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(a) Except as otherwise provided in this section, an interruption in a rental period affects the department's payment as follows:
(1) a rental period is not affected by an interruption of less than 30 days; if an interruption continues beyond the end of the rental month in which use ceases, the department will pay for the rental month in which use ceased, but will not make an additional payment until use resumes; a new date of service will be established when use resumes;
(2) rental units for which prior authorization has been received, but for which no payment is made, do not apply toward a capped rental period;
(3) if an interruption is or exceeds 30 consecutive days, or if the original rental period expires during the interruption, the provider shall submit to the department a new prior authorization request under 7 AAC 43.1910, with a statement that explains the reason for the interruption; if the department approves the request, a new rental period begins.
(b) A recipient's change of address does not affect the rental period for that recipient.
(c) Except as otherwise provided in this section, if an item is modified or replaced with a different item, the rental will continue to be applied against the current rental period and payment will be based on the least expensive item that is medically suited to the rental purpose. If the rental period has expired, additional payment will not be made for a modified or replaced item unless the provider submits to the department, on a form provided by the department, certification of medical necessity for the modified or replaced item from a physician, physician assistant, advanced nurse practitioner, physical therapist, occupational therapist, or speech-language pathologist. If the department approves the request, a new rental period begins.
(d) If an addition is made to an existing item because of a substantial change in the recipient's medical need, the rental period for the original item continues and a new rental period begins for the added item.
(e) If the recipient changes providers during the rental period, a new rental period does not begin. The new provider shall continue to supply the item during the remaining rental period.
History: Eff. 1/11/2006, Register 177
Authority: AS 47.05.010
Editor's note: The certification of medical necessity form referred to in 7 AAC 43.1950(c) may be obtained from the Department of Health and Social Services, Division of Health Care Services, P.O. Box 110601, Juneau, Alaska 99811-0601.
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Last modified 7/05/2006