Section 1200-13-09-.07 - PROVIDERS EXEMPTED FROM PROSPECTIVE PAYMENT SYSTEMThe prospective payment system shall not apply to the following hospitals and services:
(1) Any health care facility that is not a "hospital", as defined by Rule 1200-13-9-.01(9), skilled nursing facilities and intermediate care facilities located within hospitals when certified or licensed as "nursing" homes and swing beds, while being used to provide nursing services at less than the acute level of hospital care.(2) Inpatient services provided before July 1, 1988, by providers of either inpatient psychiatric services to persons under the age of twenty-one (21), or inpatient hospital services in institutions for mental disease to individuals age sixty-five (65) or older.(3) Psychiatric hospitals which elect not to submit a cost report and which have less than $10,000 annually, based on the provider's fiscal year, in total charges to patients determined eligible for Medicaid by the State of Tennessee. Such providers shall be reimbursed an amount not to exceed 80% of reasonable charges for covered items billed by the provider. Reasonable charges are those which are charged by comparable providers for similar services. In the event that providers exceed $10,000 in total Tennessee Medicaid charges annually, they will be treated as new providers as specified in Rule 1200-13-9-.11.(4) Outpatient hospital services, as defined by the October 1, 1986, edition of 42 CFR 440.20.Tenn. Comp. R. & Regs. 1200-13-09-.07
Original rule filed June 2,1988; effective July 17, 1988.Authority: T.C.A. §§ 71-5-105, 71-.5-109 and 4-.5-202.