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(1) “closed-end provider agreement” means an agreement that is for a specific period of time not to exceed 12 months and that must be renewed in order for the provider to continue to participate in the Medicaid program;

(2) “termination from participation” means a permanent exclusion from participation in the Medicaid program;

(3) “withholding of payments” means a reduction or adjustment of the amounts paid to a provider on pending and subsequently submitted bills for purposes of offsetting overpayments previously made to the provider. (Eff. 2/1/2010, Register 193) Statutory Authority: Authority: AS 47.05.010 AS 47.05.210 AS 47.07.040

AS 47.05.200 AS 47.05.220 AS 47.07.074 Article 4. Restriction of Recipient’s Choice of Providers; Cost-Sharing. Rule 7 AAC 105.600. Restriction of recipient’s choice of providers 7 AAC 105.610. Recipient cost-sharing 7 AAC 105.600. Restriction of recipient’s choice of providers. (a) The department may restrict a recipient’s choice of medical providers if the department finds that a recipient has used Medicaid services at a frequency or amount that is not appropriate as provided in (b) of this section. (b) A recipient’s use of Medicaid services is not appropriate if one or more of the following occur:

(1) the department identifies that the recipient

(A) received prescriptions from one or more providers for medications in total average daily doses that exceed those recommended in Drug Facts and Comparisons, adopted by reference in 7 AAC 160.900;

(B) during a period of three consecutive months, received prescription drugs from three or more pharmacy locations;