7 AAC 43.805. Payment for care

(a) The department will pay a home health agency for home health care services provided to a recipient who is eligible for Medicare, if on the basis of one or more of the following exclusions, Medicare will not pay for some or all of the home health care services ordered by the physician:

(1) the recipient does not need intermittent or part-time skilled nursing services;

(2) the recipient is not confined to the home.

(b) The department will not set a period longer than 60 days for prior authorization for payment of home health care services.

(c) Unless otherwise provided in this chapter, the department will make payment at a rate of 80 percent of the provider's charges that are billed in accordance with 7 AAC 43.040.

History: Eff. 8/18/79, Register 71; am 5/5/84, Register 90; am 6/27/84, Register 91; readopt 8/7/96, Register 139; am 4/28/2005, Register 174

Authority: AS 47.05.010

AS 47.07.070

Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.805 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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