Section 7 AAC 135.020 - Recipient eligibility for Medicaid behavioral health services(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.Eff. 10/1/2011, Register 199; am 7/1/2018, Register 226, July 2018; am 6/30/2021, Register 238, July 2021Authority:AS 47.05.010
AS 47.07.030