Ala. Admin. Code r. 560-X-54-.07

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

Section 560-X-54-.07 - Payment Methodology For Covered Services

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

(2) Payment will be based on the number of units of service reported on the claim for each procedure code.

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

(c) The services provided by an operating agency are 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-54-.07

New Rule: Filed May 12, 2003; effective June 16, 2003. Amended: Filed August 11, 2008; effective September 15, 2008.

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

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 09, June 29, 2018, eff. 7/26/2018.

Author: Ginger Wettingfield, Director LTC Healthcare Reform Division

Statutory Authority:42 C.F.R. Section 441, Subpart G and the Home and Community-Based Technology Assisted Waiver for Adults.