Page 3011

(24) 42 U.S.C. 1396d(gg)(l) (routine patient costs), revised as of March 15, 2022;

(25) 42 U.S.C. 1396d(gg)(2) (qualifying clinical trial defined), revised as of March 15, 2022. (c) Repealed 11/3/2012. (d) The following department documents are adopted by reference:

(1) the Alaska Medicaid Preferred Drug List, as amended from time to time;

(2) the Alaska Medicaid Prior-Authorization Medications List, as amended from time to time;

(3) the description of diagnoses and procedures included in the Select Diagnoses and Procedures Pre-certification List, revised as of January 2008;

(4) repealed 6/2/2019;

(5) the Table of ICAP Broad Independence Scores by Age, revised as of April 5, 2004;

(6) the Consumer Assessment Tool (CAT), revised as of January 29, 2009;

(7) repealed 1/26/2012;

(8) repealed 6/13/2019;

(9) repealed 7/22/2017;

(10) the Chart of Personal Care Services and Community First Choice Services Rates, dated May 1, 2023, for providers of personal care services under 7 AAC 125.010 — 7 AAC 125.199 and Community First Choice services under 7 AAC 127;

(11) Alaska Commission on Aging, Alaska State Plan for Senior Services, New Funding Formula for Title III and Title V Programs table, page 106, revised for FY 2010 — 2011;

(12) repealed 12/2/2012;

(13) repealed 5/11/2012;

(14) the Addresses for Second Level Provider Appeals list, revised August 2006;

(15) the Revenue Codes: Inpatient Hospitals and Revenue Codes: Outpatient Hospitals tables listed in the Alaska Provider Billing Manual, revised as of October 30, 2013;

(16) the Covered Revenue Codes for Tribal Outpatient Hospitals table and the Covered Revenue Codes for Tribal Inpatient Hospitals table listed in the Alaska Provider Billing Manual, revised as of June 4, 2013;

(17) Table I-1, Procedure Codes: Mental Health Services of the Federally Qualified Health Center/Rural Health Clinic Services section of the Alaska Provider Billing Manual,