Virginia Administrative Code
Title 12 - HEALTH
Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Chapter 70 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES - INPATIENT HOSPITAL SERVICES
Part V - Inpatient Hospital Payment System
Article 2 - Prospective (DRG-Based) Payment Methodology
Section 12VAC30-70-231 - Operating payment for DRG cases
Universal Citation: 12 VA Admin Code 12VAC30-70-231
Current through Register Vol. 41, No. 3, September 23, 2024
A. The operating payment for DRG cases that are not transfer cases shall be equal to the hospital specific operating rate per case, as determined in 12VAC30-70-311, times the DRG relative weight, as determined in 12VAC30-70-381.
B. Exceptions.
1. Special provisions for calculating the
operating payment for transfer cases are provided in
12VAC30-70-251.
2. Readmissions within five days of discharge
shall be considered a continuation of the same stay and shall not be treated as
a new case.
3. Effective July 1,
2020, readmissions within six to 30 days of discharge shall be paid at 50% of
the normal rate unless it is a planned readmission, an obstetrical readmission,
an admission to critical access hospitals, or in any case where the patient was
originally discharged against medical advice.
Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
Disclaimer: These regulations may not be the most recent version. Virginia 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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