Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-54 - HOME AND COMMUNITY-BASED SERVICES FOR INDIVIDUAL UNDER THE TECHNOLOGY ASSISTED (TA) WAIVER FOR ADULTS
Section 560-X-54-.07 - Payment Methodology For Covered Services

Universal Citation: AL Admin Code R 560-X-54-.07

Current through Register Vol. 43, No. 02, November 27, 2024

(1) Payments made by Medicaid to providers will be on a fee-for-service basis. Each covered service is identified on a claim by a procedure code.

(2) Payment will be based on the number of units of service reported on the claim for each procedure code.

(3) Accounting for actual cost and units of services provided during a waiver year must be captured CMS 372 Report. The following accounting definitions will be used to capture reporting data, and the audited figures used in establishing new interim fees:

(a) A waiver year consists of 12 consecutive months starting with the approval date specified in the approved waiver document.

(b) An expenditure occurs when cash or its equivalent is paid in a quarter by a state agency for waiver benefits. For a public/governmental provider, the expenditure is made whenever it is paid or recorded, whichever is earlier. Non-cash payments, such as depreciation, occur when transactions are recorded by the state agency or the provider.

(c) The services provided by an operating agency are reported and paid by dates of service. Thus, all services provided during the 12 months of the waiver year will be attributed to that year.

Author: Ginger Wettingfield, Director LTC Healthcare Reform Division

Statutory Authority: 42 C.F.R. Section 441, Subpart G and the Home and Community-Based Technology Assisted Waiver for Adults.

Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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