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7 AAC 105.130. Services requiring prior authorization. (a) Except as otherwise provided in 7 AAC 105 — 7 AAC 160, the department will not pay for the following services unless the department has given prior authorization for the service:

(1) nonemergency, medically necessary transportation and accommodation services;

(2) a specific health care service for which prior authorization is specifically required under 7 AAC 105 — 7 AAC 160;

(3) a service that exceeds an annual or periodic service limitation established in 7 AAC 105 — 7 AAC 160;

(4) an item of durable medical equipment, supplies, or hearing items identified in 7 AAC 105 — 7 AAC 160 as requiring prior authorization;

(5) respiratory therapy;

(6) home health care services under 7 AAC 125.300 — 7 AAC 125.399;

(7) home infusion therapy services;

(8) private-duty nursing services;

(9) hospice care services;

(10) magnetic resonance imaging (MRI), magnetic resonance angiogram (MRA), single-photon emission computerized tomography (SPECT), and positron emission tomography (PET);

(11) an inpatient or outpatient procedure or diagnosis, regardless of the length of stay, identified in the Select Diagnoses and Procedures Pre-certification List, adopted by reference in 7 AAC 160.900;

(12) an inpatient hospital continued stay that exceeds an applicable limitation in 7 AAC 140.320 on length of hospitalization, except that if the department reimburses an inpatient hospital under the Diagnosis Related Groups (DRG) payment rate methodology under 7 AAC 150.250, the hospital is exempt from this requirement;

(13) a prescription drug identified on the Alaska Medicaid Prior-authorized Medications List, adopted by reference in 7 AAC 160.900;

(14) an inpatient psychiatric hospital admission in accordance with 7 AAC 140.360;

(15) a residential psychiatric treatment center admission or continued stay in accordance with 7 AAC 140.405;