7 AAC 145.680 - Free-standing birth center payment rates

(a) The department will pay a free-standing birth center, in accordance with 7 AAC 145.020, an all-inclusive flat rate that is adjusted annually to be effective July 1.

(b) The department will not set an all-inclusive flat rate that exceeds 75 percent of the weighted average of the Medicaid hospital inpatient rates paid to the general acute care hospitals in Anchorage, Fairbanks, Juneau, Palmer, and Soldotna, for one inpatient hospital day. For state fiscal year 2020, the payment rate will be 95 percent of the payment rate that would have been calculated in this subsection.

(c) The department will calculate the weighted average described in (b) of this section using the Medicaid hospital inpatient rates for each facility under (b) of this section that are in effect at the start of the fourth quarter of the state fiscal year preceding the July 1 effective date. For state fiscal year 2021, the inpatient hospital payment rates used in the calculation will be what the rates would have been April 1, 2020, had the 5 percent rate reduction not been applied excluding the inflation that would have been granted in state fiscal year 2019. The department will base the weighted average on the number of paid Medicaid inpatient claims filed for a normal vaginal hospital delivery with a one-day length of stay

(1) designated by a primary diagnosis code of 080 as described in the International Classification of Diseases - 10th Revision, Clinical Modification (ICD-10-CM), adopted by reference in 7 AAC 160.900; and

(2) for each facility under (b) of this section during the most recent 12-month period that starts at the beginning of the state fiscal year's fourth quarter and for which timely filing has passed.

Notes

7 AAC 145.680

Eff. 5/1/2016, Register 218, July 2016; am 7/1/2019, Register 231, July 2019

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.070