Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 726. Coverage for mental health clinic services

7 AAC 43.726. Coverage for mental health clinic services

(a) Subject to the requirements of this section, the division will reimburse an eligible mental health clinic for the following mental health clinic services, provided to a recipient who is determined to be an emotionally disturbed child or an emotionally disturbed adult through an intake assessment, a psychiatric assessment, or psychological testing and evaluation administered under 7 AAC 43.470 or 7 AAC 43.734, if identified in the recipient's individualized treatment plan as medically necessary, in accordance with 7 AAC 43.486, and provided as active treatment:

(1) crisis intervention, as described in 7 AAC 43.738;

(2) family psychotherapy;

(3) group psychotherapy;

(4) individual psychotherapy;

(5) pharmacologic management.

(b) The division will reimburse a mental health clinic for

(1) family psychotherapy, if at least a portion of the family psychotherapy session is attended by the family or household member eligible for Medicaid coverage under this chapter, and the therapist has at least the qualifications of a mental health professional clinician;

(2) group psychotherapy, if at least one therapist is present for every 10 recipients in the group, and that therapist

(A) is participating in the therapy; and

(B) has at least the qualifications of a mental health professional clinician;

(3) biofeedback or relaxation therapy as an element of individual psychotherapy, if it is

(A) prescribed by a psychiatrist, when provided in a mental health physician clinic, or prescribed by a physician or mental health professional clinician, when provided in a community mental health clinic; and

(B) included in the individualized treatment plan as a recognized treatment or adjunct to a treatment for chronic pain syndrome, panic disorders, phobias, or similar conditions; and

(4) a psychiatric assessment, if the recipient enters into treatment, the recipient changes providers, or a change occurs in the recipient's medical condition that requires a new psychiatric assessment or an annual assessment; a psychiatric assessment must be

(A) rendered by a physician, a psychiatrist, or a physician assistant or psychiatric nurse practitioner working under the

(i) direct supervision of a psychiatrist, when the psychiatric assessment is provided in a mental health physician clinic; or

(ii) general direction of a physician or a mental health professional clinician, when the psychiatric assessment is provided in a community mental health clinic;

(B) completed within one month of entry into treatment; and

(C) updated at least annually.

(c) The division will not reimburse a provider for

(1) outpatient mental health services provided by a hospital or psychiatric facility;

(2) experimental therapy, outpatient therapy and counseling that is not medically necessary as determined in accordance with 7 AAC 43.486, therapy or counseling by telephone, telephone consultation with another service provider other than case management, preparation of reports, narcosynthesis, socialization, recreation therapy, primal therapy, rage reduction or holding therapy, marathon group therapy, megavitamin therapy, pastoral counseling, employment counseling, or explanation of an examination to a family member or other responsible individual that is provided outside of a family therapy session;

(3) any therapy or evaluation if the documentation required by 7 AAC 43.728 is inadequate or is absent from the recipient's clinical record or individualized treatment plan;

(4) room and board costs as a part of a mental health clinic service or rehabilitation service; or

(5) transportation or travel time as a part of a mental health clinic service or rehabilitation service.

History: Eff. 8/18/78, Register 71; 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 43.726 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.