§ 5A-12.5. Affordable Care Act adults; hospital access payments.
(a) The Department shall, subject to federal approval, mirror the Medical Assistance
hospital reimbursement methodology for Affordable Care Act adults who are enrolled
under a fee-for-service or capitated managed care program, including hospital access
payments as defined in Section 5A-12.2 of this Article and hospital access improvement
payments as defined in Section 5A-12.4 of this Article, in compliance with the equivalent
rate provisions of the Affordable Care Act.
(b) If the fee-for-service payments authorized under this Section are deemed to be
increases to payments for a prior period, the Department shall seek federal approval
to issue such increases for the payments made through the period ending on June 30,
2018, or as provided in Section 5A-16, even if such increases are paid out during
an extended payment period beyond such date. Payment of such increases beyond such date is subject to federal approval. If the Department receives federal approval of such increases, the Department shall
pay such increases on the same schedule as it had used for such payments prior to
June 30, 2018.
(c) As used in this Section, “Affordable Care Act” is the collective term for the Patient Protection and Affordable Care Act (Pub. L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152).
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