Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 150 - Prospective Payment System; Other Payment
7 AAC 150.110 - Methodology and criteria for proportionate share payments to privately owned or operated hospitals

(1) to qualify to receive a private hospital proportionate share payment under this subsection, a hospital must

(2) a qualifying hospital may receive proportionate share payments allocated to one or more of the following private hospital proportionate share classifications, if that hospital meets any additional criteria applicable to that classification, and subject to the limitations set out in (5) - (6) of this subsection:

(3) in an agreement under (2) of this subsection, the department may authorize the qualifying hospital to provide the required services directly, through the purchase of services, or through a person, clinic, or hospital designated by the department; a payment made under this section is not an allowable cost under the facility rate setting methodology set out in 7 AAC 150.010 - 7 AAC 150.040 and 7 AAC 150.130 - 7 AAC 150.210;

(4) for purposes of an agreement under (2)(A) or (B) of this subsection, the support services that a qualifying hospital provides must include one or more of the following:

(5) the total amount available for distribution as private hospital proportionate share payments under this subsection will be established by the department each year, based on the department's projection of hospital expenditures and within the payment limits of 42 C.F.R. 447.271 - 447.272; subject to legislative appropriation, payment of the amount the department determines to be available for private hospital proportionate share payments will be apportioned among qualifying hospitals;

(6) beginning August 11, 2004, the department will allocate the following percentage of the private hospital proportionate share payments for each payment year by proportionate share classification:

(7) each payment for the private hospital proportionate share classifications will be calculated within each classification based on the number of encounters to be performed by the qualifying hospital for that classification, as specified in the agreement required under (2) of this subsection for that classification, divided by the total number of encounters to be performed by all qualifying hospitals within that classification, as specified in the agreements required for that classification; the resulting percentage will be multiplied by the allocation amount applicable to that classification, as calculated in (5) - (6) of this subsection;

(8) on or before the qualification date, the department will send to each privately owned hospital a list of the qualifying hospitals and the amount of the payments for the upcoming payment year; the total amount available for distribution as private hospital proportionate share payments under this subsection will be established by the department each year, based on the department's projection of hospital expenditures and within the payment limits of 42 C.F.R. 447.271 - 447.272; the department's determination under this paragraph is the department's final administrative action regarding

(9) to optimize, consistent with AS 47.07 and this chapter, the use of federal money allotted to private hospital proportionate share payments, the department may enter into other agreements under (2)(A) - (H) of this subsection, if

(10) a hospital aggrieved by the department's decision under (8) of this subsection, regarding whether a hospital is a qualifying hospital, may request reconsideration of the decision by filing a request with the department, and sending a copy of the request to each qualifying hospital, no more than 10 days after the date of the department's list under (8) of this subsection; a request for reconsideration under this paragraph must state the facts in the record that support a reversal of the initial decision; a qualifying hospital to which a request for reconsideration was sent may file with the department, no more than 10 days after the date the request was sent, a response to the request for reconsideration; the response must be based on facts in the record; the department's decision on reconsideration under this paragraph is the department's final administrative action on a reconsideration request under this paragraph; if the department does not issue a decision on reconsideration 30 days or less after the deadline for filing a response to the request for reconsideration, and does not waive the 30-day deadline, the request is considered denied by the department; the denial is the department's final administrative action on a reconsideration request under this paragraph;

(11) a hospital aggrieved by the department's decision under (8) of this subsection, regarding the amount of a qualifying hospital's proportionate share payment under this subsection, may request reconsideration of the decision by filing a request with the department, and sending a copy of the request to each of the other qualifying hospitals, no more than 10 days after the date of the department's list under (8) of this subsection; if the department has made the private hospital proportionate share payment under this subsection to the qualifying hospital, the department will accept and consider a request for reconsideration under this paragraph only after return of any unearned portion of the payment is made; a request for reconsideration under this paragraph must state the facts in the record that support a change in the payment amount; a qualifying hospital to which a request for reconsideration was sent may file with the department, no more than 10 days after the date the request was sent, a response to the request for reconsideration; the response must be based on facts in the record; the department's decision on reconsideration under this paragraph is the department's final administrative action on a reconsideration request under this paragraph; if the department does not issue a decision on reconsideration 30 days or less after the deadline for filing a response to the request for reconsideration, and does not waive the 30-day deadline, the request is considered denied by the department; the denial is the department's final administrative action on a reconsideration request under this paragraph;

(12) the administrative appeal process provided by 7 AAC 150.220 and the exceptional relief process set out in 7 AAC 150.240 are not available to a hospital disputing an item on the department's list under (8) of this subsection of qualifying hospitals and amounts;

(13) unless the department considers it impractical, the department will recalculate and reallocate the proportionate share eligibility and payments for all hospitals and will recoup payments from all hospitals on a prorated basis if the

(1) "encounter" means a unit of service, visit, or face-to-face contact that is a covered service under an agreement with the department as required under this section;

(2) "payment year" means the state fiscal year;

(3) "qualification date" means July 1 of each year;

(4) "qualifying hospital" means a hospital that qualifies under (a)(1) of this subsection for a private hospital proportionate share payment;

(5) "qualifying year" means the hospital's most recent fiscal year that the department determines complete.