Current through Register Vol. 42, No. 11, August 30, 2024
(1) For
the period October 1 through September 30 in addition to any other funds paid
to private free-standing psychiatric hospitals for inpatient hospital services
to Medicaid patients, qualifying hospitals shall receive an
annual private |free-standing psychiatric hospital access payment
as described in the Alabama Medicaid Agency State Plan and amendments thereto
as currently approved by the Hospital Services and Reimbursement
Panel
(2) General - Annual cost
report filing, by completing Medicaid prescribed standard cost report forms, is
mandatory for P-psychiatric hospitals. Cost reports shall be completed in
|accordance with the Instructions for the Alabama Medicaid Uniform Cost Report.
(a) Cost Report Year-Ends - Each provider is
required to file a uniform cost report for each fiscal year. The provider may
elect the last day of any month as the fiscal year end. The cost report is due
ninety (90) days after the fiscal year endelected by the provider. To change
the fiscal year end, a written request must be received by the Alabama Medicaid
Agency no later than sixty (60) days prior to the close of the provider's
current cost reporting period. Providers must have written approval from the
Alabama Medicaid Agency before changing the reporting period.
(b) Cost Report Filing - One copy of the
complete uniform cost report must be received by Medicaid
within three |months after the Medicaid cost report
year-end. It shall be signed by an
authorized official
or owner of the hospital. If | the cost report is prepared by anyone other than
an official or a full-time employee of the hospital, such person shall duly
execute and submit the report as the Cost Report Preparer. The signatures of
both the hospital official and Cost Report Preparer, if any, must be preceded
by the following certification:
INTENTIONAL MISREPRESENTATION OR FALSIFICATION OF ANYIN
FORMATION CONTAINED IN THIS COST REPORT MAY BE PUNISHABLE BY FINE AND/OR
IMPRISONMENT UNDER FEDERAL LAW.
I HEREBY CERTIFY that I have read the above statement and -
|that I have examined the accompanying Cost Report and supporting schedules
prepared on behalf of (hospital name(s)and Number(s)) for the cost report
period beginning and ending and that to the best of my knowledge and belief, it
is a true, correct, and complete report prepared from the books and records of
the hospital(s) in accordance with applicable Alabama Medicaid Reimbursement
Principles, exceptas noted.
signed ______________________________________
Officer or Administrator of Hospital(s)
Cost Report Prepared
By:_________________________________________
Title
_________________________________________
Date
Any cost report received by Medicaid without the required
original signatures and/or certification(s) will be deemed incomplete and
returned to the hospital.
A cost report may be submitted in electronic format with a
printed signed page of certification.
(c) Extensions - Cost reports shall be
prepared with due diligence and care to prevent the necessity for later
submittals of corrected or supplemental information by hospitals. Extensions
may be granted only upon approval by Medicaid. The extension request must be in
writing, containing the reasons for the request, and must be made prior to the
cost report due date. Only one thirty-one day extension per cost reporting year
will be granted by the Agency.
(d)
Penalties. Late Filing - If a complete uniform cost report is not filed by the
due date, the hospital shall be charged a penalty of one hundred dollars per
day for each calendar day after the due date. This penalty will not be a
reimbursable Medicaid cost. The Commissioner of Medicaid may waive such penalty
for good cause shown. Such showing must be made in writing to the Commissioner
with supporting documentation. A cost report that is over ninety (90) days late
may result in termination of the hospital from the Medicaid program. Further,
the entire amount paid to the hospital during the fiscal period with respect to
which the report has not been filed will be deemed an overpayment. The hospital
will have thirty (30) days to refund the overpayment or submit the cost report
after which Medicaid may institute a suit or other action to collect this
overpayment amount. No further payment will be made to the hospital until the
cost report has been received by Medicaid.
(3) Reporting Negligence
(a) Whenever a provider includes a previously
disallowed_cost on a subsequent year's cost report, if the cost included is
attributable to the same type good or service under substantially the same
circumstances as resulted in the previous disallowance, a negligence penalty of
up to $10,000 may be assessed at the discretion of the Alabama Medicaid
Agency.
(b)
This penalty shall be in addition
to, and shall in no way
affect, Medicaid's right to also recover the entire
amount of any overpayment caused by the provider's or its representative's
negligence.
(c) A previously
disallowed cost, for the purposes of a negligence penalty assessment, is a cost
previously disallowed as the result of a desk review or a field audit of the
provider's cost report by Medicaid and such cost has not been reinstated by a
voluntary action of Medicaid. The inclusion of such cost on a subsequent cost
report by the provider, or its representative, unless the provider is pursuing
an administrative or judicial review of such disallowance, will be considered
as negligent and subject to the penalty imposed by this Rule.
(4) Calculation of Medicaid
Prospective Payment Rates for Inpatient Claims.
(a) Payments for inpatient services shall be
based on a prospective per diem rate determined by the Alabama Medicaid
Agency.
(b) Rate Setting Period -
The as-filed immediately preceding year's cost report will be used to compute a
hospital's prospective inpatient per diem rate each year, except for those
hospitals on an operating budget or filing an abbreviated cost report, thus the
base period is moving. The cost report shall be desk reviewed and any
non-reimbursable items will be removed from reported cost prior to calculating
a rate.
(c) Rate Review Period -
The per diem rates as calculated by Alabama Medicaid Agency shall be provided
to the hospitals prior to the effective date for their information and
review.
(d) Per Diem Rate
Computation - The total Medicaid cost per diems from the cost report shall be
adjusted as follows:
1. The medical education
cost per diem and the capital-related cost per diem are subtracted from the
inpatient hospital cost per diem. The remaining cost per diem is separated into
Administrative and General (A & G) and non-Administrative and General per
diem components. The components will then be multiplied by the applicable
hospital industry trend factor (as adjusted by any relevant trend factor
variance). The resulting trended A & G cost per diem will be arrayed within
hospitalI grouping in ascending order. The number of
psychiatric hospitals will be multiplied by 60% to
determine the position of the hospital that represents the 60th percentile.
That hospital's cost in each urban grouping will become the ceiling for that
grouping. The ceiling or actual cost per day (whichever is less) I will be the
adjusted A & G per diem cost. Add the adjusted (if
applicable) A & G per diem component cost to the non-administrative per
diem component cost. PsychiatricI hospitals shall be subject to a 60th
percentile ceiling.
2. Capital-Related and Medical Education
Costs PerDiem:
(i) Adjust capital-related cost
for all hospitals perdiem by any applicable low occupancy cost per
day.
(ii) Medical Education cost
per diem will be multiplied by the hospital industry medical education costs
trend factor.
3. The
total Medicaid per diem cost per day, subject to the overall 80th percentile
ceiling, shall consist of:
(i) Operating costs
as adjusted in (1) above.
(ii) Capital-related costs as determined in
(2) (b) above.
4. The total cost per day will be
arrayed inascending order. The number of hospitals will be multiplied by the
applicable percentile to determine the position of the hospital that represents
the appropriate percentile. That hospital's cost will be the ceiling.
5. The lesser of the above determined ceiling
or actual cost per day shall be added to any applicable education cost. The sum
shall be a hospital's Medicaid per diem rate for the new period.
(e) Adjustments to Rates - The
prospectively determined individual hospital's reimbursement rate may be
adjusted as deemed necessary by the Agency. Circumstances which may warrant an
adjustment include, but are not limited, to:
1. A previously submitted and/or settled cost
report that is corrected. If an increase or decrease in rate results,any
retroactive adjustments shall be applied as of the effective date of the
original rate. Any such payment or recoupment shallbe made by a rate change
and/or a lump sum adjustment if the adjustment applies to the current rate
period, or by a lump sum adjustment, if the adjustment applies to a prior rate
period.
2. The information
contained in the cost report is found to be intentionally misrepresented. Such
adjustment shallbe made retroactive to the date of the original rate.
Thissituation may be considered grounds to suspend the
hospital from |participation in the Alabama Medicaid Program.
3. The hospital experiences extraordinary
circumstances which may include, but are not limited to, an Act of God, war, or
civil disturbance. Adjustments to reimbursement rates may be made in these and
related circumstances.
4. Under no
circumstances shall adjustments resulting from paragraphs (1) through (3) above
exceed the ceiling established. However, if adjustments as specified in (1)
through(3) so warrant, Medicaid may recompute ceilings.
5. Low Occupancy Adjustment - A low occupancy
adjustment shall be computed for hospitals which fail to maintain the minimum
level of occupancy of the total licensed beds. A 70% occupancy factor will
apply to hospitals with 100 or fewer beds. An 80% occupancy factor will apply
to hospitals with 101 or morebeds. Such adjustment will be composed of the
fixed cost associated with the excess unoccupied beds and shall be a reduction
to Medicaid inpatient cost. It shall be computed in the manner outlined as
follows:
LOW OCCUPANCY ADJUSTMENT FOR HOSPITALS
LOA = (1- TBD) ACC
( Y ABD)
TBD = Total Bed Days Actually Used During the Cost Report
Period,
ACC = Allowable Capital Cost
ABD = Available Bed Days Which is Determined by Multiplying the
Total Licensed Beds Times the Number of Days in the Cost Report Period (Y = 80%
101 beds or more
Y = Occupancy Factor (Y = 70% 100 beds or less
See history at end of
chapter.
Author: Keith Boswell, Director, Provider
Audit/Reimbursement
Statutory Authority: State Plan; Title XIX,
Social Security Act; 42 C.F.R. §§401, et
seq.
