Section 86-1.29 - New hospitals and hospitals on budgeted rates

86-1.29 New hospitals and hospitals on budgeted rates.

(a)
New hospitals. Payments to new hospitals without adequate cost experience for inpatient acute care services that are not exempt from DRG case-based rates of payment shall be computed in accordance with this Subpart except as follows:

(1) Rates of payment shall be computed on the basis of 100 percent of the statewide base price determined pursuant to section 86-1.16 of this Subpart multiplied by the service intensity weight for each DRG set forth in section 86-1.18 of this Subpart.

(2) The WEF used to adjust the statewide base price shall be equal to 1.0 until adequate data becomes available.

(3) The indirect teaching adjustment shall be determined pursuant to the provisions of section 86-1.20 of this Subpart.

(4) The noncomparable operating costs of new facilities as defined in section 86-1.15 of this Subpart and direct graduate medical education costs shall consist of the hospital's budgeted operating costs for these services.

(b)
Hospitals on budgeted rates.Payments to hospitals without adequate cost experience whose rates are based on budgeted cost projections for inpatient acute care services that are not exempt from DRG case-based rates of payment shall be computed in accordance with this Subpart except as follows:
(1) Reimbursement for the costs of graduate medical education and non comparable services shall be calculated pursuant to the provisions of paragraphs (a)(3) and (4) of this section.
(2) The WEF used shall be calculated for the facility based on available historical data.

Effective Date: 
Wednesday, March 16, 2011
Doc Status: 
Complete