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016.06.20-250.212. TEFRA Exceptions.

AR ADC 016.06.20-250.212Arkansas 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 016.06.20-250.212
016.06.20-250.212. TEFRA Exceptions.
Currentness
Waiver of the TEFRA limit and adjustment of the limit are permitted in particular circumstances.
A. A state may waive the TEFRA limit for a cost-reporting period in which extraordinary circumstances cause an unusual, temporary and substantial increase in costs.
1. If the hospital can demonstrate to the state that it incurred increased costs due to extraordinary circumstances over which it had no control, the state may waive the TEFRA limit for the cost-reporting period in which the extraordinary circumstance occurred.
2. The TEFRA rate that, absent the waiver, would have applied is applied after the next cost reporting period in addition to the TEFRA rate due to be applied at that time. Waiving the TEFRA limit for one cost reporting period only suspends the application of that period's inflation factor until the next year, at which time the inflation factors for both years are applied.
B. Changes in the hospital's case mix or adding or discontinuing services or units may result in a distortion of the rate of costs increase, possibly justifying an adjustment in the TEFRA limit.
1. The hospital must demonstrate that such an event has occurred and the extent to which costs have been affected.
2. If the state finds cause for action, it may adjust the TEFRA limit for the year in which the cost distortion occurred.
C. New pediatric hospitals may request an exemption from the TEFRA rate-of-increase limit. See Section 250.610, part C.2.
D. Effective for discharge dates on and after September 1, 2006, the TEFRA rate of increase limit is not applied to in-state pediatric hospitals for covered transplant procedures other than corneal, renal, pancreas/kidney and bone marrow transplants.

Credits

Eff. Oct. 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 016.06.20-250.212, AR ADC 016.06.20-250.212
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