10A NCAC 22G .0205. OUT OF STATE HOSPITALS

(a)  Except as noted in Paragraph (c) of this Rule, the Division of Medical Assistance shall reimburse out‑of‑state hospitals using the DRG methodology.  The DRG hospital unit value for all out‑of‑state hospitals shall be equal to the unit value of the 45th percentile North Carolina hospital.  Out‑of‑state providers are eligible to receive cost and day outlier payments, but not direct medical education payment adjustments.

(b)  Hospitals that are certified for indirect medical education by Medicare may apply for an indirect medical education adjustment to its North Carolina rate.

(c)  Hospitals certified as disproportionate share hospitals by the Medicaid agency in their home state may apply for a disproportionate share adjustment to their North Carolina Medicaid rate.  The North Carolina disproportionate share hospital rate adjustment shall be the hospital's home state DSH adjustment, not to exceed 5%.

(d)  The Division of Medical Assistance may enter into contractual relationships with certain hospitals providing highly specialized inpatient services, in which case reimbursement for inpatient services shall be based on contractual terms, not to exceed fair and reasonable cost.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 108A‑55; 42 C.F.R. 447, Subpart C;

Eff. February 1, 1995.