7 AAC 150.040 - Prospective rates defined

(a) Prospective payment rates are units of payment the department will pay to enrolled facilities that render services to Medicaid recipients. A facility may not charge the department an amount that exceeds the charge to the general public for the same service.

(b) Prospective payment rates are per-day rates for

(1) inpatient services rendered in general acute care hospitals, except as provided in (c) of this section, specialty hospitals, and inpatient psychiatric hospitals; and

(2) long-term care facilities.

(c) Prospective payment rates are per-stay rates for inpatient services rendered in general acute care hospitals subject to 7 AAC 150.250.

(d) Prospective payment rates are a percentage of charges for outpatient hospital services, except for outpatient clinical laboratory services.

(e) Prospective payment rates are per-procedure rates for

(1) outpatient clinical laboratory services; and

(2) ambulatory surgical centers.

(f) Prospective payment rates are per-visit rates for

(3) rural health clinics; and

(4) federally qualified health centers.

(g) The department will establish effective dates for all prospective payment rates. The department will pay for services provided at the rate in effect at the time the service was provided. For services provided that are to be paid under different prospective payment rates, the facility must provide separate bills to the department for each prospective payment rate period. However, the department will pay at the rate in effect on the date of discharge for inpatient services rendered at general acute care hospitals subject to the Diagnosis Related Groups (DRG) payment system set out under 7 AAC 150.250.

Notes

7 AAC 150.040

Eff. 2/1/2010, Register 193; am 1/1/2024, Register 248, January 2024

Authority:AS 47.05.010

AS 47.07.070