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physician or other licensed health care provider, exercising prudent clinical judgment, would give the child the service, supply, or prescription drug for the purpose of evaluating, diagnosing, or treating an illness, an injury, a disease, or its symptoms; for the Department of Health to make a determination that a service, supply, or prescription drug is medically necessary, the provision of the service, supply, or prescription drug

(A) must be in accordance with generally accepted standards of medical practice; in this subparagraph, generally accepted standards of medical practice are standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community; otherwise the standards must be consistent with physician specialty society recommendations; the standards must be consistent with the views of physicians practicing in relevant clinical areas and any other relevant factors;

(B) must be clinically appropriate, in terms of type, frequency, extent, site, and duration, and must be considered effective for the patient’s illness, injury, or disease;

(C) may not be mostly for the convenience of the patient or physician or other health care provider; and

(D) may not be more costly than an alternative service or sequence of services at least as likely to produce the same therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease. (Eff. 3/31/2005, Register 173; am 4/13/2011, Register 198; am 7/1/2022, Register 242) Statutory Authority: Authority: AS 13.26.153 AS 25.23.230 AS 47.14.120

AS 25.23.210 AS 47.14.100 7 AAC 53.250. Definitions. Repealed. (Eff. 7/1/90, Register 114; am 11/16/94, Register 132; am 1/10/97, Register 141; repealed 3/31/2005, Register 173) 7 AAC 53.255. Reimbursement for nonrecurring adoption expenses.