Made available by
Touch N' Go Systems, Inc., and the
Law Offices of James B. Gottstein.
You can also go to The Alaska Legal Resource Center or search the entire website search.
|
(a) The division will enroll as a Medicaid provider of outpatient occupational therapy services
(1) an occupational therapist practicing independently who is licensed under AS 08.84; and
(2) an outpatient occupational therapy center that is certified by the division under 42 C.F.R. 488.26 as in compliance with 42 C.F.R. 485.701 - 485.729 (made applicable by 42 U.S.C. 1395x(g)).
(b) Reimbursement for occupational therapy under this section will be made only for an eligible recipient. The division will directly reimburse an occupational therapist for services that are
(1) prescribed by a physician, advanced nurse practitioner, or other licensed health care practitioner who may prescribe the services as within the scope of the practitioner's license;
(2) within the scope of practice of an occupational therapist; and
(3) provided by or under the direction of a qualified occupational therapist as provided in AS 08.84.
(c) After an evaluation of a recipient, a written treatment plan must be established by the occupational therapist. The plan must specify the diagnosis, anticipated treatment goals, and the type, amount, frequency, and duration for each service. A treatment plan must be reviewed as often as the recipient's condition requires, or at least every 30 days for recipients age 21 or older, every six months or when medically indicated for recipients under age three, and annually or when medically indicated for recipients age three through 20. Changes to the treatment plan must be noted in the clinical record. The initial treatment plan and each review must be signed by the prescribing health care practitioner. Before or at the time of initiating treatment, the occupational therapist shall obtain
(1) the recipient's significant past medical history;
(2) diagnosis, if established, and the extent to which the recipient is aware of the diagnosis and prognosis;
(3) prescribing health care practitioner orders, if any;
(4) rehabilitation goals and potential for achievement;
(5) contraindications, if any; and
(6) a summary of any prior treatment, if known.
(d) The division will reimburse in-state occupational therapy services in accordance with 7 AAC 43.040, except that the division will pay 85 percent of the rate identified in the fee schedule established under 7 AAC 43.108. The division will calculate maximum allowable rates for covered services by using the factors and formula described in 7 AAC 43.108. The division will reimburse an enrolled occupational therapist for procedures identified in the January 1999 version of the Medicaid Procedures Guide . The January 1999 version of the Medicaid Procedures Guide is adopted by reference. The descriptions and billing codes for these procedures are provided in the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 1998, as amended from time to time, and adopted by reference.
(e) Repealed 12/2/2005.
History: Eff. 12/31/92, Register 124; am 9/1/94, Register 131; readopt 8/7/96, Register 139; am 2/1/97, Register 141; am 10/12/97, Register 144; am 6/26/98, Register 146; am 5/5/99, Register 150; am 7/11/2002, Register 163; am 12/2/2005, Register 176
Authority: AS 47.05.010
Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.923 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.
The reimbursement rates for occupational therapy services calculated under 7 AAC 43.108 appear in Table I-3 of the occupational therapy section of the Alaska Medicaid Provider Billing Manual, which may be obtained by contacting the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
The Medicaid Procedures Guide may be obtained by contacting the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
The United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) may be obtained by contacting the Superintendent of Documents, United States Government Printing Office, Washington, D.C. 20402. A copy of the HCPCS is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
On December 10, 1999, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.923, would be in effect on January 1, 2000: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2000. The amended version may be be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska, 99503-7167.
On February 1, 2001, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.923, would be in effect on February 5, 2001: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2001. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska, 99503-7167.
On January 4, 2003, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.923, would be in effect on January 1, 2003: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2003. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska, 99503-7167.
As of Register 165 (April 2003), the regulations attorney made a technical revision under AS 44.62.125 (b)(6) and AS 44.62.245 (d), to 7 AAC 43.923(d) , to set out the full title of the Healthcare Common Procedure Coding System (HCPCS), and to reflect a change in the name in the federal agency that issues the document, from the Healthcare Financing Administration (HCFA) to the Centers for Medicare and Medicaid Services (CMS).
On December 5, 2003, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.923, would be in effect on January 1, 2004: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2004. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage Alaska, 99503-7167.
On December 1, 2004, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.923, would be in effect on January 1, 2005: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2005. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
Note to HTML Version:
The Alaska Administrative Code was automatically converted to HTML from a plain text format. Every effort has been made to ensure its accuracy, but neither Touch N' Go Systems nor the Law Offices of James B. Gottstein can be held responsible for any possible errors. This version of the Alaska Administrative Code is current through June, 2006.
If it is critical that the precise terms of the Alaska Administrative Code be known, it is recommended that more formal sources be consulted. Recent editions of the Alaska Administrative Journal may be obtained from the Alaska Lieutenant Governor's Office on the world wide web. If any errors are found, please e-mail Touch N' Go systems at E-mail. We hope you find this information useful. Copyright 2006. Touch N' Go Systems, Inc. All Rights Reserved.
Last modified 7/05/2006