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available to meet the medical needs of the recipient:

(1) the provider may request a higher reimbursement rate by submitting the alternate reimbursement rate request form, available on the department website, with the claim and the required documentation with the claim;

(2) an approved request will be reimbursed at the actual acquisition cost, as substantiated by a submitted final, unaltered invoice, free of alteration described in (o) of this section, plus

(A) 35 percent for items with an actual acquisition cost below $5,000; or

(B) 30 percent for items with an actual acquisition cost at or above $5,000;

(3) enteral nutrition products assigned a “B” code under the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, and incontinence supplies assigned a “T” code are not eligible for reimbursement rates higher than those published on the Alaska Medicaid DMEPOS Fee Schedule, Tables I-5 through I-9, or the Alaska Medicaid DMEPOS Interim Fee Schedule. (k) Subject to the applicable provisions of 7 AAC 120.200 — 7 AAC 120.399, a provider enrolled under 7 AAC 105.210 as a durable medical equipment provider may request payment for the reasonable direct costs of delivery or shipping, as follows:

(1) from the manufacturer to the provider for customized or optimally configured durable medical equipment repair and replacement parts that are specialized or unique to a recipient’s equipment or service and for which the final unaltered purchase invoice price exceeds $250; the shipping method used must be the most cost-effective method available; the unaltered final purchase invoice, free of alterations described in (o) of this section, must include the purchase invoice for the replacement items or repair and must include shipping costs; if the unaltered final purchase invoice is free of alterations described in (o) of this section but contains one or more items in addition to the repair or replacement part, the department will pay for the shipping cost attributed to the repair or replacement part, as calculated by dividing the shipping cost on the unaltered final purchase invoice by the number of items purchased and multiplying by the number of repair or replacement parts specific to the recipient’s need; expedited, next day, rush, or delivery charges resulting from the use of a shipping method other than the most cost-effective method available will not be covered;

(2) from the dispensing provider to the recipient when the following conditions apply:

(A) the recipient resides outside the municipality where the business of the enrolled dispensing provider is located;

(B) the item or service is unavailable from a provider enrolled under 7 AAC 105.210 in the municipality where the recipient resides;

(i) recipient’s name;