Ala. Admin. Code r. 560-X-10-.12

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-10-.12 - Utilization Review For ICF/IID

(1) An ICF/IID must comply with the utilization review requirements contained in 42 C.F.R. §§ 456.350-456.438 ("Utilization Review Requirements").

(2) Medicaid or its designee will conduct retrospective audits to ensure the facility complies with the Utilization Review Requirements. The ICF/IID must make available to Medicaid or its designee such documents, records, and other writings as are necessary to demonstrate compliance with the Utilization Review Requirements.

(3) If an ICF/IID fails to comply with the Utilization Review Requirements, Medicaid may take appropriate action, including but not limited to provider education, recoupment of the amount of payments made during the time which the ICF/IID did not comply with the Utilization Review Requirements, or denial of payments for the new admissions to the ICF/IID.

Ala. Admin. Code r. 560-X-10-.12

Rule effective October 1, 1982. Emergency rule: effective October 1, 1990. Amended: Effective February 13, 1991; August 14, 1991. Amended: Filed December 7, 1993; effective January 14, 1994. Amended: Filed August 11, 2003; effective September 15, 2003.

Amended by Alabama Administrative Monthly Volume XXXV, Issue No. 04, January 31, 2017, eff. 2/25/2017.

Rule 560-X-10-.11, Utilization Review, was renumbered to Rule, Utilization Review for ICF/MR as per certification filed August 11, 2003; effective September 15, 2003.

Author: Robin Arrington, Associate Director, LTC Provider/Recipient Services Unit

Statutory Authority: State Plan; Title XIX, Social Security Act; P.L. 92-603; 42 C.F.R. §§ 401, et seq.