N.Y. Comp. Codes R. & Regs. tit. 18 § 530.1

Current through Register Vol. 46, No. 45, November 2, 2024

Section 530.1 - Basic policy

(a) For admissions on or after January 1, 1988, payment for inpatient services will be based on a prospective case payment reimbursement system in accordance with 10 NYCRR Part 86. Hospitals or hospital units that are exempt from the Medicare prospective system are exempt from this case payment system and will continue to be paid on a per diem basis. In addition, designated acquired immune deficiency syndrome (AIDS) units and alcohol rehabilitation units are also exempt, as described in 10 NYCRR 86-1.57, and will be paid on a per diem basis.

(b) In addition to the case payment rate, a hospital may receive a long length of stay outlier payment calculated pursuant to 10 NYCRR 86-1.55(b), a high cost outlier payment calculated pursuant to 10 NYCRR 86-1.55(c), or an alternative level of care payment calculated pursuant to 10 NYCRR 86-1.56, if the conditions for such payments, as set forth in 10 NYCRR Part 86, are satisfied. Further, in lieu of case-based rates of payments, a hospital may receive a short length of stay outlier payment calculated pursuant to 10 NYCRR 86-1.55(a) or a transfer payment calculated pursuant to 10 NYCRR 86- 1.54(l) if the conditions for such payments, as set forth in 10 NYCRR Part 86, are satisfied.

(c) The date of admission or the date of discharge may be counted as a day of care but in no instance will both the day of admission and the day of discharge be reimbursable.

(d) A hospital may be reimbursed for an interim billing on the basis of an inpatient admission, reconciled to final payment on the basis of discharge date, with such reconciliations established at time periods specified by the department. Under such a system, variances between amounts paid on an admission basis and actual amounts due and to be paid on a discharge basis may be reflected in the amounts to be paid on an admission basis. The failure by a hospital to submit a discharge bill within the time period specified by the department will result in the recovery of the amount paid on an admission basis.

(e) If welfare districts plan to pay hospitals for X-ray, laboratory, electrocardiogram, metabolism and related services for outpatients on a fee-for-service basis, the costs of operating these services for outpatients must be excluded from the statement of operating costs upon which the per diem rate for inpatient care is based.

(f) Hospital care is reimbursable for State charges for the entire approved period of hospital care when such care is rendered pursuant to section 505.4 of this Title.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 530.1