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(a) Prospective payment rates are units of payment to be paid by the department for services rendered by facilities for recipients of Medicaid. Charges to the department may not exceed charges to the general public.
(b) Prospective payment rates for inpatient services rendered in acute care, specialty, and psychiatric hospitals will be per-day rates. Prospective payment rates for outpatient hospital services will be a percentage of charges not including outpatient clinical laboratory services. Prospective payment rates for outpatient clinical laboratory services will be per-procedure rates.
(c) Prospective payment rates for long-term care facilities will be per-day rates.
(d) Prospective payment rates will have an effective date. Services provided will be paid by the department 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 the department with separate bills for each prospective payment rate period.
(e) Prospective payment rates will be a per-visit rate for rural health clinics and federally qualified health centers.
(f) Prospective payment rates will be a per-procedure rate for outpatient surgical clinics.
History: Eff. 8/9/86, Register 99; am 5/8/88, Register 106; am 6/19/88, Register 106; readopt 8/7/96, Register 139; am 12/27/96, Register 140; am 12/30/2000, Register 156; am 7/11/2002, Register 163; am 1/1/2004, Register 168
Authority: AS 47.05.010
Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.676 in its entirety, without change, under AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.
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Last modified 7/05/2006