Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 725. Conditions for payment

7 AAC 43.725. Conditions for payment

(a) To be eligible for Medicaid reimbursement, a mental health clinic must be a

(1) community mental health clinic that meets the requirements of (b) of this section; or

(2) mental health physician clinic that meets the requirements of (b) and (c) of this section.

(b) To be eligible for Medicaid reimbursement, a mental health clinic must be administratively, organizationally, financially, and otherwise separate from a health facility, as defined in AS 47.07.900 , except that

(1) a governmental or corporate entity may concurrently operate a mental health clinic and a health facility in the same building or in separate locations if

(A) the health facility's administrator and governing board have no administrative or financial authority over the mental health clinic; and

(B) all expenses and income of the mental health clinic are accounted for separately from the expenses and income of the health facility so that the costs of operating the mental health clinic are excluded from the costs considered by the department in determining the health facility's prospective payment rate under 7 AAC 43.670 - 7 AAC 43.709;

(2) a mental health clinic operated by a governmental or corporate entity that concurrently operates a health facility may enter into a written agreement with the health facility under which the health facility is to provide administrative and other support services, except supervision of the mental health clinic, to the mental health clinic, subject to the following limitations:

(A) if the health facility charges the mental health clinic for a service provided by the health facility, the charge must be based on the direct cost incurred by the health facility for providing the service;

(B) if the health facility does not charge the mental health clinic for a service provided, the costs incurred by the health facility in providing the service will be excluded from the costs considered by the department in determining the health facility's prospective payment rate under 7 AAC 43.670 - 7 AAC 43.709; and

(C) a mental health clinic may not obtain the services of the supervising psychiatrist required under subsection (c) through an agreement with a health facility;

(3) a physician or other health professional who is employed by a health facility operated by a governmental or corporate entity that concurrently operates a mental health clinic may also be employed, under a separate written agreement, by the mental health clinic only if

(A) the services provided under the employment agreement do not include those of the supervising psychiatrist required by subsection (c);

(B) the cost of services provided by this employee is separately accounted for by the mental health clinic; and

(C) the cost of services provided by this employee is excluded from the costs considered by the department in determining the health facility's prospective payment rate under 7 AAC 43.670 - 7 AAC 43.709; and

(4) a physician or other health professional who provides services under a contract or other agreement to a health facility that is operated by a governmental or corporate entity that concurrently operates a mental health clinic may also provide services to the mental health clinic under a separate agreement with the mental health clinic only if the costs of the services provided are separately accounted for by the mental health clinic and are excluded from the costs considered by the department in determining the health facility prospective payment rate under 7 AAC 43.670 - 7 AAC 43.709.

(c) The division will reimburse for mental health clinic services provided by a mental health physician clinic only if

(1) the services are provided by a psychiatrist or by a mental health professional clinician working under the direct supervision of a psychiatrist;

(2) the psychiatrist operating the clinic provides direct supervision, as described in 7 AAC 43.1990, to all service providers in the clinic and assumes responsibility for the treatment given; and

(3) necessary adjunctive treatment is provided either directly or through a written agreement with another qualified mental health professional clinician.

(d) To qualify for reimbursement under 7 AAC 43.470 - 7 AAC 43.478 and 7 AAC 43.725 - 7 AAC 43.729, all mental health clinic services must be provided on the premises of the mental health clinic.

(e) Notwithstanding the provisions of this section, 7 AAC 43.470 - 7 AAC 43.478, and 7 AAC 43.726 - 7 AAC 43.729, the division will reimburse a community mental health clinic for the services described in 7 AAC 43.470(a) and listed in 7 AAC 43.726(a) only upon certification by the division of mental health and developmental disabilities that the clinic operates in accordance with the provisions of 7 AAC 71.

History: Eff. 8/18/79, Register 71; am 5/5/93, Register 126; am 12/31/94, Register 132; readopt 8/7/96, Register 139; am 11/1/2000, Register 156

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 43.725 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.