Sec. 7 AAC 72.520 - Mental health services eligible for financial assistance

ยง 7 AAC 72.520. Mental health services eligible for financial assistance

(a) Subject to (d) of this section, if the department determines under 7 AAC 72.540 that a person who received evaluation or treatment at a designated facility is eligible for financial assistance, the department will provide reimbursement under 7 AAC 72.510 for the following mental health services that are provided by a designated facility and that are directly related to a patient's mental health condition that resulted in eligibility for financial assistance under AS 47.31.010:

(1) emergency room costs;

(2) staff physician services, if those services are not already included in the facility's daily rate;

(3) physician services, if those services require the action of a physician who is not a member of the designated facility's staff;

(4) physician court time costs for participation in a commitment hearing;

(5) medical costs, if related to the evaluation, diagnosis, and treatment of a patient's mental illness;

(6) room and board costs related to the evaluation, diagnosis, and treatment of a patient's mental illness;

(7) laboratory costs that are required for all patients entering a facility and laboratory costs related to mental health evaluation, diagnosis, and treatment;

(8) medication costs related to mental health diagnosis and treatment;

(9) transportation costs that are not covered by AS 47.30.870 or 47.30.905;

(10) other services directly related to the admission being billed, as determined by the department on a case-by-case basis.

(b) The department will reimburse a designated evaluation facility for no more than seven days for evaluation and crisis stabilization or for transition to community-based services if the department determines the amount of time is clinically appropriate and

(1) the patient continues under, or has transferred to, voluntary commitment and the treating physician has certified, on a form supplied by the department, that the patient meets the involuntary commitment criteria in AS 47.30.700-47.30.815; or

(2) the court extends the time for evaluation and treatment for a patient who continues to meet the involuntary commitment criteria in AS 47.30.700-47.30.815.

(c) The department will reimburse a designated treatment facility for no more than 40 days for evaluation, treatment, and crisis stabilization or for transition to community-based services if the department determines the amount of time is clinically appropriate and

(1) the patient continues under, or has transferred to, voluntary commitment and the treating physician has certified, on a form supplied by the department, that the patient meets the involuntary commitment criteria in AS 47.30.700-47.30.815; or

(2) the court extends the time for evaluation and treatment for a patient who continues to meet the involuntary commitment criteria in AS 47.30.700-47.30.815, or the patient is authorized to remain at the facility under AS 47.30.745(g).

(d) The department will not reimburse a designated facility under 7 AAC 72.510 for

(1) physician time spent performing administrative or supervisory duties; this exclusion does not include time spent participating in a commitment hearing;

(2) facility costs for space, overhead, supplies, or equipment;

(3) local ambulance service, unless

(A) a medical emergency directly related to the patient's mental condition results in eligibility for financial assistance under AS 47.31.010;

(B) the patient requires restraint; or

(C) ambulance service is necessary to meet the requirements of 42 U.S.C. 1395 dd (Emergency Medical Treatment and Active Labor Act (EMTALA)) and 42 C.F.R. 489.24;

(4) the co-pay portion of a third-party reimbursement;

(5) any transportation or other expense to be paid by the court system for proceedings under AS 47.30; or

(6) any service that is not directly related to the patient's mental condition that resulted in eligibility for financial assistance under AS 47.31.010.

(e) For a patient admitted after an involuntary commitment under AS 47.30.700-47.30.815 or a voluntary commitment chosen after the patient's physician determines that the patient meets the involuntary commitment criteria in AS 47.30.700-47.30.815, the treating physician shall

(1) using a form supplied by the department, certify upon admission that the patient meets the involuntary commitment criteria in AS 47.30.700-47.30.815; if the patient subsequently transfers to voluntary commitment, the treating physician shall certify daily, on the patient's chart, whether the patient continues to meet the involuntary commitment criteria; and

(2) recertify every seven days, on the form supplied by the department, whether the patient continues to meet the involuntary commitment criteria.

(f) The department may, on a case-by-case basis, deny reimbursement under 7 AAC 72.540 if the department determines that a service provided is not directly related to the patient's mental health condition.

(Eff. 3/16/2001, Register 157; am 6/24/2004, Register 170)

Authority:AS 47.30.660

AS 47.31.025

AS 47.31.090

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