Section R9-22-712.65. DRG Provider Policy Adjustor

A.      After calculating the DRG base payment as required in sec- tions R9-22-712.62, R9-22-712.63, or R9-22-712.64, for claims from a high-utilization hospital, the product of the DRG base rate and the DRG relative weight for the post- HCAC DRG code shall be multiplied by a provider policy adjustor of 1.055.

B.       A hospital is a high-utilization hospital if the hospital had:

1.        At least 46,112 AHCCCS-covered inpatient days using adjudicated claim and encounter data during the fiscal year beginning October 1, 2010, which is equal to at least four hundred percent of the statewide average number of AHCCCS-covered inpatient days at all hospitals of 11,528 days; and,

2.        A Medicaid inpatient utilization rate greater than 30% calculated as the ratio of AHCCCS-covered inpatient days to total inpatient days as reported in the hospital’s Medicare Cost Report for the fiscal year ending 2011.

Historical Note

New Section made by final rulemaking at 20 A.A.R.

1956, September 6, 2014 (Supp. 14-3).