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(a) Except as provided in (c) of this section for mental health services, the following types of provider are eligible to enroll with the department and bill directly for services rendered:
(1) a person currently licensed by the state to practice medicine, osteopathy, dentistry, optometry, chiropractic, podiatry, occupational therapy, or audiology;
(2) a speech pathologist with a current certificate of clinical competence from the American Speech-Language-Hearing Association;
(3) a hospital currently licensed by the department;
(4) a long-term care facility providing skilled nursing care and intermediate care;
(5) a licensed pharmacy;
(6) a home health services agency certified by the department;
(7) a company or individual not excluded in (b) of this section, supplying
(A) medical transportation, ambulance services, oxygen, eyeglasses, prosthetic devices, durable medical equipment, supplies, respiratory therapy assessment visits, and home infusion therapy; or
(B) items reimbursable under 7 AAC 43.1055 as specialized medical equipment and supplies;
(8) a provider of screening services under 7 AAC 43.452;
(9) repealed 5/5/93;
(10) a rural health clinic certified by the Medicare program;
(11) a licensed outpatient surgical care center;
(12) a licensed physical therapist;
(13) a facility providing services for end stage renal disease;
(14) a person currently licensed by the state as an advanced nurse practitioner;
(15) a personal care attendant or personal care agency;
(16) a hospice care agency certified by the department;
(17) residential psychiatric treatment center for persons age 21 and under;
(18) a home and community-based services provider, as defined at 7 AAC 43.1110;
(19) a care coordination agency provider, as defined at 7 AAC 43.1110;
(20) repealed 5/15/2004;
(21) a residential supported living services provider, as defined at 7 AAC 43.1110;
(22) a substance abuse rehabilitative service provider approved by the department;
(23) a federally qualified health center (FQHC);
(24) a licensed direct-entry midwife.
(25) a person currently licensed by the state as a dietician or nutritionist;
(26) a hospital or clinic operated by a tribal organization, as defined in 25 U.S.C. 450b(1), under a funding agreement under 25 U.S.C. 450-458aaa (Indian Self-Determination and Education Assistance Act) as amended by P.L. 106-260 (Tribal Self-Governance Amendments of 2000);
(27) a provider of in-state freestanding or portable x-ray services who meets the requirements of 7 AAC 43.940(a) (1) or (2);
(28) a provider of behavioral rehabilitation services for severely emotionally disturbed children.
(b) The services of a licensed or unlicensed practitioner not specifically provided for in this chapter are not covered under the Medicaid program in this state.
(c) The following types of provider are eligible to enroll with the department and bill directly for outpatient mental health services:
(1) a physician licensed to practice in the state in which service is provided;
(2) a community mental health clinic; or
(3) a mental health physician clinic.
(d) Notwithstanding (a) of this section, a federal employee assigned to a health program operated by a tribal organization that operates a hospital or clinic under (a)(26) of this section is exempt from state licensure. However, to be enrolled as a Medicaid provider in the state, the employee must provide proof of current licensure from a jurisdiction in the United States. For purposes of this subsection, "jurisdiction in the United States" means a state, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, or Guam.
History: Eff. 8/18/79, Register 71; am 12/31/92, Register 124; em am 1/8/93 - 5/7/93, Register 125; am 5/5/93, Register 126; am 6/5/93, Register 126; am 12/19/93, Register 128; am 2/23/94, Register 129; am 9/28/95, Register 135; readopt 8/7/96, Register 139; am 2/12/99, Register 149; am 3/3/2001, Register 157; am 5/15/2004, Register 170; am 9/29/2005, Register 175; am 12/16/2005, Register 176; am 1/11/2006, Register 177
Authority: AS 47.05.010
Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.035 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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Last modified 7/05/2006