Current through November 28, 2024
(a) The
department will pay for behavioral health clinic services for the following
individuals only:
(1) a child experiencing an
emotional disturbance;
(2) a child
experiencing a severe emotional disturbance;
(3) an adult experiencing an emotional
disturbance;
(4) an adult
experiencing a serious mental illness.
(b) The department will pay for behavioral
health rehabilitation services for the following individuals only:
(1) an individual experiencing a substance
use disorder characterized by
(A) a
maladaptive pattern of substance use; or
(B) cognitive, behavioral, or physiological
symptoms indicating that the individual will continue to use a substance
despite significant substance-related problems associated with its
use;
(2) a child
experiencing a severe emotional disturbance;
(3) except as provided in (d) of this
section, an adult experiencing a serious mental illness;
(4) an individual under 21 years of age who
meets the criteria in (e) or (f) of this section.
(c) If, during the assessment, evaluation, or
treatment of a child experiencing an emotional disturbance, a provider
determines that the recipient may have a severe behavioral health disorder and
that the recipient is in need of behavioral health rehabilitation services,
that provider shall refer the recipient to a provider that provides behavioral
health rehabilitation services in the community.
(e) To be eligible for payment under 7 AAC
105 - 7 AAC 160 for autism services, a recipient must
(1) be under 21 years of age;
(2) have a qualifying diagnosis of autism
spectrum disorder, as determined by either a mental health professional as
defined in
AS
47.30.915 or a health care professional who
is qualified based on that individual's scope of practice, training, education,
and experience to assess and diagnose autism spectrum disorders in children;
and
(3) provide documentation,
completed by a licensed behavior analyst who meets the requirements of
7
AAC 135.300, that includes a recipient assessment
conducted under
7
AAC 135.350 and that
(A) establishes the presence of
(i) functional impairments;
(ii) delays in communication, behavior, or
social interaction; or
(iii)
repetitive or stereotyped behaviors;
(B) establishes that the recipient's
identified impairments, delays, or behaviors adversely affect normal child
growth and development, communication, or both, such that
(i) the recipient cannot adequately
participate in home, school, or community activities because the behaviors or
social skill deficits interfere or impede access with these activities;
or
(ii) the recipient's behaviors
endanger either the recipient or another person; and
(C) indicates that the requested autism
services are expected to result in measurable improvement in either the
recipient's behaviors, skills, or both.
(f) In addition to those individuals who are
eligible under (e) of this section, an individual who is eligible for home and
community-based waiver services under
7
AAC 130.205(d)(1) and (3) and who
received prior authorization from the department to receive, and was receiving,
applied behavioral analysis services through intensive active treatment under
7
AAC 130.275 as of June 30, 2018, remains eligible for
autism services under this section as of July 1, 2018.
Authority:AS
47.05.010
AS
47.07.030
