1. (a) Payments to providers of inpatient acute care hospital services shall be based on the sum of the following:

   1. (1) One hundred thirteen percent of the DRG payment.
   2. (2) One hundred percent of payments that are reimbursed on the prospective payment system, as listed in subsection (b).
   3. (3) One hundred percent of pass-through costs.
   4. (4) One hundred percent of applicable cost outliers or 100% of applicable day outliers.

2. (b) In calculating the payment due, the following payments, which are reimbursed on a prospective payment basis by the Medicare Program, shall be multiplied by 100%:

   1. (1) The prospective portions of capital-related costs relating to payments to the following:

      1. (i) Fully-prospective hospitals.
      2. (ii) Hold-harmless hospitals reimbursed at 100% of the Federal rate (100% hold harmless).
      3. (iii) Blended hold-harmless hospitals.
   2. (2) Direct medical education costs.
   3. (3) Indirect medical education costs.

3. (c) In calculating the payment due, the following costs, which are reimbursed on a cost basis by the Medicare Program, shall be multiplied by 100%:

   1. (1) The cost portions of capital-related costs relating to the following:

      1. (i) Blended hold-harmless hospitals.
      2. (ii) Capital-exceptional hospitals.
   2. (2) Paramedical education costs.
   3. (3) Cost outliers or day outliers.

Cross References

This section cited in 34 Pa. Code § 127.101 (relating to medical fee caps—Medicare); 34 Pa. Code § 127.154 (relating to medical fee updates on and after January 1, 1995—inpatient acute care providers subject to DRGs plus add-on payments).