D.C. Mun. Regs. tit. 29, r. 29-4802

Current through Register Vol. 71, No. 43, October 25, 2024

Rule 29-4802 - INPATIENT SERVICES: CALCULATION OF COST-TO-CHARGE RATIO (CCR)

4802.1

For Medicaid reimbursement of inpatient hospital discharges, hospital-specific cost-to-charge ratios (CCRs) shall be calculated annually.

4802.2

The CCR shall be developed based on each hospital's submitted cost reports for the hospital's fiscal year that ends prior to October 1 of the prior calendar year.

4802.3

The CCR used to calculate the cost of a claim shall be hospital-specific for hospitals providing in-patient hospital services.

4802.4

DHCF shall apply a weighted average of in-District hospitals' CCRs to out-of-District hospitals.

4802.5

For the purposes of determining the overall hospital CCR, total costs reported shall be allocated to inpatient and outpatient costs based on the ratio of inpatient and outpatient charges reported in each cost center.

4802.6

For the purpose of excluding inpatient capital costs, capital costs associated with each ancillary cost center shall be allocated to inpatient and outpatient capital costs based on the ratio of inpatient and outpatient charges reported by each cost center.

D.C. Mun. Regs. tit. 29, r. 29-4802

Final Rulemaking published at 45 DCR 4141, 4145 (June 26, 1998); as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 2691 (March 26, 2010) [EXPIRED]; as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 6837 (July 10, 2010) [EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 4323, 4326 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012); amended by Final Rulemaking published at 63 DCR 5234 (4/8/2016)

29 DCMR § 4802 is formerly entitled SCalculation of the District-wide Average Cost per Discharge ("District-wide ACD)".

Authority: The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2001; Supp. 2008)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2001; Supp. 2008)).