Page 3014

waiver services under 7 AAC 130;

(57) the Community First Choice Personal Care Services: Service Level Computation, dated August 2, 2018;

(58) the Chart of Long Term Services and Supports Targeted Case Management Services Rates, dated May 1, 2023;

(59) the Chart of Community Behavioral Health and Mental Health Physician Clinic Medicaid Covered Services Rates, dated October 22, 2024;

(60) Medicaid Form E-1, dated July 2018;

(61) the Nursing Oversight and Care Management Services Conditions of Participation, dated January 25, 2019.

(62) the Chart of Waiver Services Rates, dated May 1, 2023, for providers of home and community-based waiver services under 7 AAC 130;

(63) repealed 5/21/2020;

(64) repealed 2/2/2024;

(65) Chart of Behavioral Health Reform 1115 Medicaid Services Rates, dated April 5, 2024;

(66) the Adverse Childhood Experiences Questionnaires, dated May 27, 2020;

(67) the Alaska Behavioral Health Provider Service Standards & Administrative Procedures for SUD Provider Services, dated October 9, 2023;

(68) the Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services, dated October 9, 2023;

(69) Chart of Psychiatric Residential Treatment Facility Rates, dated November 31, 2021;

(70) the Supplemental Emergency Medical Transportation (SEMT) Cost Report, dated February 24, 2021;

(71) the Supplemental Emergency Medical Transportation (SEMT) Cost Report Instructions, dated April 1, 2021;

(72) the Supplemental Emergency Medical Transportation (SEMT) Provider Participation Agreement, dated April 1, 2021.

(73) Medicaid Procedure Codes and Rates - Autism Services, dated April 13, 2023. (e) The following department fee schedules are adopted by reference:

(1) State Fiscal Year 2019 CPT Fee Schedule for Chiropractic Services, revised as of