Ala. Admin. Code r. 560-X-46-.03

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

Section 560-X-46-.03 - Reimbursement

(1) Swing bed services are reimbursed on a per diem basis at the average rate per patient day paid by Medicaid to SNF/ICF Combination facilities for routine services furnished during the previous calendar year. There shall be no year end cost settlement. Refer to Chapter 22 for details on rate computation.

(2) Ancillary services such as lab, x-ray, and prescription drugs must be billed and reimbursed separately under the appropriate program areas. For example, x-ray services provided in the outpatient department of the hospital should be billed as outpatient hospital services. These services will be subject to routine benefit limitations.

(3) The per diem rate includes routine supplies and over the counter medications such as acetaminophen, aspirin, antacids, antidiarrheals, laxatives, and stool softeners which are routinely used in the care of patients.

(4) Medicaid may pay the Medicare Part A coinsurance for dually eligible or QMB recipients who qualify under Medicare rules for skilled level of care. An amount equal to that applicable to Medicare Part A coinsurance, but not greater than the average nursing facility rate will be paid.

Author: Vicki Huff

Ala. Admin. Code r. 560-X-46-.03

Emergency rule effective March 30, 1989. Permanent rule effective July 13, 1989. Emergency rule effective January 8, 1990. Amended effective February 13, 1991.

Statutory Authority: Title XIX, Social Security Act; State Plan, Attachment 3.1-A, 4.19-D; 42 CFR §§447.280, 413.114, 413.53.