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(a) The department will pay a provider enrolled under 7 AAC 43.1900 for respiratory therapy equipment and supplies if the
(1) provider employs or contracts with a
(A) registered respiratory therapist who
(i) holds a valid national registry number and certificate from the National Board for Respiratory Care (NBRC) or a certificate from another body that the National Board for Respiratory Care recognizes as a credentialing equivalent; and
(ii) is enrolled under (b) of this section; or
(B) certified respiratory therapy technician who
(i) holds a valid national certificate from the National Board for Respiratory Care (NBRC) or a certificate from another body that the National Board for Respiratory Care recognizes as a credentialing equivalent; and
(ii) is enrolled under (b) of this section; and
(2) equipment is not provided by, or under arrangements made by, a home health agency or hospice program.
(b) The department will enroll a registered respiratory therapist or a certified respiratory therapy technician under (a)(1) of this section as a rendering provider.
(c) The department will not pay an enrolled registered respiratory therapist or enrolled certified respiratory therapy technician separately for respiratory therapy assessment visits. The department will pay an enrolled durable medical equipment provider a maximum of $75 per hour for each assessment provided to a ventilator-dependent recipient by an enrolled registered respiratory therapist or an enrolled certified respiratory therapy technician during an assessment visit, if the visit is
(1) given prior authorization as part of the recipient's plan of care; and
(2) certified as medically necessary by the recipient's attending physician, physician assistant, or advanced nurse practitioner, on a form provided by the department.
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 43.1955(c) 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