7 AAC 43.015. Alternate resources

(a) The division will make payment only when other resources are not available to assume responsibility for the recipient's medical need. Full use must be made of alternate resources in the community. Benefits may be available

(1) under a worker's compensation law or plan of the United States or a particular state;

(2) under a health insurance plan or as health benefits of such a plan whether governmental or other;

(3) for items or services furnished by reason of membership in a prepayment plan or otherwise;

(4) for items or services provided or paid for directly or indirectly by a health insurance plan or as health benefits of a governmental entity, including but not limited to

(A) Veterans Administration,

(B) Armed Forces Retirees and Dependents Military Medical Benefits Act,

(D) parts A and B of medicare,

(E) Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) or TriCare;

(F) Fisherman's Fund;

(5) to residents of another state under that state's medicaid program.

(b) Treatment and treatment planning beyond the limits of coverage under medicaid is strictly a matter between patient and provider.

(c) If an applicant or recipient of medical assistance is receiving medical treatment for an injury caused negligently or intentionally by another individual, institution, corporation, business, or public or private agency, all details of that injury or accident must be provided by the applicant or beneficiary to the division. Medical providers are responsible for notifying the division at the time of billing when such injuries are treated. This information may be transmitted by the division to the attorney general for evaluation of potential participation in a lawsuit or settlement for damages in order that the state may seek the cost of medical care for the injured individual. The division will not delay payment of the provider's billing while this investigation is being pursued.

History: Eff. 8/18/79, Register 71; readopt 8/7/96, Register 139; am 3/3/2001, Register 157

Authority: AS 47.05.010

AS 47.07.050

Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.015 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.

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