Tenn. Comp. R. & Regs. 1200-13-09-.11 - RATE OR PAYMENT ADJUSTMENTS

(1) Prospective per diem rate or lump sum payment amounts are subject to adjustment in the event of a mistake.

(2) Operating per diem rates may be adjusted if there is a significant change in case mix resulting in a $25,000 effect on Tennessee Medicaid reimbursement. Case mix, for this purpose, is a diagnostic or therapeutic related factor requiring either an increase or decrease in the professional staff per patient ratio. Requests for adjustments must be accompanied by detailed supporting information. Such rate adjustments if approved become effective on the first day of the month following the approval.

(3) Providers may request an increase in monthly interim payments for return on equity, capital, and direct medical education if a provider's actual amounts are expected to exceed the estimated amount by at least 25%. Supporting financial data must be submitted with the request. No more than one request per year for an increase will be accepted per provider. The Commissioner reserves the right, after notifying the provider, to decrease estimated payments when information is made available indicating the estimated payments are materially higher than what is actually being incurred.

Notes

Tenn. Comp. R. & Regs. 1200-13-09-.11

Original rule filed June 2, 1992; effective July 17,1988. Amendment renumbering 1200-13-.10 through 1200-13-.14 to read 1200-13-.11 through 1200-13-.15 filed January 29, 1990; effective March 15, 1990.

Authority: TC.A. §§ 71-5-105, 71-5-109 and 4--5-202.