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For a nursing facility to be eligible for payment under 7 AAC 105 — 7 AAC 160 for providing nursing facility services, the following requirements must be met:

(1) the nursing facility must

(A) be enrolled with the department under 7 AAC 105.210 as an intermediate care facility or skilled nursing facility;

(B) if located out of state, be enrolled in the Medicaid program in the jurisdiction where services are provided;

(C) meet all federal utilization control and Medicare long-term care facility requirements under 42 C.F.R. Part 456 and 42 C.F.R. Part 483, adopted by reference in 7 AAC 160.900; and

(D) meet all certification and licensing requirements of the jurisdiction in which the nursing facility is located; if located in this state, the nursing facility must be licensed and certified under AS 47.32;

(2) the department has determined under 7 AAC 140.505 that the recipient’s medical needs require the level of care that the nursing facility is certified to provide;

(3) the department has given prior authorization to the recipient’s placement in the nursing facility. (Eff. 2/1/2010, Register 193) Statutory Authority: Authority: AS 47.05.010 AS 47.07.040

AS 47.07.030 AS 47.07.070 7 AAC 140.505. Authorization for admission and determination of level of care. (a) The department will authorize an individual for nursing facility services as a new admission, transfer, or continuing placement. Authorization may be given even if an individual is currently receiving services in a general acute care hospital or in an inpatient psychiatric hospital, or nonacute care services in a skilled nursing facility, an intermediate care facility, a home, or other nonacute setting. The department will determine the appropriate level of care by considering