Section R9-22-712.75. DRG Reimbursement: Payment for Administra- tive Days

A.      Administrative days are days of a hospital stay in which a member does not meet criteria for an acute inpatient stay, but is not discharged because an appropriate placement outside the hospital is not available, the Administration or the contractor fail to provide for the appropriate placement outside the hospi- tal in a timely manner, or the member cannot be safely dis- charged or transferred.

B.       Administrative days do not include days when the member is awaiting appropriate placement or services that are currently available but the hospital has not transferred or discharged the member because of the hospital’s administrative or operational delays.

C.      Prior authorization is required for administrative days.

D.      A hospital shall submit a claim for administrative days sepa- rate from any claim for reimbursement for the inpatient stay otherwise reimbursable under the DRG payment methodology.

E.       Administrative days are reimbursed at the rate the claim would have paid had the services not been provided in an inpatient hospital setting but had been provided at the appropriate level of care (e.g., as nursing facility days).

Historical Note

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

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