Alabama Code 40-26B-79. Inpatient Medicaid base payments
Terms Used In Alabama Code 40-26B-79
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- state: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Alabama Code 1-1-1
- year: means a calendar year; but, whenever the word "year" is used in reference to any appropriations for the payment of money out of the treasury, it shall mean fiscal year. See Alabama Code 1-1-1
If the Medicaid Agency begins making payments pursuant to Article 9 of Chapter 6 of Title 22, on or before September 30, 2019, the agency shall pay hospitals as a base amount for state fiscal year 2019, for inpatient services an APR-DRG payment that is equal to the total modeled UPL submitted and approved by CMS during fiscal year 2019. If the agency begins making payments pursuant to Article 9 of Chapter 6 of Title 22, on a date other than the first day of fiscal year 2019, there shall be no retroactive adjustment to payments already made to hospitals in accordance with the approved state plan. If approved by CMS, the agency shall publish the APR-DRG rates for each hospital prior to September 30, 2018. If the agency does not begin making payments pursuant to Article 9 of Chapter 6 of Title 22, on or before September 30, 2025, the agency shall pay hospitals as a base amount for fiscal years 2023, 2024, and 2025, the greater of a hospital’s current per diem as published for fiscal year 2022 or sixty-eight percent of total inpatient payments made by the agency during state fiscal year 2019, divided by the total patient days paid in state fiscal year 2019, multiplied by patient days paid during fiscal years 2023, 2024, and 2025. A hospital may request to have their per diem reviewed and revised at the sole discretion of the Medicaid Agency. This payment to be paid using the agency’s published check write table is in addition to any hospital access payments the agency may elect to pay hospitals as inpatient payments other than per diems and access payments, if the agency does not make payments pursuant to Article 9 of Chapter 6 of Title 22 in fiscal year 2019, or fiscal years 2023, 2024, and 2025, only if the Hospital Services and Reimbursement Panel approves the change in hospital payments.