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(A) after Medicare cost reports for health clinic fiscal years one and two are submitted and are reviewed by the department, and will be inflated in accordance with (c) of this section, except that the first two fiscal years of data that the clinic has available will be substituted for fiscal years 1999 and 2000; and

(B) to allow payments for each succeeding health clinic fiscal year to be established by using the base per-visit rate set for the previous clinic fiscal year, and increasing that rate by the percentage increase in the number set out in the first quarter publication of Global Insight’s Health-Care Cost Review, Skilled Nursing Facility Total Market Basket; adjustments for that clinic fiscal year will be made to take into account any increase or decrease in the scope of services that the department has approved under (f) of this section, whether the change in the scope of services is proposed for that fiscal year or occurred in the preceding fiscal year. (h) A health clinic may appeal, under 7 AAC 150.240, the final rate set by the department by submitting a written request to the commissioner, so that the commissioner receives the request no later than 30 days after the date that the final rate agreement letter is issued. (i) The amount, duration, and scope of primary care and ambulatory medical services provided by a health clinic are subject to the limits upon covered services under 7 AAC 105 — 7 AAC 160 as applied to other Medicaid recipients. (j) The department will pay a health clinic that is outside this state and that provides covered services to a Medicaid recipient eligible under 7 AAC 100 at the lesser of the

(1) per-visit rate established by the agency responsible for Medicaid in the jurisdiction where the health clinic is located; or

(2) the average per-visit rate established by the department for health clinics in this state. (k) In this section,

(1) “ambulatory services” has the meaning given in 7 AAC 140.229;

(2) “change in the scope of services” means

(A) the addition of a category of service to, or the deletion of a category of service from, those categories of service that a rural health clinic or federally qualified health center provides; or

(B) an increase or decrease in the intensity of a category of service provided by a rural health clinic or federally qualified health center that may be reasonably expected to span at least one year; in this subparagraph, “intensity” means the cost of a category of service due to a change in the level of medical care provided to the population served by the rural health clinic or federally qualified health center;

(3) “medically necessary and appropriate” means