Made available by
Touch N' Go Systems, Inc., and the
Law Offices of James B. Gottstein.
You can also go to The Alaska Legal Resource Center or search the entire website search.
|
(a) The department will enroll a school district as a Medicaid provider of school-based services if the school district meets the applicable requirements of AS 47.07 and this chapter and enters into an agreement with the department as required by AS 47.07.063 .
(b) The school district shall submit each request for payment for a school-based service using the provider code number assigned to the school district at enrollment.
(c) The department will pay for school-based services in accordance with 7 AAC 43.040 and established at 85 percent of the resource-based relative value scale (RBRVS) fee schedule determined under 7 AAC 43.108(b) and (c) for procedures with an established relative value unit (RVU). For services with no established RVU, the department will pay according to the department's School-Based Services Fee Schedule, dated May 2005 and adopted by reference.
(d) The department will pay the cost of an evaluation, screening, or assessment of a Medicaid-eligible child's need for a school-based service only if the outcome indicates the child's need for services included in the individualized education plan described in (e) of this section.
(e) The department will pay for school-based services for a Medicaid-eligible child if the individualized education plan developed for the child under AS 14.30.278 specifies the services that the school district is seeking reimbursement for, each health condition to be addressed, the anticipated treatment goals, and the type, amount, frequency, and duration of each service to be offered. Any change to a plan that adds, eliminates, or alters a service, material, or supply described under this section must be documented in the Medicaid-eligible child's clinical record by or under the direction of a physician, physician's assistant, advanced nurse practitioner, physical therapist, occupational therapist, speech-language pathologist, audiologist, psychologist or psychological associate, behavioral health professional, behavioral health associate, or other health care provider who is
(1) acting within the scope of that health care provider's
(A) license under AS 08; or
(B) training and experience, if the health care provider is a psychologist or psychological associate described in (i)(7)(A)(ii) of this section, a behavioral health professional, or a behavioral health associate; and
(2) familiar with the child's plan, health condition, and treatment history.
(f) In addition to meeting the requirements for provider records in 7 AAC 43.030 and AS 47.07.063 (b), and before the department will pay for school-based services, the school district must assure that each Medicaid-eligible child's clinical record includes
(1) documentation of the relationship of the service provided to the child's achievement of individualized education plan goals and objectives; and
(2) on each page of service documentation, the Medicaid recipient identification number and at least one other item of unique identification for the Medicaid-eligible child who received the service; for the purposes of this paragraph, "item of unique identification" includes the child's name, date of birth, social security number, and the student identification number assigned by the school district.
(g) Nothing in this section precludes a private enrolled provider from furnishing the same service to the same child at a different time on the same day that the child was furnished a school-based service, if the applicable requirements of this chapter are otherwise met.
(h) Subject to the requirements of AS 47.07.063 (a), the department will pay a school district for the following school-based services furnished in accordance with this chapter to a Medicaid-eligible child with a disability, and for materials and supplies provided to the recipient in the course of performing the services, if those materials and supplies are furnished in accordance with this chapter:
(1) physical therapy services furnished by or under the direction of a physical therapist licensed under AS 08.84, and practicing in accordance with 7 AAC 43.921, regardless of whether that person is enrolled under that section;
(2) occupational therapy services furnished by or under the direction of an occupational therapist licensed under AS 08.84, and practicing in accordance with the provisions of 7 AAC 43.923, regardless of whether that person is enrolled under that section;
(3) speech-language pathology services furnished by or under the direction of a speech-language pathologist who
(A) meets the requirements of 42 C.F.R. 440.110(c) or is licensed under AS 08.11; and
(B) is practicing in accordance with the provisions of 7 AAC 43.926, regardless of whether that person is enrolled under that section;
(4) hearing services furnished by or under the direction of an audiologist licensed under AS 08.11, and practicing in accordance with the provisions of 7 AAC 43.927, regardless of whether that person is enrolled under that section;
(5) behavioral health services including
(A) the following services furnished by a behavioral health associate or behavioral health professional:
(i) emotional support assistance to help a child process emotions during periods of elevated stress;
(ii) behavior management education that teaches behavior management, modification, and redirection techniques to elicit positive behaviors with families, groups, and individuals;
(B) the following services furnished by a behavioral health professional:
(i) crisis response services that include short-term interventions to prevent harm, build coping skills, develop mechanisms for positive self-care, and stabilize a child or family in acute distress;
(ii) behavior modification assistance using counseling techniques to assist in modifying behavior to individuals and groups;
(iii) functional behavioral assessments to assess a child's behavior;
(iv) psychoeducational services designed to help a child develop or improve specific self-care skills and engage in age-appropriate social behavior; and
(C) services furnished by a psychologist or psychological associate, including
(i) testing a child's psychological, cognitive, and emotional functioning; and
(ii) interpreting a child's psychological, cognitive, emotional, and behavioral assessment results;
(6) medication services furnished by a nurse licensed under AS 08.68, including medication administration, direct observation, training, and support.
( i ) In this section,
(1) "child with a disability" has the meaning given in AS 14.30.350 ;
(2) "individualized education plan" and "plan" means the plan developed for a Medicaid-eligible child with a disability through an "individualized education program" described in AS 14.30.278 ;
(3) "school-based service" means a service identified in this section that is furnished in accordance with AS 47.07 and this chapter by an enrolled school district to a Medicaid-eligible child with a disability;
(4) "school district" has the meaning given in AS 47.07.063 ;
(5) "behavioral health associate" means a person who has less than a master's degree in psychology, social work, counseling, or a related field with specialization or experience in working with children experiencing behavioral, physical, and emotional disabilities, and is working within the scope of the person's training and experience; "behavioral health associate" does not include a person employed as a teacher;
(6) "behavioral health professional" means a person who has a master's degree in psychology, social work, counseling, or a related field with specialization or experience in working with children experiencing behavioral, physical, and emotional disabilities, and is working within the scope of the person's training and experience; "behavioral health professional" does not include a person employed as a teacher;
(7) "psychologist or psychological associate"
(A) means a psychologist or psychological associate
(i) licensed under AS 08.86 and working within the scope of the person's license; or
(ii) with a special services certificate (Type C) under 4 AAC 12 endorsed in "school psychology," who is employed by the school district and working within the scope of the person's training and experience; and
(B) does not include a person employed as a teacher by the school district.
History: Eff. 8/19/2004, Register 171; am 9/18/2005, Register 175
Authority: AS 47.05.010
Editor's note: A copy of the department's School-Based Services Fee Schedule, adopted by reference in 7 AAC 43.461(c) may be obtained from the Department of Health and Social Services, Division of Behavioral Health, Box 110620, Juneau, Alaska 99811-0620.
Note to HTML Version:
The Alaska Administrative Code was automatically converted to HTML from a plain text format. Every effort has been made to ensure its accuracy, but neither Touch N' Go Systems nor the Law Offices of James B. Gottstein can be held responsible for any possible errors. This version of the Alaska Administrative Code is current through June, 2006.
If it is critical that the precise terms of the Alaska Administrative Code be known, it is recommended that more formal sources be consulted. Recent editions of the Alaska Administrative Journal may be obtained from the Alaska Lieutenant Governor's Office on the world wide web. If any errors are found, please e-mail Touch N' Go systems at E-mail. We hope you find this information useful. Copyright 2006. Touch N' Go Systems, Inc. All Rights Reserved.
Last modified 7/05/2006