NOTICE OF PROPOSED CHANGES IN THE REGULATIONS OF THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES
BRIEF DESCRIPTION
The Department of Health and Social Services proposes regulations on Medicaid revisions including covered and noncovered services, prior authorization, appeals, imaging, transportation, and drug lists.
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The Department of Health and Social Services proposes to adopt regulation changes in Title 7, Chapters 105, 110, 120, 140, and 160, of the Alaska Administrative Code, dealing with prior authorization, appeals, imaging services, surgical assistants, transportation services, hospital services, and drug lists to clarify current practices, including the following:
- 7 AAC 105.130, Services requiring prior authorization, is proposed to be amended to clarify imaging services that will be paid for once the department has given prior authorization for the service and to be consistent with 7 AAC 110.440.
- 7 AAC 105.270, First-level provider appeal, is proposed to be amended to clarify that a provider may appeal a denied or reduced claim or service.
- 7 AAC 110.440, Physician radiology and imaging services, is proposed to be amended to further clarify what prior authorized imaging services will be paid for by the department and to be consistent with
7 AAC 105.130.
- 7 AAC 110.450, Surgical assistant, is proposed to be amended to revise the list of health care providers that will not be paid separately from the payment made to the surgeon when acting as a surgical assistant.
- 7 AAC 120.405, Transportation and accommodation covered services, is proposed to be amended to further define the services that the department will cover related to transportation and the requirements for a provider of these services.
- 7 AAC 120.410, Nonemergency transportation services, is proposed to be amended to change the section title and repeal and readopt the section to further define the requirements for reimbursement for nonemergency transportation services.
- 7 AAC 140.315, Noncovered hospital services, is proposed to be amended to further define the services that will not be paid for by the department to a hospital, including health care-acquired conditions and provider preventable conditions.
- 7 AAC 140.325, Billing for hospital services, is proposed to be amended to require a hospital to submit a claim to the department if a health care-acquired or provider preventable condition is reported as a diagnosis.
- 7 AAC 160.900, Requirements adopted by reference, is proposed to be amended to add the definition of health care-acquired condition and update the Alaska Medicaid Preferred Drug List and the Alaska Medicaid Prior-Authorization Medications List adopted by reference.
You may comment on the proposed regulation changes, including the potential costs to private persons of complying with the proposed changes, by submitting written comments to Susan Dunkin, Division of Health Care Services, 4501 Business Park Blvd, Suite 24, Anchorage, AK 99503; E-mail: susan.dunkin@alaska.gov.
The comments must be received no later than 4:00 p.m. on July 26, 2013.
If you are a person with a disability who needs a special accommodation in order to participate in this process, please contact Susan Dunkin at the address above or by phone at (907) 269-3638 no later than July 19, 2013 to ensure that any necessary accommodations can be provided.
For a copy of the proposed regulation changes, contact Susan Dunkin at the address, phone number, or E-mail address above, or go to the Alaska Online Public Notice System website at: http://aws.state.ak.us/OnlinePublicNotices/
After the public comment period ends, the Department of Health and Social Services will either adopt these or other provisions dealing with the same subject, without further notice, or decide to take no action on them. The language of the final regulations may be different from that of the proposed regulations. You should comment during the time allowed if your interests could be affected.
Statutory Authority: AS 47.05.010, AS 47.05.012, AS 47.07.030, AS 47.07.040, AS 47.07.074.
Statutes Being Implemented, Interpreted, or Made Specific: AS 47.05.010, AS 47.05.012, AS 47.07.030, AS 47.07.040, AS 47.07.074.
Fiscal Information: The proposed regulation changes are not expected to require an increased appropriation.
Date: 6/14/2013
/s/William J. Streur, Commissioner
Department of Health and Social Services
ADDITIONAL REGULATIONS NOTICE INFORMATION
(AS 44.62.190(d))
1. Adopting agency: Department of Health and Social Services
2. General subject of regulation: Medicaid revisions.
3. Citation of regulation (may be grouped): 7 AAC 105, 110, 120, 140, 160.
4. Reason for the proposed action:
(X) compliance with federal law
( ) compliance with new or changed state statute
( ) compliance with court order
(X) development of program standards
( ) other: (please list)
5. RDU/component affected: Health Care Services
6. Cost of implementation to the state agency and available funding (in thousands of dollars):
Initial Year Subsequent
FY 14 Years
Operating Cost $0 $0
Capital Cost $0________ $0_______
Federal receipts $0 $0
General fund match $0 $0
General fund $0________ $0________
General fund/
program receipts $0 $0________
General fund/
mental health $0________ $0________
Other funds (specify) $0________ $0________
7. The name of the contact person for the regulations:
Susan Dunkin
Division of Health Care Services
4501 Business Park Blvd, Suite 24
Anchorage, AK 99503
E-mail: susan.dunkin@alaska.gov
8. The origin of the proposed action:
__X__ staff of state agency
_____ federal government
_____ general public
_____ petition for regulation change
_____ other (please list)___________________________________________________
9. Date: 6/14/2013
Prepared by: Kurt D. West
Project Coordinator