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document that shows evidence of income for the month during which a patient received care provided by a designated facility; and

(3) identification of and information about any third-party payor that provides insurance coverage to the patient; for purposes of this paragraph, the following persons are not third-party payors under AS 47.31.010:

(A) the United States Department of Interior, Bureau of Indian Affairs;

(B) the United States Department of Health and Human Services, Indian Health Service;

(C) the patient’s private insurance company, if the company does not cover mental health inpatient treatment or the maximum benefit level for that treatment has been reached. (b) If a designated facility makes a notification under AS 47.31.015(b), the notification must

(1) be signed and submitted by the administrator; and

(2) include

(A) any information as to whether a thirty-party payor is responsible for payment; and

(B) subject to the disclosure restrictions of 42 C.F.R. Part 2 for a patient who is also being treated for alcohol or drug abuse in a facility that receives federal assistance as described in 42 C.F.R. Part 2, a copy of the invoice for the services for which financial assistance is sought. (c) If the facility receives payment from a patient or a third-party payor after being reimbursed by the department under this chapter, the administrator shall return the money to the department. (Eff. 3/16/2001, Register 157; am 6/24/2004, Register 170) Statutory Authority: Authority: AS 47.30.660 AS 47.31.015 AS 47.31.090 7 AAC 72.540. Decision regarding eligibility for financial assistance. (a) The department will review information submitted under 7 AAC 72.530 to verify that the