Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1163 - INPATIENT HOSPITAL SERVICES
Subchapter A - ACUTE CARE GENERAL HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEM
PAYMENT FOR HOSPITAL SERVICES
Section 1163.52 - Prospective payment methodology
Current through Register Vol. 54, No. 44, November 2, 2024
(a) The Department will base payment for inpatient hospital services on the classification of inpatient hospital discharges by DRGs used by the Medicare Program.
(b) The Department will assign a DRG to each MA discharge. The assignment of a DRG is based on:
(c) For a DRG, the Department will determine a relative value which reflects the cost of hospital resources used to treat cases in that DRG relative to the Statewide average cost of hospital cases. The Department will determine the relative value under § 1163.122 (relating to determination of DRG relative values).
(d) The Department will base payment for compensable inpatient hospital services under the DRG payment system on the hospital's base DRG rate determined under § 1163.126 (relating to computation of hospital specific base payment rates).
(e) The Department will not make a separate APR-DRG payment for a normal newborn when the following occur:
The provisions of this §1163.52 amended under sections 201, 403(b), 403.1 and 443.1(1) of the Public Welfare Code (62 P. S. §§ 201, 403(b), 403.1 and 443.1(1)).
