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, and United Medical Center; and

- (c) Major Teaching Hospitals: Georgetown University Hospital, George Washington University Hospital, Howard University Hospital, and Washington Hospital Center.4801.2 Effective October 1, 2012, the base year period shall be each hospital's fiscal year that ends prior to October 1, 2011.4801.3 Effective October 1, 2012, the base payment rate for each hospital shall be developed utilizing costs from each hospital's submitted cost report for the fiscal year that ends prior to October 1, 2011, as well as facility case mix data, claims data, and discharge data from all participating hospitals for the District's fiscal year ending September 30, 2011.4801.4 Effective October 1, 2013, and annually thereafter, the base payment rate for each hospital shall be developed utilizing costs from each hospital's submitted cost report for the fiscal year that ends prior to October 1 of the prior calendar year, as well as facility case mix data, claims data, and discharge data from all participating hospitals for the District's most recently completely fiscal year.4801.5 Effective October 1, 2012, and annually thereafter, the costs set forth in subsection 4801.3 shall be updated by applying the cost-to-charge ratio determined by each hospital's submitted cost report for the fiscal year that ends prior to October 1 of the previous calendar year.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 4801.7.4801.7 Subject to federal upper payment limits, each hospital's base year

payment rate shall not exceed a rate that approximates an overall payment to cost ratio of ninety-eight percent (98%) for the base year. The payment to cost ratio is determined by modeling payments to each facility using claims data from the District’s most recently completely fiscal year.

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); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012).