Clinic Four Walls

The clinic four wall requirement has been in the news lately. The Division of Behavioral Health (DBH) thought it would be a great moment to provide citations and regulatory language for our Community Behavioral Health and Mental Health Physician Clinics convenience.

Clinic Services Overview

Clinic services at Section 1905(a)(9) of the Social Security Act (Act) are defined at 42 Code of Federal Regulations (CFR) 440.90 to include preventive, diagnostic, therapeutic, rehabilitative, or palliative services that are furnished by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. These services are provided in the following types of clinics (not limited to): dental, mental health, end-stage renal disease (ESRD), ambulatory surgical center (ASC), family planning, primary care, and Tribal/638 clinics.

In addition, the regulation specifies that clinic services must be provided under the direction of a physician (including dentists) and that their services must be provided within the facility (four walls of the clinic) unless being provided to eligible individuals who do not have a permanent dwelling, fixed home, or mailing address.

Clinic Services Rate Sheet

The Community Behavioral Health and Mental Health Physician Clinic Medicaid Covered Services rate sheet identifies the clinic services that must be performed within the four walls of the clinic for your reference.

If you have questions, please don’t hesitate to reach out to the mailbox at mpassunit@alaska.gov.

Kindly, fb

Farina Brown
Deputy Director, Division of Behavioral Health
Alaska Department of Health and Social Services

 

 

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