Title: Section 425.24 - Payment

425.24 Payment

(a) Payments to adult day health care programs by State government agencies.

(1) A program may only bill for one visit per registrant per day.

(2) The majority of registrants for whom the program receives a payment made by a government agency must be in attendance for at least five hours.

(b) Payments to adult day health care programs by managed care plans.

(1) Payments shall be made in accordance with the negotiated agreement between the adult day health care program and the managed care plan.

(2) The full range of adult day health care services shall be available to registrants with a medical need for such services. Based on a registrant’s individual medical needs, as determined in the comprehensive assessment, the managed care plan may order less than the full range of adult day health care services. Nothing shall prohibit adult day health care programs and managed care plans from agreeing to reimbursement terms that reflect a registrant’s receipt of less than the full range of adult day health care services.