Section 7 AAC 145.600 - General acute care hospital payment rates(a) The department will pay an in-state general acute care hospital for services rendered in the state at the rate determined in accordance with 7 AAC 150.(b) The department will pay an out-of-state general acute care hospital for (1) outpatient care services at the Medicaid rate used by the jurisdiction where the hospital is located, or if no Medicaid rate has been established, the hospital's Medicare rate;(2) inpatient care services at the All Patient Refined (APR) Diagnosis Related Groups (DRG) rates established in 7 AAC 150.250.(c) Except in emergency situations, payment will not be made for out-of-state hospital services that are available in this state unless the out-of-state hospitalization has been specifically approved by the department.(d) The department may negotiate a hospital-specific payment agreement for unique expertise or specialized services not available in the state. Factors that the department will consider in the decision to negotiate a facility-specific payment agreement under this subsection include(1) the medical necessity for the out-of-state hospital service;(2) whether the service is widely available out of state or available only from a limited number of out-of-state providers;(3) the professional standing of the facility within the health care services community for the unique expertise or specialized service;(4) any extreme circumstance concerning the medical needs of the patient;(5) whether a facility-specific payment agreement is necessary to ensure access to appropriate medical services that otherwise would not be available; and(6) whether 7 AAC 150.250 is applicable to the provider.(e) The hospital-specific payment agreement under (d) of this section is not available for general services offered by the hospital and is limited to the specific services set out in the payment agreement. General services offered by the hospital and not associated with unique expertise or specialized services in the payment agreement will be paid under (b) of this section.(f) The hospital-specific payment agreement under (d) of this section will be for a specific period of time not to exceed two years.(g) Except as provided in this section, the department will process claims for out-of-state hospital services in accordance with the claim process established for hospitals in this state under 7 AAC 140.300 - 7 AAC 140.325.(h) Charges to the department for out-of-state inpatient and outpatient hospital services may not exceed the hospital's usual and customary charges for the same service to the general public.(i) The department payment to a hospital (1) under the Diagnosis Related Groups (DRG) program in 7 AAC 150.250 includes services rendered by the hospital from the day of admission through the day of discharge, transfer to another facility, or death; or(2) under the cost-based prospective payment system includes the day of admission but not the day of discharge, transfer to another facility, or death.Eff. 2/1/2010, Register 193; am 7/1/2019, Register 231, July 2019; am 1/1/2024, Register 248, January 2024Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040