Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 150 - Prospective Payment System; Other Payment
7 AAC 150.240 - Exceptional relief to prospective payment rate setting

(a) If application of the methodology in 7 AAC 145.700 or in 7 AAC 150.040 - 7 AAC 150.190 and 7 AAC 150.250 results in a permanent prospective payment rate that does not allow reasonable access to quality patient care provided by an efficiently and economically managed facility, the facility may apply to the deputy commissioner for exceptional relief from the rate-setting methodology.

(b) To apply for exceptional relief under (a) of this section, at a minimum the facility's application must include

(c) The facility shall provide other information requested by the deputy commissioner to evaluate the request for exceptional relief. If a facility fails to supply the requested information within a reasonable period, the deputy commissioner may deny the request for exceptional relief.

(d) The deputy commissioner may use any information available in department records to evaluate the request. The deputy commissioner shall provide copies of the additional material to the facility upon request of the facility.

(e) The deputy commissioner may increase the prospective payment rate, by all or part of the facility's request, if the deputy commissioner finds by clear and convincing evidence that the rate established under the methodology in 7 AAC 145.700 or 7 AAC 150.040 - 7 AAC 150.190 does not allow for reasonable access to quality patient care provided by an efficiently and economically managed facility, and that the granting of an exception is in the public interest. In determining whether the exception is in the public interest, the deputy commissioner may consider at least

(f) The deputy commissioner may impose conditions on the receipt of exceptional relief. Those conditions may include one or more of the following:

(g) If the deputy commissioner grants exceptional relief under this section, any amount granted may not be included as part of the base on which future prospective payment rates are determined.

(h) Exceptional relief granted under this section is effective prospectively from the date of the exceptional relief decision, and for a period not to extend beyond the end of the facility's rate-setting year. A facility may apply for exceptional relief in the following year by submitting a new application under (a) of this section.

(i) Notwithstanding 7 AAC 150.220, a party aggrieved by a decision of the deputy commissioner concerning exceptional relief may, not later than 30 days after the date of mailing of the decision to that party or the date of providing that party the decision by electronic mail, request an administrative hearing to the commissioner of the department. The commissioner will consider the request for appeal as untimely filed if the commissioner has not received the request 30 days or less after the deputy commissioner's mailing of the notice of the decision to the party or providing the notice of decision to the party by electronic mail. The exceptional relief granted by the deputy commissioner will be effective subject to adjustment based on the decision reached by the commissioner on the appeal. A copy of the commissioner's decision on appeal will be provided to the facility, to the deputy commissioner, and to the department staff that oversees Medicaid payment rates.

(j) The deputy commissioner shall send copies of the decision of the deputy commissioner concerning exceptional relief to the facility, to the director of the division of the department responsible for paying Medicaid program claims, and to the department staff that oversees Medicaid payment rates. The exceptional relief decision shall be accompanied by a certificate showing the date the decision was mailed or electronically delivered to the persons listed in this subsection.