016.06.18 Ark. Code R. 005

Current through Register Vol. 49, No. 10, October, 2024

Rule 016.06.18-005 - Outpatient Hospital Services State Plan Amendment

METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES -OTHER TYPES OF CARE ATTACHMENT 4.I9-

2.

a.Outpatient Hospital Scmccs

(7)Border City University-Affiliated Pediatric Teaching Hospitals Special consideration is given to border city university-affiliated pediatric teaching hospitals due to the higher costs typically associated with such hospitals. Eflective for claims with dates of service on or after January 1,2018, outpatient hospital facility services provided to patients under the age of 21 at border city university-affiliated pediatric teaching hospitals will be reimbursed based on reasonable costs with interim payments and a year-end cost settlement. The State will utilize cost data in a manner approved by CMS consistent with the method used for identifying cost for the private hospital access payments as outlined in this Attachment 4.19-B, Page la.

Arkansas Medicaid will use the lesser of the reasonable costs or customary charges to establish cost settlements. The cost settlements will be calculated using the methods and standards used by the Medicare Program.

A border city university-afTiliated pediatric teaching hospital is defined as a hospital located within a bordering city (see Attachment 4.19-A page3b) that submits to the Arkansas Medicaid Program a copy of a current and effective affiliation agreement with an accredited university, and documentation establishing that the hospital is university-affiliated, is licensed and designated as a pediatric hospital or pediatric primary hospital within its home state, maintains at least five different intern pediatric specialty training programs, and maintains at least one-hundred (100) operated beds dedicated exclusively for the treatment of patients under the age of 21.

016.06.18 Ark. Code R. 005

7/18/2018