4801 CALCULATION OF BASE PAYMENT RATES

4801.1 For purposes of establishing the base payment rates, the participating hospitals located in the District of Columbia shall be separated into three (3) peer groups as follows:

(a) Children's Hospitals: Children's National Medical Center;

(b) Community Hospitals: Providence Hospital, Sibley Hospital, United Medical Center; and

(c) Major Teaching Hospitals: Georgetown University Hospital, George Washington University Hospital, Howard University Hospital, Washington Hospital Center.

4801.2 The base year period shall be the District's fiscal year ending on September 30, 2007.

4801.3 The base year payment rate for each participating hospital shall be based on costs from each hospital's fiscal year 2006 submitted cost report.

4801.4 The base year payment rate shall also be developed using facility case mix data, claims data, and discharge data from all participating hospitals for the District's fiscal year ending September 30, 2007.

4801.5 The costs set forth in subsection 4801.3 shall be updated to 2007 by applying the 2006 cost-to-charge ratio to claims data for 2007.

4801.6 The final base year payment rate for each hospital shall be equal to the peer group average cost per discharge calculated pursuant to section 4803, plus the hospital specific cost per discharge of indirect medical education calculated pursuant to section 4804, subject to a gain/loss corridor as set forth in subsection 4801.7 and adjusted for inflation pursuant to subsection 4801.8.

4801.7 Each hospital's base year payment rate shall not exceed a rate that approximates an overall payment to cost ratio between ninety-five percent (95%) and one hundred percent (100%) for the base year, unless the hospital is in a public-private partnership with the District. The payment to a hospital in a public-private partnership's base year payment shall be set at a rate that approximates an overall payment to cost ratio of one hundred percent (100%) for the base year. The

payment to cost ratio is determined by modeling payments to each facility using claims data from the base year data set.

4801.8 Each hospital’s base year payment shall be adjusted from 2007 to June 30, 2010, using an inflation factor obtained from the Centers for Medicare and Medicaid Services (CMS) Hospital Market Basket Index.

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 Notice of Emergency and Proposed Rulemaking published at 57 DCR 2691 (March 26, 2010)[EXPIRED]; as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 6837 (July 10, 2010)[EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 4323, 4325 (May 20, 2011).