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7 AAC 135.020. Recipient eligibility for Medicaid behavioral health services. (a) The department will pay for behavioral health clinic services for the following individuals only:

(1) a child experiencing an emotional disturbance;

(2) a child experiencing a severe emotional disturbance;

(3) an adult experiencing an emotional disturbance;

(4) an adult experiencing a serious mental illness. (b) The department will pay for behavioral health rehabilitation services for the following individuals only:

(1) an individual experiencing a substance use disorder characterized by

(A) a maladaptive pattern of substance use; or

(B) cognitive, behavioral, or physiological symptoms indicating that the individual will continue to use a substance despite significant substance-related problems associated with its use;

(2) a child experiencing a severe emotional disturbance;

(3) except as provided in (d) of this section, an adult experiencing a serious mental illness;

(4) an individual under 21 years of age who meets the criteria in (e) or (f) of this section. (c) If, during the assessment, evaluation, or treatment of a child experiencing an emotional disturbance, a provider determines that the recipient may have a severe behavioral health disorder and that the recipient is in need of behavioral health rehabilitation services, that provider shall refer the recipient to a provider that provides behavioral health rehabilitation services in the community. (d) repealed 6/30/2021. (e) To be eligible for payment under 7 AAC 105 — 7 AAC 160 for autism services, a recipient must

(1) be under 21 years of age;

(2) have a qualifying diagnosis of autism spectrum disorder, as determined by either a mental health professional as defined in AS 47.30.915 or a health care professional who is qualified based on that individual’s scope of practice, training, education, and experience to assess and diagnose autism spectrum disorders in children; and