Current through August 30, 2024
(a) The department will enroll an in-state
school district as a Medicaid provider of school-based services if the school
district meets the requirements of AS 47.07 and 7 AAC 105 - 7 AAC 160 and
enters into an agreement with the department as required by
AS
47.07.063.
(b) The school district shall submit each
request for payment for a school-based service using the provider code number
assigned to the school district at enrollment.
(c) The department will pay the cost of an
evaluation, screening, or assessment of a Medicaid-eligible child's need for a
school-based service only if the outcome indicates the child's need for
services included in the individualized education plan described in (d) of this
section.
(d) The department will
pay for school-based services for a Medicaid-eligible child if the
individualized education plan developed for the child under
AS
14.30.278 specifies the services that the
school district is seeking payment for, each health condition to be addressed,
the anticipated treatment goals, and the type, amount, frequency, and duration
of each service to be offered. Any change to a plan that adds, eliminates, or
alters a service, material, or supply described under this section must be
documented in the Medicaid-eligible child's clinical record by or under the
direction of a physician, a physician assistant, an advanced practice
registered nurse, a physical therapist, an occupational therapist, a
speech-language pathologist, an audiologist, a psychologist or psychological
associate, a behavioral health professional, a behavioral health associate, or
other health care provider who is
(1) acting
within the scope of that health care provider's
(A) license under AS 08; or
(B) training and experience, if the health
care provider is a psychologist or psychological associate described in
(h)(7)(A)(ii) of this section, a behavioral health professional, or a
behavioral health associate; and
(2) familiar with the child's plan, health
condition, and treatment history.
(e) In addition to meeting the requirements
for provider records in
7 AAC 105.230 and
AS
47.07.063(b), and before the
department will pay for school-based services, the school district must assure
that each Medicaid-eligible child's clinical record includes
(1) documentation of the relationship of the
service provided to the child's achievement of individualized education plan
goals and objectives; and
(2) on
each page of service documentation, the Medicaid-eligible child's recipient
identification number and at least one other item of unique identification for
the Medicaid-eligible child who received the service; for the purposes of this
paragraph, "item of unique identification" includes the child's name, date of
birth, and student identification number assigned by the school
district.
(f) Nothing in
this section precludes a private enrolled provider from furnishing the same
service to the same child at a different time on the same day that the child
was furnished a school-based service, if the applicable requirements of 7 AAC
105 - 7 AAC 160 are otherwise met.
(g) Subject to the requirements of
AS
47.07.063(a), the department
will pay a school district for the following school-based services furnished in
accordance with 7 AAC 105 - 7 AAC 160 to a Medicaid-eligible child with a
disability, and for materials and supplies provided to the child in the course
of performing the services, if those materials and supplies are furnished in
accordance with 7 AAC 105 - 7 AAC 160:
(1)
physical therapy services furnished by or under the direction of a physical
therapist licensed under AS 08.84, and practicing in accordance with
7 AAC 115.300 -
7 AAC 115.320, regardless of whether that person is
enrolled under
7 AAC 115.300;
(2) occupational therapy services furnished
by or under the direction of an occupational therapist licensed under AS 08.84,
and practicing in accordance with
7 AAC 115.100 -
7 AAC 115.120, regardless of whether that person is
enrolled under
7 AAC 115.100;
(3) speech-language pathology services
furnished by or under the direction of a speech-language pathologist who
(A) meets the requirements of
42 C.F.R.
440.110(c) or is licensed
under AS 08.11; and
(B) is
practicing in accordance with
7 AAC 115.400 -
7 AAC 115.420, regardless of whether that person is
enrolled under
7 AAC 115.400;
(4) hearing services furnished by or under
the direction of an audiologist licensed under AS 08.11, and practicing in
accordance with
7 AAC 115.500 - AAC 115.549, regardless of whether that
person is enrolled under
7 AAC 115.500;
(5) behavioral health services including
(A) the following services furnished by a
behavioral health associate or behavioral health professional:
(i) emotional support assistance to help a
child process emotions during periods of elevated stress;
(ii) behavior management education that
teaches behavior management, modification, and redirection techniques to elicit
positive behaviors with families, groups, and individuals;
(B) the following services furnished by a
behavioral health professional:
(i) crisis
response services that include short-term interventions to prevent harm, build
coping skills, develop mechanisms for positive self-care, and stabilize a child
or family in acute distress;
(ii)
behavior modification assistance using counseling techniques to assist in
modifying behavior to individuals and groups;
(iii) functional behavioral assessments to
assess a child's behavior;
(iv)
psychoeducational services designed to help a child develop or improve specific
self-care skills and engage in age-appropriate social behavior; and
(C) services furnished by a
psychologist or a psychological associate, including
(i) testing a child's psychological,
cognitive, and emotional functioning; and
(ii) interpreting a child's psychological,
cognitive, emotional, and behavioral assessment results;
(6) medication services furnished
by a nurse licensed under AS 08.68, including medication administration, direct
observation, training, and support.
(h) In this section,
(1) "child with a disability" has the meaning
given in AS 14.30.350;
(2) "individualized education plan" and
"plan" means the plan developed for a Medicaid-eligible child with a disability
through an individualized education program described in
AS
14.30.278;
(3) "school-based service" means a service
identified in this section that is furnished in accordance with AS 47.07 and 7
AAC 105 - 7 AAC 160 by a school district to a Medicaid-eligible child with a
disability;
(4) "school district"
has the meaning given in
AS
47.07.063;
(5) "behavioral health associate" means a
person who has less than a master's degree in psychology, social work,
counseling, or a related field with specialization or experience in working
with children experiencing behavioral, physical, and emotional disabilities,
and is working within the scope of the person's training and experience;
"behavioral health associate" does not include a person employed as a
teacher;
(6) "behavioral health
professional" means a person who has a master's degree in psychology, social
work, counseling, or a related field with specialization or experience in
working with children experiencing behavioral, physical, and emotional
disabilities, and is working within the scope of the person's training and
experience; "behavioral health professional" does not include a person employed
as a teacher;
(7) "psychologist or
psychological associate"
(A) means a
psychologist or psychological associate
(i)
licensed under AS 08.86 and working within the scope of the person's license;
or
(ii) with a special services
certificate (Type C) under 4 AAC 12 endorsed in "school psychology," who is
employed by the school district and working within the scope of the person's
training and experience; and
(B) does not include a person employed as a
teacher by the school district.
Authority:AS
47.05.010
AS 47.07.030
AS 47.07.040
AS
47.07.063
