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 145.545 - Exceptional changes to payment rates for personal care services, Community First Choice services, long-term services and supports targeted case management services, and home and community-based waiver services

Universal Citation: 7 AK Admin Code 145.545

Current through November 28, 2024

(a) If application of the methodology in the department's Rate-Setting Methodology for Personal Care Services, Community First Choice Services, Long-Term Services and Supports Targeted Case Management Services, and Waiver Services, adopted by reference in 7 AAC 160.900, results in a rate in the Chart of Personal Care Services and Community First Choice Services Rates, Chart of Long-Term Services and Supports Targeted Case Management Services Rates, or Chart of Waiver Services Rates, adopted by reference in 7 AAC 160.900, that does not allow reasonable access to quality care provided by an efficiently and economically managed provider, the department may increase the rate if

(1) the department finds by clear and convincing evidence that the rate established using the department's Rate-Setting Methodology for Personal Care Services, Community First Choice Services, Long-Term Services and Supports Targeted Case Management Services, and Waiver Services, adopted by reference in 7 AAC 160.900, does not allow for reasonable access to quality care provided by an efficiently and economically managed provider; and

(2) increasing the rate is in the public interest.

(b) In determining whether increasing the rate is in the public interest, the department will consider at least

(1) the necessity of the rate increase to allow reasonable access to quality care provided by an efficiently and economically managed provider;

(2) the assessment of continued need for the services in the community;

(3) whether providers have taken effective steps to adopt effective strategies to alleviate or avoid the future need for exceptional changes to payment rates;

(4) whether Medicaid recipients will lose access to Medicaid services available to the general public in the same geographic area if exceptional changes to payment rates are not made;

(5) the availability of other resources to providers; and

(6) other factors relevant to assess reasonable access to quality care provided by an efficiently and economically managed provider.

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.036

AS 47.07.040

AS 47.07.045

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