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(a) Beneficiaries of medicare who are not in a state institution shall use their nonrenewable lifetime hospitalization reserve of 60 days before payment for hospitalization will be made from medicaid funds.
(b) Hospitalization for the treatment of acute and chronic renal failure is provided by medicare after the third month of treatment. The division will pay the deductible and coinsurance for a beneficiary who is eligible for medicare benefits and who is hospitalized for that treatment or for kidney transplant, up to the limits established by the medicare program or by the division, whichever is less.
(c) The division will not make payment for weekend stays when admission was made on Friday or Saturday for surgery scheduled on Monday except for emergencies or cases where the physical or mental condition of the beneficiary necessitates extensive preoperative preparation or therapy.
(d) The division will make payment for nonemergency inpatient hospital services that have been authorized as appropriate by the division before the beneficiary was admitted to the hospital. Failure to obtain authorization will result in nonpayment regardless of the eligibility of the beneficiary or the appropriateness of the services.
(e) The division will make payment for emergency inpatient hospital services that have been reported to the division within three working days after admission. If a beneficiary is eligible for coverage under 7 AAC 43.020, payment will be made for emergency hospital services only if the services have been determined to be appropriate by the division; failure to notify the division will result in non-payment regardless of the eligibility of the beneficiary or the appropriateness of the services.
History: Eff. 8/18/79, Register 71; am 3/25/83, Register 85; readopt 8/7/96, Register 139
Authority: AS 47.05.010
Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.435 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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Last modified 7/05/2006