GroundRules
12VAC30-70-231: Operating payment for DRG cases
Where this section sits in the code
- Title 12. Health
- Agency 30. Department of Medical Assistance Services
- Chapter 70. Methods and Standards for Establishing Payment Rates; In-Patient Hospital Care
- Part V. Inpatient Hospital Payment System
- Article 2. Prospective (DRG-Based) Payment Methodology
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.
Collected 2026-09-14T04:50:58Z. Source file · JSON