Attachments to Section 4.19 - Payment for Services

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ATTACHMENTS AND SUPPLEMENTS

ATTACHMENT 4.19-A  METHODS & STANDARDS FOR ESTABLISHING PAYMENT RATES - INPATIENT HOSPITAL

• Definitions (pgs. 1-1.9) PDF
• Reimbursement Limits (pgs. 2-16) PDF
• Classification of Fixed and Variable Costs (pgs. 17-37) PDF
• Disproportionate Share Hospitals (pgs. 18-37B)  PDF
• Reimbursement for Short-Doyle/Medi-Cal Acute Inpatient Services (pgs. 38-51) PDF
• XXX (pgs 52-54)
Supplement  1 to Attachment 4.19-A  PDF

Supplement 2 to Attachment 4.19-A  PDF

Appendix 1 to Attachment 4.19-A  Government-Operated Hospitals Approved by CMS PDF

Appendix 2 to Attachment 4.19-A  Prior DSH Methodology in effect as of 2004-05 payment adjustment year PDF

Appendix 3 to Attachment 4.19-A Supplemental Reimbursement for Hospital Inpatient Services PDF

Appendix 4 to Attachment 4.19-A Supplemental Reimburement for Hospital Inpatient Services PDF

ATTACHMENT 4.19-B  METHODS & STANDARDS FOR ESTABLISHING PAYMENT RATES - OTHER TYPES OF CARE 
• Reimbursement Methodology (1-5) PDF
• Reimbursement Methodology for Case Management Services (5a-5k) PDF
• Payment Reimbursement - FQHC and RHC (6-6V) PDF
• Payment Rates (7-20a) PDF
• Reimbursement for Short-Doyle/Medi-Cal Outpatient, Rehabilitative, Case Management and Other Services/SMA Methodology (21-37) PDF
• Reimbursement for Drug Medi-Cal Services (38-42) PDF
• Sign Language Interpreter Services/Supplemental Reimbursement for Public Outpatient Hospital Services (43-51c) PDF
• Reimbursement to Specified Government-Operated Providers for Costs of Professional Services (52-64) PDF
• XXX (pgs. 65-79)
SUPPLEMENTS TO ATTACHMENT 4.19-B 

• Supplement 1  Payment of Medicare Part A, B and C Deductible/Coinsurance PDF
• Supplement 2  Payment Methodology for Prescription Drugs PDF
• Supplement 3  Federal Financial Participation Under New Federal Drug Rebate Program PDF
• Supplement 4  Policy and Methods for Establishing Payment Rates PDF
• Supplement 5  Cost-Based Reimbursement PDF
• Supplement 6  Reimbursement for Indian Health Services and Tribal 638 Health Facilities PDF
• Supplement 7  Provider Based Rural Health Clinics PDF
• Supplement 8  Payment for Local Education Agency (LEA) Services PDF
• Supplement 9  Reimbursement to State-Owned Health Care Clinics For Medi-Cal Beneficiaries PDF
• Supplement 10
• Supplement 11
• Supplement 12 Supplement Reimbursement for Hospital Outpatient Services PDF
• Supplement 13 Supplemental Reimbursement for Hospital Outpatient Services PDF
• Supplement 14
• Supplement 15 Outpatient Providers (Subject to Provider Payment Reductions) PDF
• Supplement 16
• Supplement 17

ATTACHMENT 4.19-C  PAYMENTS FOR RESERVED BEDS PDF

ATTACHMENT 4.19-D  METHODS & STANDARDS FOR ESTABLISHING PAYMENT RATES - SKILLED NURSING & INTERMEDIATE CARE FACILITY SERVICES  PDF

SUPPLEMENTS TO ATTACHMENT 4.19-D

• Supplement 2  Study to Determine Subacute Cost-Based Reimbursement PDF
• Supplement 3  Study to Determine Rates For Transitional Inpatient Care PDF
• Supplement 4  Methods & Standards for Establishing Facility-Specific Reimbursement Rates For Freestanding Nursing Facilities PDF

 APPENDIX TO ATTACHMENT 4.19-D PDF

ATTACHMENT 4.19-E  Timely Payment of Claims - Definition of a Claim by Type of Services PDF