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(a) The department will pay a provider enrolled under 7 AAC 43.1900 in accordance with 7 AAC 43.040.
(b) The department will pay an enrolled provider for durable medical equipment, medical supplies, prosthetics, orthotics, and noncustomized-fabricated orthotics for which a price has been issued by CMS, based on 100 percent of the DMEPOS Fee Schedule 2005 1st Quarter established by CMS for these items in this state and adopted by reference.
(c) The department will pay an enrolled provider for durable medical equipment, medical supplies, prosthetics, orthotics, and noncustomized-fabricated orthotics, for which CMS has not issued a price as described in (b) of this section, at 80 percent of billed charges from enrolled providers in this state for the first nine billings that reflect a charge for an item not already on the schedule established under this subsection. Thereafter, the fee will be established based on the 50th percentile of the first 10 billings. The department will add new fees to the payment schedule under this subsection each time the department receives 10 billings for an item not already on the schedule. To be paid under this subsection, a billing must reflect a charge that complies with the applicable standards in 7 AAC 43.040.
(d) The department will pay separately for labor and repair parts for damaged durable medical equipment, prosthetics, and orthotics with the following limitations:
(1) the department will not pay more than $20 for each 15 minutes of labor costs;
(2) the billing for a repair part must reflect a charge that complies with the applicable standards in 7 AAC 43.040;
(3) labor and repair parts for the item must be documented as necessary; documentation must include
(A) a statement signed by the recipient or the recipient's authorized representative, that describes the cause for and nature of the repair;
(B) a description of the item being repaired and its serial number, if available;
(C) the beginning and end dates of warranty coverage, if available; and
(D) documentation for labor charges that includes the amount of time spent on the repair, rounded up to the nearest quarter hour, and the hourly rate charged for the repair;
(4) the department will not pay for labor and repair parts if the item is covered under a manufacturer's or supplier's warranty, or if the labor or parts are necessary to repair an item that needs repair because of a manufacturer's defect;
(5) payment will not be made for labor and repair parts for a rented item; the provider shall ensure that a rented item functions as intended after the provider repairs or replaces the item.
(e) The department will not pay an enrolled provider more than the average wholesale price accepted monthly by the department from the American Druggist Blue Book, plus 10 percent of that amount, for the following items:
(1) skin sealants;
(2) skin protectants;
(3) skin moisturizers;
(4) skin ointments;
(5) skin cleaners;
(6) skin sanitizers.
(f) The department will pay an enrolled provider based on the Incontinence Supplies Fee Schedule, dated December 2005, and adopted by reference, for the following incontinence supplies:
(1) garments;
(2) liners;
(3) under pads;
(4) nonsterile gloves;
(5) diaper wipes;
(6) disposable washcloths.
History: Eff. 1/11/2006, Register 177; addt'l am 1/11/2006, Register 177
Authority: AS 47.05.010
Editor's note: A copy of the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) DMEPOS Fee Schedule 2005 1st Quarter, adopted by reference in 7 AAC 43.1920(b), 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.
A copy of the American Druggist Blue Book referred to in 7 AAC 43.1920(e) 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.
A copy of the Incontinence Supplies Fee Schedule, adopted by reference in 7 AAC 43.1920(f), 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.
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Last modified 7/05/2006