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016.06.20-250.230. Daily Upper Limit

AR ADC 016.06.20-250.230Arkansas 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 016.06.20-250.230
016.06.20-250.230. Daily Upper Limit
Currentness
A daily upper limit to inpatient hospital reimbursement is established in the Title XIX State Plan.
A. A daily upper limit amount of $675.00 is effective for dates of service April 1, 1996 through June 30, 2006. The $675.00 daily upper limit for this period represents the 90th percentile of the cost-based per diems (per the cost settlements of their fiscal year-end 1994 cost reports) of all hospitals subject to the Arkansas Medicaid daily upper limit at the time of the computation.
B. For dates of service July 1, 2006 and after, DMS will review the hospital cost report data at least biennially and adjust the daily upper limit reimbursement amount if necessary.
C. A daily upper limit amount of $850.00 is effective for dates of service on and after January 1, 2007; effective October 1, 2014 inpatient days beyond 24 will be reimbursed at $400.00 per day. This is a prospective per diem rate and will not be included in the cost settlement.
D. The daily upper limit does not apply to the following.
1. Pediatric hospitals
2. Arkansas State Operated Teaching Hospitals, effective for cost reporting periods ending on or after June 30, 2000
3. Border City, University-affiliated, Pediatric Teaching hospitals
4. Inpatient services for children under the age of 1
5. Inpatient services for children, from their first birthday until their discharge date, who were admitted on or before their first birthday and were discharged after their first birthday
E. The daily upper limit is determined as follows.
1. The aggregate daily upper limit amount for a hospital is calculated by multiplying the hospital's cost-reporting period's covered days (excluding days subject to the $400 per diem prospective reimbursement amount) by the $850 upper cost per diem limit.
2. The aggregate daily upper limit amount is compared to the amount carried forward from the comparison of TEFRA-limited costs or charges.
3. The lesser of those two amounts becomes the new aggregate daily upper limit amount, subject to any additional payments or adjustments that may apply, such as direct graduate medical education (GME) costs or disproportionate share hospital (DSH) payments.
4. Effective for dates of service on or after July 1, 2006, Medicaid will review hospital cost report data at least biennially, in accordance with the methodology described above in subparts 1, 2, and 3 and adjust the daily upper limit amount if necessary.

Credits

Eff. July 1, 2007. Amended Dec. 26, 2015.
<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 016.06.20-250.230, AR ADC 016.06.20-250.230
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