7 AAC 43.275. Medicare coinsurance

(a) The division will pay, on behalf of eligible recipients, the coinsurance established under part A of medicare, for care rendered from the 21st through the 100th day of care in an SNF. The division will pay the SNF rate established for care in that particular facility beyond the 100th day.

(b) Rejection or non-payment by medicare of services provided by an SNF because the services were custodial in nature or because the facility did not choose to participate as a medicare provider is not, by itself, justification for the division to make full payment to an SNF during the period from the 1st to the 100th day of care at an SNF. The division will make payment to the facility for that level of care appropriate to the recipient's needs as determined by the utilization review committee and approved by the division.

History: Eff. 8/18/79, Register 71; 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 43.275 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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