Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 145 - Medicaid Payment Rates
Article 7 - Payment Rates; Home and Community-Based Waiver Services
7 AAC 145.520 - Home and community-based waiver services payment rates

(a) The department will pay a home and community-based waiver services provider in accordance with the rates and methodologies set out in this section.

(b) For care coordination services provided under 7 AAC 130.240,

(c) For specialized medical equipment and supplies provided under 7 AAC 130.305, the department will pay at the lesser of the

(d) For specialized private duty nursing services provided under 7 AAC 130.285, the department will pay a unit of service at the lesser of the

(e) For environmental modification services provided under 7 AAC 130.300, the department will pay at 100 percent of billed charges to a home and community-based waiver services provider that oversees the purchase and installation of an environmental modification for a recipient. In addition, the department will pay the provider an administrative fee of two percent of the billed charges or $100, whichever is greater, if the provider is

(f) For adult day services provided under 7 AAC 130.250, residential supported-living services provided under 7 AAC 130.255, day habilitation services provided under 7 AAC 130.260, residential habilitation services provided under 7 AAC 130.265, employment services provided under 7 AAC 130.270, intensive active treatment services provided under 7 AAC 130.275, respite care services provided under 7 AAC 130.280, transportation services provided under 7 AAC 130.290(a), or meal services provided under 7 AAC 130.295, the department will pay a unit of service at the lesser of . . .

(g) For the types of service listed in (f) of this section other than intensive active treatment services provided under 7 AAC 130.275, if the provider's average per-unit allowed amount for the type of service, for claims with dates of service after June 30, 2009 and before October 1, 2009, and processed before February 3, 2010, is higher than the rate established under (f) of this section, the recipient care rate until July 1, 2026 is the average per-unit allowed amount for the period after June 30, 2009 and before October 1, 2009.

(h) A qualified recipient receiving residential supported-living services under 7 AAC 130.255 that are assigned procedure code T2031 in the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, or group-home habilitation services under 7 AAC 130.265 that are assigned procedure code T2016 in the Healthcare Common Procedure Coding System, is eligible for, in addition to the qualified recipient's daily rate provided under (f) and (g) of this section, an acuity add-on rate at the daily rate established in the Chart of Waiver Services Rates, adopted by reference in 7 AAC 160.900. For purposes of this subsection, a qualified recipient is a recipient for whom the department has given prior authorization under 7 AAC 130.267 for additional services.

(i) If a recipient has been determined eligible for Medicaid coverage under 7 AAC 100.002(d)(8), the recipient's income, exclusive of the personal needs allowance and other deductions described in 7 AAC 100.550 - 7 AAC 100.579 is a prior resource for home and community-based waiver services. Once the department has determined the recipient's monthly cost-of-care amount under 7 AAC 100.554, the recipient or the recipient's representative, on behalf of the recipient, shall pay that liability under 7 AAC 100.552.