Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 3 - Payment Rates; Professional Services › 7 AAC 145.265 - Targeted case management payment rates

Current through May 31, 2024
(a) Before billing
				  the department for targeted case management services, a provider of those
				  services shall bill the recipient's alternate resources under
				  7 AAC 160.200. After it receives notification from each
				  third party of the amount, if any, that the third party will pay, the provider
				  of targeted case management services may seek payment from Medicaid for the
				  remaining cost of service.
(b) The
				  department will base payment for targeted case management services on a
				  prospective monthly encounter rate, computed with data from base year 2004, as
				  follows:
(1) using the base year's reported
				  units of contact for the specified service categories identified by the
				  department, the department will determine the average annual proportion of time
				  participating grantees spent providing case management services;
(2) the department will compute the annual
				  portion of case manager salaries and benefits attributed to case management,
				  using the base year's reported expenditures for each individual providing case
				  management services, and then, using the proportion determined in (1) of this
				  subsection, the department will compute the average portion of salaries and
				  benefits attributed to case management versus other activities;
(3) to the number reached in (2) of this
				  subsection, the department will add the portion of other operating costs,
				  including travel, supplies, telephone, and occupancy costs, attributed to case
				  management;
(4) to the number
				  reached in (3) of this subsection, the department will add direct supervisory
				  costs, computed by using the base year's reported expenditures for each
				  individual who provides direct supervision to case managers, and then, using
				  the proportion determined in (1) of this subsection, computing the portion of
				  salaries and benefits attributed to direct supervision of case managers versus
				  other activities;
(5) to the number
				  reached in (4) of this subsection, the department will add the average indirect
				  administrative costs of provider organizations, computed by using the base
				  year's reported expenditures for indirect administrative costs, and then, using
				  the proportion determined in (1) of this subsection, computing the portion of
				  indirect administrative costs attributed to case management versus other
				  activities;
(6) the department will
				  divide the sum of the results reached in (2) - (5) of this subsection by the
				  total number of statewide case managers to obtain the total annual cost per
				  case manager; the department will determine the total number of statewide case
				  managers by calculating the portion of direct service provider full-time
				  equivalents dedicated to case management, using the base year's actual reported
				  full-time equivalents and the proportion determined in (1) of this
				  subsection;
(7) the department will
				  divide the total annual cost per case manager, as computed in (6) of this
				  subsection, by 12 to obtain the monthly statewide average cost per case
				  manager;
(8) using the base year's
				  average actual number of children served per case manager, the department will
				  divide the monthly statewide average cost per case manager by the statewide
				  average number of children served by each case manager per month;
(9) the calculated rate from base-year data
				  will be annually updated by 2.7 percent for inflation on July 1 of each
				  year;
(10) for state fiscal year
				  2020, the department will not apply the inflation adjustment described in (9)
				  of this subsection.