Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION
Article 7 - STANDARDS FOR PAYMENTS
Section R9-22-712.65 - DRG Provider Policy Adjustor
Universal Citation: AZ Admin Code R 9-22-712.65
Current through Register Vol. 30, No. 38, September 20, 2024
A. After calculating the DRG base payment as required in sections 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 that is included in the AHCCCS capped fee schedule available on the agency's website.
B. A hospital is a high-utilization hospital if the hospital had:
1. Covered inpatient days
subject to DRG reimbursement, determined using adjudicated claim and encounter
data during the fiscal year beginning October 1, 2015, equal to at least four
hundred percent of the statewide average number of AHCCCS-covered inpatient
days at all hospitals;
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 2016; and,
3. Received less than $2 million in add-on
payment for outliers under
R9-22-712.68,
based on adjudicated claims and encounters for fiscal year beginning October 1,
2015.
Disclaimer: These regulations may not be the most recent version. Arizona may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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