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service provided out of state to the same extent it would cover the service provided in this state if
(1) the service is provided to a recipient who is a resident of this state; and
(2) the department is able to verify one of the following situations:
(A) the recipient requires a medical service that is not available in this state or the provision of that service out of state is more cost-effective;
(B) the medical service is needed due to a medical emergency while a recipient is out of state and the recipient’s health would be endangered if the recipient were required to travel to this state for the needed medical service;
(C) laboratory specimens are sent out of state because
(i)the laboratory service is not offered in this state;#
(i) the laboratory service is not offered in this state;
(ii)the laboratory service is more readily available out of…#
(ii) the laboratory service is more readily available out of state; or
(iii) to have the laboratory work performed out of state is more cost-effective. (b) The department may pay an out-of-state provider for a service provided to a recipient from this state that meets the requirements of (a) of this section if the provider
(1) is enrolled in the Medicaid program in this state;
(2) is enrolled in the Medicaid program in the jurisdiction where the service is provided; and
(3) possesses the appropriate license in the other jurisdiction to provide the required service. (c) The department may deny a request for a service provided out of state that requires prior authorization by the department if the requirements of (a) of this section are not met. (d) An inpatient psychiatric hospital, psychiatric facility, and a residential psychiatric treatment center may be approved by the department as a provider, if the department determines that a need exists for the service under (a)(2) of this section. (Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199) Statutory Authority: Authority: AS 47.05.010 AS 47.07.032
AS 47.07.030 AS 47.07.040