Ala. Admin. Code r. 580-5-30-.03
All intellectual disabilities services will be provided in accordance with the ADMH Standards, DDD Operational Guidelines and other federal funding source guidelines such as Home and Community Based Waiver Services (HCBS), and Community Standards for Services for Persons with Intellectual Disabilities.
Appropriate certifications will be maintained in accordance with applicable Standards.
Federal and state guidelines, statutes, and rules will be observed to ensure maximum intra- and inter-agency cooperation and coordination of service.
Community Service Providers will operate in accordance with applicable federal, state, municipal and local laws, regulations, ordinances and codes, including, but not limited to, Federal Medicaid regulations, the State Medicaid Agency plan, the Alabama Medicaid Agency 's Administrative Code the Alabama Department of Mental Health 's Administrative Code and Audit Guidelines Manual and subsequent amendments, the State Ethics Law, and applicable state policies and procedures. Medicaid funding is passed through from the Alabama Medicaid Agency (AMA). This funding comes from the US Department of Health and Human Services Medical Assistance Program (Catalog of Federal Domestic Assistance Number 93.778) and is subject to Title XIX of the Social Security Act of 1965 and administrative regulations found in the Code of Federal Regulations, 42 CFR Part 430 to end. -Only those services and units in the authorization record for each individual, actually delivered, will be forwarded to Medicaid. Of those claims forwarded, only those claims adjudicated to be paid by Medicaid as determined from the respective Explanation of Payment (EOP) reports, will be paid to the provider. ADMH will have no obligation for service units denied or suspended by Medicaid.
If a chargeback occurs, the provider alone will be responsible for paying Medicaid. If the provider does not submit documentation for an informal review of the overpayment within thirty (30) calendar days, request a fair hearing, or submit payment within sixty (60) calendar days of the date of the letter informing them of the overpayment, ADMH will proceed with recoupments from future check writes If ADMH suffers a recoupment from Medicaid due to a community service provider violation of Medicaid or Medicare regulations, community service provider has an affirmative duty to immediately (no longer than 30 days) reimburse ADMH for the total State and Federal amounts associated with the Medicaid or Medicare recoupment.
Ala. Admin. Code r. 580-5-30-.03
Author: Division of Developmental Disabilities
Statutory Authority:Code of Ala. 1975, § 22-50-11.