1. (a) The following documents referenced in 7 AAC 105 - 7 AAC 160 are adopted by reference:

   1. (1) American Medical Association, Current Procedural Terminology, Professional Edition, as revised for 2010 ("CPT 2010"), as amended from time to time;
   2. (2) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Healthcare Common Procedure Coding System (HCPCS) 2010, as amended from time to time, and published by the American Medical Association;
   3. (3) International Classification of Diseases - 10th Revision, Clinical Modification (ICD-10-CM), 2016 revision, as amended from time to time;
   4. (4) American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, June 2013 (DSM-5), as amended from time to time;
   5. (5) United States Department of Health and Human Services, National Institutes of Health, Glossary of Terms for Human Subjects Protection and Inclusion Issues, dated April 25, 2001;
   6. (6) Indian Health Service encounter rates, published in 74 Fed. Reg. 27554 - 27555 (June 10, 2009), as amended from time to time;
   7. (7) American Society of Anesthesiologists, Relative Value Guide, 2006, as amended from time to time;
   8. (8) the nonfacility individual relative value units (RVUs) for the Medicare program for each medical procedure, including the geographic practice cost indices (GPCI) for this state, as published in 74 Fed. Reg. 62014 - 62146 and 62148 (Addenda A, B, C, and E) (November 25, 2009), as amended from time to time;
   9. (9) Drug Facts and Comparisons, 2007 edition, published by Wolters Kluwer Health, Inc.;
   10. (10) Overview of the Chart of Accounts, pages 55 - 64 of the publication entitled Chart of Accounts for Hospitals, by L. Vann Seawell, 1994 Edition, ISBN 1-55738-619-6;
   11. (11) repealed 5/19/2023;
   12. (12) Inventory for Client and Agency Planning (ICAP), as revised as of 1986;
   13. (13) repealed 6/2/2019;
   14. (14) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Ambulatory Surgical Centers (ACS) Approved HCPCS Codes and Payment Rates spreadsheet, revised as of February 26, 2007;
   15. (15) United States Department of Health and Human Services, Public Health Service, Quick Reference Guide for Clinicians: Treating Tobacco Use and Dependence, dated October 2000, pages 9 - 11;
   16. (16) the optional standard mileage rate for medical purposes published in the United States Internal Revenue Service announcement IR-2008-82, published June 23, 2008;
   17. (17) repealed 11/3/2012;
   18. (18) repealed 11/3/2012;
   19. (19) the federal Medicare ambulatory surgical center payment rates for federal fiscal year 2000, as set out in 65 Fed. Reg. 6380 - 6383 (February 9, 2000);
   20. (20) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.10 (Cardiac Rehabilitation Programs), Revision 98, revised as of December 24, 2008;
   21. (21) Comptroller General of the United States, Government Auditing Standards, December 2011 revision;
   22. (22) repealed 5/18/2014;
   23. (23) Consumer Price Index for All Urban Consumers (CPI-U), all items, for Anchorage Alaska, as revised for calendar year 2012 by the United States Department of Labor, Bureau of Labor Statistics, and as amended from time to time;
   24. (24) the Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care, revised as of October 2015, as amended from time to time;
   25. (25) the American Academy of Pediatric Dentistry's Recommendations for Pediatric Oral Health Assessment, Preventive Services, and Anticipatory Guidance/Counseling, revised as of 2018;
   26. (26) the American Academy of Pediatric Dentistry's guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents, revised as of 2018;
   27. (27) Zero to Three: National Center for Infants, Toddlers, and Families, Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R), revised as of 2005.
   28. (28) United States Preventive Services Task Force (USPSTF), A & B Recommendations for Adults, revised as of September 2021;
   29. (29) Centers for Disease Control and Prevention (CDC), Immunization Schedules, revised as of February 17, 2022;
   30. (30) Health Resources and Services Administration (HRSA), Women's Preventive Services Guidelines, revised as of January 2022;
   31. (31) United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), The Provider Reimbursement Manual - Part 1, Publication Number 15-1, Chapter 21 (Costs Related to Patient Care), published December 30, 2020 as a .pdf document, as indicated on the United States Department of Health and Human Services guidance portal website.

2. (b) The following provisions of federal statutes and regulations are adopted by reference:

   1. (1) 42 U.S.C. 1396a(bb)(1) - (6), revised as of December 29, 2007;
   2. (2) 42 U.S.C. 1396r-8(k)(6) (definition of "medically accepted indication"), revised as of October 1, 2008;
   3. (3) 42 C.F.R. 405.515 (reimbursement for clinical laboratory services billed by physicians), revised as of October 1, 2008;
   4. (4) 42 C.F.R. 405.2400 - 405.2452 (rural health clinic and federally qualified health clinic services), revised as of October 1, 2020;
   5. (5) 42 C.F.R. Part 418 (hospice care), revised as of October 1, 2008;
   6. (6) 42 C.F.R. Part 442 (standards for payment to nursing facilities and intermediate care facilities for the mentally retarded), revised as of October 1, 2008;
   7. (7) 42 C.F.R. 447.280 (hospital providers of NF services (swing-bed hospitals), revised as of October 1, 2008;
   8. (8) 42 C.F.R. 447.300 - 447.371 (payment methods for other institutional and noninstitutional services), revised as of October 1, 2008;
   9. (9) 42 C.F.R. 447.512 (drugs: aggregate upper limits of payment), revised as of October 1, 2008;
   10. (10) repealed 5/18/2014;
   11. (11) 42 C.F.R. Part 456 (utilization control), revised as of October 1, 2008;
   12. (12) 42 C.F.R. Part 483 (requirements for states and long term care facilities), revised as of October 1, 2008;
   13. (13) 42 C.F.R. 485.701 - 485.729 (conditions of participation for clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services), revised as of October 1, 2008;
   14. (14) 42 C.F.R. 486.100 - 486.110 (conditions for coverage: portable x-ray services), revised as of October 1, 2008;
   15. (15) 42 C.F.R. 488.11 (state survey agency functions) and 42 C.F.R. 488.26 (determining compliance), revised as of October 1, 2008;
   16. (16) 42 C.F.R. Part 491 (certification of certain health care facilities), revised as of October 1, 2020;
   17. (17) repealed 1/1/2013;
   18. (18) 42 C.F.R. Part 494 (conditions for coverage for end-stage renal disease facilities), revised as of October 1, 2011;
   19. (19) 42 C.F.R. 410.50 (institutional dialysis services and supplies: scope and conditions), revised as of October 1, 2011;
   20. (20) 42 C.F.R. 410.52 (home dialysis services, supplies, and equipment: scope and conditions), revised as of October 1, 2011;
   21. (21) 42 C.F.R. 447.26(b) and (c) (prohibition on payment for provider-preventable conditions), revised as of October 1, 2013.
   22. (22) 42 C.F.R. 424.57(c) (Special payment rules for items furnished by DMEPOS suppliers and issuance of DMEPOS supplier billing privileges: Application certification standards), revised as of November 24, 2014;
   23. (23) 42 C.F.R. 447.502 (definitions; covered outpatient drug), revised as of November 25, 2019;
   24. (24) 42 U.S.C. 1396d(gg)(l) (routine patient costs), revised as of March 15, 2022;
   25. (25) 42 U.S.C. 1396d(gg)(2) (qualifying clinical trial defined), revised as of March 15, 2022;
   26. (26) 42 C.F.R. 413.1 - 413.157 (principles of reasonable cost reimbursement), revised as of October 1, 2024.
3. (c) Repealed 11/3/2012.

4. (d) The following department documents are adopted by reference:

   1. (1) the Alaska Medicaid Preferred Drug List, as amended from time to time;
   2. (2) the Alaska Medicaid Prior-Authorization Medications List, as amended from time to time;
   3. (3) the description of diagnoses and procedures included in the Select Diagnoses and Procedures Pre-certification List, revised as of January 2008;
   4. (4) repealed 6/2/2019;
   5. (5) the Table of ICAP Broad Independence Scores by Age, revised as of April 5, 2004;
   6. (6) the Consumer Assessment Tool (CAT), revised as of January 29, 2009;
   7. (7) repealed 1/26/2012;
   8. (8) repealed 6/13/2019;
   9. (9) repealed 7/22/2017;
   10. (10) the Chart of Personal Care Services and Community First Choice Services Rates, dated May 1, 2023, for providers of personal care services under 7 AAC 125.010 - 7 AAC 125.199 and Community First Choice services under 7 AAC 127;
   11. (11) Alaska Commission on Aging, Alaska State Plan for Senior Services, New Funding Formula for Title III and Title V Programs table, page 106, revised for FY 2010 - 2011;
   12. (12) repealed 12/2/2012;
   13. (13) repealed 5/11/2012;
   14. (14) the Addresses for Second Level Provider Appeals list, revised August 2006;
   15. (15) the Revenue Codes: Inpatient Hospitals and Revenue Codes: Outpatient Hospitals tables listed in the Alaska Provider Billing Manual, revised as of October 30, 2013;
   16. (16) the Covered Revenue Codes for Tribal Outpatient Hospitals table and the Covered Revenue Codes for Tribal Inpatient Hospitals table listed in the Alaska Provider Billing Manual, revised as of June 4, 2013;
   17. (17) Table I-1, Procedure Codes: Mental Health Services of the Federally Qualified Health Center/Rural Health Clinic Services section of the Alaska Provider Billing Manual, revised as of January 2003;
   18. (18) the Specialized Medical Equipment Fee Schedule, dated January 25, 2019, for home and community-based waiver services and Community First Choice Services;
   19. (19) the State of Alaska, Department of Health, Behavioral Health Inpatient Psychiatric Review Provider Manual, revised as of October 2015;
   20. (20) Medicaid Hospital and Long-Term Care Facility Reporting Manual, dated August 22, 2022;
   21. (21) Medicaid Log of Uninsured Care Reporting Form, dated February 26, 2002;
   22. (22) the Handicapping Labiolingual Deviation (HLD) Index Report, revised as of October 2010;
   23. (23) repealed 12/1/2022;
   24. (24) the Alaska Geographic Differential Study 2008, Table I-1, dated April 30, 2009;
   25. (25) the Cost Survey andCost Survey Instructions, dated August 18, 2022, for providers of personal care services under 7 AAC 125.010 - 7 AAC 125.199 and home and community-based waiver services under 7 AAC 130;
   26. (26) repealed 6/30/2021;
   27. (27) repealed 4/24/2020;
   28. (28) repealed 4/24/2020;
   29. (29) the Personal Care Services: Service Level Computation, revised as of June 2, 2017;
   30. (30) the Certificate to Request Funds for Abortion, revised as of December 2013;
   31. (31) repealed 3/31/2021;
   32. (32) the Adult Day Services Conditions of Participation, dated September 5, 2017;
   33. (33) the Care Coordinator Certification Application, dated May 2, 2013;
   34. (34) the Care Coordination Services and Long Term Services and Supports Targeted Case Management Conditions of Participation, dated July 1, 2022;
   35. (35) the Community First Choice Chore Services Conditions of Participation, effective January 1, 2021;
   36. (36) the Day Habilitation Services Conditions of Participation, dated July 1, 2022;
   37. (37) the Developmental Disabilities (DD) Registration and Review form, dated January 4, 2018;
   38. (38) the Material Improvement Reporting for ALI/APDD Waivers, dated May 2, 2013;
   39. (39) the Material Improvement Reporting for CCMC Waivers, dated May 2, 2013;
   40. (40) the Material Improvement Reporting for IDD Participants Age Three or Over, dated May 2, 2013;
   41. (41) the Material Improvement Reporting for IDD Participants Under The Age of Three, dated May 2, 2013;
   42. (42) the Meal Services Conditions of Participation, dated September 5, 2017;
   43. (43) the Nursing Facility Level of Care Assessment Form for Children, dated March 22, 2011;
   44. (44) the Provider Conditions of Participation for Home and Community-Based Waiver Services and Community First Choice Chore Services, effective September 1, 2022;
   45. (45) the Residential Habilitation Services Conditions of Participation, dated September 5, 2017;
   46. (46) the Residential Supported-Living Services Conditions of Participation, dated September 5, 2017;
   47. (47) repealed 10/1/2018;
   48. (48) the Respite Care Services Conditions of Participation, dated July 1, 2022;
   49. (49) the Employment Services Conditions of Participation, dated November 15, 2024;
   50. (50) the Transportation Services Conditions of Participation, dated September 5, 2017;
   51. (51) the Alaska Medicaid 90 Day Generic Prescription Medication List, dated June 27, 2013;
   52. (52) Information About Your Prescription Drug Benefits and Prior Authorization, dated May 2014;
   53. (53) the Environmental Modification Services Conditions of Participation, dated September 5, 2017;
   54. (54) the Orthodontic Referral Oral Health and Hygiene Assessment, revised as of July 2015;
   55. (55) the Personal Care Services and Community First Choice Personal Care Services Provider Conditions of Participation, dated September 1, 2022;
   56. (56) the Rate-Setting Methodology for Personal Care Services, Community First Choice Services, Long-Term Services and Supports Targeted Case Management Services, and Waiver Services, dated August 18, 2022, for providers of personal care services under 7 AAC 125.010 - 7 AAC 125.199, Community First Choice services under 7 AAC 127, long term services and supports targeted case management services under 7 AAC 128, and home and community-based waiver services under 7 AAC 130;
   57. (57) the Community First Choice Personal Care Services: Service Level Computation, dated August 2, 2018;
   58. (58) the Chart of Long Term Services and Supports Targeted Case Management Services Rates, dated May 1, 2023;
   59. (59) the Chart of Community Behavioral Health and Mental Health Physician Clinic Medicaid Covered Services Rates, dated February 12, 2026;
   60. (60) Medicaid Form E-1, dated July 2018;
   61. (61) the Nursing Oversight and Care Management Services Conditions of Participation, dated January 25, 2019.
   62. (62) the Chart of Waiver Services Rates, dated May 1, 2023, for providers of home and community-based waiver services under 7 AAC 130;
   63. (63) repealed 5/21/2020;
   64. (64) repealed 2/2/2024;
   65. (65) Chart of Behavioral Health Reform 1115 Medicaid Services Rates, dated April 28, 2026;
   66. (66) the Adverse Childhood Experiences Questionnaires, dated May 27, 2020;
   67. (67) the Alaska Behavioral Health Provider Service Standards & Administrative Procedures for SUD Provider Services, dated October 9, 2023;
   68. (68) the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, dated October 9, 2023;
   69. (69) Chart of Psychiatric Residential Treatment Facility Rates, dated November 31, 2021;
   70. (70) the Supplemental Emergency Medical Transportation (SEMT) Cost Report, dated February 24, 2021;
   71. (71) the Supplemental Emergency Medical Transportation (SEMT) Cost Report Instructions, dated April 1, 2021;
   72. (72) the Supplemental Emergency Medical Transportation (SEMT) Provider Participation Agreement, dated April 1, 2021;
   73. (73) Medicaid Procedure Codes and Rates - Autism Services, dated February 12, 2026;
   74. (74) Chart of Justice-Involved Youth Targeted Case Management Services Rate, dated April 16, 2025.

5. (e) The following department fee schedules are adopted by reference:

   1. (1) State Fiscal Year 2019 CPT Fee Schedule for Chiropractic Services, revised as of August 24, 2018;
   2. (2) State Fiscal Year 2024 Fee Schedule: Dental Services for Children, revised as of September 11, 2023, State Fiscal Year 2024 Fee Schedule: Emergent Adult Dental Services, revised as of September 11, 2023, State Fiscal Year 2024 Fee Schedule: Prosthodontic Adult Dental Services, revised as of September 11, 2023, and State Fiscal Year 2024 Fee Schedule: Enhanced Adult Dental Services, revised as of September 11, 2023, and State Fiscal Year 2024 Fee Schedule: Advanced Practice Dental Hygienist Services, dated September 11, 2023;
   3. (3) State Fiscal Year 2024 Fee Schedule for Direct-Entry Midwife Services, revised as of August 11, 2023;
   4. (4) State Fiscal Year 2019 CPT Fee Schedule for Audiology Services, Table I-2(a), State Fiscal Year 2019 HCPC Fee Schedule for Audiology Services, Table I-2(b), and State Fiscal Year 2019 HCPC Fee Schedule for Hearing Aid Dealer Services, Table I-3, revised as of January 15, 2019;
   5. (5) 2019 CPT Fee Schedule for Home Infusion Therapy Services, Table I-3(a), revised as of September 10, 2018, and 2019 HCPC Fee Schedule for Home Infusion Therapy Services, Table I-3(b), revised as of September 10, 2018;
   6. (6) repealed 7/1/2019;
   7. (7) State Fiscal Year 2022 Fee Schedule for Therapy Services, revised as of November 2, 2021;
   8. (8) repealed 3/3/2023;
   9. (9) repealed 3/3/2023;
   10. (10) State Fiscal Year 2019 CPT Fee Schedule for Podiatry Services, and State Fiscal Year 2019 HCPC Fee Schedule for Podiatry Services, revised as of August 24, 2018;
   11. (11) State Fiscal Year 2019 CPT Fee Schedule for School-Based Services, and State Fiscal Year 2019 HCPC Fee Schedule for School-Based Services, revised as of January 22, 2019;
   12. (12) repealed 3/3/2023;
   13. (13) Transportation/Accommodation Fee Schedule, revised as of June 29, 2018;
   14. (14) State Fiscal Year 2022 Fee Schedule for Vision Services, revised as of November 4, 2021;
   15. (15) Alaska Medicaid DMEPOS Fee Schedule, Table I-5, revised as of March 30, 2018;
   16. (16) Alaska Medicaid DMEPOS Fee Schedule, Table I-6, revised as of March 30, 2018;
   17. (17) Alaska Medicaid DMEPOS Fee Schedule, Table I-7, revised as of March 30, 2018;
   18. (18) Alaska Medicaid DMEPOS Fee Schedule, Table I-8, revised as of March 30, 2018;
   19. (19) Alaska Medicaid DMEPOS Fee Schedule, Table I-9, revised as of March 30, 2018.
   20. (20) Fee Schedule for Independent Licensed Professional Counselors (LPC), dated July 1, 2022;
   21. (21) Fee Schedule for Independent Licensed Marital and Family Therapists (LMFT), dated July 1, 2022;
   22. (22) Fee Schedule for Independent Licensed Clinical Social Workers (LCSW), dated July 1, 2022.
   23. (23) State Fiscal Year 2023 Fee Schedule for Pharmacist Renderer, revised as of February 14, 2022.
6. (f) The United States Department of Health and Human Services federal poverty guidelines for this state, established in 73 Fed. Reg. 3971 - 3972, revised as of January 23, 2008, and as amended from time to time, are adopted by reference.

(Eff. 2/1/2010, Register 193; am 8/25/2010, Register 195; am 12/1/2010, Register 196; am 1/1/2011, Register 196; am 1/15/2011, Register 197; am 2/9/2011, Register 197; am 3/1/2011, Register 197; am 10/1/2011, Register 199; am 12/1/2011, Register 200; am 1/26/2012, Register 201; am 3/8/2012, Register 201; am 4/1/2012, Register 201; add’l am 4/1/2012, Register 201; am 5/11/2012, Register 202; am 10/16/2012, Register 204; am 11/3/2012, Register 204; am 12/1/2012, Register 204; am 12/2/2012, Register 204; am 1/1/2013, Register 204; am 1/16/2013, Register 205; am 7/1/2013, Register 206; add’l am 7/1/2013, Register 206; am 11/3/2013, Register 208; am 1/1/2014, Register 208; am 2/2/2014, Register 209; am 3/19/2014, Register 209; am 3/22/2014, Register 209; am 5/18/2014, Register 210; am 2/26/2015, Register 213; am 3/15/2015, Register 213; am 7/1/2015, Register 214; am 5/1/2016, Register 218; am 7/22/2017, Register 223; am 11/5/2017, Register 224; am 3/1/2018, Register 225; am 10/1/2018, Register 227; am 1/1/2019, Register 228; am 3/24/2019, Register 229; am 6/2/2019, Register 230; am 6/13/2019, Register 230; am 7/1/2019, Register 231; am 10/25/2019, Register 232; am 11/10/2019, Register 232; am 4/24/2020, Register 234; am 5/21/2020, Register 234; am 6/25/2020, Register 234; am 10/1/2020, Register 235; am 10/4/2020, Register 236; am 1/1/2021, Register 236; am 3/31/2021, Register 238; am 6/30/2021, Register 238; am 8/27/2021, Register 239; am 9/9/2021, Register 239; am 10/9/2021, Register 240; am 11/1/2021, Register 240; am 5/25/2022, Register 242; am 9/4/2022, Register 243; am 9/18/2022, Register 243; am 10/16/2022, Register 244; am 12/1/2022, Register 244; am 12/23/2022, Register 244; am 3/3/2023, Register 245; am 3/26/2023, Register 245; am 5/1/2023, Register 246; am 5/19/2023, Register 246; am 1/1/2024, Register 248; am 2/1/2024, Register 249; am 2/2/2024, Register 249; add’l am 2/2/2024, Register 249; am 3/1/2024, Register 249; am 11/8/2024, Register 252; am 1/5/2025, Register 253; am 5/25/2025, Register 254)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.085, AS 47.05.012, AS 47.07.040