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016.06.20-250.203. Cost Settlement.

AR ADC 016.06.20-250.203Arkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 20. Hospital/Critical Access Hospital (CAH)/End-Stage Renal Disease (ESRD) Provider Manual (Refs & Annos)
Section 250.000. Reimbursement.
Ark. Admin. Code 016.06.20-250.203
016.06.20-250.203. Cost Settlement.
Currentness
A. The Division of Medical Services or its designee audits each hospital's cost report.
1. Allowable costs are determined and validated in accordance with CMS Publication 15-1 (costs and allowable costs) and CMS Publication 15-2 (cost reports).
2. Accounting exceptions specific to Title XIX or to the Arkansas Medicaid Program are noted in this section (Reimbursement, section 250.000) of this provider manual.
B. With the exception of special payments and adjustments listed below in part C, Arkansas Medicaid limits total inpatient reimbursement to the lowest of three amounts. The amounts compared are as follows.
1. Allowable costs after application of the TEFRA rate of increase limit (the TEFRA rate of increase limit does not apply to Arkansas State Operated Teaching Hospitals for cost reporting periods ending on and after June 30, 2000)
2. The hospital's customary charges to the general public for the services
3. An upper limit per Medicaid day
C. Special adjustments or payments apply to some hospitals.
1. In-state hospitals and certain qualifying out-of-state hospitals receive “disproportionate share hospital” payments. See Sections 250.300 through 250.500 for details.
2. Arkansas State Operated Teaching Hospitals receive direct graduate medical education (GME) payments. See Section 250.621 for details.
3. Arkansas State Operated Teaching Hospitals receive an adjustment based on the Medicare daily upper limit. See Section 250.622 for details.
4. Arkansas private, acute care, critical access, psychiatric and rehabilitative hospitals receive an adjustment based on the Medicaid upper payment limit. See section 250.623 for details.
5. Arkansas non-state government-owned or operated acute care and critical access hospitals receive an adjustment based on the Medicare upper payment limit. See section 250.624 for details.

Credits

Eff. July 1, 2006.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.20-250.203, AR ADC 016.06.20-250.203
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