Section 7 AAC 135.010 - Scope of Medicaid behavioral health services(a) The department will pay for a behavioral health service under 7 AAC 135.010 - 7 AAC 135.370 if (1) the recipient meets the criteria for services under 7 AAC 135.020;(2) the provider meets the criteria for payment under 7 AAC 135.030;(3) the service is identified as a treatment need in (A) a professional behavioral health assessment under 7 AAC 135.110 or a reassessment conducted while the recipient is receiving behavioral health services; and(B) a behavioral health treatment plan;(4) screening and brief intervention services are provided in accordance with 7 AAC 135.240;(5) the department has given prior authorization for the service under 7 AAC 105.130 and 7 AAC 135.040;(6) the service is medically necessary and clinically appropriate;(7) the service is provided as active treatment;(8) the service, if it is a behavioral health clinic service, is provided under the general direction of a physician;(9) the service is provided by a member of the provider's staff who is performing that service as a regular duty within the scope of that staff member's knowledge, experience, and education;(10) the clinical record requirements of 7 AAC 105.230 and 7 AAC 135.130 are met; and(11) the provider meets the criteria for payment under 7 AAC 135.300, if the provider is providing autism services.(b) A provider may not bill the department for the following behavioral health clinic services unless the service is provided in accordance with this chapter by (1) a mental health professional clinician within the meaning given under 7 AAC 160.990(b), a physician licensed as required under 7 AAC 110.400, a physician assistant licensed as required under 7 AAC 110.455, an advanced practice registered nurse licensed and certified as required under 7 AAC 110.100, a psychologist licensed as required under 7 AAC 110.550, a clinical social worker licensed as required under 7 AAC 110.565, a marital and i ! family therapist licensed as required under 7 AAC 110.575, or a professional counselor licensed as required under 7 AAC 110.585, if the provider is working within the scope of the provider's education, training, and experience: (A) the following professional behavioral health assessments conducted in accordance with 7 AAC 135.110: (i) a mental health intake assessment;(ii) an integrated mental health and substance use intake assessment;(iii) psychological testing and evaluation;(B) psychotherapy conducted in accordance with 7 AAC 135.150;(C) short-term crisis intervention services conducted in accordance with 7 AAC 135.160;(D) screening and brief intervention services in accordance with 7 AAC 135.240:(c) A provider may not bill the department for the following behavioral health rehabilitation services unless the service is provided in accordance with this chapter by a member of the provider's staff who is qualified to perform that service as a regular duty within the scope of that staff member's knowledge, experience, and education: (1) behavioral health screening under 7 AAC 135.100;(2) a substance use intake assessment under 7 AAC 135.110(c);(3) case management under 7 AAC 135.180;(4) withdrawal management services under 7 AAC 135.190;(6) therapeutic behavioral health services for children under 7 AAC 135.220;(8) medication administration services under 7 AAC 135.260, from an individual listed in the definition of "medication administration services" in 7 AAC 70.990;(9) medical evaluation provided by a physician, physician assistant, or advanced practice registered nurse;(10) methadone, buprenorphine. buprenorphine-ualoxone combination, or naltifexonce administration or administration of any other drug approved by the United States Food and Drug Administration for the treatment of opioid addiction if administered in an opioid use disorder treatment program under 7 AAC 70.125 and provided by an individual listed in the definition of "medication administration services" in 7 AAC 70.990:(11) behavioral health treatment plan review for a recipient in an opioid use disorder treatment program;(12) day treatment services for children under 7 AAC 135.250;(14) residential substance use disorder treatment services under 7 AAC 135.280;(15) short-term crisis stabilization services under 7 AAC 135.170;(16) autism services under 7 AAC 135.350;(17) short-term crisis intervention services conducted in accordance with 7 AAC 135.160 provided by an individual listed in the definition of "mental health professional clinician" in 7 AAC 160.990;(18) psychotherapy services under 7 AAC 135.150 provided by an individual listed in the definition of "mental health professional clinician" in 7 AAC 160.990.(d) The department will not pay for any of the following services as a Medicaid covered service under this chapter: (1) outpatient mental health services provided by a hospital or psychiatric facility, unless the outpatient program is a mental health physician clinic that is enrolled in accordance with 7 AAC 105.210;(2) experimental therapy;(3) consultation or coordination by means of a telehealth modality with another service provider other than case management;(4) preparation of reports as a separate service;(9) rage reduction or holding therapy;(10) marathon group therapy;(11) megavitamin therapy;(12) pastoral counseling;(13) explanation of an examination to a family member or other responsible individual that is provided outside of a family therapy session;(14) therapy or evaluation if the documentation required by 7 AAC 105.230, 7 AAC 135.120, and 7 AAC 135.130 is inadequate or is absent from the recipient's clinical record or behavioral health treatment plan;(15) room and board costs as a part of a behavioral health clinic service or rehabilitation service;(16) transportation or travel time as a part of a behavioral health clinic service or rehabilitation service, except as provided under 7 AAC 135.180;(17) a behavioral health clinic service not provided on the premises or by means of a telehealth modality under 7 AAC 110.620 - 7 AAC 110.639, unless the service is provided to a person experiencing homelessness.Eff. 10/1/2011, Register 199; am 4/9/2017, Register 222, July 2017; am 7/1/2018, Register 226, July 2018; am 4/24/2020, Register 234, April 2020; am 7/8/2020, Register 235, October 2020; am 6/30/2021, Register 238, July 2021; am 8/27/2021, Register 239, October 2021; am 12/23/2022, Register 244, January 2023; am 9/1/2023, Register 247, October 2023; am 2/2/2024, Register 249, April 2024Authority:AS 47.05.010
AS 47.07.030
AS 47.07.069