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Authority: AS 47.05.010 AS 47.07.030 AS 47.07.040 7 AAC 145.420. Durable medical equipment, supplies, prosthetics, orthotics, and respiratory therapy payment rates. (a) Payment by the department to a provider enrolled under 7 AAC 105.210 as a durable medical equipment provider will be made in accordance with this section. (b) A provider enrolled under 7 AAC 105.210 as a durable medical equipment provider providing durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2) to eligible recipients may submit, as follows, claims covered in the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, for which a rate or rate methodology has been established by CMS or the department or for covered codes with rate-setting methodologies set out in (c) — (e) of this section:

(1) payment rates set by the department for items and services provided by enrolled providers to recipients physically located in this state will be based on 100 percent of the current quarter’s Medicare DMEPOS Fee Schedule established by CMS for these items and services in this state;

(2) payment rates set by the department for items and services provided to recipients when the recipient is physically located outside of this state will be based on 100 percent of the current quarter’s Medicare DMEPOS Fee Schedule established by CMS for these items and services in the state where the item or service was provided;

(3) payment rates set by the department for items and services not established on the current quarter’s Medicare DMEPOS Fee Schedule will be based on the methodology set out in (c) — (f) of this section. (c) Payment rates for durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2) for covered non-miscellaneous codes that are from the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, but for which CMS has not issued a rate on the current quarter’s Medicare DMEPOS Fee Schedule as described in (b) of this section or for which the department has not established a rate and published the rate on the Alaska Medicaid DMEPOS Fee Schedules, Tables I-5 through I-9, adopted by reference in 7 AAC 160.900, or Alaska Medicaid DMEPOS Interim Fee Schedule, will be based on the submitted unaltered final purchase invoice price plus 35 percent, as follows, for claims submitted on or after June 2, 2019