1. (a) Except as provided in (b) and (c) of this section and 7 AAC 105.130(d), the department will not pay for behavioral health services unless the department has given prior authorization for those services.

2. (b) A community behavioral health services provider or mental health physician clinic may provide the following behavioral health clinic services without prior authorization from the department:

   1. (1) any combination of individual, group, and family psychotherapy under 7 AAC 135.150;
   2. (2) psychiatric assessments under 7 AAC 135.110(e);
   3. (3) psychological and neuropsychological testing and evaluation under 7 AAC 135.110(g);
   4. (4) pharmacologic management services under 7 AAC 135.140;

   5. (5) an integrated mental health and substance use intake assessment under 7 AAC 135.110, or a combination of a mental health intake assessment and a substance use intake assessment under 7 AAC 135.110; the assessment or combination of assessments must consist of

      1. (A) one or more face-to-face sessions; and
      2. (B) a review of collaterally connected information;
   6. (6) repealed 7/1/2025;
   7. (7) short-term crisis intervention services under 7 AAC 135.160, or a combination of behavioral health clinic service, rehabilitation service, and intervention service under 7 AAC 135.010 that are included in the crisis plan that do not exceed 22 consecutive hours in a single encounter;
   8. (8) screening and brief intervention services under 7 AAC 135.240.

3. (c) A community behavioral health services provider may provide the following behavioral health rehabilitation services without prior authorization by the department:

   1. (1) case management services under 7 AAC 135.180; a directing clinician may bill not more than one hour each week for service monitoring for a recipient of case management services;
   2. (2) individual therapeutic behavioral health services for children under 7 AAC 135.220, or a combination of individual therapeutic behavioral health services for children and peer support services under 7 AAC 135.210 and 7 AAC 135.220;
   3. (3) group therapeutic behavioral health services for children under 7 AAC 135.220;
   4. (4) family therapeutic behavioral health services for children under 7 AAC 135.220, or a combination of family therapeutic behavioral health services for children and peer support services under 7 AAC 135.210 and 7 AAC 135.220;
   5. (5) repealed 6/30/2021;
   6. (6) repealed 6/30/2021;
   7. (7) repealed 6/30/2021;
   8. (8) medication administration services under 7 AAC 135.260, limited to one billable service each day;

   9. (9) medical evaluation of a recipient receiving opioid use disorder treatment services, including

      1. (A) consultation and referral; and
      2. (B) establishing dosage for medication for the treatment of opioid use disorder;
   10. (10) medication administration services of medication for the treatment of an opioid use disorder or alcohol use disorder;
   11. (11) withdrawal management services under 7 AAC 135.190, not to exceed one withdrawal management service episode each day; in this paragraph, "service episode" means the completion of services identified in this paragraph for which a single payment is made in accordance with 7 AAC 145.580;
   12. (12) behavioral health screening in accordance with 7 AAC 135.100 to determine eligibility for admission to a treatment program;
   13. (13) medical evaluation for a recipient prior to providing withdrawal management services;
   14. (14) behavioral health treatment plan review for a recipient in an opioid treatment program;
   15. (15) day treatment services for children under 7 AAC 135.250, not to exceed six hours each school day;
   16. (16) repealed 11/10/2019;
   17. (17) residential substance use disorder treatment services under 7 AAC 135.280, not to exceed one billable service each day;
   18. (18) short-term crisis stabilization services under 7 AAC 135.170 that do not exceed 22 consecutive hours in a single encounter; and
   19. (19) autism services provided in accordance with 7 AAC 135.350.

4. (d) A provider request for prior authorization of an extension of a service beyond service limitations or a provider request for a change in the level of the service that a recipient previously received must be made in writing on a form approved by the department. The request must

   1. (1) be documented in the clinical record prepared under 7 AAC 105.230 and 7 AAC 135.130;
   2. (2) include a listing of all Medicaid reimbursable services and the expected duration of these services as set out in the recipient's behavioral health treatment plan; and
   3. (3) affirm that the recipient's treatment team for a recipient under 18 years of age, in accordance with 7 AAC 135.120, has reviewed the behavioral health treatment plan and recommended the requested services as medically necessary and clinically appropriate.
5. (e) An extension made under (d) of this section is valid through the date set by the director of the division responsible within the department for behavioral health services, or the director's designee.
6. (f) Repealed 7/1/2025.

7. (g) After considering the area of the state where the service is provided, the provider's location, and whether other providers are available to a recipient, the director of the division responsible within the department for behavioral health services, or the director's designee, shall extend a behavioral health clinic service limitation under 7 AAC 135.010 - 7 AAC 135.280 if the director or director's designee determines that

   1. (1) the recipient's circumstances are exceptional; and
   2. (2) the extension is necessary to protect the recipient's health.
8. (h) Repealed 7/1/2025.

(Eff. 10/1/2011, Register 199; am 4/9/2017, Register 222; am 7/1/2018, Register 226; am 11/10/2019, Register 232; am 4/24/2020, Register 234; am 6/30/2021, Register 238; am 12/23/2022, Register 244; am 7/1/2025, Register 254)

Authority: AS 47.05.010, AS 47.07.030