7 AAC 43.560. Conditions for payment

(a) To receive payment under Medicaid for inpatient psychiatric services, an enrolled inpatient psychiatric hospital facility must

(1) be licensed under AS 18.20, and accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO);

(2) comply with the requirements of the prospective payment system under 7 AAC 43.670 - 7 AAC 43.709;

(3) provide services in accordance with the requirements of 7 AAC 43.552, 7 AAC 43.555, and 7 AAC 43.556;

(4) receive prior authorization under 7 AAC 43.552 from the division for the inpatient psychiatric services for each recipient billed for under Medicaid;

(5) provide therapeutically appropriate, medically necessary diagnostic and treatment services to recipients who are admitted to the inpatient psychiatric hospital facility, including the following services:

(A) intake assessment;

(B) admitting history and physical examination;

(D) group psychotherapy;

(E) family psychotherapy;

(F) pharmacologic management;

(G) crisis intervention.

(b) To receive payment under Medicaid, an enrolled provider of residential psychiatric treatment center services must

(1) be licensed under 7 AAC 50 by the division of family and youth services in the department;

(2) be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities, or the Council on Accreditation of Services for Families and Children as a residential psychiatric treatment center for care of children under 21 years of age;

(3) comply with the admission requirements of 7 AAC 43.552;

(4) in addition to the care and services required under 7 AAC 50, provide basic residential care and services that include

(A) dwelling space provided in separate buildings or units with no more than 60 beds per building and no more than 30 beds provided for sleeping accommodation per unit; and

(B) equipment, supplies, maintenance, and insurance used by residents for program activities and case-specific services;

(5) provide therapeutically appropriate, medically necessary diagnostic and treatment services for emotionally disturbed children, and severely emotionally disturbed children, including the following services:

(A) individual psychotherapy;

(B) group psychotherapy;

(D) group skill development services;

(E) individual skill development services;

(F) pharmacologic management;

(G) crisis intervention;

(H) intake assessment; and

(6) receive a determination by the division that the inpatient psychiatric services provided were medically necessary for each recipient billed for under Medicaid.

(c) The division will not separately reimburse an inpatient psychiatric hospital facility for the required inpatient psychiatric services described in (a) of this section.

History: Eff. 8/18/79, Register 71; am 5/5/84, Register 90; am 6/27/84, Register 91; am 1/8/93, Register 125; am 3/26/93, Register 126; am 6/5/93, Register 126; am 12/31/94, Register 132; am 1/1/96, Register 136; readopt 8/7/96, Register 139; am 11/1/2000, Register 156; am 4/19/2001, Register 158

Authority: AS 47.05.010

AS 47.07.030

AS 47.07.040

Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.560 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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