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(a) Except as provided in (b) of this section and in accordance with 7 AAC 43.470 - 7 AAC 43.478 and 7 AAC 43.725 - 7 AAC 43.739, the division will reimburse an enrolled physician for medically necessary and appropriate mental health services only if those services are rendered directly by the physician. Mental health services rendered by someone other than the physician must be provided in accordance with 7 AAC 43.470 - 7 AAC 43.478 and 7 AAC 43.725 - 7 AAC 43.739 to be eligible for reimbursement by the division.
(b) Unless the physician is a psychiatrist, the division will not reimburse a physician for mental health services provided in a licensed and Medicaid-certified psychiatric hospital or facility, a general acute care hospital as defined in 7 AAC 12.100, a long term care facility as defined in 7 AAC 43.709, or an intermediate care facility for the mentally retarded.
(c) The division will not reimburse a physician for experimental therapy, nonmedical outpatient therapy, nonmedical counseling, including any of the following services:
(1) telephone consultation;
(2) preparing of reports;
(3) narcosynthesis;
(4) socialization;
(5) recreation therapy;
(6) primal therapy;
(7) marathon group therapy;
(8) megavitamin therapy;
(9) pastoral counseling;
(10) employment counseling; or
(11) explanation of an examination to a family member or other responsible person when the explanation is provided outside of a family therapy session.
(d) Reimbursement for mental health services will be made only if those services are specified in a treatment plan that meets the requirements of 7 AAC 43.728.
(e) For purposes of diagnosis, evaluation, and management of the recipient during the recipient's stay in an inpatient psychiatric hospital facility, the division will reimburse for no more than one physician visit each day of the first seven-day period after the recipient's admission and for no more than three physician visits during each subsequent seven-day period.
(f) The division will not reimburse a physician for providing group psychotherapy services to a recipient in an inpatient psychiatric hospital facility that is subject to the provisions of 7 AAC 12.200 - 7 AAC 12.215 or in an acute care hospital offering psychiatric services that is subject to the provisions of 7 AAC 12.100 - 7 AAC 12.180.
History: Eff. 5/5/93, Register 126; am 12/31/94, Register 132; readopt 8/7/96, Register 139
Authority: AS 47.05.010
Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.131 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