Sec. 7 AAC 160.900 - Requirements adopted by reference

ยง 7 AAC 160.900. Requirements adopted by reference

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

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

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

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

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

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

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

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

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

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

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

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

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

(13) repealed 6/2/2019;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 March 11, 2016 and appearing in the American Academy of Pediatric Dentistry's 2015-16 Definitions, Oral Health Policies, and Clinical Practice Guidelines;

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

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

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

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

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

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

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

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

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

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

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

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

(10) repealed 5/18/2014;

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

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

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

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

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

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

(17) repealed 1/1/2013;

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

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

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

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

(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;

(c) Repealed 11/3/2012.

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

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

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

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

(4) 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, effective January 1, 2021, for providers of personal care services under 7 AAC 125.010 - 7 AAC 125.199 and Community First Choice personal care 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 and Social Services, Behavioral Health Inpatient Psychiatric Review Provider Manual, revised as of October 2015;

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

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

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

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

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

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

(26) 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 August 2, 2018;

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

(36) the Day Habilitation Services Conditions of Participation, effective January 1, 2021;

(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 January 1, 2021;

(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 September 5, 2017;

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

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

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

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

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

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

(55) the Personal Care Services and Community First Choice Personal Care Services Provider Conditions of Participation, dated August 2, 2018;

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

(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 August 2, 2018;

(59) the Chart of Community Behavioral Health and Mental Health Physician Clinic Medicaid Covered Services Rates, dated January 1, 2019

(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, effective January 1, 2021, for providers of home and community-based waiver services under 7 AAC 130;

(63) repealed 5/21/2020.

(64) Chart of 1115 Waiver Services, June 2019 Edition.

(65) Chart of 1115 Medicaid Waiver Services, dated June 30, 2021;

(66) the Adverse Childhood Experiences Questionnaires, dated June 30, 2021.

(67) the Alaska Behavioral Health Providers Service Standards & Administrative Procedures for SUD Provider Services, dated May 27, 2020;

(68) the Alaska Behavioral Health Providers Service Standards & Administrative Procedures for Behavioral Health Provider Services, dated June 30, 2021.

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

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

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

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

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

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

(6) repealed 6/2/2019;

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

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

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

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

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

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

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

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

(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.

(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.

(Eff. 2/1/2010, Register 193; am 8/25/2010, Register 195; am 12/1/2010, Register 196; am 1/1/2011, Register 196; am 1/15/2011, Register 197; am 2/9/2011, Register 197; am 3/1/2011, Register 197; am 10/1/2011, Register 199; am 12/1/2011, Register 200; am 1/26/2012, Register 201; am 3/8/2012, Register 201; am 4/1/2012, Register 201; add'l am 4/1/2012, Register 201; am 5/11/2012, Register 202; am 10/16/2012, Register 204; am 11/3/2012, Register 204; am 12/1/2012, Register 204; am 12/2/2012, Register 204; am 1/1/2013, Register 204; am 1/16/2013, Register 205; am 7/1/2013, Register 206; add'l am 7/1/2013, Register 206; am 11/3/2013, Register 208; am 1/1/2014, Register 208; am 2/2/2014, Register 209, April 2014; am 3/19/2014, Register 209, April 2014; am 3/22/2014, Register 209, April 2014; am 5/18/2014, Register 210, July 2014; am 2/26/2015, Register 213; am 3/15/2015, Register 213, April 2015; am 7/1/2015, Register 214, July 2015; am 5/1/2016, Register 218, July 2016; am 6/16/2016, Register 218, July 2016; am 7/22/2017, Register 223, October 2017; am 11/5/2017, Register 224, January 2018; am 3/1/2018, Register 225, April 2018; am 1/1/2019, Register 228, January 2019; am 3/24/2019, Register 229, April 2019; am 6/2/2019, Register 230, May 2019; am 6/13/2019, Register 230, May 2019; am 7/1/2019, Register 231, July 2019; am 10/25/2019, Register 232, January 2020; am 11/10/2019, Register 232, January 2020; am 4/24/2020, Register 234, April 2020; am 5/21/2020, Register 234, July 2020; am 1/1/2021, Register 236, January 2021; am 3/3/2021, Register 238, July 2021; am 6/30/2021, Register 238, July 2021)

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

Authority:AS 47.05.010

AS 47.05.012

AS 47.07.030

AS 47.07.040

The following state regulations pages link to this page.