7 AAC 43.075. Out-of-state covered services

(a) Unless otherwise provided in this chapter, the department will cover services provided in another state to the same extent it would cover services in this state if

(1) the services are provided to a recipient who is a resident of this state; and

(2) the department is able to verify one of the following situations:

(A) medical services are needed because of a medical emergency;

(B) the recipient requires medical services that are not available in this state or the provision of services in another state is more cost-effective;

(C) medical services are needed due to an accident or sudden illness while a recipient is visiting in another state and the recipient's health would be endangered if the recipient were required to travel to this state for the needed medical services;

(D) laboratory specimens are sent out of state because

(i) the laboratory service is not offered in this state;

(ii) the laboratory service is more readily available in another state; or

(iii) to have the laboratory work performed in another state is more cost-effective.

(b) The department may pay an out-of-state provider for services provided to a recipient from this state that meet the requirements of (a) of this section if the provider

(1) is enrolled in the medical assistance program in this state;

(2) is enrolled in the medical assistance program in the state where services are provided if the service is covered under the other state's Medicaid program; and

(3) possesses the appropriate license in the other state to provide the required services.

(c) The department may deny a request for a service provided out of state that requires prior authorization by the department if the requirements of (a) of this section are not met.

(d) Inpatient psychiatric hospital facilities, psychiatric facilities, and residential psychiatric treatment centers may be approved by the department as providers, if the department determines that a need exists for the service under (a)(2) of this section.

History: Eff. 8/18/79, Register 71; am 4/19/2001, Register 158; am 12/2/2005, Register 176

Authority: AS 47.05.010

AS 47.07.020

The Alaska Administrative Code was automatically converted to HTML from a plain text format. Every effort has been made to ensure its accuracy, but neither Touch N' Go Systems nor the Law Offices of James B. Gottstein can be held responsible for any possible errors. This version of the Alaska Administrative Code is current through June, 2006.

If it is critical that the precise terms of the Alaska Administrative Code be known, it is recommended that more formal sources be consulted. Recent editions of the Alaska Administrative Journal may be obtained from the Alaska Lieutenant Governor's Office on the world wide web. If any errors are found, please e-mail Touch N' Go systems at E-mail. We hope you find this information useful. Copyright 2006. Touch N' Go Systems, Inc. All Rights Reserved.