CurrentAlaska MedicaidPolicy N/A

Fiscal agent town hall: guidance on therapy utilization delay, DMEPOS SA classification, and travel vouchers

Summarizes Alaska Medicaid fiscal agent transition communications affecting providers about delayed implementation of adult therapy utilization limits, new guidance for urgent and delayed DMEPOS service authorizations, travel voucher ordering and use, and a public health bulletin on congenital syphilis; applies to Alaska Medicaid providers and suppliers.

Policy Summary

PayerAlaska Medicaid

PolicyFiscal agent town hall: therapy limits delay, DMEPOS SA guidance, travel vouchers

Policy CodePolicy N/A

Change TypeOperational guidance (no material coverage changes)

Effective DateN/A

Next Review DateN/A

Key ActionOrder Travel Voucher (AK-04) from HMS and record issued vouchers in the Travel Voucher Request Log before distributing to the patient.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Nov 2023suspended implementation target

48 hrsurgent SA discharge window

AK-04travel voucher form

3major topics

Coverage and Authorization Criteria

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Therapy utilization enforcement delay

Adult therapy services utilization limits — enforcement suspended until the implementation date below.

ALL of the following

Implementation of utilization limits for adult therapy services (physical therapy, occupational therapy, and speech-language pathology) is suspended until November 2023.
Members who have reached threshold limits may continue therapy services without prior authorization until November 2023.
All rendered services must be medically necessary and meet program requirements, including treatment plan requirements defined by regulation (7 AAC 115.120; 7 AAC 115.220; 7 AAC 115.320; 7 AAC 115.420).
Comagine (the department's utilization management contractor) will issue guidance and conduct training in preparation for the November 2023 implementation to support provider readiness for the new prior authorization process.

Urgent and delayed SA criteria

Classification and handling of DMEPOS service authorizations — submit as URGENT only when ALL of the following are met; delayed submissions permitted only in rare, documented circumstances.

ALL of the following

Recipient is discharging from the hospital within 48 hours.
The inpatient stay was too short to coordinate equipment and supply service authorization more than 48 hours prior to discharge.
The equipment or supplies will be ready to dispense on the date of discharge (the supplier must have the item available to dispense).
The medical record identifies the discharge plan and planned discharge date.
Examples
- Appropriate urgent situation: recipient with a short hospital stay requires a basic manual wheelchair that the supplier can dispense on discharge.

Travel vouchers (ordering, use, submission)

Ordering, issuing, and submission pathways for Travel Vouchers (AK-04) to document authorized nonemergent travel and lodging.

ALL of the following

Travel vouchers (AK-04) are ordered from HMS and are used to document authorized units of nonemergent travel and lodging for patients.
Patients provide issued vouchers to enrolled transportation and accommodation providers to use when billing for services.
Use the Travel Voucher (AK-04) Order Request form to request vouchers and to include documentation of previously issued voucher use.
Travel Voucher Order Request forms and Travel Voucher Request Logs can be submitted by email (aktravelvoucher@gainwelltechnologies.com), fax (907.644.8126), or mail (HMS, PO Box 240808, Anchorage, AK 99524-0808).

Travel voucher completion and submission requirements

Steps and required entries when completing and distributing approved travel vouchers after authorization.

ALL of the following

Record the approved authorization number and name of the agent who approved the request on the voucher.
Complete patient information and the patient/escort Approved Units sections on the voucher prior to distribution.
Provide one voucher that includes all approved lodging and meal needs for the member's trip.
Provide one voucher for each approved ground transportation unit.
Distribute vouchers to the patient and/or their escort prior to travel.

Key Dates and Timeframes

Therapy utilization thresholds enforcement date

Enforcement dateImplementation suspended until November 2023

Applies toAdult therapy services: physical therapy, occupational therapy, speech-language pathology

Provider implicationMembers reaching thresholds may continue services without prior authorization until November 2023 but services must be medically necessary and meet treatment plan requirements

Reference regulations7 AAC 115.120; 7 AAC 115.220; 7 AAC 115.320; 7 AAC 115.420

Urgent submission discharge timeframe

Urgent discharge windowRecipient discharging from the hospital within 48 hours

Condition rationaleUsed to determine eligibility for urgent Service Authorization (SA) submission when inpatient stay was too short to coordinate SA >48 hours prior

Dispense readinessEquipment or supplies must be ready to dispense on the date of discharge

Provider Responsibilities and Operational Steps

Note

Adult therapy utilization limits suspension

Implementation of adult therapy utilization limits is suspended until November 2023. Members who reach threshold limits for physical therapy, occupational therapy, and speech‑language pathology do not require prior authorization to continue services during the suspension; however, all services must be medically necessary and meet program and treatment plan requirements (see relevant 7 AAC sections). Comagine will provide guidance and training before implementation.

Prior Authorization

DMEPOS urgent and delayed SA guidance

Certain DMEPOS service authorizations (SAs) should be classified and submitted as urgent or delayed only when the specific criteria in the guidance are met. See below for provider actions when preparing these request types.

Urgent Requests: submit as urgent only when ALL apply: recipient discharging within 48 hours; inpatient stay too short to coordinate SA >48 hours before discharge; equipment/supplies will be ready to dispense on discharge date; medical record documents discharge plan and planned discharge date. If the supplier will not have the item available on discharge date, do not submit as urgent.
Delayed Submissions: indicate on the SA fax cover sheet when delayed due to retroactive/backdated eligibility ('The request is delayed due to retroactive eligibility.') or when the supplier failed to renew an SA timely. These are reviewed case‑by‑case and may be authorized retroactively in rare instances. Do not delay submitting an SA when prescriber delays providing information; mark the fax cover sheet that the request is incomplete and that supplier is working with prescriber. Provide explanation on fax cover sheet for scenarios not outlined; such requests are reviewed case‑by‑case.

Documentation Required

Issuing and documenting travel vouchers

Order travel vouchers (AK‑04) from HMS and issue them to patients to document authorized nonemergent travel and lodging units. Record each issued voucher in the Travel Voucher Request Log as you distribute vouchers to patients and escorts. Ensure patient information and approved units (lodging/meals as one voucher, one voucher per approved ground transportation unit) are completed on each voucher before distribution.

Vouchers are supplied by HMS and given to enrolled transportation/accommodation providers when they bill.
Record necessary information for every issued voucher in the Travel Voucher Request Log; logs must be submitted when requesting additional vouchers.
When a trip includes lodging and/or ground transportation, complete vouchers so: 1 voucher includes all approved lodging and meals; 1 voucher for each approved ground transportation unit.

Prior Authorization

Submitting voucher order requests

Submit the Travel Voucher (AK‑04) Order Request form along with your Travel Voucher Request Log showing prior voucher use. Acceptable submission methods: email aktravelvoucher@gainwelltechnologies.com, fax 907.644.8126, or mail to HMS, PO Box 240808, Anchorage, AK 99524‑0808. Order forms and logs are available on the Arranging Patient Travel page. Include the requested administrative fields (e.g., Request Date & Time, Certified Letter #, CRN#, Voucher Control Number Range, Submitted By, Date) as applicable.

Include documentation of previously issued vouchers with each AK‑04 order request.
Use one of the listed submission channels (email, fax, or mail).
Keep Travel Voucher Request Logs current and submit them when requesting additional vouchers.

Definitions and Term Clarifications

Urgent SA request — classification criteria

Discharge timeframeRecipient discharging within 48 hours

Insufficient inpatient stayInpatient stay too short to coordinate equipment and supply SA more than 48 hours prior to discharge

Ready-to-dispenseEquipment or supplies will be ready to dispense on the date of discharge

Documentation requiredMedical record must identify the discharge plan and planned discharge date

Delayed submission — acceptable justifications and fax cover sheet note

Permitted examplesSupplier missed renewing an SA, prescriber paperwork errors, or recipient retroactive/backdated eligibility

Fax cover sheet requirementIndicate delayed submission circumstances on the SA fax cover sheet and describe the specific reason (e.g., 'The request is delayed due to retroactive eligibility')

Review approachDelayed requests will be reviewed case-by-case and may be authorized retroactively in rare instances

Travel Voucher (AK-04) — form description and use

Form nameTravel Voucher (AK-04) Order Request form

PurposeUsed to order travel vouchers that document authorized units of nonemergent travel and lodging for patients

Issued to providersVouchers are issued by HMS and provided to enrolled transportation and accommodation providers for billing

Travel Voucher / Travel Voucher Request Log — form names and purposes

Order formTravel Voucher (AK-04) Order Request form — used to submit requests for travel vouchers and documentation of prior voucher use

Request logTravel Voucher Request Log — record issued vouchers and related information when issuing vouchers to patients

AvailabilityForms and logs are available on the Arranging Patient Travel (Arranging Member Travel) webpage

Authorized Units (travel/lodging)

DefinitionAuthorized units are nonemergent travel and lodging units approved for patients that enrolled transportation and accommodation providers use to bill for services

DocumentationUse travel vouchers to document the approved units of nonemergent travel and lodging

DistributionProvide vouchers to patients to give to transportation/accommodation providers when they bill

Delayed submission criteria

Delayed submission is a very rare instance when either a supplier missed renewing an SA timely, a prescriber failed to correctly complete necessary paperwork, or the recipient received a retroactive or backdated eligibility determination.
When delayed due to retroactive eligibility, indicate on the SA fax cover sheet the dispense date and include language: 'The request is delayed due to retroactive eligibility.'
When delayed due to supplier failure to renew, indicate this clearly on the SA fax cover sheet; such requests will be reviewed case-by-case and may, in rare instances, be authorized retroactively.
Do not delay submitting an SA to the Fiscal Agent SA unit when the prescriber does not submit needed information timely; incomplete SA requests follow the standard RTP and denial process and should be marked as incomplete on the fax cover sheet with note that supplier is working with prescriber.