Current through August 30, 2024
(a) Subject to (d)
of this section, if the department determines under
7 AAC 72.540 that a person who received evaluation or
treatment at a designated facility is eligible for financial assistance, the
department will provide reimbursement under
7 AAC 72.510 for the following mental health services
that are provided by a designated facility and that are directly related to a
patient's mental health condition that resulted in eligibility for financial
assistance under
AS
47.31.010:
(1) emergency room costs;
(2) staff physician services, if those
services are not already included in the facility's daily rate;
(3) physician services, if those services
require the action of a physician who is not a member of the designated
facility's staff;
(4) physician
court time costs for participation in a commitment hearing;
(5) medical costs, if related to the
evaluation, diagnosis, and treatment of a patient's mental illness;
(6) room and board costs related to the
evaluation, diagnosis, and treatment of a patient's mental illness;
(7) laboratory costs that are required for
all patients entering a facility and laboratory costs related to mental health
evaluation, diagnosis, and treatment;
(8) medication costs related to mental health
diagnosis and treatment;
(9)
transportation costs that are not covered by
AS
47.30.870 or
47.30.905;
(10) other services directly related to the
admission being billed, as determined by the department on a case-by-case
basis.
(b) The
department will reimburse a designated evaluation facility for no more than
seven days for evaluation and crisis stabilization or for transition to
community-based services if the department determines the amount of time is
clinically appropriate and
(1) the patient
continues under, or has transferred to, voluntary commitment and the treating
physician has certified, on a form supplied by the department, that the patient
meets the involuntary commitment criteria in
AS
47.30.700-47.30.815; or
(2) the court extends the time for evaluation
and treatment for a patient who continues to meet the involuntary commitment
criteria in
AS
47.30.700-47.30.815.
(c) The department will reimburse a
designated treatment facility for no more than 40 days for evaluation,
treatment, and crisis stabilization or for transition to community-based
services if the department determines the amount of time is clinically
appropriate and
(1) the patient continues
under, or has transferred to, voluntary commitment and the treating physician
has certified, on a form supplied by the department, that the patient meets the
involuntary commitment criteria in
AS
47.30.700-47.30.815; or
(2) the court extends the time for evaluation
and treatment for a patient who continues to meet the involuntary commitment
criteria in
AS
47.30.700-47.30.815, or the patient is
authorized to remain at the facility under
AS
47.30.745(g).
(d) The department will not
reimburse a designated facility under
7 AAC 72.510 for
(1)
physician time spent performing administrative or supervisory duties; this
exclusion does not include time spent participating in a commitment
hearing;
(2) facility costs for
space, overhead, supplies, or equipment;
(3) local ambulance service, unless
(A) a medical emergency directly related to
the patient's mental condition results in eligibility for financial assistance
under AS
47.31.010;
(B) the patient requires restraint;
or
(C) ambulance service is
necessary to meet the requirements of
42 U.S.C.
1395 dd (Emergency Medical Treatment and
Active Labor Act (EMTALA)) and
42 C.F.R.
489.24;
(4) the co-pay portion of a third-party
reimbursement;
(5) any
transportation or other expense to be paid by the court system for proceedings
under AS 47.30; or
(6) any service
that is not directly related to the patient's mental condition that resulted in
eligibility for financial assistance under
AS
47.31.010.
(e) For a patient admitted after an
involuntary commitment under
AS
47.30.700-47.30.815 or a voluntary
commitment chosen after the patient's physician determines that the patient
meets the involuntary commitment criteria in
AS
47.30.700-47.30.815, the treating physician
shall
(1) using a form supplied by the
department, certify upon admission that the patient meets the involuntary
commitment criteria in
AS
47.30.700-47.30.815; if the patient
subsequently transfers to voluntary commitment, the treating physician shall
certify daily, on the patient's chart, whether the patient continues to meet
the involuntary commitment criteria; and
(2) recertify every seven days, on the form
supplied by the department, whether the patient continues to meet the
involuntary commitment criteria.
(f) The department may, on a case-by-case
basis, deny reimbursement under
7 AAC 72.540 if the department determines that a service
provided is not directly related to the patient's mental health
condition.
Authority:AS
47.30.660
AS 47.31.025
AS
47.31.090
