Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

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Products and Devices

Transportation Services

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Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Alaska (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes	$3/visit	Specified surgical procedures		Prospective cost based rate	CN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes	$3/visit		Mental Health Clinics must be state approved, Public Health Clinics not covered	Fee for service	CN
Federally Qualified Health Center Services
Yes	$3/visit			Prospective cost based rate/visit with ancillaries paid fee for service	CN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes	$50/day up to $200/admission	Non emergency admissions except maternity, admissions for specified procedures, LOS greater than 3 days	LOS limited to 50th percentile of published guidelines for region	Prospective cost based per diem	CN
Outpatient Hospital Services
Yes	5% of payment for non-emergency services	Specified surgical procedures	Outpatient psych and substance abuse not covered	Prospective cost based rate using percentage of charge	CN
Rehabilitation Services: Mental Health and Substance Abuse
Yes			Residential substance abuse treatment services covered in state-certified facilities only, services in residential psychiatric treatment centers and day treatment services not covered	Fee for service	CN
Rural Health Clinic Services
Yes	$3/visit			Prospective cost based rate/visit with ancillaries paid fee for service	CN
Practitioner Services
Certified Registered Nurse Anesthetist Services
No
Chiropractor Services
No
Dental Services
Yes			Preventive and restorative services covered up to annual limit of $1,150	Fee for service	CN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes				Fee for service	CN
Nurse Midwife Services
Yes				Fee for service at 85% of physician fee	CN
Nurse Practitioner Services
Yes				Fee for service at 85% of physician fee	CN
Optometrist Services
Yes			1 refractive exam/year	Fee for service	CN
Physician Services
Yes	$3/visit			Fee for service, second and subsequent surgeries performed at same time paid at lesser rate	CN
Podiatrist Services
No
Psychologist Services
Yes				Fee for service	CN
Prescription Drugs
Prescription Drugs
Yes	$2/Rx	Specified drugs		AWP-5%, plus a dispensing fee dependent on Medicaid volume ($3.45 to $11.46)	CN
Physical Therapy and Other Services
Occupational Therapy Services
Yes				Fee for service at 85% of physician fee	CN
Physical Therapy Services
Yes				Fee for service at 85% of physician fee	CN
Services for Speech, Hearing and Language Disorders
Yes				Fee for service at 85% of physician fee	CN
Products and Devices
Dentures
Yes		Yes	Coverage of dentures is included in $1,150 annual limit and limited to 1 denture/5 years	Fee for service	CN
Eyeglasses
Yes			1 pair eyeglasses/year	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN
Hearing Aids
Yes			2 earmolds/ear/year	Fee for service	CN
Medical Equipment and Supplies
Yes		Specified med equipment and med supply items		Fee for service	CN
Prosthetic and Orthotic Devices
Yes				Fee for service	CN
Transportation Services
Ambulance Services
Yes				Fee for service, using Medicare upper limits	CN
Non-Emergency Medical Transportation Services
Yes		Yes		See service-specific FN	CN
Other Services
Diagnostic, Screening and Preventive Services
Yes			Limited to diagnostic and screening services only, specified coverage criteria for mammography	Fee for service	CN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service, and using Medicare payment ceilings for lab services	CN
Targeted Case Management
Yes				Fee for service	CN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 2, 4, 6 & 8 - See service-specific FN	Dependent upon the services provided	CN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	Specified med equipment		Percentage of charge	CN
Hospice Care
Yes	Yes	210 days unless additional days certified by physician	Prospective rates based on Medicare methodology	CN
Personal Care Services
Yes		Limited to 8 hours/day or 35/week	Fee for service using hourly rates	CN
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
No
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes	Initially to determine LOC, initially and periodically for LOS	Hosp leave days not covered, 5 therapeutic leave days/year	Prospective cost based per diem	CN
Inpatient Psychiatric Services, under age 21
Yes	Initially to determine LOC, initially and periodically for LOS		Prospective cost based per diem	CN
Intermediate Care Facility Services for the Mentally Retarded
Yes	Initially to determine LOC, initially and periodically for LOS	Hosp leave days not covered, 5 therapeutic leave days/year	Prospective cost based per diem with limits	CN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes	Initially to determine LOC, initially and periodically for LOS	Hosp leave days not covered, unlimited therapeutic leave days/year up to 5 days consecutively	Prospective per diem based on cost	CN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Balanced Budget Act of 1997. These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 250 percent of the federal poverty level (FPL) established for the State (which is 25 percent higher than in the 48 contiguous states and the District of Columbia). Beneficiaries in this group with income above the FPL must pay an income-based monthly premium.