Ala. Admin. Code r. 560-X-23-.02

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

Section 560-X-23-.02 - Definitions And Basic Concepts

(1) Access Payment: A payment by the Medicaid program to an eligible hospital for inpatient and outpatient hospital care provided to a Medicaid recipient.

(2) Hospital: For purposes of Medicaid base, access and DSH payments for the period from October 1 through September 30 a facility, which is licensed as a hospital under the laws of the State of Alabama, provides 24-hour nursing services, and is primarily engaged in providing, by or under the supervision of doctors of medicine or osteopathy, inpatient services for the diagnosis, treatment, and care or rehabilitation of persons who are sick, injured, or disabled.

(3) Cost Report: The electronic cost report (ECR) filing of the CMS Form 2552-96 and 2552-10 Hospital and Hospital Health Care Complex Cost Report, as defined in CMS Provider Reimbursement Manual (PRM) 15-11 (hereinafter referred to as "CMS form 2552").

(4) Privately Owned and Operated Hospital: For purposes of Medicaid base, access and DSH payments for the period from October 1 through September 30 a hospital in Alabama other than:

(a) Any hospital that is owned and operated by the federal government;

(b) A hospital that is a state agency or unit of state government, including without limitation a hospital owned by a state agency or a state university.

(c) A hospital created and operating under the authority of a governmental unit which has been established as a public corporation pursuant to Chapter 21 of Title 22 or Chapter 95 of Title 11, or a hospital otherwise owned and operated by a unit of local government.

(d) A hospital that limits services to patients primarily to rehabilitation services as authorized by Alabama Administrative Code 410-2-4-.08; or

(e) A hospital granted a Certificate of Need as a Long Term Acute Care Hospital as defined by Alabama Administrative Code 410-2-4-.02(8).

(5) Non State Government Owned and Operated Hospital: For purposes of Medicaid base, access and DSH payments for the period from October 1 through September 30 a hospital in Alabama created or operating under the authority of a governmental unit which has been established as a public corporation pursuant to Ala. Code, Chapter 21 of Title 22 or Chapter 95 of Title 11, or a hospital otherwise owned or operated by a unit of local government.

(6) State Owned or Operated Hospital: For purposes of Medicaid base, access and DSH payments for the period from October 1 through September 30 a hospital in Alabama that is a state agency or unit of state government, including without limitation a hospital owned or operated by a state agency or a state university.

Ala. Admin. Code r. 560-X-23-.02

Rule effective June 9, 1986. Amended: effective October 11, 1986; September 9, 1987; May 25, 1988. Amended: effective November 10, 1988; April 14, 1989. Emergency rule effective October 1, 1991. Amended: effective January 14, 1992; September 11, 1992. Amended: effective May 11, 1993. Amended: Filed December 6, 1995; effective January 11, 1996. Repealed and New Rule: Filed November 10, 2010; effective December 15, 2010. Amended: Filed December 12, 2011; effective January 16, 2012. Amended: Filed September 11, 2013; effective October 16, 2013.

See history note at end of chapter.

Authors: Keith Boswell, Director, Provider Audit/Reimbursement

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§401, etseq.