4810 PAYMENT TO OTHER HOSPITALS FOR INPATIENT HOSPITAL SERVICES

4810.1 The Hospital for Sick Children, Washington Specialty-Hadley Memorial Hospital, Washington Specialty-Capitol Hill, and National Rehabilitation Hospital shall be reimbursed on a per diem basis subject to the TEFRA Target Rate.

4810.2 St. Elizabeths Hospital shall be reimbursed on a per diem basis and shall not be paid more than the sum of its charges for inpatient and in-and-out surgery services to Medicaid patients in any hospital fiscal year.

4810.3 The Psychiatric Institute of Washington shall be reimbursed on a per diem basis. The per diem rate shall be calculated as follows:

(a) The base year for purposes of reimbursement shall be the District's FY 2007;

(b) Inlier claims paid by DHCF for children in the District's FY 2007 shall be priced pursuant to the Inpatient Psychiatric Facility Prospective Payment System PC PRICER as described and in accordance with the requirements set forth in Section 124(c) of the Medicare, Medicaid and SCHIP Balanced Budget Refinement Act of 1999, approved November 29, 1999 (113 Stat. 1501; 42 U.S.C. § 1395ww(s));

(c) The inlier claims paid by DHCF for children shall be used to develop the reimbursement rates for all beneficiaries, including those age sixty-five (65) and above; and

(d) For each claim an average per diem shall be calculated by dividing the output of the pricer by the length of stay on the claim. The average per diems shall be summed and divided by the total number of claims to determine the final per diem rate.

SOURCE: Final Rulemaking published at 45 DCR 4141, 4149 (June 26, 1998); 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, 4330 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012).