​​​​​Attachments, Supplements and Appendix to Section 4.19 - Payment for Services

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Attachment 4.19-A

Attachment 4.19-A  Methods and Standards for Establishing Payment Rates - Inpatient Hospitals (pages 1-54)

  Supplements to Attachment 4.19-A 

  • Supplement 1  Section 1902(a)(13)(A) of the Social Security Act Compliance

  • Supplement 2  Supplemental Reimbursement For Inpatient Hospital Services

Appendix to Attachment 4.19-A

  • Appendix 1   Government-Operated Hospitals Approved by CMS

  • Appendix 2   Prior DSH Methodology in Effect As of 2004-05 Payment Adjustment Year

  • Appendix 3   Supplemental Reimbursement for Hospital Inpatient Services

  • Appendix 4   Supplemental Reimbursement for Hospital Inpatient Services

  • Appendix 5   Supplemental Reimbursement for Hospital Inpatient Services

Attachment 4.19-B 

Attachment 4.19-B Methods and Standards Used for Payment of Facility Services Except Inpatient Hospital, Nursing

Facility Services and Services in Intermediate Care Facilities for the Mentally Retarded (pages 1-77)  

Adding New Pages to the State Plan Pending Approval (pgs. 78-80)

Adding New Page to the State Plan Pending Approval (pg. 81)

Supplements to Attachments 4.19-B

Attachment 4.19-C 

Attachment 4.19-D 

  • ATTACHMENT 4.19-D  Methods and Standards for Payment Rates - Skilled Nursing and Intermediate Care Facility Services (PDF)

Supplements to Attachment 4.19-D

  • Supplement 2  Study to Determine Subacute Cost-Based Reimbursement

  • Supplement 3  Study to Determine Rates For Transitional Inpatient Care

  • Supplement 4  Methods & Standards for Establishing Facility-Specific Reimbursement Rates For Freestanding Nursing Facilities

Appendix to Attachment 4.19-D 

Attachment 4.19-E 

Attachment 4.19-F

Last modified date: 1/16/2020 9:13 AM