Section 29-4818. SPECIALTY INPATIENT SERVICES: POLICY ADJUSTER(S)

 

4818.1DHCF may apply an age-adjuster to claims associated with specialty hospital inpatient stays where the beneficiary’s age falls outside of the age range used to calculate the base rate as is typically associated with that hospital’s patient population.

 

4818.2In order to ensure budget predictability, monitor payments, and identify deviations from budget targets, DHCF shall make a documentation and coding adjustment (DCA) that reduces the base rate to offset case mix increases due to operational improvements in documentation and coding.  DHCF, or its designee, shall evaluate the DCA every six (6) months. 

 

4818.3  Where Healthcare-Acquired Conditions (HAC) assignment impacts the relative weights of a claim, DHCF shall use the weight minus the HAC diagnosis to determine final payment to the specialty hospital.   

 

 

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 63 DCR 5234 (April 8, 2016).