Ariz. Admin. Code § 9-22-712.66

Current through Register Vol. 30, No. 44, November 1, 2024

Section R9-22-712.66 - DRG Service Policy Adjustor

In addition to subsection R9-22-712.65, for claims with DRG codes in the following categories, the product of the DRG base rate, the DRG relative weight for the post-HCAC DRG code, and the DRG provider policy adjustor shall be multiplied by the service policy adjustor listed in the AHCCCS capped fee schedule, available on the agency's website, corresponding to the following DRG codes:

1. Normal newborn DRG codes

2. Neonates DRG codes

3. Obstetrics DRG codes

4. Psychiatric DRG codes

5. Rehabilitation DRG codes

6. Burn DRG codes.

7. Claims for members under age 19 assigned DRG codes other than listed above:

a. For dates of discharge occurring on or after October 1, 2014 and ending no later than December 31, 2015 regardless of severity of illness level,

b. For dates of discharge on or after January 1, 2016, for severity of illness levels 1 and 2,

c. For dates of discharge on or after January 1, 2016 and before January 1, 2017, for severity of illness levels 3 and 4.

d. For dates of discharge on or after January 1, 2017, and before January 1, 2018 for severity of illness levels 3 and 4.

e. For dates of discharge on or after January 1, 2018, for severity of illness levels 3 and 4.

8. Claims for members assigned DRG codes other than listed above.

Ariz. Admin. Code § R9-22-712.66

New Section made by final rulemaking at 20 A.A.R. 1956, effective 9/6/2014. Amended by final rulemaking at 22 A.A.R. 2193, effective 10/1/2016. Amended by final rulemaking at 23 A.A.R. 2896, effective 1/1/2018.