Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 145 - Medicaid Payment Rates
Article 1 - Medicaid Payment; Conditions and Methods
7 AAC 145.020 - Methodology used to establish provider payment rates
Universal Citation: 7 AK Admin Code 145.020
Current through November 28, 2024
(a) Regardless of the payment methodology or payment rate adopted under 7 AAC 105 - 7 AAC 160, and except as provided in 7 AAC 155.010 with regard to tribal health programs, the department will pay a provider for a covered service at the lowest of the
(1) specific payment rate established in 7
AAC 105 - 7 AAC 160;
(2) provider's
billed charges; or
(3) provider's
lowest charge that is advertised, quoted, posted, billed, or discounted for any
other purchaser of services for that unit of service and provided on the same
date, determined in accordance with (b) of this section.
(b) When determining the provider's lowest charge under (a) of this section, the department will not consider
(1) a sliding fee scale established in
writing that is based upon income for families and individuals with income
equal to or less than 250 percent of the applicable federal poverty guidelines
for this state, as adopted by reference under
7
AAC 160.900(f);
(2) any single contract that contains a
discounted rate for a service or group of services and that does not exceed 20
percent of a provider's annual gross income;
(3) a reduced rate for a service or group of
services the provider offers to the provider's employees as part of an employee
benefit package; or
(4) a contract
with a federal or state government agency.
Authority:AS 47.05.010
AS 47.07.040
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