D.C. Mun. Regs. tit. 29, r. 29-4809

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-4809 - INPATIENT SERVICES: POLICY ADJUSTOR(S)

4809.1

DHCF may utilize policy adjustors to increase or decrease APR-DRG relative weights for certain care categories or for a range of DRGs to meet policy goals.

4809.2

For Medicaid reimbursement of inpatient hospital discharges occurring on or after October 1, 2014, DHCF shall apply the following policy adjustors to the DRG weights for all inpatient stays according to Medicaid Care Category (MCC) for children under the age of twenty-one (21), excluding normal newborns:

(a) Pediatric mental health MCC equal to a factor of 2.25;

(b) Neonate MCC equal to a factor of 1.25; and

(c) All other pediatric stays except normal newborns equal to a factor of 1.5.

4809.3

The value of the policy adjustor(s) shall be reevaluated annually or more frequently when necessary.

D.C. Mun. Regs. tit. 29, r. 29-4809

Final Rulemaking published at 45 DCR 4141, 4149 (June 26, 1998); as Final Rulemaking published at 49 DCR 8719 (September 20, 2002); as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 2691 (March 26, 2010) [EXPIRED]; as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 6837 (July 10, 2010) [EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 4323, 4330 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012); amended by Final Rulemaking published at 63 DCR 5234 (4/8/2016)

29 DCMR § 4809 is formerly entitled SPayment to Other Hospitals for Inpatient Hospital Services".

Authority: The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2001; Supp. 2008)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2001; Supp. 2008)).