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by 7 AAC 23.180; and

(8) sufficient money has been appropriated to pay the cost, and the total costs paid on the child’s behalf under the program during any state fiscal year does not exceed $20,000, except as provided in 7 AAC 23.190. (Eff. 6/28/85, Register 94) Statutory Authority: Authority: AS 18.05.010 AS 18.05.030 AS 18.05.040 Editor’s note: With Register 179, October 2006 and under the authority of AS 44.62.125, the regulations attorney changed obsolete terminology concerning persons with disabilities in conformity with ch. 25, SLA 2006. 7 AAC 23.120. Application. (a) A person may apply for assistance for the diagnosis and treatment of a child under the program for children with disabilities if that person could legally consent to the provision of medical care to the child. To apply, a person shall use forms provided by the department and must submit the application to the department. If an application is not complete, the department, may either reject the application or assist the applicant in completing the application. (b) An application must include

(1) the name, address, and birthdate of the child with a disability for whom assistance is sought;

(2) the name, home and business address, and telephone numbers of the applicant;

(3) the name, address, telephone number, employment status, and employer of the child’s parents or, if applicable, guardians, if the applicant knows this information;

(4) the status of the child’s eligibility for Medicaid, Alaska Native Health Service benefits, or other government entitlements;

(5) the status of the child’s coverage under any health or dental insurance policy, or under other insurance that might pay for treatment;

(6) the number of persons in the child’s family;

(7) the gross income and resources and the allowable deductions of the child’s family, as