Section 16.03.10.036 - GENERAL REIMBURSEMENT01.Long-Term Care Facility Payment. Long-term care facilities will be reimbursed the lower of their customary charges, their actual reasonable costs, adjusted by a budget adjustment factor (BAF) for nursing facilities, or the standard costs for their class as set forth in the Provider Reimbursement Manual, but the upper limits for payment must not exceed the payment that would be determined as reasonable costs using the Title XVIII Medicare standards and principles.02.Individual Provider Payment. The Department will not pay the individual provider more than the lowest of:a. The provider's actual charge for service; orb. The maximum allowable charge for the service as established by the Department on its pricing file, if the service or item does not have a specific price on file, the provider must submit documentation to the Department and reimbursement will be based on the documentation; orc. The Medicaid upper limitation of payment on those services, minus the Medicare payment, where a participant is eligible for both Medicare and Medicaid. The Department will not reimburse providers an amount in excess of the amount allowed by Medicaid, minus the Medicare payment.Idaho Admin. Code r. 16.03.10.036