12 Va. Admin. Code § 30-70-231

Current through Register Vol. 41, No. 6, November 4, 2024

Section 12VAC30-70-231 - Operating payment for DRG cases

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.

12 Va. Admin. Code § 30-70-231

Derived from Virginia Register Volume 16, Issue 18, eff. July 1, 2000; Amended, Virginia Register Volume 37, Issue 09, eff. 1/20/2021.

Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.