7 AAC 110.210 - EPSDT covered services

(a) The department will pay for a service recommended as a result of the EPSDT screening, if that service is an authorized service under 42 U.S.C. 1396- 1396w-1.

(b) The department will pay for the following additional services for children under 21 years of age if the screening identifies a need for that service:

(1) podiatry services under 7 AAC 110.500 - 7 AAC 110.505;

(2) nutrition services under 7 AAC 110.275;

(3) private-duty nursing services under 7 AAC 110.520 - 7 AAC 110.535;

(4) hospice care under 7 AAC 140.280;

(5) chiropractic services under 7 AAC 110.120;

(6) dental services under 7 AAC 110.145 - 7 AAC 110.155;

(7) physical therapy under 7 AAC 115.300 - 7 AAC 115.320;

(8) occupational therapy under 7 AAC 115.100 - 7 AAC 115.120;

(9) speech therapy under 7 AAC 115.400 - 7 AAC 115.420;

(10) autism services under 7 AAC 135.350.

(c) The department will pay for transportation services identified in (d) of this section if, before the date of travel, the recipient or provider requests prior authorization for travel from the department and if the department determines that

(1) the transportation is needed to

(A) obtain an EPSDT screening or medically necessary service identified by an EPSDT screening;

(B) obtain a prenatal screening and resulting referrals;

(C) attend an appointment with a local office responsible within the department for implementing the Special Supplemental Nutrition Program for Women Infants, and Children (WIC) under 42 U.S.C. 1786;

(D) obtain necessary medical care for a recipient under 21 years of age, if

(i) the medical care involves intercommunity travel;

(ii) the medical care is not the result of an EPSDT screening;

(iii) the recipient lives in a community not served by a common carrier; and

(iv) the recipient is not eligible for transportation services under 7 AAC 120.400 - 7 AAC 120.490; or

(E) obtain a prescription that is required as a result of an EPSDT or prenatal screening;

(2) the recipient is under 21 years of age and eligible for Medicaid under 7 AAC 100;

(3) other appropriate transportation services are not available; and

(4) the medical service requested is not available closer to the recipient's residence.

(d) The department will pay for the following transportation services authorized under (c) of this section:

(1) a bus token or pass;

(2) a taxi, shuttle, or similar form of ground transportation;

(3) a mileage payment for use of a private vehicle driven for medical purposes.

Notes

7 AAC 110.210

Eff. 2/1/2010, Register 193; am 5/1/2016, Register 218, July 2016; am 7/1/2018,Register 226, July 2018; am 12/1/2022, Register 244, January 2023

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040