Ariz. Admin. Code § 9-22-712.62

Current through Register Vol. 30, No. 50, December 13, 2024

Section R9-22-712.62 - DRG Base Payment

A. The initial DRG base payment is the product of the DRG base rate, the DRG relative weight for the post-HCAC DRG code assigned to the claim, and any applicable provider and service policy adjustors.

B. The DRG base rate for each hospital is the statewide standardized amount of which the hospital's labor-related share of that amount is adjusted by the hospital's wage index. The hospital's labor share is determined based on the labor share for the Medicare inpatient prospective payment system published in Volume 85 of the Federal Register at page 59060 and 59061 published September 18, 2020. The hospital's wage index is determined based on the wage index tables reference in Volume 85 of the Federal Register at page 59059 published September 18, 2020. The statewide standardized amount is included in the AHCCCS capped fee schedule available on the agency's website.

C. Claims shall be assigned both a DRG code derived from all diagnosis and surgical procedure codes included on the claim (the "pre-HCAC" DRG code) and a DRG code derived excluding diagnosis and surgical procedure codes associated with the health care acquired conditions that were not present on admission or any other provider-preventable conditions (the "post-HCAC" DRG code). The DRG code with the lower relative weight shall be used to process claims using the DRG methodology.

Ariz. Admin. Code § R9-22-712.62

New Section made by final rulemaking at 20 A.A.R. 1956, effective 9/6/2014. Amended by final rulemaking at 23 A.A.R. 2896, effective 1/1/2018. Amended by final rulemaking at 27 A.A.R. 2512, effective 10/6/2021.