Ala. Admin. Code r. 560-X-44-.08

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

Section 560-X-44-.08 - Payment Methodology For Covered Services

(1) Payments made by the Alabama Medicaid Agency to providers will be on a fee-for-service basis. Each covered service is identified on a claim by a procedure code.

(2) Accounting for actual cost and units of services provided during a waiver year must be captured on CMS Form 372. The following accounting definitions will be used to capture reporting data, and the audited figures used in establishing new interim fees:

(a) A waiver year consists of 12 consecutive months starting with the approval date specified in the approved waiver document.

(b) An expenditure occurs when cash or its equivalent is paid in a quarter by a state agency for waiver benefits. For a public/governmental provider, the expenditure is made whenever it is paid or recorded, whichever is earlier. Non-cash payments, such as depreciation, occur when transactions are recorded by the state agency.

(c) The services provided by a direct service provider agency is reported and paid by dates of service. Thus, all services provided during the 12 months of the waiver year will be attributed to that year.

Ala. Admin. Code r. 560-X-44-.08

Rule effective October 12, 1988. Amended: Filed July 6, 1995; effective August 12, 1995. Repealed: Filed January 9, 2004; effective February 13, 2004. New Rule: Filed February 10, 2012; effective March 16, 2012.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 08, May 31, 2018, eff. 6/25/2018.

Author: Ginger Wettingfeld, Director, LTC Healthcare Reform

Statutory Authority: Social Security Act §1915(c); 42 CFR Section 441, Subpart G-Home and Community-Based Services: Waiver Requirements.