Ala. Admin. Code r. 560-X-22-.05

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

Section 560-X-22-.05 - Medicaid Per Diem Rate Computation

(1) The Medicaid per diem rate will be determined under reimbursement methodology contained in this chapter. (See Rule 560-X-22-.06.) The rates will be based on the cost data contained in cost reports (normally covering the period July 1 through June 30th). In order to allow adequate time for a provider to prepare and submit the cost report and for Medicaid to compute a new rate, each provider will be paid an interim per diem rate. This interim rate will cover the period July 1 through December 31. The interim rate shall be the lower of the latest allowable computed rate or the ceiling rate per day. The allowable rate per day shall be trended by the Alabama Medicaid trend factor. [See Rule 560-X-22-.07(4)] Providers will be paid a weighted per diem rate for the portion of the fiscal year remaining after the provider's new rates are established. The weighted per diem rate will be determined as outlined below:

(2) To calculate the weighted per diem rate: Multiply the allowable per diem rates times twelve. Deduct from that product the interim per diem rate multiplied by the number of months paid. Divide the remainder by the number of months remaining in the fiscal year.

(a) Example 1. Provider's interim rate has been in effect for five (5) months. Provider's weighted rate will be in effect for seven (7) months:

Allowable per diem rate for the year $50.00

Interim rate paid $48.00

Allowable per diem rate multiplied by 12 = $50.00 x 12 $600.00

Deduct interim per diem rate multiplied by number of months paid = $48.00 x 5 = $240.00

Remainder = $360.00

Divide the remainder by the number of remaining months in the fiscal year = $360.00 - 7

= Weighted per diem rate = $51.43

(b) Example 2. Provider's interim rate has been in effect for six (6) months. Provider's weighted rate will be in effect for six (6) months:

Allowable per diem rate for the year $50.00

Interim rate paid $48.00

Allowable per diem rate multiplied by 12 = $50.00 x 12 $600.00

Deduct interim per diem rate multiplied by number of months paid = $48.00 x 6 = $288.00

Remainder = $312.00

Divide the remainder by the number of remaining months in the fiscal year = $312.00 - 6 = Weighted per diem rate = $52.00

(c) Unapproved Beds. Capital expenditures must be approved under the State Certificate of Need Program.

Authors: Michael C. Murphy, Susan Mims

Ala. Admin. Code r. 560-X-22-.05

Rule effective October 1, 1982. Amended: effective March 15, 1983; May 9, 1984, September 8, 1984. Emergency rule effective December 1, 1986. A permanent rule incorporating the provisions of this emergency rule was not adopted and therefore the original wording in paragraph 5 was reinstated upon expiration of the emergency rule. Amended: effective September 9, 1987; March 12, 1988; June 14, 1989. Emergency rule effective June 20, 1989. Amended: effective September 13, 1989. Emergency rule effective January 17, 1990. Amended: effective April 17, 1990; October 1, 1990. Emergency rule effective September 12, 1991. Amended effective December 12, 1991.

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R., §§447.200 - .272, etseq.