Section R9-22-712.67. DRG Reimbursement: Transfers

A.      For purposes of this subsection a “transfer” means the transfer of a member from a hospital to a short-term general hospital for inpatient care, to a designated cancer center or children’s hospital, or a critical access hospital.

B.       Designated cancer center or children’s hospitals are those hos- pitals identified as such in the UB-04 billing manual published by the National Uniform Billing Committee.

C.      The hospital the member is transferred from shall be reim- bursed either the initial DRG base payment or the transfer DRG base payment, whichever is less.

D.      The transfer DRG base payment is an amount equal to the ini- tial DRG base payment, as determined after making any pro- vider or service policy adjustors, divided by the DRG National Average length of stay for the DRG code multiplied by the sum of one plus the length of stay.

E.       The hospital the member is transferred to shall be reimbursed under the DRG payment methodology without a reduction due to the transfer.

F.       Unadjusted DRG base payment. The unadjusted DRG base payment is either the initial DRG base payment, as determined after making any provider or service policy adjustors, or the transfer DRG base payment, whichever is less.

Historical Note

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

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