Ala. Admin. Code r. 560-X-61-.05

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

Section 560-X-61-.05 - Reimbursement

(1) Children's Specialty Clinics will be reimbursed by as follows:

(a) Governmental providers will be reimbursed by an encounter rate based on reasonable allowable costs, as defined by OMB Circular A-87, and established by the Medicaid Agency based on completion of the required cost report documentation.

(b) Nongovernmental providers will be reimbursed by a rate established by Medicaid based on usual, customary, and reasonable charges.

(2) Only one clinic visit per date of service per recipient will be reimbursed. Exception: A dental encounter may be billed in conjunction with a clinic visit for the same date of service for the same recipient.

Author: Lynn Sharp, Associate Director, Policy Development, Medical Services Division

Ala. Admin. Code r. 560-X-61-.05

New Rule: Filed April 8, 1996; effective May 13, 1996. Amended: Filed February 6, 1997; effective March 14, 1997. Amended: Filed June 5, 1998; effective July 10, 1998. Amended: Filed June 8, 1999; effective July 13, 1999.

Statutory Authority: Title XIX, Social Security Act; State Plan; 42 C.F.R. §440.90.