7 AAC 43.740. Substance abuse rehabilitative services

(a) The division may reimburse enrolled providers for the following substance abuse rehabilitative services provided to a Medicaid recipient:

(1) assessment and diagnosis services;

(2) outpatient services, including

(A) individual, group, and family counseling,

(B) care coordination, and

(3) intensive outpatient services;

(4) intermediate services; and

(5) medical services.

(b) The division will enroll a provider of substance abuse rehabilitative services only if the provider is certified by the division of alcoholism and drug abuse in the department as:

(1) a recipient of grant funds from the division of alcoholism and drug abuse; and

(2) a valid certificate holder for an approved facility or program under 7 AAC 29.010 - 7 AAC 29.900.

(1) identified as a treatment need in the intake assessment, the result of an evaluation, or the result of a reassessment during treatment;

(2) provided by qualified program staff performing duties regularly within the scope of their authority, training, and job description; and

(3) specified in the recipient's treatment plan which, based on the results of required assessments or evaluations, must

(A) be comprehensive and in writing;

(B) specify

(i) the primary diagnosis and any relevant secondary diagnosis or diagnoses,

(ii) a problem list,

(iii) treatment objectives,

(iv) the services to be provided, and

(v) the frequency and expected duration of treatment;

(C) be signed and dated within 30 days of initial treatment by the person providing the service and authorized by a member of the supervisory staff in the substance abuse treatment center, the director of the substance abuse treatment center, or, in the case of contracted services, by a supervisor or the director of the contracting entity;

(D) be reviewed by the director or a member of the supervisory staff of the substance abuse treatment center, or, in the case of contracted services, by a supervisor or the director of the contracting entity, within 90 days of the initiation of treatment and every six months thereafter; and

(E) be included in the recipient's clinical record.

(d) A progress note signed and dated by the person providing the service must be entered in the recipient's clinical record upon completion of each service episode. The progress note must describe the service provided and the duration of the service episode.

(e) The department will reimburse for the services described in this section only if the documentation that is required to be in the recipient's record and treatment plan under the provisions of this section and 7 AAC 43.741(b) is complete. Subject to the other provisions of this subsection, a provider may satisfy the recordkeeping requirements of this section and 7 AAC 43.741(b) for recipient records through electronic records that meet the applicable requirements of 7 AAC 85. Notwithstanding the requirements of this section, a provider may be required to retain paper or paper-based copies of documents under other state or federal law for audit or other purposes. If a provider that is awarded a grant under 7 AAC 78 or 7 AAC 81 closes or ceases to exist as a service provider, the provider's records under that grant, including recipient records, are subject to the requirements of 7 AAC 78.255 or 7 AAC 81.185, as applicable. For purposes of this subsection, "paper-based copies" means documents stored on microfilm or microfiche, in tagged image file format (TIFF), portable document file (PDF) format, or in another format that allows for the efficient storage of documents.

(f) The division will not reimburse for consultations outside of individual, group, or family counseling sessions, preparations of reports, recreation therapy, or vocational or employment counseling.

(g) The division will reimburse an enrolled provider for covered services rendered by a public or private agency or company which contracts with the provider to furnish services, only if the contracting entity is approved by the division of alcoholism and drug abuse in the department to provide the services for which the enrolled provider is seeking Medicaid reimbursement. However, the division will neither enroll nor directly reimburse the contracting entity.

(h) The division will reimburse an enrolled provider for the medical services specified in 7 AAC 43.745 which are provided by an entity which contracts with the provider to furnish medical services, only if the contracting entity is licensed as a medical professional in the state, is performing the service within the scope of appropriate licensure, and meets the applicable licensure or certification requirement specified for that service in 7 AAC 43.746. Except as specified in 7 AAC 43.746, the division will not directly reimburse the contracting entity for medical services provided under the contract, even if the contracting entity is separately enrolled as a Medicaid provider.

History: Eff. 2/23/94, Register 129; am 9/23/2004, Register 171

Authority: AS 18.23.100

AS 47.05.010

AS 47.07.030

Editor's note: Before Register 129, April 1994, the substance of 7 AAC 43.740 was generally contained in 7 AAC 43.928, which was adopted by emergency regulation and allowed to lapse on 12/3/92. The history note for 7 AAC 43.740 does not reflect the history note for 7 AAC 43.928.

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