D.C. Mun. Regs. tit. 29, § 903
Outpatient and Emergency Room Services
Authority: An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2014 Repl.)), and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)). Source: Final Rulemaking published at 29 DCR 4132 (September 17, 1982); as amended by Final Rulemaking published at 29 DCR 4551 (October 15, 1982); as amended by Final Rulemaking published at 61 DCR 2119 (March 14, 2014); as amended by Final Rulemaking published at 62 DCR 14077 (October 30, 2015); as amended by Final Rulemaking published at 63 DCR 6946 (May 6, 2016); as amended by Final Rulemaking published at 63 DCR 15765 (December 23, 2016); as amended by Final Rulemaking published at 65 DCR 0406 (January 19, 2018); as amended by Final Rulemaking published at 65 DCR 13954 (December 28, 2018); as amended by Final Rulemaking published at 67 DCR 3711 (April 3, 2020).District of Columbia, Office of the Secretary
903.1 The Department shall pay for all outpatient and emergency room visits at a fixed rate based on each hospital's fiscal 1980 costs, as reflected in that hospital's cost report filed with the Office of Health Care Financing, plus nine percent (9%). The base rate shall be subject to adjustment when the audit of the 1980 cost report is completed.
903.2 The rate established under §903.1 shall be used for all visits occurring after September 17, 1982.
903.3 Outpatient and emergency room services rendered by a hospital prior to September 17, 1982, shall be reimbursed in accordance with the existing reimbursement method.
903.4 The Department shall negotiate a utilization "target" with each hospital for the twelve (12) month period beginning September 17, 1982. Utilization in excess of the target figure shall be paid for at a lower rate.
903.5 For the emergency room patient who is admitted to the hospital as an inpatient, the actual emergency room charges shall be added to the inpatient claim.
SOURCE: Final Rulemaking published at 29 DCR 4132 (September 17, 1982); as amended by Final Rulemaking published at 29 DCR 4551 (October 15, 1982).