(a) Subject to applicable requirements of 7 AAC 120.200 - 7 AAC 120.399, the department will pay a provider enrolled under 7 AAC 105.210 as a durable medical equipment provider providing durable medical equipment, medical supplies, and prefabricated off-the-shelf orthotics or related items and services under 7 AAC 120.200(a)(2) for enteral and oral nutritional products at the rate established in 7 AAC 145.420 if the products are
- (1) not provided by, or under arrangements made by, a home health agency or hospice program;
- (2) prescribed by the attending physician, physician assistant, or advanced practice registered nurse;
- (3) certified as medically necessary by the attending physician, physician assistant, advanced practice registered nurse, or dietitian on a form provided by the department; certification of medical necessity must indicate that sufficient caloric or protein intake is not obtainable through regular, liquefied, or pureed food; and
- (4) identified as an enteral formula in the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900.
- (b) In this section, "dietitian" means an individual who is licensed under AS 08.38 as a dietitian.
(Eff. 2/1/2010, Register 193; am 6/2/2019, Register 230; am 4/24/2020, Register 234)