Chapter 70. Methods and Standards for Establishing Payment Rates; In-Patient Hospital CareRead Chapter
- Part I.Read allPer Diem Methodology
- Section 10
- Effect of participation in Health Insurance for the Aged program
- Section 20
- Standards applied to non-participants in Title XVIII programs
- Section 30
- Limitations of Medical Assistance Program payment; Medicare reimbursement principles
- Section 40
- Payment of reasonable costs based on other methods
- Section 50
- Hospital reimbursement system
- Section 60
- Establishment of reasonable and adequate payment rates; cost reporting
- Section 70
- Revaluation of assets
- Section 80
- Refund of overpayments
- Section 90
- Reimbursement of certified hospitals exempt from Medicare Prospective Payment system
- Section 100
- Reimbursement of return on equity capital to proprietary providers
- Section 110
- Group ceiling for state-owned university teaching hospitals
- Section 120
- [Repealed]
- Section 130
- Payment adjustment fund
- Part II.Read allHospital Appeals of Reimbursement Rates [Repealed]
- Section 140
- [Repealed]
- Part III.Read allDispute Resolution for State-Operated Facilities
- Section 150
- Methods and standards for establishing payment rates - inpatient hospital care: Dispute resolution for state-operated providers
- Part IV.Read all[Reserved]
- Section 160
- [Reserved]
- Section 200
- [Repealed]
- Part V.Read allInpatient Hospital Payment System
- Article 1.Read allApplication of Payment Methodologies
- Section 201
- Application of payment methodologies
- Section 210
- [Repealed]
- Section 220
- [Repealed]
- Article 2.Read allProspective (DRG-Based) Payment Methodology
- Section 221
- General
- Section 230
- [Repealed]
- Section 231
- Operating payment for DRG cases
- Section 240
- [Repealed]
- Section 241
- Operating payment for per diem cases
- Section 250
- [Repealed]
- Section 251
- Operating payment for transfer cases
- Section 260
- [Repealed]
- Section 261
- Outlier operating payment
- Section 270
- [Repealed]
- Section 271
- Payment for capital costs
- Section 280
- [Repealed]
- Section 281
- Payment for direct medical education costs of nursing schools, paramedical programs, and graduate medical education for interns and residents
- Section 290
- [Repealed]
- Section 291
- Payment for indirect medical education costs
- Section 300
- [Repealed]
- Section 301
- Payment to disproportionate share hospitals
- Section 310
- [Repealed]
- Section 311
- Hospital specific operating rate per case
- Section 320
- [Repealed]
- Section 321
- Hospital specific operating rate per day
- Section 330
- [Repealed]
- Section 331
- Statewide operating rate per case
- Section 340
- [Repealed]
- Section 341
- Statewide operating rate per day
- Section 350
- [Repealed]
- Section 351
- Updating rates for inflation
- Section 360
- [Repealed]
- Section 361
- Base year standardized operating costs per case
- Section 370
- [Repealed]
- Section 371
- Base year standardized operating costs per day
- Section 380
- [Repealed]
- Section 381
- DRG relative weights and hospital case-mix indices
- Section 390
- [Repealed]
- Section 391
- Recalibration and rebasing policy
- Article 3.Read allOther Provisions for Payment of Inpatient Hospital Services
- Section 400
- Determination of per diem rates
- Section 410
- State university teaching hospitals
- Section 415
- Reimbursement for freestanding psychiatric hospital services under EPSDT
- Section 417
- Reimbursement for inpatient psychiatric services in residential treatment facilities (Level C) under EPSDT
- Section 418
- Reimbursement for residential and inpatient substance use treatment services
- Section 420
- Reimbursement of noncost-reporting general acute care hospital providers
- Section 425
- Supplemental payments for non-state-government-owned hospitals for inpatient services
- Section 426
- [Repealed]
- Section 428
- Supplemental payments for private hosptial partners of Type One hospitals
- Section 430
- Medicare upper limit
- Section 435
- Lump sum payment
- Section 440
- [Repealed]
- Section 441
- Public comment process
- Section 450
- Cost reporting requirements
- Section 460
- Hospital settlement
- Section 470
- Underpayments
- Section 480
- Refund of overpayments
- Section 490
- Medicaid Hospital Payment Policy Advisory Council
- Section 500
- Outlier methodology illustration