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REGISTER

South Dakota Legislative Research Council Volume 45 Monday, 8:00 a.m., March 25, 2019

FILINGS IN THE LEGISLATIVE RESEARCH COUNCIL'S OFFICE: Notice of Proposed Rules: (The date in parentheses is the date the rules were filed with the Legislative Research Council.) Department of Agriculture: (March 21, 2019) intends to amend rules to increase the number of voting districts for members of the Soybean Research and Promotion Council from seven to nine and reorganize the counties into those nine new districts. The general authority for these rules, as cited by the department, is SDCL § 38-29-3. A public hearing will be held at the South Dakota Department of Agriculture Conference Room, 3rd Floor, Foss Building, 523 East Capitol Avenue, Pierre, South Dakota, on April 17, 2019, at 10:00 a.m. CT. Copies of the rules may be obtained without charge from and written comments sent to the South Dakota Department of Agriculture, 523 E. Capitol, Pierre, SD 57501. Material sent by mail or email must reach the department by April 29, 2019 to be considered. This hearing is being held in a physically accessible place. Persons who have special needs for which the department can make arrangements are asked to call (605) 773-5425.

Office of the Secretary of State: Board of Finance: (March 22, 2019) intends to amend rules to increase in-state lodging rates for state employees to $75 plus tax per night and increase per diem rates for state employees to a maximum of $40 per day for in-state and $56 per day for out-of-state travel claims. The general authority for these rules, as cited by the board, is SDCL § 3-9-2. A public hearing will be held in the Governor's Small Conference Room, 2nd floor, State Capitol, Pierre, South Dakota, on April 16, 2019, at 2:00 p.m. CT. Copies of the proposed rules may be obtained without charge from and written comments sent to the Secretary of State, Room 204, State Capitol, 500 E. Capitol, Pierre, SD 57501. Material sent by mail must be received by April 16, 2019, to be considered. This hearing is being held in a physically accessible place. Persons who have special needs for which the board can make arrangements are asked to call (605) 773-3537 at least 48 hours before the hearing. NOTICE: The Department of Social Services intends to make changes to the South Dakota Medicaid State Plan to implement inflationary rate increases appropriated by the state legislature during the 2019 legislative session. The updated fee schedules will be posted on the department's website on or around April 1, 2019 at: http://dss.sd.gov/medicaid/providers/feeschedules/. South Dakota Medicaid providers should

GET COPIES OF PROPOSED RULES AND OTHER INFORMATION AT NO CHARGE

at https://rules.sd.gov or by contacting the agency directly via the means outlined in

their notice of hearing.

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continue to submit claims and bill South Dakota Medicaid as they did prior to April 1, 2019. Fee schedules are the maximum allowable reimbursement amount; per ARSD 67:16:01:09 payment for services is limited to the provider's usual and customary charge. The proposed amendment revises Attachment 4.19-A, page 1, page 2, and page 5 and Attachment 4.19-B, Introduction page 1 and page 1a. The Department intends to make this SPA effective April 1, 2019. The following services are receiving a 1.5 percent inflationary increase:

• Instate DRG Inpatient Hospital Services

• Instate DRG Exempt Inpatient Hospital Units

• Instate APC Outpatient Hospital Services

• Physician Services including Health Homes Per Member Per Month

• Dental Services including Orthodontic Services and Dentures

• Optometric Services • Chiropractic Services • Nutritionists and Dietician Services • Durable Medical Equipment (Not

including items subject to Section 1903(i)(27)) of the Social Security Act)

• Clinic Services • Physical Therapy • Occupational Therapy • Speech, Hearing, or Language,

Disorder Services • Prosthetic Devices • Eyeglasses • Diabetes Self-Management Training • Nurse Midwife Services • Community Transportation • Secure Medical Transportation • Air and Ground Ambulance except for

the following codes which are receiving a targeted increase of

4 percent: o A0429 o A0430 o A0431

• Home Health Agencies except for the following codes which are receiving a targeted increase of 4 percent:

o S9123 o S9122 o S9124

• Independent Mental Health Practitioners Services except for the following codes which are receiving a targeted increase of 4 percent:

o 90791 o 90832 o 90837

• Nutrition Items The following services are receiving a 4.0 percent inflationary increase:

• Community Mental Health Centers • Substance Use Disorder Agencies • Personal Care Services • Child Private Duty Nursing

The estimated expenditures listed below solely due to rate increases. No rates are being decreased. The department estimates the total annual aggregate increase in expenditures will be the following:

• Hospital Services - $3,584,200 • Physician Services including Health

Home Per Member Per Month - $1,079,490

• Dental Services including Orthodontic Services and Dentures - $339,596

• Optometric - $28,778 • Chiropractic Services - $10,357 • Air and Ground Ambulance

Transportation - $186,805 • Community Mental Health Centers and

Substance Use Disorder Agencies - $2,529,251

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• Home Health Services, Child Private Duty Nursing, Personal Care Services - $242,077

• Other Medical Services - $336,494

The Other Medical Services category includes the following services:

• Independent Mental Health Practitioners Services

• Nutritionists and Dietician Services • Durable Medical Equipment • Clinic Services • Physical Therapy • Occupational Therapy • Speech, Hearing, or Language,

Disorder Services • Prosthetic Devices • Eyeglasses • Diabetes Self-Management Training • Nurse Midwife Services • Community Transportation • Secure Medical Transportation • Nutrition Items

The SPA also contains language to allow the state to include hospital specific

data relative to at risk populations in capital costs. The SPA is available to view on the department’s website at http://dss.sd.gov/medicaid/medicaidstateplan.aspx. Copies of the proposed SPA pages are also available at the Department of Social Services, Division of Medical Services. Written requests for a copy of these changes, and corresponding comments, may be sent to Division of Medical Services, Department of Social Services, 700 Governors Drive, Pierre, SD 57501. FILINGS IN THE SECRETARY OF STATE'S OFFICE: (None) NOTE REGARDING ADOPTED RULES: The following agencies have permission from the Interim Rules Review Committee to charge for adopted rules: the Division of Insurance, the Cosmetology Commission, the State Board of Examiners in Optometry, the State Plumbing Commission, the Board of Nursing, the Department of Social Services, the State Electrical Commission, the South Dakota Board of Pharmacy, the Real Estate Commission, the Gaming Commission, the Department of Revenue, and the Department of Labor and Regulation for Article 47:03.

REMINDER OF HEARINGS SCHEDULED

4-4-2019 South Dakota Retirement System: Amend rules to update statutory citations of

authority and internal cross references to correspond with the changes resulting from passage of House Bill 1010 of the 2019 Legislative Session, and to clarify language and repeal obsolete provisions; 45 SDR 115, March 11, 2019.

4-4-2019 Department of Game, Fish and Parks: Amend or establish rules to alter the boundary of an existing unit as described in rule; close the antlerless elk units listed in ARSD 41:06:47:01; allow for an individual who submits a habitat solution with such solution being deemed worthy by the Secretary to receive either authorization to access the state park system or hunt small game without a fee for one calendar year; establish a resident special any whitetail deer license and set a fee; establish a nonresident special any whitetail deer license and set a fee; set application fees and create one Custer State Park any bison license and three super license packages that include tags for one any elk, one any deer, and one any antelope; extend the date from May 1 to August 31 that traps, snares, and associated equipment may be used on public lands and improved road rights-of-ways; require that traps, snares, and associated equipment be actively operated and checked in accordance with trap-check rules; outline the guidelines of the Nest Predator Bounty Program; simplify

March 25, 2019

RE: South Dakota Medicaid State Plan Amendment #SD-19-006 The South Dakota Department of Social Services intends to make changes to the South Dakota Medicaid State Plan to implement inflationary rate increases appropriated by the state legislature during the 2019 legislative session. The updated fee schedules will be posted on the department’s website on or around April 1, 2019: http://dss.sd.gov/medicaid/providers/feeschedules/dss/. South Dakota Medicaid providers should continue to submit claims and bill South Dakota Medicaid as they did prior to April 1, 2019. Fee schedules are the maximum allowable reimbursement amount; per ARSD 67:16:01:09 payment for services is limited to the provider’s usual and customary charge. The proposed amendment revises Attachment 4.19-A, page 1, page 2, and page 5 and Attachment 4.19-B, Introduction page 1 and page 1a. The Department intends to make this SPA effective April 1, 2019. The following services are receiving a 1.5 percent inflationary increase:

• Instate DRG Inpatient Hospital Services • Instate DRG Exempt Inpatient Hospital Units • Instate APC Outpatient Hospital Services • Physician Services including Health Homes Per Member Per Month • Dental Services including Orthodontic Services and Dentures • Optometric Services • Chiropractic Services • Nutritionists and Dietician Services • Durable Medical Equipment (Not including items subject to Section 1903(i)(27)) of the

Social Security Act) • Clinic Services • Physical Therapy • Occupational Therapy • Speech, Hearing, or Language, Disorder Services • Prosthetic Devices • Eyeglasses • Diabetes Self-Management Training • Nurse Midwife Services • Community Transportation • Secure Medical Transportation

DEPARTMENT OF SOCIAL SERVICES DIVISION OF MEDICAL SERVICES

700 GOVERNORS DRIVE

PIERRE, SD 57501-2291

PHONE: 605-773-3495

FAX: 605-773-5246

WEB: dss.sd.gov

• Air and Ground Ambulance except for the following codes which are receiving a targeted increase of 4 percent:

o A0429 o A0430 o A0431

• Home Health Agencies except for the following codes which are receiving a targeted increase of 4 percent:

o S9123 o S9122 o S9124

• Independent Mental Health Practitioners Services except for the following codes which are receiving a targeted increase of 4 percent:

o 90791 o 90832 o 90837

• Nutrition Items The following services are receiving a 4.0 percent inflationary increase:

• Community Mental Health Centers • Substance Use Disorder Agencies • Personal Care Services • Child Private Duty Nursing

The estimated expenditures listed below solely due to rate increases. No rates are being decreased. The department estimates the total annual aggregate increase in expenditures will be the following:

• Hospital Services - $3,584,200 • Physician Services including Health Homes Per Member Per Month • - $1,079,490 • Dental Services including Orthodontic Services and Dentures - $339,596 • Optometric - $28,778 • Chiropractic Services - $10,357 • Air and Ground Ambulance Transportation - $186,805 • Community Mental Health Centers and Substance Use Disorder Agencies - $2,529,251 • Home Health Services, Child Private Duty Nursing, Personal Care Services - $242,077 • Other Medical Services - $336,494

The Other Medical Services category includes the following services:

• Independent Mental Health Practitioners Services • Nutritionists and Dietician Services • Durable Medical Equipment • Clinic Services • Physical Therapy • Occupational Therapy • Speech, Hearing, or Language, Disorder Services • Prosthetic Devices • Eyeglasses

• Diabetes Self-Management Training • Nurse Midwife Services • Community Transportation • Secure Medical Transportation • Nutrition Items

The SPA also contains language to allow the state to include hospital specific data relative to at risk populations in capital costs. The SPA is available to view on the department’s website at http://dss.sd.gov/medicaid/medicaidstateplan.aspx. Please contact me within 30 days of receipt of this message with any questions or comments. Sincerely, Sarah Aker Deputy Director Division of Medical Services South Dakota Department of Social Services CC: M. Greg DeSautel, MD, Cabinet Secretary Brenda Tidball-Zeltinger, Deputy Secretary William Snyder, Director

Medicaid State Plan Amendment Proposal Transmittal Number: SD-19-006 Effective Date: 4/1/2019 Brief Description: This State Plan Amendment implements inflationary rate increases appropriated by the state legislature during the 2019 legislative session. Area of State Plan Affected: Attachment 4.19-A and Attachment 4.19-B Page(s) of State Plan Affected: Attachment 4.19-A, page 1, page 2, and page 5 and Attachment 4.19-B, Introduction page 1 and page 1a. Estimate of Fiscal Impact, if Any: The department estimates the total annual aggregate increase will be the following:

• Hospital Services - $3,584,200 • Physician Services including Health Homes Per Member Per Month • - $1,079,490 • Dental Services including Orthodontic Services and Dentures - $339,596 • Optometric - $28,778 • Chiropractic Services - $10,357 • Air and Ground Ambulance Transportation - $186,805 • Community Mental Health Centers and Substance Use Disorder Agencies

- $2,529,251 • Home Health Services, Child Private Duty Nursing, Personal Care

Services - $242,077 • Other Medical Services - $336,494

Reason for Amendment: Implement inflationary increases appropriated by the state legislature and allow the state to include hospital specific data relative to at risk populations in capital costs.

INPATIENT HOSPITAL PAYMENT METHODOLOGY

Attachment 4.19-A Page 1

GENERAL

The South Dakota Medicaid program has reimbursed hospitals for inpatient services under a prospective Diagnosis Related Groups (DRGs) methodology, with a few exceptions, since January 1, 1985. The State uses the federal definitions of DRGs, classifications, weights, geometric mean lengths of stay, and outlier cutoffs. The DRG Grouper program has been updated annually as of October 1 of each year beginning with the Medicare grouper version 15 (effective October 1, 1997). The agency provides a link to Medicare’s DRGs on its website at http://dss.sd.gov/sdmedx/includes/providers/feeschedules/dss/index.aspx. The agency calculates Medicaid-specific weight and geometric mean length of stay factors annually using the latest three years of non-outlier claim data, this three-year claims database updated annually to establish new weight and geometric length of stay factors with each new grouper.

The agency developed hospital-specific costs per Medicaid discharge amounts for all instate

hospitals using Medicare cost reports and non-outlier claims data for the hospitals’ fiscal years ending after June 30, 1996 and before July 1, 1997. The agency applied an inflation factor, specific to each hospital’s fiscal year end, to the cost per discharge amounts of all hospitals with more than thirty (30) Medicaid discharges during the base year to establish target amounts for the most recently completed federal fiscal year. There is a cap on the hospitals’ target amounts, under which no hospital is allowed a target amount that exceeds 110% of the statewide weighted average of all target amounts.

South Dakota Medicaid reimburses out-of-state hospitals on the same basis as the Medicaid

agencies in the states where the hospitals are located. If the hospital's home state refuses to provide the amount they would pay for a given claim, the payment will be at 44.15% of billed charges. Payment is for individual discharge or transfer claims only. Out of state specialty hospitals are reimbursed at 44.15% of billed charges unless otherwise approved by the state. There is no annual cost settlement with out-of-state hospitals or instate DRG hospitals unless an amount is due the South Dakota Medicaid program.

For claims with dates of service beginning April 1, 2019, the reimbursement for instate DRG

hospitals and all out-of-state hospitals not paid the above-stated percentage of charges is increased by 1.5 percent over what the calculated amounts were for State fiscal year 2018 after any cost sharing amount due from the patient and any third party liability amounts have been deducted, and after computation of any cost outlier payment. The agency will increase reimbursements to South Dakota hospitals classified as Medicare Critical Access or Medicaid Access Critical by 1.5 percent for claims with dates of service on and after April 1, 2019.

SPECIFIC DESCRIPTION

Each year the agency calculates a hospital’s target amounts for non-outlier claims by dividing the hospital's average cost per discharge for non-outlier claims by the hospital's case mix index. To ensure budget neutrality, the agency adjusts annually a hospital’s target amount for any change in that hospital’s case mix index resulting from the establishment of new program specific weight factors. For each hospital, the case mix index is the calculated result of accumulating the weight factors for all claims submitted during the base period and dividing by the number of claims.

TN # 19-006 Supersedes Approval Date Effective Date 04/01/19 TN # 18-003

Attachment 4.19-A Page 2

The agency calculates the average cost per discharge for non-outlier claims by subtracting the charges for ancillary services on outlier claims, multiplied by the average ancillary cost to charge ratio, from the total allowable ancillary charges for the hospital. Total Medicaid days and discharges are reduced by the number of days and discharges from outlier claims to calculate the routine costs for non-outlier claims. Routine costs and ancillary costs related to non-outlier claims are added and then the total allowable costs were divided by the number of non-outlier discharges during the base period. The agency publishes the annually updated cost outlier figure and a link to Medicare’s DRGs on its website at http://dss.sd.gov/sdmedx/includes/providers/feeschedules/dss/index.aspx

CAPITAL COSTS

South Dakota Medicaid makes interim payments for capital and education costs to instate hospitals that had more than thirty (30) Medicaid discharges during the hospitals’ fiscal year ending after June 30, 1996 and before July 1, 1997 on a per diem basis. The agency calculates hospital-specific interim rates using the most recently-reviewed Medicare cost report and may include hospital specific data relative to at risk populations for each hospital, with reimbursements increased 2.7% for the year beginning July 1, 2016.

TRANSFER PATIENTS

Payment is allowed to the transferring hospital whenever a patient is transferred to another hospital regardless of whether the receiving hospital is paid under the DRG system or is an exempt hospital or unit.

The amount of payment made to the transferring hospital is on a per diem basis

calculated by dividing the standard DRG payment for the particular stay by the geometric mean length of stay for the DRG. The per diem rate is then multiplied by the number of days stay prior to the transfer. In no instance will the payment to the transferring hospital be any higher than the full DRG payment amount if the patient had been discharged home. The daily capital/education pass-through will be added to the DRG payment.

The receiving hospital will be paid a normal DRG payment unless the patient is again

transferred to another hospital.

COVERED DIAGNOSTIC RELATED GROUPS

South Dakota has adopted all DRGs, except DRG 522, established in the version of the grouper program being used by the Department as of the admission date on the claim.

TN # 19-006 Supersedes Approval Date________ Effective Date 04/01/19 TN # 16-003

Attachment 4.19-A Page 5

5. Rehabilitation Units (only upon request and justification);6. Children’s Care Hospitals;7. Indian Health Service Hospitals;8. Hospitals with less than 30 Medicaid discharges during the hospital’s fiscal year ending after June 30, 1993, and

before July 1, 1994; and9. Specialized Surgical Hospitals.

Payment for rehabilitation hospitals and units, perinatal units, and children’s care hospitals will continue on theMedicare retrospective cost base system with the following exceptions:

1. Costs associated with certified registered nurse anesthetist services that relate to exempt hospitals and unitswill be included as allowable costs.

2. Malpractice insurance premiums attributable to exempt units or hospitals will be allowed using 7.5% of the riskportion of the premium multiplied by the ratio of inpatient charges to total Medicaid inpatient charges for thesehospitals or units.

The agency provides a link to Medicare’s DRGs on its website at http://dss.sd.gov/sdmedx/includes/providers/feeschedules/dss/index.aspx

Payment for psychiatric hospitals, psychiatric units, rehabilitation hospitals, rehabilitation units, perinatal units, and children’s care hospitals is on a per diem basis based on the facility’s reported, allowable costs, as established by the State. This per diem amount is updated annually as directed by the Legislature based on review of economic indices and input from interested parties not to exceed the rate as established by the medical care component of the Consumer Price Index of the most recent calendar year. The per diem for state operated psychiatric hospitals is updated annually based on facility’s reported allowable costs, as established by the state.

Specialized surgical hospitals payments for payable procedures will be based upon group assignments. Payment rates are effective April 1, 2019 and will be listed on the agency’s website http://dss.sd.gov/sdmedx/includes/providers/feeschedules/dss/index.aspx. The fee schedule is subject to annual/periodic adjustment. Payable procedures include: nursing, technician, and related services; patient’s use of facilities; drugs, biologicals, surgical dressings, supplies, splints, casts, and appliances and equipment directly related to the surgical procedures; diagnostic or therapeutic services or items directly related to the surgical procedures; administrative and recordkeeping services; housekeeping items and supplies; and materials for anesthesia. Items not reimbursable include those payable under other provisions of State Plan, such as physician services, laboratory services, X-ray and diagnostic procedures, prosthetic devices, ambulance services, orthotic devices, and durable medical equipment for use in the patient’s home, except for those payable as directly related to the surgical procedures.

Indian Health Service hospitals are paid on a per diem basis as established by CMS.

Instate hospitals with less than 30 discharges during the hospital’s fiscal year ending after June 30, 1993, and before July 1, 1994, are paid 95% of billed charges.

For claims with dates of service on and after April 1, 2019, the amount of reimbursement for psychiatric hospitals, rehabilitation hospitals, perinatal units, psychiatric units, rehabilitation units, children’s care hospitals, and specialized surgical hospitals will be increased 1.5% over the April 1, 2018 calculations after any cost sharing amounts due from the patient, any third-party liability amounts have been deducted and other computation of any cost outlier payment.

EXCEPTION TO PAYMENT METHODOLOGIES FOR ACCESS-CRITICAL AND AT-RISK HOSPITALS

South Dakota Medicaid will reimburse hospitals classified as Medicare Critical Access or Medicaid Access Critical at the greater of actual allowable cost or the payment received under the provisions contained in this Attachment.

TN # 19-06 Supersedes Approval Date ________ Effective Date 04/01/19 TN # 19-04

ATTACHMENT 4.19-B

INTRODUCTION

Introduction Page 1

Payment rates for the services listed below are effective for services provided on or after the corresponding date. Fee schedules are published on the Department’s website at

http://dss.sd.gov/medicaid/providers/feeschedules/. Effective dates listed on the introductory page supersede the effective dates listed elsewhere in Attachment 4.19-B. Unless otherwise noted in the referenced state plan pages, reimbursement rates are the same for both governmental and private providers.

Service Attachment Effective Date

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Attachment 4.19-B, Page 4 April 1, 2019

Physician Services Attachment 4.19-B, Page 6 April 1, 2019 Optometrist Services Attachment 4.19-B, Page 9 April 1, 2019 Chiropractic Services Attachment 4.19-B, Page 10 April 1, 2019 Independent Mental Health Practitioners

Attachment 4.19-B, Page 11 April 1, 2019

Nutritionist and Dietician Services

Attachment 4.19-B, Page 11 April 1, 2019

Home Health Services Attachment 4.19-B, Page 12 April 1, 2019 Durable Medical Equipment Attachment 4.19-B, Page 13 April 1, 2019 Clinic Services Attachment 4.19-B, Page 15 April 1, 2019 Dental Services Attachment 4.19-B, Page 16 April 1, 2019 Physical Therapy Attachment 4.19-B, Page 17 April 1, 2019 Occupational Therapy Attachment 4.19-B, Page 18 April 1, 2019 Speech, Hearing, or Language Disorder Services

Attachment 4.19-B, Page 19 April 1, 2019

Dentures Attachment 4.19-B, Page 21 April 1, 2019 Prosthetic Devices Attachment 4.19-B, Page 22 April 1, 2019 Eyeglasses Attachment 4.19-B, Page 23 April 1, 2019 Diabetes Self-Management Training

Attachment 4.19-B, Page 26 April 1, 2019

Community Health Workers Attachment 4.19-B, Page 26 April 1, 2019

Community Mental Health Centers

Attachment 4.19-B, Page 26 April 1, 2019

Substance Use Disorder Agencies

Attachment 4.19-B, Page 26 April 1, 2019

Nurse Midwife Services Attachment 4.19-B, Page 31 April 1, 2019 Transportation Attachment 4.19-B, Page 38 April 1, 2019 Personal Care Services Attachment 4.19-B, Page 38 April 1, 2019 Freestanding Birth Centers Attachment 4.19-B, Page 39 April 1, 2019 Professional Services Provided in a Freestanding Birth Center

Attachment 4.19-B, Page 39 April 1, 2019

TN# 19-06 SUPERCEDES Approval Date ________ Effective Date 04/01/19 TN# 19-05

Page 1a ATTACHMENT 4.19-B

PAYMENTS FOR MEDICAL AND REMEDIAL CARE AND SERVICES

South Dakota Medicaid will make payments to medical providers who sign agreements with the State under which the provider agrees: (a) to accept as payment in full the amounts paid in accordance with the payment structures of the State; (b) to keep such records as are necessary to fully disclose the extent of the services provided to individuals receiving assistance under the State Plan; and (c) to furnish the State Agency with such information, regarding any payments claimed by such person or institution for services provided under the State Plan, as the agency may request from time to time.

The following describes policy and methods the agency uses to establish payment rates for each type of care and service, other than inpatient hospital or nursing home services, included in the State Plan. In no instance will the amount of payment under the provisions of this attachment exceed the payment made by the general public for identical services.

1. Inpatient Hospital Services (See Attachment 4.19-A)

2a. Outpatient Hospital Services

Effective August 2, 2016, Medicare Prospective Payment System hospitals will be paid using the Medicaid Agency’s Outpatient Prospective Payments System (OPPS). Under OPPS, services are reimbursed using Ambulatory Payment Classifications. Effective August 2, 2016, the Department will establish a conversion factor and discount factor specific to each hospital. The hospital specific conversion factor and discount factors are published on the State agency’s website at http://dss.sd.gov/medicaid/providers/feeschedules/dss/. Effective April 1, 2019, Medicare Prospective Payment System hospitals paid using the Medicaid Agency’s OPPS will be increased by 1.5 percent.

South Dakota Medicaid will pay remaining participating outpatient hospitals with more than 30 Medicaid inpatient discharges during the hospital’s fiscal year ending after June 30, 1993 and before July 1, 1994 on the basis of Medicare principles of reasonable reimbursement with the following exceptions:

1. Costs associated with certified registered nurse anesthetist services are allowable costs. These costs are identified on the CMS 2552-10 on Worksheet A-8 and included in the facilities’ costs.

2. All capital and education costs incurred for outpatient services are allowable costs. These costs are

identified on the CMS 2552-10 on Worksheet D Part III and included in the facilities’ costs.

3. Payments to Indian Health Service outpatient hospitals will be per visit and based upon the approved rates published each year in the Federal Register by the Department of Health and Human Services, Indian Health Service, under the authority of sections 321(a) and 322(b) of the Public Health Service Act (42 U.S.C. 248 and 249(b)), Public Law 83-568 (42 U.S.C. 2001(a)), and the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.). The State agency will make payments for visits of the same type of service on the same day at the same provider location only if the services provided are different or if they have different diagnosis codes.

TN # 19-006 SUPERSEDES Approval Date________ Effective Date 4/1/19 TN # 18-003