Section 29-4801. INPATIENT SERVICES: CALCULATION OF DISTRICT-WIDE BASE RATE

 

4801.1 For Medicaid reimbursement of inpatient hospital discharges occurring on or after October 1, 2014, DHCF shall use a single, District-wide base rate for all general hospitals.

 

4801.2 Effective October 1, 2014, and annually thereafter, the base year period is the District’s fiscal year that ends prior to October 1 of the prior calendar year.

 

4801.3 The District-wide base rate is based on aggregate costs for the base year. Aggregate cost is calculated using the hospital specific cost-to-charge ratio, as described in Section 4802, as well as facility casemix data, and claims data from all in-District participating hospitals for the base year.

 

4801.4 Subject to federal upper payment limits, the District-wide base rate shall not exceed a rate that approximates an aggregate payment to cost ratio of ninety-eight percent (98%) for the base year for in-District general hospitals. The payment to cost ratio is determined by modeling payments to all hospitals using claims data relevant to the base year.

 

4801.5 The District-wide base rate calculated pursuant to Subsections 4801.3 and 4801.4 may be adjusted for IME as set forth in Section 4804.  

 

4801.6 The Indirect Medical Education (IME) component of the District-Wide Base Rate shall be hospital-specific for each in-District general hospital with IME costs, as recognized on their cost report.

 

 

authority

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. 744; D.C. Official Code § 1-307.02 (2014 Repl.& 2015 Supp.)) 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) (2012 Repl.)).

source

Final Rulemaking published at 45 DCR 4141, 4144 (June 26, 1998); as amended by Final Rulemaking published at 46 DCR 8271, 8272 (October 15, 1999); as amended by Emergency and Proposed Rulemaking published at 57 DCR 2691 (March 26, 2010)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 57 DCR 6837 (July 10, 2010)[EXPIRED]; as amended by Final Rulemaking published at 58 DCR 4323, 4325 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012); as amended by Final Rulemaking published at 63 DCR 5234 (April 8, 2016).