Title 7 . Health and Social Services

Chapter 81 . Electronic and Other Records Containing Behavioral Health Information

Section 70. Provider agreements

7 AAC 81.070. Provider agreements

(a) In addition to any requirements specific to a grant program, the department will address the following in a provider agreement:

(1) the services for which payment will be made;

(2) that failure to meet the terms of the agreement, at any time, may result in termination of the agreement by the department;

(3) provider eligibility requirements;

(4) recipient eligibility requirements;

(5) terms and conditions of payment, including

(A) the basis for payment, as described in 7 AAC 81.040(a) (3);

(B) that the provider must exercise reasonable efforts to obtain payment for the services provided to a recipient from other available sources of payment; and

(C) that the provider shall credit back to the department any other-source payments received by the provider for services for which the department has paid the provider;

(6) that the provider's provision of services to eligible recipients and billing the department for those services constitutes the provider's agreement

(A) to cooperate in reports, surveys, or audits conducted by the department; and

(B) to comply with applicable statutes and regulations applicable to the grant program from which the provider will be paid;

(7) retention by the provider of records necessary to disclose fully to the department the extent of services provided to recipient, with information regarding any specific payment to be made available to the department upon request;

(8) on-site inspection by authorized representatives of the department of facilities used to provide services under the agreement;

(9) that endorsement of a warrant received from the department by a provider or the provider's agent constitutes certification that the claim for which the warrant is issued is true and accurate, unless written notice of an error is sent by the provider to the department within 30 days after the date that the warrant is cashed;

(10) that, except for good cause shown for the delay, the department will not pay a cost of service unless the provider of the service submits a bill for the service to the department within 30 days after the service was provided;

(11) immediate notification by the provider to the department and automatic termination of the agreement if the provider is no longer eligible to provide services based on applicable provider eligibility requirements;

(12) termination of the agreement by the department without prior notice if the provider fails to comply with the terms of the agreement;

(13) except as otherwise provided in the agreement, termination of the agreement by the department at any time on 30 days prior notice;

(14) termination of the agreement by the provider at any time upon 30 days prior notice under 7 AAC 81.185 and assistance by the provider to the department in making arrangements for transfer of the recipients of services under the agreement to other providers, if appropriate; and

(15) the effective date of the agreement.

(b) A provider agreement remains in force until the provider or the department terminates the agreement or a material term of the agreement is changed. If a material term of a provider agreement is changed, a new agreement must be executed.

History: Eff. 7/21/2002, Register 163; am 6/24/2004, Register 170

Authority: AS 18.05.040

AS 18.08.010

AS 18.08.080

AS 18.25.100

AS 18.28.010

AS 18.28.050

AS 29.60.600

AS 44.29.020

AS 47.05.010

AS 47.20.075

AS 47.20.110

AS 47.27.005

AS 47.27.050

AS 47.30.477

AS 47.30.530

AS 47.37.030

AS 47.37.045

AS 47.40.041

AS 47.40.120

AS 47.80.130