Reimbursement

Reimbursement A. The Division of Medicaid uses rate setting as a prospective method of reimbursement on both the state and federal level. This method does not allow for retrospective settlements. The rates are determined from cost reports and appropriate audits. B. Standard rates will remain the same as those in effect for State Fiscal Year (SFY) 2021. The Division of Medicaid uses a fee-for-service reimbursement rate which will remain the same as those in effect for State Fiscal Year (SFY) 2021. In no case may the reimbursement rate for services provided exceed an individual facility’s customary charge to the public for such services in the aggregate, except for those public facilities rendering such services free of charge or at a nominal charge. C. Payments under the plan do not duplicate payments made to public agencies or private entities under other program authorities for the same purpose.