Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 727. Service limitations

7 AAC 43.727. Service limitations

(a) Reimbursement to providers for mental health clinic services without prior authorization by the division in accordance with 7 AAC 43.484, is limited to

(1) any combination of individual, group, and family psychotherapy, no more than 10 hours in a calendar year;

(2) no more than four psychiatric assessments per recipient during a calendar year;

(3) psychological testing and evaluation, no more than six hours per recipient during a calendar year, except that neuropsychological testing and evaluation is limited to 12 hours per recipient in a calendar year if the provider documents in writing to the division the provider's qualifications to provide neuropsychological testing and evaluation services;

(4) pharmacologic management, no more than one visit per week for the initial month following the recipient's entry into Medicaid-covered treatment, and, thereafter, no more than once per month, unless use of a specific medication requires more frequent monitoring or a recipient's unusual clinical reaction to a medication requires more frequent medication monitoring;

(5) an intake assessment, upon admission to treatment, and consisting of one or more sessions that total no more than three hours in aggregate, and one intake assessment of no more than one hour in duration every six months that the recipient remains in continuous treatment;

(6) case management, no more than 180 hours per recipient per calendar year;

(7) individual skill development services, no more than

(A) 100 hours per recipient under age 21, per calendar year; and

(B) 240 hours per adult recipient, per calendar year;

(8) group skill development services, no more than 140 hours per calendar year;

(9) family skill development, no more than 180 hours per calendar year; and

(10) recipient support services, no more than four hours per day.

(b) The division will reimburse a provider for crisis intervention, as described in 7 AAC 43.738, if

(1) the total crisis intervention services provided to a recipient do not exceed 22 hours during a calendar year, or services in excess of 22 hours have been extended in accordance with 7 AAC 43.488; and

(2) the services are provided during a brief psychiatric emergency of no more than 72 hours in duration, that is documented in the recipient's clinical record.

History: Eff. 5/5/93, Register 126; am 12/31/94, Register 132; am 3/13/96, Register 137; 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 43.727 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.