Cal. Code Regs. tit. 22, § 51556
(b) The noncontract reimbursement reduction, if any, for partial FPE contracting hospitals, those hospitals which have gone on or off contracting during their settlement fiscal period, shall be determined as follows:
Noncontract Reduction = PRNC * FYR
Where:
PRNC = NMCN/TMCN
PRNC = Proportion of reimbursement not under contract
FYR = Full fiscal period all services reimbursement reduction as determined by the PIRL.
NMCN = Noncontracting Medi-Cal net cost of covered services
TMCN = Total Medi-Cal net cost of covered services for the entire fiscal period for all services.
(a)(1) The reimbursement limitation for the noncontract service costs of contracting hospitals which had a valid contract during the entire settlement fiscal period shall be determined by the following method:
Noncontract Reduction = NMCN - TCL
Where:
NMCN = Noncontract Medi-Cal net cost of covered services including third-party liability amounts
TCL = PYNCPD * PDL * SYND
PYNCPD = PYNC/PYND
TCL = Total cost limit exclusive of any reductions for third-party liability
PYNCPD = Prior fiscal period noncontract cost per day
PYNC = Prior fiscal period noncontract costs
PYND = Prior fiscal period noncontract days
PDL = Per diem limit increase which shall be the target as specified in federal regulation CFR 42, Section 413.40(c)(3).
SYND = Settlement fiscal period noncontract days
Note: Authority cited: Sections 10725, 14100.1, 14105, 14105.1, 14106 and 14124.5, Welfare and Institutions Code; and Chapter 1594, Statutes of 1982, Section 87 (SB 2012). Reference: Sections 14105 and 14106, Welfare and Institutions Code.
1. New section filed 4-23-92; operative 5-25-92 (Register 92, No. 20).
2. Change without regulatory effect amending subsection (b) filed 8-5-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 32).