Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-35 - HOME- AND COMMUNITY-BASED WAIVER FOR PERSONS WITH INTELLECTUAL DISABILITIES
Section 560-X-35-.09 - Payment Methodology For Covered Services
Current through Register Vol. 43, No. 02, November 27, 2024
(1) The Medicaid reimbursement for each service provided by a mental health service provider shall be based on a fee-for-service system. Each covered service is identified on a claim by a procedure code.
(2) Providers should bill no more than one month's services on a claim for a recipient. There may be multiple claims in a month, but no single claim may cover services performed in different months. For example, October 15, 1990, to November 15, 1990, would not be allowed. If the submitted claim covers dates of service, part or all of which were covered in a previously paid claim, it will be rejected.
(3) Payment will be based on the number of units of service reported for HCPCS codes.
(4) All claims for services must be submitted within 12 months from the date of service.
(5) Accounting for actual cost and units of services provided during a waiver year must be accomplished on HCFA's form 372. The following accounting definitions will be used to capture reporting data, and the audited figures used in establishing new interim fees:
Author: Samantha McLeod, Associate Director, LTC Specialized Waiver Programs
Statutory Authority:42 C.F.R. § 441, Subpart G; Home- and Community-Based Waiver for persons with Intellectual Disabilities.