Section 86-4.38 - Computation of basic rates of payment for services provided to Medicaid patients by specialty clinics

86-4.38 Computation of basic rates of payment for services provided to Medicaid patients by specialty clinics.

(a) Notwithstanding other provisions of this Subpart or Subpart 86-1, rates of reimbursement for specialty services, including but not limited to hemo and peritonial dialysis and outpatient rehabilitative services, shall be calculated in the manner described in section 86-4.37(a) through (h). Rates of reimbursement for methadone maintenance treatment services shall be calculated in the manner described in section 86-4.39. Rates of reimbursement for day health care services provided to patients with acquired immune deficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) related illnesses by freestanding ambulatory care facilities shall be calculated in the manner described in section 86-4.41. Such payment levels will be made available to providers who document in writing and through site inspection or records review that they are, in fact, organized and providing specialty services.

(b) The criteria for recognition as a specialty service include but are not limited to: requirement for highly specialized staff, equipment or facilities; whether the facility presently provides the services to the population in need; whether the services may be provided safely and effectively on an outpatient basis; and whether the services are structured to address extensive and complex needs for patients with chronic or infectious medical conditions.

(c) In addition to complying with the requirements for recording and reporting financial and statistical data in sections 86-4.3, 86-4.4 and 86-4.5 of this Subpart, facilities shall complete surveys of patient characteristics, treatment patterns, health care organization factors, costs associated with patient care, and other factors as undertaken from time to time by the Commissioner.
 

Effective Date: 
Thursday, April 22, 1993
Doc Status: 
Complete