Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 140 - Medicaid Coverage; Facility and Facility-Based Services
Article 2 - Health Clinic Services; Federally Qualified Health Centers and Rural Health Clinics
7 AAC 140.200 - Health clinic enrollment and reporting

(a) The department will pay a health clinic for services provided to a recipient if the health clinic

(b) Each permanent site operated by a health clinic must be separately enrolled and meet the requirements of this section. In this subsection, "permanent site"

(c) For each site where it operates, a health clinic shall maintain sufficient financial records and statistical data to allow the department to identify and verify the costs and charges associated with providing services at each site.

(d) On or before the last day of the fifth month after the close of its fiscal year, a health clinic shall file an annual year-end report, even if the clinic did not provide medical services to recipients during that fiscal year. The annual year-end report must contain the items listed in the definition of "year-end report" in 7 AAC 150.990, except that

(e) If no change in the scope of services occurred during the health clinic fiscal year, and the health clinic does not intend to request a change, the health clinic shall submit to the department, on or before the last day of the fifth of the month after the close of that fiscal year, a written statement indicating that no change in the scope of services occurred or is being requested.

(f) If a change in scope of services occurred during the health clinic fiscal year, the health clinic shall submit to the department the additional reports listed in this subsection. The data contained in these reports will be used to evaluate the change in scope of service request made under 7 AAC 145.700(f), to adjust the health clinic payment rates in accordance with that subsection, and to ensure, in accordance with 7 AAC 145.700(c) (4), that the prospective payment rate does not exceed upper payment limits. The reports must be submitted on or before the last day of the fifth month after the close of the health clinic fiscal year during which the change in the scope of services occurred, and on or before the last day of the fifth month after 12 continuous months of operation with the change. The reports must include the following:

(g) If the facility receives an extension for filing the Medicare cost report from the Medicare intermediary, the facility must forward a copy of the intermediary's letter that grants the extension to the facility to the department. The department will then grant an extension for the year-end report and the change-in-scope report to coincide with the due date given by the Medicare intermediary. Otherwise, for good cause shown to the department's satisfaction, the department will grant a 30-day extension of the due date for submitting the information required under (d) - (f) of this section. In order to receive an extension from the department, a health clinic must submit to the department an extension request in writing before the due date. For purposes of this subsection, "good cause"

(h) The department will withhold 20 percent of the payment due to a health clinic if the clinic fails to submit complete information as required in (d) - (f) of this section. The department will restore, without interest, a payment withheld under this subsection, if the health clinic submits complete information as required in (d) - (f) of this section.

(i) The department may conduct audits, perform special analysis, and review the records of a health clinic to verify compliance with Medicare and Medicaid laws, audit claims for payment submitted or paid, and make adjustments based on audits to a health clinic's payment rate. A health clinic shall provide to the department financial and all other information regarding Medicaid claims for services provided to eligible recipients, shall provide Medicare cost reports upon request, and shall provide access to all facilities and records.

(j) A health clinic may terminate its agreement to participate as a rural health clinic or a federally qualified health center by submitting a written notice to the department and identifying a termination date not less than 30 days after submitting the notice of termination.

(k) In this section, (a)(1) and (3) and (d) - (i) of this section do not apply to a federally qualified health center that elects to be reimbursed under 7 AAC 155.010(1).