Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services
Article 2 - Durable Medical Equipment and Medical Supplies; Related Services
7 AAC 120.245 - Home infusion therapy

Universal Citation: 7 AK Admin Code 120.245

Current through November 28, 2024

(a) The department will enroll a provider of home infusion therapy services if the provider

(1) meets the requirements of this section and 7 AAC 120.200(a);

(2) presents evidence of a pharmacy or pharmacist license issued under AS 08.80; and

(3) documents that it meets the guidelines for pharmacies and pharmacists under 12 AAC 52.400 - 12 AAC 52.440, on a form provided by the department.

(b) The department will pay a provider that employs or contracts with a registered nurse who performs home infusion nursing services and has provided to the provider documentation of training and skills in

(1) intravenous insertion techniques;

(2) parenteral administration;

(3) line and site management; and

(4) the proper use of equipment.

(c) For drugs covered under 7 AAC 120.110 and used in home infusion therapy, the department will accept electronic claims in the standard claim format adopted under 45 C.F.R. 162.1102(b)(1) by the United States Secretary of Health and Human Services.

(d) The department will not separately pay a provider under this section for the following items identified in the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900:

(1) routine servicing of an infusion device for equipment already included under 7 AAC 145.425(b);

(2) catheter care and maintenance identified as "not otherwise classified";

(3) nursing services only for insertion of a peripherally inserted central venous catheter (PICC);

(4) nursing services only for insertion of a midline central venous catheter;

(5) nursing services when same-day services are provided by a home health agency;

(6) nursing services when same-day services are provided at a hospital or facility during an outpatient visit;

(7) the following items, without a specific dosage timing or quantity:
(A) pain management infusion;

(B) chemotherapy infusion;

(C) total parenteral nutrition (TPN);

(D) hydration therapy;

(E) antibiotic, antiviral, or antifungal therapy;

(F) professional pharmacy services;

(8) continuous insulin infusion therapy;

(9) after-hours care;

(10) home injectable therapy;

(11) dietitian services;

(12) delivery or service to high-risk areas requiring escort or extra protection;

(13) high-technology registered nursing services;

(14) infusion suite services;

(15) home therapy enteral nutrition;

(16) home administration of aerosol drug therapy;

(17) home transfusion of blood products;

(18) home irrigation therapy.

A copy of the pharmacists' guidelines form referred to in 7 AAC 120.245(a) may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.

A copy of the standard claim format referred to in 7 AAC 120.245(c) may be obtained from the National Council for Prescription Drug Programs, 9240 E. Raintree Dr., Scottsdale, Arizona 85260-7518; telephone: (480) 477-1000; Internet address: http://www.ncpdp.org.

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040

Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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