Fiscal agent town hall: guidance on therapy utilization delay, DMEPOS SA classification, and travel vouchers
Customize your policy alerts
Sign up for all Alaska Medicaid policy alerts
Know when Alaska Medicaid releases new policies or updates existing guidance.
Monitor payer policy activity
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.
No material clinical or coverage changes in this revision.
Coverage and Authorization Criteria
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.
- Non-urgent example: recipient needs an item the supplier will not have available to dispense prior to discharge; this is not urgent and may be coordinated for delivery after discharge.
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.
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).
- As you issue vouchers to patients, record voucher details into the Travel Voucher Request Log; these logs must be submitted with requests for additional vouchers.
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.
- Record issued vouchers in the Travel Voucher Request Log; submit the log when requesting additional vouchers and include documentation of prior voucher use with order requests.
Key Dates and Timeframes
Provider Responsibilities and Operational Steps
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.
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.
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.
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
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.