Section 7 AAC 145.020 - Methodology used to establish provider payment rates(a) Regardless of the payment methodology or payment rate adopted under 7 AAC 105 - 7 AAC 160, and except as provided in 7 AAC 155.010 with regard to tribal health programs, the department will pay a provider for a covered service at the lowest of the (1) specific payment rate established in 7 AAC 105 - 7 AAC 160;(2) provider's billed charges; or(3) provider's lowest charge that is advertised, quoted, posted, billed, or discounted for any other purchaser of services for that unit of service and provided on the same date, determined in accordance with (b) of this section.(b) When determining the provider's lowest charge under (a) of this section, the department will not consider (1) a sliding fee scale established in writing that is based upon income for families and individuals with income equal to or less than 250 percent of the applicable federal poverty guidelines for this state, as adopted by reference under 7 AAC 160.900(f);(2) any single contract that contains a discounted rate for a service or group of services and that does not exceed 20 percent of a provider's annual gross income;(3) a reduced rate for a service or group of services the provider offers to the provider's employees as part of an employee benefit package; or(4) a contract with a federal or state government agency.Eff. 2/1/2010, Register 193Authority:AS 47.05.010
AS 47.07.040