(a) Unless otherwise provided in 7 AAC 105 - 7 AAC 160, the department will cover a service provided out of state to the same extent it would cover the service provided in this state if
- (1) the service is provided to a recipient who is a resident of this state; and
(2) the department is able to verify one of the following situations:
- (A) the recipient requires a medical service that is not available in this state or the provision of that service out of state is more cost-effective;
- (B) the medical service is needed due to a medical emergency while a recipient is out of state and the recipient's health would be endangered if the recipient were required to travel to this state for the needed medical service;
(C) laboratory specimens are sent out of state because
- (i) the laboratory service is not offered in this state;
- (ii) the laboratory service is more readily available out of state; or
- (iii) to have the laboratory work performed out of state is more cost-effective.
(b) The department may pay an out-of-state provider for a service provided to a recipient from this state that meets the requirements of (a) of this section if the provider
- (1) is enrolled in the Medicaid program in this state;
- (2) is enrolled in the Medicaid program in the jurisdiction where the service is provided; and
- (3) possesses the appropriate license in the other jurisdiction to provide the required service.
- (c) The department may deny a request for a service provided out of state that requires prior authorization by the department if the requirements of (a) of this section are not met.
- (d) An inpatient psychiatric hospital, psychiatric facility, and a residential psychiatric treatment center may be approved by the department as a provider, if the department determines that a need exists for the service under (a)(2) of this section.
(Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199)
Authority: AS 47.05.010, AS 47.07.030, AS 47.07.032, AS 47.07.040