Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 255. All-inclusive rate

7 AAC 43.255. All-inclusive rate

(a) The rate established for a facility includes all services, supplies, and equipment required for complete care, except the following:

(1) health care services by providers not employed by the facility or on contract with the facility to provide services;

(2) personal incidental items authorized for payment from the recipient's personal incidental allowance or cash reserve; and

(3) oxygen as described in (f) of this section.

(b) Legend drugs and biologicals are not included in the all-inclusive rate. Payment will be made as specified in 7 AAC 43.591. Non-prescription drugs may be included in the rate as determined under 7 AAC 43.670 - 7 AAC 43.709.

(c) Repealed 2/1/89.

(d) The facility must provide rehabilitative nursing care, including service of restorative aides and nurses, as part of nursing and supportive care services included in the all-inclusive rate.

(1) Consultation, training and other non-direct patient care services by a physical therapist, physical therapy assistant, occupational therapist or occupational therapy assistant are included in the all-inclusive rate, whether or not the therapist or assistant is an employee of the facility.

(2) Direct physical or occupational therapy services to an individual recipient, prescribed by a physician, are included in the all-inclusive rate.

(e) Medical services, including X-ray and laboratory procedures, provided in or out of a facility by a physician, hospital, or other provider, are not included in the all-inclusive rate.

(f) If a recipient requires only periodic oxygen, the cost is included in the all-inclusive rate. Non-emergency, continuous heavy use of oxygen which must be available to the recipient at all times is not included in the all-inclusive rate. The facility must complete a Request for Authorization form which details the need for continuous heavy use of oxygen either through physician orders or physician or nursing notes. Payment will be made to the facility at the facility's cost for the oxygen. The amount of oxygen given to the recipient must be accurately metered and measurable to the recipient. The metered amount of oxygen and dates used must be noted on the billing by the facility.

(g) All transportation related to the recipient's care and recreation in a facility's vehicle is included in the all-inclusive rate:

(1) essential transportation for recipients to and from the source of medical care is not included in the all-inclusive rate; payment for such essential transportation is made by the division directly to the carrier;

(2) the facility is responsible for transportation planning; the type of carrier is to be determined by considering the recipient's condition, distance to the medical facility or provider of service, and the frequency of the trip; the least expensive mode of transportation must be used consistent with these conditions;

(3) payment for non-emergency, in-state transportation must have prior authorization by a regional assistance manager or his or her designee where the cost of transportation is under $250 a person one-way; reasonable notice should be given by the facility to the regional office when non-emergency transportation is required; non-emergency in-state medical transportation exceeding $250 a person one-way and all non-emergency, out-of-state medical transportation must be authorized in advance by the medical practice review section;

(4) emergency transportation provided when the regional office is closed or when the regional office authorization of payment cannot be immediately obtained must be reported to the regional office as soon as feasible but not later than three working days after the transportation is required;

(5) transportation for non-medical reasons in other than the facility's vehicle is the responsibility of the recipient or the facility; this expense is not included in the all-inclusive rate.

(h) The cost of annual physical examinations for recipients in long-term care facilities is included in the all-inclusive rate.

History: Eff. 8/18/79, Register 71; am 2/1/89, Register 109; am 6/14/89, Register 110; readopt 8/7/96, Register 139

Authority: AS 47.05.010

AS 47.07.070

Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.255 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.