Ala. Admin. Code r. 560-X-52-.09

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

Section 560-X-52-.09 - Payment Methodology For Covered Services

(1) Actual reimbursement will be based on the rate in effect on the date of service.

(2) Rates will be established and reported to the Alabama Medicaid Agency's fiscal agent for claims submitted for payment.

(3) Payment will be based on the number of units of service reported for each HCPC code.

(4) All claims for services must be submitted within one year from the date of service.

(5) Accounting for actual cost and units of services provided during a waiver year must be captured on the CMS 372 Report.

Ala. Admin. Code r. 560-X-52-.09

Amended by Alabama Administrative Monthly Volume XXXII, Issue No. 09, June 30, 2014, eff. 7/16/2014.

Author: Samantha McLeod, Associate Director, Long Term Care Specialized Waiver Programs

Statutory Authority: Social Security Act §1915(c); 42 C.F.R.

Section 441, Subpart G-Home and Community-Based Services: Waiver Requirements.