Alaska Admin. Code tit. 7, § 140.215 – Health clinic services and payment conditions

(a) The department will pay a health clinic for providing services under (b) - (e) of this section rendered to a patient of the clinic by an employee or a contract worker of the clinic. Except as otherwise provided in this section, the department will pay a provider for services under this section in accordance with the payment rate established in 7 AAC 145.700, or 7 AAC 155.010, as applicable.
(b) The department will pay for primary care services provided by a physician, a physician assistant, or an advanced practice registered nurse acting within the scope of that individual's license to practice. The department will not pay a federally qualified health center under the rate methodology established in 7 AAC 145.700 for services that the department determines to be incidental to primary care services, including laboratory services, x-ray services, and supplies.
(c) The department will pay for ambulatory services under 7 AAC 105 - 7 AAC 160, including
1. (1) vision services under 7 AAC 110.705;
2. (2) speech-language pathology services under 7 AAC 115.410;
3. (3) hearing services under 7 AAC 115.520 and 7 AAC 115.530;
4. (4) EPSDT screening and EPSDT services under 7 AAC 110.205 and 7 AAC 110.210;
5. (5) podiatry services under 7 AAC 110.505;
6. (6) nutrition services under 7 AAC 110.275 and 7 AAC 110.280;
7. (7) private-duty nursing services under 7 AAC 110.525;
8. (8) hospice services under 7 AAC 140.275 and 7 AAC 140.280;
9. (9) family planning services under 7 AAC 110.230;
10. (10) physical therapy services under 7 AAC 115.310;
11. (11) occupational therapy services under 7 AAC 115.110;
12. (12) chiropractic services under 7 AAC 110.120; and
13. (13) nonprimary care services that are provided in a hospital by a rural health clinic physician, physician assistant, or advanced practice registered nurse acting within the scope of that individual's license to practice.
(d) The department will separately pay a health clinic for dental services covered under 7 AAC 110.145 - 7 AAC 110.155 provided by a dentist who is enrolled separately under 7 AAC 110.140.
(e) The department will pay the established encounter rate to a health clinic for the behavioral health services identified in Table 1-1. Procedure Codes: Mental Health Services of the Federally Qualified Health Center/Rural Health Clinic Services section of the Alaska Provider Billing Manual, adopted by reference in 7 AAC 160.900, if those services are provided to a recipient by a psychologist, clinical social worker, marital and family therapist, or professional counselor acting within the scope of that individual's license to practice. Behavioral health services covered under this subsection include
1. (1) psychiatric diagnostic interview procedures;
2. (2) psychological testing and examination services;
3. (3) individual psychotherapy;
4. (4) group psychotherapy;
5. (5) family psychotherapy; and
6. (6) health and behavior assessment and intervention services.
7. (7) screening and brief intervention services.
(f) In accordance with the relevant fee schedule established under 7 AAC 145.050, the department will separately pay a health clinic eligible under 7 AAC 140.205(a)(1), (2), or (3) for labor and delivery services provided by a physician, a physician assistant, or an advanced practice registered nurse, including a nurse midwife, who has separately enrolled under 7 AAC 105 - 7 AAC 160. The department will pay a health clinic eligible under 7 AAC 140.205(a)(4) in accordance with 7 AAC 155.010.
(g) The department will separately pay a health clinic for pharmacy services and for prescription drugs provided by the health clinic under 7 AAC 120.110 if the health clinic is enrolled as a dispensing provider in accordance with 7 AAC 120.100. The department will pay a provider under this subsection in accordance with the rates established in 7 AAC 145.400 and 7 AAC 145.410.
(h) The department will not pay a health clinic eligible under 7 AAC 140.205(a)(1), (2), or (3) for
1. (1) services or supplies that a health clinic routinely provides to individuals other than Medicaid-eligible recipients;
2. (2) services or supplies that the health clinic routinely furnishes for free or without regard to the recipient's ability to pay; or
3. (3) services provided off-site of the health clinic, except as provided in 7 AAC 140.220; this paragraph does not apply to a federally qualified health center.

(Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199; am 4/24/2020, Register 234; am 11/1/2021, Register 240; am 12/1/2022, Register 244; am 4/16/2023, Register 246)

Authority: AS 47.05.010, AS 47.07.040, AS 47.07.073, AS 47.07.030, AS 47.07.070