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7 AAC 135.020. Recipient eligibility for Medicaid behavioral health services 7 AAC 135.030. Behavioral health provider enrollment and organization 7 AAC 135.040. Service authorization and limitation 7 AAC 135.050. Adult experiencing an emotional disturbance 7 AAC 135.055. Adult experiencing a serious mental illness 7 AAC 135.060. Child experiencing an emotional disturbance 7 AAC 135.065. Child experiencing a severe emotional disturbance 7 AAC 135.010. Scope of Medicaid behavioral health services. (a) The department will pay for a behavioral health service under 7 AAC 135.010 — 7 AAC 135.370 if

(1) the recipient meets the criteria for services under 7 AAC 135.020;

(2) the provider meets the criteria for payment under 7 AAC 135.030;

(3) the service is identified as a treatment need in

(A) a professional behavioral health assessment under 7 AAC 135.110 or a reassessment conducted while the recipient is receiving behavioral health services; and

(B) a behavioral health treatment plan;

(4) screening and brief intervention services are provided in accordance with 7 AAC 135.240;

(5) the department has given prior authorization for the service under 7 AAC 105.130 and 7 AAC 135.040;

(6) the service is medically necessary and clinically appropriate;

(7) the service is provided as active treatment;

(8) the service, if it is a behavioral health clinic service, is provided under the general direction of a physician;

(9) the service is provided by a member of the provider’s staff who is performing that service as a regular duty within the scope of that staff member’s knowledge, experience, and education;

(10) the clinical record requirements of 7 AAC 105.230 and 7 AAC 135.130 are met; and

(11) the provider meets the criteria for payment under 7 AAC 135.300, if the provider is providing autism services. (b) A provider may not bill the department for the following behavioral health clinic services unless the service is provided in accordance with this chapter by

(1) a mental health professional clinician within the meaning given under 7 AAC

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Official source

(1) the recipient meets the criteria for services under 7 AAC 135.020;

(2) the provider meets the criteria for payment under 7 AAC 135.030;

(3) the service is identified as a treatment need in

(A) a professional behavioral health assessment under 7 AAC 135.110 or a reassessment conducted while the recipient is receiving behavioral health services; and

(B) a behavioral health treatment plan;

(4) screening and brief intervention services are provided in accordance with 7 AAC 135.240;

(5) the department has given prior authorization for the service under 7 AAC 105.130 and 7 AAC 135.040;

(6) the service is medically necessary and clinically appropriate;

(7) the service is provided as active treatment;

(8) the service, if it is a behavioral health clinic service, is provided under the general direction of a physician;

(9) the service is provided by a member of the provider’s staff who is performing that service as a regular duty within the scope of that staff member’s knowledge, experience, and education;

(10) the clinical record requirements of 7 AAC 105.230 and 7 AAC 135.130 are met; and

(1) a mental health professional clinician within the meaning given under 7 AAC