Section 7.160.900. 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) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), DMEPOS Fee Schedule 2006 1st Quarter;  
		(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.  
	(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) the Durable Medical Equipment Prior Authorization List, dated August 2005;  
		(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) the Home and Community-Based Waiver Services Provider Certification Application, dated April 4, 2014;  
		(9) the Personal Care Assistant Agency Certification Application Packet, dated 2005;  
		(10) the Chart of Personal Care Attendant and Waiver Services Rates, dated April 24, 2013, 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;  
		(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 August 16, 2013, for home and community-based waiver 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 Instructions, dated February 1, 2012, 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) the Residential Behavioral Rehabilitation Services Handbook, 2013 Edition, revised as of August 7, 2013;  
		(27) the Alaska Screening Tool, revised as of June 21, 2010;  
		(28) the Client Status Review form, revised as of June 21, 2010;  
		(29) the Personal Care Assistance Service Level Computation, revised as of March 20, 2012;  
		(30) the Certificate to Request Funds for Abortion, revised as of December 2013;  
		(31) the Application for Alaskans Living Independently Waiver and Adults with Physical and Developmental Disabilities Waiver, dated May 13, 2013;  
		(32) the Adult Day Services Conditions of Participation, dated May 2, 2013;  
		(33) the Care Coordinator Certification Application, dated May 2, 2013;  
		(34) the Care Coordination Services Conditions of Participation, dated March 4, 2015;  
		(35) the Chore Services Conditions of Participation, dated May 2, 2013;  
		(36) the Day Habilitation Services Conditions of Participation, dated May 2, 2013;  
		(37) the Intellectual & Developmental Disabilities Registration and Review form, dated May 15, 2013;  
		(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 May 2, 2013;  
		(43) the Nursing Facility Level of Care Assessment Form for Children, dated March 22, 2011;  
		(44) the Provider Conditions of Participation, dated March 21, 2014;  
		(45) the Residential Habilitation Services Conditions of Participation, dated May 2, 2013;  
		(46) the Residential Supported-Living Services Conditions of Participation, dated March 21, 2014;  
		(47) the Screening Tool for Children with Complex Medical Conditions (CCMC) Waiver Program, dated March 22, 2011;  
		(48) the Respite Care Services Conditions of Participation, dated May 2, 2013;  
		(49) the Supported Employment Services Conditions of Participation, dated March 21, 2014;  
		(50) the Transportation Services Conditions of Participation, dated March 4, 2015;  
		(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 April 4, 2014.  
		(54) the Orthodontic Referral Oral Health and Hygiene Assessment, revised as of July 2015.  
	(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) 2010 HCPC Fee Schedule for Incontinence Supplies, Table I-1, revised as of March 4, 2010;  
		(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.  
	(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.  

Authorities

47.05.010;47.05.012;47.07.030;47.07.040;44.62.245

Notes

Reference

7 AAC 105.110
7 AAC 105.130
7 AAC 105.270
7 AAC 105.280
7 AAC 105.600
7 AAC 110.120
7 AAC 110.153
7 AAC 110.180
7 AAC 110.205
7 AAC 110.230
7 AAC 110.240
7 AAC 110.405
7 AAC 110.505
7 AAC 110.705
7 AAC 115.110
7 AAC 115.200
7 AAC 115.210
7 AAC 115.310
7 AAC 115.410
7 AAC 115.530
7 AAC 115.540
7 AAC 120.110
7 AAC 120.112
7 AAC 120.120
7 AAC 120.130
7 AAC 120.140
7 AAC 120.210
7 AAC 120.240
7 AAC 120.245
7 AAC 120.299
7 AAC 125.020
7 AAC 125.024
7 AAC 125.060
7 AAC 125.080
7 AAC 130.207
7 AAC 130.215
7 AAC 130.219
7 AAC 130.220
7 AAC 130.238
7 AAC 130.240
7 AAC 130.245
7 AAC 130.250
7 AAC 130.255
7 AAC 130.260
7 AAC 130.265
7 AAC 130.270
7 AAC 130.280
7 AAC 130.290
7 AAC 130.295
7 AAC 130.300
7 AAC 130.305
7 AAC 135.040
7 AAC 135.055
7 AAC 135.065
7 AAC 135.100
7 AAC 135.110
7 AAC 135.130
7 AAC 135.150
7 AAC 135.230
7 AAC 135.800
7 AAC 140.105
7 AAC 140.200
7 AAC 140.205
7 AAC 140.210
7 AAC 140.215
7 AAC 140.220
7 AAC 140.270
7 AAC 140.275
7 AAC 140.289
7 AAC 140.310
7 AAC 140.315
7 AAC 140.325
7 AAC 140.360
7 AAC 140.400
7 AAC 140.405
7 AAC 140.500
7 AAC 140.575
7 AAC 140.600
7 AAC 140.640
7 AAC 140.700
7 AAC 140.710
7 AAC 145.012
7 AAC 145.020
7 AAC 145.050
7 AAC 145.100
7 AAC 145.120
7 AAC 145.140
7 AAC 145.200
7 AAC 145.220
7 AAC 145.340
7 AAC 145.350
7 AAC 145.410
7 AAC 145.420
7 AAC 145.425
7 AAC 145.440
7 AAC 145.500
7 AAC 145.520
7 AAC 145.531
7 AAC 145.535
7 AAC 145.580
7 AAC 145.630
7 AAC 145.660
7 AAC 145.680
7 AAC 145.690
7 AAC 145.695
7 AAC 145.700
7 AAC 150.110
7 AAC 150.130
7 AAC 150.160
7 AAC 150.180
7 AAC 150.190
7 AAC 150.200
7 AAC 150.990
7 AAC 155.010
7 AAC 160.140
7 AAC 160.990

Authority

AS 47.05.010 AS 47.05.012 AS 47.07.030 AS 47.07.040 Editor's note: The department's Handicapping Labiolingual Deviation (HLD) Index Report adopted by reference in 7 AAC 160.900(d), may be obtained from Xerox Business Services, LLC web site at http://www.medicaidalaska.com/provi- ders/forms.html, the department's Internet site at http://dhss.alaska.gov/ Pages/default.aspx or at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167. The American Medical Association's Current Procedural Terminology (CPT), Professional Edition; the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS), the International Classification of Diseases - 10th Revision, Clinical Modification (ICD-10-CM), and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), all adopted by reference in 7 AAC 160.900, may be obtained by contacting the Order Department, American Medical Association, P.O. Box 930876, Atlanta, Georgia 31193-0876, or by visiting the AMA Bookstore at Internet address: https://catalog. ama-assn.org/Catalog/home.jsp. These publications may also be available at other retail book sellers. A copy of each of these publications is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167 or the Office of the Commissioner, 350 Main Street, Juneau, Alaska 99801. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 160.900, may also be obtained from American Psychiatric Association - Publishing, Inc., 1000 Wilson Boulevard, Suite 1825, Arlington, Virginia 22209-3901, telephone [phone] or [phone]; or from the American Psychiatric Association - Publishing, Inc. at the following Internet address: https://appi.org. The United States Department of Health and Human Services, National Institutes of Health's Glossary of Terms for Human Subjects Protection and Inclusion Issues, adopted by reference in 7 AAC 160.900, may be obtained by contacting the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167 or at the National Institutes of Health Internet address: http://grants.nih.gov/grants/peer /tree=hrzglossary.pdf. The Federal Register may be obtained through the nearest public library. If the Federal Register is not available at your nearest library, the material can be obtained by the library through the interlibrary loan system. It may also be obtained at http://www.gpo.gov/fdsys/. The American Society of Anesthesiologists' Relative Value Guide, adopted by reference in 7 AAC 160.900, may be obtained by contacting American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, Illinois 60068-2573, Internet address: http://www.asahq.org/shop-asa/billing-coding. The nonfacility individual relative value units (RVUs) for the Medicare program, and the geographic practice cost indices (GCPI) for this state, adopted by reference in 7 AAC 160.900, may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167. Drug Facts and Comparisons, adopted by reference in 7 AAC 160.900, may be obtained from the publisher, Wolters Kluwer Health, Inc., by telephone at [phone]. The book may also be ordered from the publisher at http://www.wolterskluwercdi.com/drug-facts-and-comparisons-bound/ or by writing to the following address: Wolters Kluwer Health, Inc., 77 Westport Plaza, Suite 450, St. Louis, Missouri 63146. A copy of this document is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167. Alternative Link's ABC Coding Manual for Integrative Healthcare, adopted by reference in 7 AAC 160.900, may be obtained from Alternative Link, 6121 Indian School Road NE, Suite 131, Albuquerque, New Mexico 87110; telephone: [phone]; or the following Internet address: http://abccodes.com. A copy of this document is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167. The Inventory for Client and Agency Planning, adopted by reference in 7 AAC 160.900, is available for inspection at the Department of Health and Social Services, Division of Senior and Disabilities Services, Court Plaza Building, 240 Main Street, Suite 602, Juneau, Alaska. A copy of the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) DMEPOS Fee Schedule, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167. The 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, adopted by reference in 7 AAC 160.900, may be obtained by contacting the Superintendent of Documents, United States Government Printing Office, Washington, D.C. 20402. A copy of this spreadsheet is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167 or may be found at the following CMS Internet address: http://www.cms.hhs.gov/ASC Payment/01=hrzOverview.asp. The United States Department of Health and Human Services, Public Health Service's Quick Reference Guide for Clinicians: Treating Tobacco Use and Dependence, adopted by reference in 7 AAC 160.900, may be obtained by contacting any of the following Public Health Service clearinghouse telephone numbers: Agency for Healthcare Research and Quality (AHRQ), [phone]; Centers for Disease Control and Prevention (CDC), (800) CDC-1311 ([phone]); National Cancer Institute (NCI), (800) 4-CANCER ([phone]). The publication may also be obtained at the following Internet address: http://www.ahrq.gov/professionals/ clinicians-providers/guidelines-recom- mendations/tobacco/clinicians/presenta- tions/2008update-overview/index.htm. The United States Internal Revenue Service optional standard mileage rate for medical purposes announcement IR-2008-82, published June 23, 2008, and adopted by reference in 7 AAC 160.900, may be obtained from the Internal Revenue Service at the following Internet address: http://www.irs.gov/uas/LatestNews. The department's Alaska Medicaid Preferred Drug List, Alaska Medicaid Prior-Authorized Medications List, and Select Diagnoses and Procedures Pre-certification List, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167; or may be obtained at the department's Internet site at http:// dhss.alaska.gov/dhcs/Pages/default.aspx. The Durable Medical Equipment Prior Authorization List, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167. The Table of ICAP Scores by Age and Consumer Assessment Tool (CAT), adopted by reference in 7 AAC 160.900, are available for inspection at the Department of Health and Social Services, Division of Senior and Disabilities Services, Court Plaza Building, 240 Main Street, Suite 602, Juneau, Alaska. The Personal Care Assistant Agency Certification Application Packet, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Senior and Disabilities Services, 3601 C Street, Suite 310, Anchorage, Alaska 99503. The FY 2010 - 2011 New Funding Formula for Title III and Title V Programs table, page 106, of the Alaska Commission on Aging Alaska State Plan for Senior Services, FY 2008 - FY 2011, adopted by reference in 7 AAC 160.900, 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. The Alaska Commission on Aging Alaska State Plan for Senior Services, FY 2008 - FY 2011 is also posted on the Department of Health and Social Services, Alaska Commission on Aging's Internet site at http://dhss.alaska.gov/acoa/Pages /stateplan.aspx. The Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care, adopted by reference in 7 AAC 160.900, is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167. The Addresses for Second Level Provider Appeals list, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167. Sections of the Alaska Provider Billing Manual, adopted by reference in 7 AAC 160.900(d), may be obtained at the following Xerox Business Services, LLC Internet site: http://manuals.medicaidalaska.com/, or may be obtained by contacting the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167. The Specialized Medical Equipment Fee Schedule, adopted by reference in 7 AAC 160.900, may be obtained by contacting the Department of Health and Social Services, Division of Senior and Disabilities Services, 3601 C Street, Suite 310, Anchorage, Alaska 99503-5684. The State of Alaska, Department of Health and Social Services, Behavioral Health Inpatient Psychiatric Review Provider Manual, adopted by reference in 7 AAC 160.900, may be obtained by contacting Qualis Health, PO Box 243609, Anchorage, AK 99524-3609, or may be obtained at the following Qualis Health Internet site: http://www.qualishealth.org/healthcare-professionals/alaska-medicaid- behavioral-health/provider-resources. This manual is also available for inspection at the Department of Health and Social Services, Division of Behavioral Health, 3601 C Street, Suite 878, Anchorage, Alaska 99503. The Medicaid Hospital and Long-Term Care Facility Reporting Manual, and the relevant pages from the Chart of Accounts for Hospitals, adopted by reference in 7 AAC 160.900, are available from the Office of Rate Review, Department of Health and Social Services, 3601 C Street, Ste 978, Anchorage, Alaska 99503. The Medicaid Log of Uninsured Care Reporting Form, adopted by reference in 7 AAC 160.900, is available from the Department of Health and Social Services, DSH Program, P.O. Box 110660, Juneau, Alaska 99811-0660. The department fee schedules, adopted by reference in 7 AAC 160.900(e), may be obtained by contacting the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167, or may be obtained at the following Xerox Business Services, LLC's Internet site http://manuals.medicaid alaska.com/. The department's Orthodontic Services Statement of Coverage, adopted by reference in 7 AAC 160.900, may be obtained from the department's Internet website at: http://dhss.alaska.gov/dhcs/Pages /default.aspx or at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167. The department's Orthodontic Referral Oral Health and Hygiene Assessment, adopted by reference in 7 AAC 160.900, may be obtained from the department's Internet website at: http://dhss.alaska.gov/dhcs/Pages /default.aspx or at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167. On December 7, 2010, as required by AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a), would be in effect on January 1, 2011: the Current Procedural Terminology, 4th edition as revised for 2011 ("CPT 2011 "), and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2011. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska 99503-7167. The Chart of Personal Care Attendant and Waiver Services Rates, adopted by reference in 7 AAC 160.900, 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. The Chart of Personal Care Attendant and Waiver Services Rates is also posted on the Department of Health and Social Services, Division of Senior and Disabilities Services' website at http://dhss.alaska.gov/ dsds/Pages/info/costsurvey.aspx. The Cost Survey and Cost Survey 2011 Instructions, adopted by reference in 7 AAC 160.900, 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. The materials are also posted on the Department of Health and Social Services, Division of Senior and Disabilities Services' website at http:// dhss.alaska.gov/dsds/Pages/info/cost survey.aspx. On January 26, 2011, as required by AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 160.900, would be in effect on March 1, 2011: the United States Department of Health and Human Services poverty guidelines established in 76 Fed. Reg. 3637 - 3638 (January 20, 2011). The Federal Register with the amended version may be obtained through the nearest public library. If the Federal Register is not available at that library site, the material can be obtained by that library through the interlibrary loan system. It may also be obtained at http://www.gpo.gov/fdsys. The department's Residential Behavioral Rehabilitation Services Handbook, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Behavioral Health, P.O. Box 110620, Juneau, Alaska 99811-0620. The department's Alaska Screening Tool, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Behavioral Health, Policy and Planning Section, 3601 C Street, Suite 878, Anchorage, AK 99503. The department's Client Status Review form, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Behavioral Health, Policy and Planning Section, 3601 C Street, Suite 878, Anchorage, AK 99503. The Consumer Price Index for All Urban Consumers (CPI-U), all items, for Anchorage, Alaska published annually by the United States Department of Labor, Bureau of Labor Statistics, adopted by reference in 7 AAC 160.900, may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167 or at the United States Department of Labor, Bureau of Labor Statistics' Internet website at http://bls.gov/cpi/. The Personal Care Assistance Service Level Computation, adopted by reference in 7 AAC 160.900, is available for inspection at the Department of Health and Social Services, Division of Senior and Disabilities Services, Court Plaza Building, 240 Main Street, Suite 602, Juneau, Alaska, or may be obtained at the department's Internet site at http://dhss.alaska.gov/dsds/Pages/pca/de- p0;0 fault.aspx. On December 7, 2011, as required by AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a), would be in effect on January 1, 2012: the Current Procedural Terminology, 4th edition, as revised for 2012 ("CPT 2012") and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2012. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska, 99503-7167. The Certificate to Request Funds for Abortion, adopted by reference in 7 AAC 160.990, is available for inspection at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167. On December 13, 2012, as required by AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a), would be in effect on January 1, 2013: the Current Procedural Terminology, 4th edition, as revised for 2013 ("CPT 2013" ) and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2013. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska 99503-7167. The Application for Alaskans Living Independently Waiver and Adults with Physical and Developmental Disabilities Waiver, Adult Day Services Condition of Participation, Care Coordinator Certification Application, Care Coordination Services Conditions of Participation, Chore Services Conditions of Participation, Day Habilitation Services Conditions of Participation, Intellectual & Developmental Disabilities 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, Home and Community-Based Waiver Services Provider Certification Application, Meal Services Conditions of Participation, Nursing Facility Level of Care Assessment Form for Children, Provider Conditions of Participation, Residential Habilitation Services Conditions of Participation, Residential Supported-Living Services Conditions of Participation, Screening Tool for Children with Complex Medical Conditions (CCMC) Waiver Program, Supported Employment Services Conditions of Participation, Transportation Services Conditions of Participation, and Environmental Modification Services 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 Internet website at http://dhss.alaska.gov/dsds. On December 25, 2013, as required by AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a), would be in effect on January 1, 2014: the Current Procedural Terminology, 4th edition, as revised for 2014 ("CPT 2014 ") and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2014. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska 99503-7167. The department's Alaska Medicaid 90 Day Generic Prescription Medication List, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167, or may be obtained at the department's Internet site at http:// dhss.alaska.gov/dhcs/Pages/pharmacy/ medpriorauthoriz.aspx. The department's Information About Your Prescription Drug Benefits and Prior Authorization, adopted by reference in 7 AAC 160.900, may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, AK 99503-7167; or may be obtained at the department's Internet site at http://dhss.alaska.gov/dhcs/Pages/phar- macy/medpriorauthoriz.aspx. On June 2, 2015, as required under AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 160.900, would be in effect on January 22, 2015: the United States Department of Health and Human Services poverty guidelines established in 80 Fed. Reg. 3236 - 3237 (January 22, 2015). The Federal Register with the amended version may be obtained through the nearest public library. If the Federal Register is not available at that library site, the material can be obtained by that library through the interlibrary loan system. It may also be obtained at http://www.gpo.gov/fdsys. On January 29, 2016, as required by AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 160.900, would be in effect on October 1, 2015: the 2016 version of the American Medical Association's International Classification of Diseases - 10th Revision, Clinical Modification, (ICD-10-CM). The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167. On February 2, 2016, as required by AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 160.900, would be in effect on January 25, 2016: the United States Department of Health and Human Services poverty guidelines established in 81 Fed. Reg. 4036 - 4037 (January 25, 2016). The Federal Register with the amended version may be obtained through the nearest public library. If the Federal Register is not available at that library site, the material can be obtained by that library through the interlibrary loan system. It may also be obtained at http://www.gpo.gov/fdsys/. On February 2, 2016, as required by AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 160.900, would be in effect in June 2013: the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, June 2013 (DSM-5). The amended version may be reviewed at the Department of Health and Social Services, Division of Behavioral Health, 3601 C Street, Anchorage, Alaska, 99503. The DSM-5 may also be obtained from the American Psychiatric Association - Publishing, Inc., 1000 Wilson Boulevard, Suite 1825, Arlington, Virginia 22209-3901, telephone [phone] or [phone]; or from the American Psychiatric Association - Publishing, Inc. at the following Internet address: https://appi.org. On January 29, 2016, as required by AS 44.62.245 and AS 47.05.012, the department gave notice that the following amended versions of material, previously adopted by reference in 7 AAC 160.900(a), would be in effect on January 1, 2016: the Current Procedural Terminology, 4th edition, as revised for 2016 ("CPT 2016") and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) 2016. The amended versions may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Building L, Anchorage, Alaska 99503-7167. A copy of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R), adopted by reference in 7 AAC 160.900, is available for examination at the Department of Health and Social Services, Division of Behavioral Health, 3601 C Street, Suite 878, Anchorage, Alaska 99503-7167.

History

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; am 3/19/2014, Register 209; am 3/22/2014, Register 209; am 5/18/2014, Register 210; am 2/26/2015, Register 213; am 3/15/2015, Register 213; am 7/1/2015, Register 214; am 5/1/2016, Register 218; am 6/16/2016, Register 218

References

7.160.900;7.160.990