For the purposes of this chapter, the following terms shall have the meanings ascribed:

Base year - the standardized year on which rates for all hospitals for inpatient hospital services are calculated to derive a prospective reimbursement rate.

Department of Health Care Finance - the executive agency of the District government responsible for administering the Medicaid program within the District of Columbia effective October 1, 2008.

Diagnosis Related Group (DRG) - a patient classification system that reflects clinically cohesive groupings of inpatient hospitalizations utilizing similar hospital resources.

Direct Medical Education Costs - the total direct medical education (DME) amount on line 25 of schedule E-4 (or its successor) of the Medicare cost report divided by total inpatient days (including nursery days) multiplied by the number of Medicaid days (including nursery days). Costs shall be determined consistent with Medicare per resident amounts and capped residency counts.

High-cost outliers - claims with costs exceeding two point five (2.5) standard deviations from the mean Medicaid cost for each APDRG classification.

Low-cost outliers - claims with costs less than twenty-five percent (25%) of the average cost for each APDRG classification.

Service intensity weights - A numerical value which reflects the relative resource requirements for the DRG to which it is assigned.

TEFRA Target Rate - The rate ceiling for hospitals that are not reimbursed on a prospective payment system.

SOURCE: 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, 4334 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012).