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(d) A provider request for prior authorization of an extension of a service beyond service limitations or a provider request for a change in the level of the service that a recipient previously received must be made in writing on a form approved by the department. The request must

(1) be documented in the clinical record prepared under 7 AAC 105.230 and 7 AAC 135.130;

(2) include a listing of all Medicaid reimbursable services and the expected duration of these services as set out in the recipient’s behavioral health treatment plan; and

(3) affirm that the recipient’s treatment team for a recipient under 18 years of age, in accordance with 7 AAC 135.120, has reviewed the behavioral health treatment plan and recommended the requested services as medically necessary and clinically appropriate. (e) An extension made under (d) of this section is valid through the date set by the director of the division responsible within the department for behavioral health services, or the director’s designee. (f) Repealed 7/1/2025. (g) After considering the area of the state where the service is provided, the provider’s location, and whether other providers are available to a recipient, the director of the division responsible within the department for behavioral health services, or the director’s designee, shall extend a behavioral health clinic service limitation under 7 AAC 135.010 — 7 AAC 135.280 if the director or director’s designee determines that

(1) the recipient’s circumstances are exceptional; and

(2) the extension is necessary to protect the recipient’s health. (h) Repealed 7/1/2025. (Eff. 10/1/2011, Register 199; am 4/9/2017, Register 222; am 7/1/2018, Register 226; am 11/10/2019, Register 232; am 4/24/2020, Register 234; am 6/30/2021, Register 238; am 12/23/2022, Register 244; am 7/1/2025, Register 254) Statutory Authority: Authority: AS 47.05.010 AS 47.07.030 7 AAC 135.050. Adult experiencing an emotional disturbance.