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Medicaid-eligible child’s need for a school-based service only if the outcome indicates the child’s need for services included in the individualized education plan described in (d) of this section. (d) The department will pay for school-based services for a Medicaid-eligible child if the individualized education plan developed for the child under AS 14.30.278 specifies the services that the school district is seeking payment for, each health condition to be addressed, the anticipated treatment goals, and the type, amount, frequency, and duration of each service to be offered. Any change to a plan that adds, eliminates, or alters a service, material, or supply described under this section must be documented in the Medicaid-eligible child’s clinical record by or under the direction of a physician, a physician assistant, an advanced practice registered nurse, a physical therapist, an occupational therapist, a speech-language pathologist, an audiologist, a psychologist or psychological associate, a behavioral health professional, a behavioral health associate, or other health care provider who is

(1) acting within the scope of that health care provider’s

(A) license under AS 08; or

(B) training and experience, if the health care provider is a psychologist or psychological associate described in (h)(7)(A)(ii) of this section, a behavioral health professional, or a behavioral health associate; and

(2) familiar with the child’s plan, health condition, and treatment history. (e) In addition to meeting the requirements for provider records in 7 AAC 105.230 and AS 47.07.063(b), and before the department will pay for school-based services, the school district must assure that each Medicaid-eligible child’s clinical record includes

(1) documentation of the relationship of the service provided to the child’s achievement of individualized education plan goals and objectives; and

(2) on each page of service documentation, the Medicaid-eligible child’s recipient identification number and at least one other item of unique identification for the Medicaid-eligible child who received the service; for the purposes of this paragraph, “item of unique identification” includes the child’s name, date of birth, and student identification number assigned by the school district. (f) Nothing in this section precludes a private enrolled provider from furnishing the same service to the same child at a different time on the same day that the child was furnished a school-based service, if the applicable requirements of 7 AAC 105 — 7 AAC 160 are otherwise met. (g) Subject to the requirements of AS 47.07.063(a), the department will pay a school district for the following school-based services furnished in accordance with 7 AAC 105 — 7 AAC 160 to a Medicaid-eligible child with a disability, and for materials and supplies provided to the child in the course of performing the services, if those materials and supplies are furnished in accordance with 7 AAC 105 — 7 AAC 160: