1. A. The operating payment for DRG cases that are not transfer cases shall be equal to the hospital specific operating rate per case, as determined in 12VAC30-70-311, times the DRG relative weight, as determined in 12VAC30-70-381.

2. B. Exceptions.

   1. 1. Special provisions for calculating the operating payment for transfer cases are provided in 12VAC30-70-251.
   2. 2. Readmissions within five days of discharge shall be considered a continuation of the same stay and shall not be treated as a new case.
   3. 3. Effective July 1, 2020, readmissions within six to 30 days of discharge shall be paid at 50% of the normal rate unless it is a planned readmission, an obstetrical readmission, an admission to critical access hospitals, or in any case where the patient was originally discharged against medical advice.

Statutory Authority

§ 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.

Historical Notes

Derived from Virginia Register Volume 16, Issue 18, eff. July 1, 2000; amended, Virginia Register Volume 37, Issue 9, eff. January 20, 2021.