950              COVERED MEDICAL SERVICES

The Chronic and Acute Medical Assistance program pays for the following services only:

1. prescription drugs (maximum 3 per month) and limited medical suppies (maximum 30 day supply);
   
   
2. physician visits;
   
   
3. outpatient hospital radiation and chemotherapy services rendered to a recipientAn individual who is receiving a public assistance program. in need of chemotherapy treatment for cancer; and
   
   
4. outpatient laboratory and x-ray services.

950-1           PRESCRIPTION DRUGS , MEDICAL SUPPLIES, AND PHYSICIAN VISITS

CAMAChronic and Acute Medical Assistance may pay for prescription drugs , limited medical supplies, and physician visits that are medically necessary for treatment.

A recipientAn individual who is receiving a public assistance program. may receive no more than a 30-day supply of any drug.  The only non-prescription drug that can be reimbursed without obtaining prior authorization from the Division of Health Care Services (DHCSDivision of Health Care Services) is insulin.  

A recipientAn individual who is receiving a public assistance program. who is eligible for prescription drug coverage at a military medical facility must obtain the prescription from that source unless the drug is unavailable at that military medical facility.  If the drug is unavailable, the recipientAn individual who is receiving a public assistance program. must obtain a written statement from the military medical facility and present the statement to the civilian pharmacist who fills the prescription.  The pharmacist must submit the statement with the claim.  If the recipientAn individual who is receiving a public assistance program. fails to obtain such a statement, the civilian pharmacist may call the military medical facility pharmacist to determine whether the drug is available.  If it is not, the civilian pharmacist should make a record of the telephone contact on the claim submitted to Affiliated Computer Systems.

950-5           NONCOVERED MEDICAL SERVICES

CAMAChronic and Acute Medical Assistance will not pay for any of the following expenses:

1. major medical careNon-elective inpatient hospital services that cannot be performed on an outpatient basis and are certified as necessary by the professional review organization under contract with the Division of Health Care Services.;
    
2. Nursing home care;
    
3. Drugs, medical supplies, radiation, or chemotherapy not properly prescribed or determined necessary by an appropriate health care providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program.;
    
4. Medical care for a person in the care and custody of a correctional facility, including a jvuenile detention facility;
    
5. An Elective ProcedureA procedure that is subject to the choice or decision of the patient or physician regarding medical services that are advantageous to the patient but not necessary to prevent death or disability of the patient.;
    
6. Services provided by an Indian Health Service (IHS) or IHSIndian Health Service funded facility that is provided to an IHSIndian Health Service beneficiary and for which there is no charge to the individual;
    
7. Drugs or medical supplies not directly related to the treatment of a covered medical condition;
    
8. Drugs or medical supplies after the first three prescriptions are filled within a calendar month;
    
9. Transportation expenses; and
    
10. Physician services if the physician service is provided in an inpatient hospital or in a nursing facility.
     

 Note:

Individuals in need of inpatient psychiatric hospital services should be referred to the Alaska Behavioral Health Resource Guide at: https://dhss.alaska.gov/health/abada/Documents/pdf/200804resourceguide.pdf.

950-6           RECIPIENTAn individual who is receiving a public assistance program. CHARGES

The recipientAn individual who is receiving a public assistance program. is responsible for paying:

1. all charges incurred if no coupon is presented;
    
2. charges incurred before and after the eligibility period; and
    
3. a $1 co-payment on each prescribed drug or medical supply.