee. These requests must provide specific information about the employer's needs and the circumstances involved and must substantiate that no alternatives are feasible. The commissioner or the commissioner's designee may issue an alteration or a waiver if it is demonstrated that the
(1) employment will not be detrimental to the health, development, or welfare of the child;
(2) child will be supervised adequately; and
(3) education of the child will not be neglected.
8 AAC 05.330. Working conditions.
(a) A parent or guardian of a child under 16 or the parent's or guardian's representative must accompany and remain with the child on the set or location. An employer must, at any time, allow parents or guardians or their representatives access to the child.
(b) An employer must provide
(1) a safe, secure, and suitable place for children to rest and play; and
(2) suitable nursery facilities, if a child age 3 years or younger is employed on the set or location.
(c) A baby or infant under six months of age may not be exposed to lights of greater than 100 foot candlelight intensity for more than 30 seconds at a time.
(d) Transportation to the closest medical facility providing emergency services must be available at all times while children are present at the place of employment.
(e) On location, the employer shall provide the child with return transportation to the child's living quarters in an adequate vehicle promptly upon completion of allowable work time.
8 AAC 05.340. Prohibited practices.
A person may not employ or allow a child under 18 years of age to work in the entertainment industry in
(1) a practice, exhibition, or situation that places the child in clear and present danger to the health, development, or welfare of the child; or
(2) an illegal, an indecent, or a lewd exhibition or practice, including the following actual or simulated acts:
(A) acts described as unlawful exploitation of a minor under
AS 11.41.455
;
(B) sexual masochism or sadism.
Article 10
General Provisions
8 AAC 05.900. Definitions.
(a) In this chapter and in
AS 23.10.325
- 23.10.370, unless the context requires otherwise,
(1) "commissioner" means the commissioner of labor and workforce development;
(2) "department" means the Department of Labor and Workforce Development;
(3) "division" means the labor standards and safety division of the Department of Labor and Workforce Development;
(4) "power-driven woodworking machines" means all fixed or portable machines or tools driven by power and used or designed for cutting, shaping, forming, surfacing, nailing, stapling, wire stitching, fastening, or otherwise assembling, pressing, or printing wood or veneer;
(5) "sharpened tools" means knives and implements used for butchering, boning, gilling, filleting, and other meat and fish processing functions; and axes, machetes, scythes, brush hooks, or other implements determined by the commissioner, on a case-by-case basis, to be hazardous;
(6) "community entertainment" means a local performing arts group or association established to serve a certain locale that is staffed primarily by volunteers drawn from the people it serves;
(7) "entertainment industry" includes an organization or individual using the services of a child in motion pictures of any type, using any format, by any medium, including film, videotape, commercial documentary, theater, television, or videocassette; modeling; photography; recording; theatrical productions; publicity; rodeos; circuses; musical performances; and any other live or recorded performances or rehearsals where a child performs to entertain the public;
(8) "guardian" means an individual who, by testamentary or court appointment, has the legal responsibilities for the care and management of the person and the estate of the child during the child's minority;
(9) "nurse" means a registered nurse, advanced nurse practitioner, physician assistant, emergency medical technician, mobile intensive care paramedic, or primary community health aide;
(10) "parent" means biological parent, adoptive parent, or step parent;
(11) "outside helper" means an individual, other than a driver, whose work includes riding on a vehicle outside the cab of the vehicle for the purpose of assisting in transporting or delivering property, including goods.
(b) In
8 AAC 05.300
-
8 AAC 05.340
and in
AS 23.10.330
and 23.10.360, unless the context otherwise requires, "child" means a natural person under the age of 18 who has not been emancipated by the court.
Chapter 10
Private Employment Agencies
Article 1
Application Bond and Permit
8 AAC 10.010. Permit required.
(a) A person may not operate or engage in an employment agency business unless he has procured a permit from the department.
(b) The permit must be posted in a conspicuous place in the main room of the agency used by the public.
8 AAC 10.020. Application for permit.
(a) A written application for a permit must be made to the commissioner on a form prescribed by the department and must state:
(1) name and address of the applicant;
(2) the business name of the employment agency;
(3) the address of the place or places at which the agency will conduct business and the address of the main office of the business;
(4) whether the employment agency is owned as a sole proprietorship, partnership, or corporation;
(5) if the applicant is not a corporation, the names and addresses of all persons who are financially interested either as partners, associates, profit sharers, or other persons receiving a share of the net profits from the operation of the agency, and the share of the net profit each person is to receive;
(6) if the applicant is a corporation, the names, titles and addresses of the persons acting as executive officers of the corporation or who have managing responsibility in the state;
(7) whether an officer, director, manager or owner has been arrested or convicted of a felony or misdemeanor constituting a crime involving moral turpitude and, if so, the nature of the crime and outcome;
(8) the business or occupation of the owner and manager for the two years preceding the date of the application, and, if the applicant is a corporation, the business or occupation of each officer, director and manager for the two years preceding the date of the application;
(9) whether any officer, director, manager or owner of the agency has had experience in employment agency work, the dates of this experience, and the names and addresses of agencies in which the experience was acquired;
(10) the name of any officer, director, manager or owner of the agency who has applied for a permit to operate an employment agency in Alaska or elsewhere, whether that application was granted or denied, and the names and address of the agency;
(11) whether any officer, director, manager or owner of the agency has a financial interest in a travel agency or benefits financially from the sale of air, steamship or bus transportation; and
(12) whether any officer, director, manager or owner of the employment agency was disciplined by a state or had a private employment agency permit suspended, revoked or denied or was otherwise disqualified and the reason for that disqualification.
(b) An application for a permit, if made by an individual, must be signed by that individual; if made by a partnership, by all partners; if made by a corporation, by an officer of the corporation who must affix the seal of the corporation to the application.
(c) A change in the information furnished under (a) of this section must be reported to the department within seven days.
8 AAC 10.030. Character of applicant.
Repealed 12/31/80.
8 AAC 10.040. Expiration of license.
Repealed 6/23/74.
8 AAC 10.050. Bond.
Before the issuance or renewal of a permit an applicant for a permit shall deposit with the department a numbered surety bond for $10,000. A separate bond must be furnished to the department for each kind of agency for which a permit is sought. A separate bond is not required for a branch office of an agency. The bond must be in a form prescribed by the department.
8 AAC 10.055. Issuance of permit.
(a) The department will issue a permit after:
(1) determination by the department that the applicant is a person of good moral character;
(2) a bond is filed with the department which fulfills the requirements of
8 AAC 10.050
;
(3) the application fee required by
AS 23.15.390
is paid; and
(4) a copy of a current Alaska business license is provided to the department;
(b) A permit is valid only for the employment agency and premises named in it. The location of an employment agency may not be changed without written notice to the department. The department must endorse all changes on the permit before the employment agency may operate on its new premises.
8 AAC 10.060. Conditions of bond.
Repealed 6/23/74.
8 AAC 10.065. Duration of permit; renewal.
Repealed 12/31/80.
8 AAC 10.067. Duration of permit; renewal.
Unless revoked or suspended for cause under
AS 23.15.410
, a permit is valid until June 30 of the second calendar year following the date of issuance. A permit may be renewed upon payment of the biennial fee required by
AS 23.15.390
and upon filing with the department
(1) an application for renewal, containing the information required by
8 AAC 10.020
;
(2) a bond that meets the requirements of
8 AAC 10.050
;
(3) a copy of the employment agency's current state business license.
8 AAC 10.070. Assignment or transfer of license.
Repealed 6/23/74.
Article 2
Agency Procedures and Requirements
8 AAC 10.075. Registration.
An employment agency must maintain a permanent applicant register which contains:
(1) the name and address of each applicant for employment, employment services, or to whom employment information was provided for a fee;
(2) a control registration number for each applicant, assigned in a consecutive order by the agency, which must be used on all agency records pertaining to that applicant as a means of identifying each applicant for employment services;
(3) the date of each application for employment services;
(4) the amount of registration fee paid;
(5) the amount of registration fee refund due; and
(6) the date a refund is paid.
8 AAC 10.077. Registration fee.
If an agency charges an applicant a fee to register or list an applicant for employment services, the agency must give the applicant a receipt for the fee. The receipt must contain the name, address and phone number of the agency, the applicant's full name, the amount of the fee paid, the date of issue and the signature of the person collecting the fee.
8 AAC 10.080. Permission to transfer license.
Repealed 6/23/74.
8 AAC 10.085. Distribution of employment information.
An employment agency selling employment information by mail or other media must file a copy with the department for approval of this information before sale or distribution. Any reference to wage rates, employment, unemployment and cost-of-living in the state must be factually depicted.
8 AAC 10.090. Actions to recover.
Repealed 6/23/74.
8 AAC 10.095. Publications.
(a) Advertisements of an employment agency by cards, circulars or signs and in newspapers and other publications, and all letterheads, receipts, and forms must contain the licensed name and address of the employment agency and the word "agency" or a derivative of that word. Each position advertised must include a job order number.
(b) An employment agency which advertises through newspapers or other media must keep a record of all newspaper or other printed advertisement initiated by the agency for a least four months after its public release.
(c) If an agency advertises the highest salary which may be paid for a job, the advertisement must contain the word "to" before the salary quoted.
8 AAC 10.100. Records.
Repealed 6/23/74.
8 AAC 10.110. Job order.
(a) An employment agency must keep a separate record of each job order received by the agency on a form approved by the department. A job order must contain:
(1) the name and address of each employer from whom a job order is received;
(2) the name and position of the individual placing the job order;
(3) the date of receipt of the job order;
(4) the offered starting wage or salary and job description or classification title; and
(5) the names and registration numbers of the persons referred.
(b) Job orders received by an agency must be consecutively numbered. The original must be maintained in the agency for inspection by the department.
8 AAC 10.120. Referral receipt.
(a) An employment agency must give to an applicant for employment who is referred for employment a referral receipt which contains:
(1) the complete name, address, and telephone number of the employment agency;
(2) the name and address of the person to whom the applicant is to report for an interview;
(3) the address where the applicant for employment will be employed, if hired;
(4) the estimated minimum fee the applicant may be charged by the employment agency;
(5) the cost of transportation, if any, to the place of employment, if known, and by whom paid or advanced;
(6) the proposed type or classification of work;
(7) the daily and weekly hours of work;
(8) the starting wage or salary rate, including any consideration of privilege;
(9) a description of the board and lodging furnished by the employer and the cost of those services;
(10) an estimate of the length of the employment and whether the employer anticipates it to be temporary or longer than 90 days;
(11) the registration number of the applicant;
(12) a disclosure of any labor dispute which exists at the place of employment, the name of the union involved and whether union membership is required; and
(13) a disclosure of labor agreements in effect at the place of employment, the name of the union and whether union membership is required.
(b) A duplicate of the receipt must be given to the applicant for employment and the original retained in the agency for inspection by the department.
8 AAC 10.130. Return of fee.
If an applicant who has paid a registration fee fails to obtain employment, the agency must return the amount of the fee to the applicant not later than 48 hours after receiving a demand from the applicant.
8 AAC 10.140. Employer's obligations.
Repealed 6/23/74.
8 AAC 10.145. Agency to maintain records.
An employment agency must maintain on file all records, orders, or receipts referred to in this chapter for at least two years unless specified otherwise in this chapter.
8 AAC 10.150. Employment in existence.
Repealed 6/23/74.
8 AAC 10.160. Labor contract in existence.
Repealed 6/23/74.
Article 3
Fee Schedule
8 AAC 10.170. Schedule of fees filed with commissioner.
Repealed 6/23/74.