1. (a) The department will pay for outpatient nutrition services provided to a recipient under 21 years of age who, consistent with the criteria in (b) of this section, is determined to be at high risk nutritionally by a physician, an advanced practice registered nurse, or another licensed or certified health care practitioner who may order those services within the scope of the practitioner's license or certification.

2. (b) A recipient under 21 years of age is at high risk nutritionally if the recipient

   1. (1) has a flat growth curve or failure to thrive;
   2. (2) has an atypical height-to-weight ratio, head circumference, or sudden weight change;
   3. (3) has a hemoglobin count of less than 10 grams or a hemostat of less than 30 percent;
   4. (4) has a weight of 2,500 grams or less, or a gestation of 36 weeks or less at birth;
   5. (5) has a chronic disease or condition, including diabetes, cystic fibrosis, kidney disease, cancer, colitis, hypertension, diarrhea, constipation, anemia, and infection;
   6. (6) has a congenital anomaly or genetic disorder, including cleft lip or palate, Down syndrome, spina bifida, heart disease, and phenylketonuria;
   7. (7) is pregnant or breast-feeding; or
   8. (8) has a growth problem with a nutritional condition that requires a special formula or diet.

3. (c) Except as provided in 7 AAC 110.200(3), the department will pay for the following nutrition services provided to a recipient who meets the requirements of (a) and (b) of this section:

   1. (1) one initial assessment, not to exceed one hour, in a calendar year;
   2. (2) up to 12 hours of services in a calendar year for counseling and follow-up care after the initial assessment for counseling and follow-up care;

   3. (3) more than 12 hours of service in a calendar year if those hours are

      1. (A) medically justified and prescribed by a physician, an advanced practice registered nurse, or a physician assistant, who may order those services within the scope of the practitioner's license; and
      2. (B) given prior authorization by the department.
4. (d) The department will pay an independently practicing enrolled provider of nutrition services directly. If a provider of nutrition services provides services as a member of the staff of a hospital or other facility that is a Medicaid provider, the department will make payment to the facility. The department will not separately pay for inpatient nutrition services provided to a recipient in a hospital or nursing facility.

(Eff. 2/1/2010, Register 193; am 5/1/2016, Register 218; am 4/24/2020, Register 234)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040