{"data":{"id":"us-va/12vac30-70-251","jurisdiction":"us-va","citation":"12VAC30-70-251","heading":"Operating payment for transfer cases","body":"A. The operating payment for transfer cases shall be determined as follows:\n\n1. A transferring hospital shall receive the lesser of (i) a per diem payment equal to the hospital's DRG operating payment for the case, as determined in 12VAC30-70-231, divided by the arithmetic mean length of stay for the DRG into which the case falls times the length of stay for the case at the transferring hospital or (ii) the hospital's full DRG operating payment for the case, as determined in 12VAC30-70-231. The transferring hospital shall be eligible for an outlier operating payment, as specified in 12VAC30-70-261, if applicable criteria are satisfied.\n\n2. The final discharging hospital shall receive the hospital's full DRG operating payment, as determined in 12VAC30-70-231. The final discharging hospital shall be eligible for an outlier operating payment, as specified in 12VAC30-70-261, if applicable criteria are satisfied.\n\nB. Exceptions.\n\n1. Cases falling into DRG 456, 639, or 640 shall not be treated as transfer cases. Effective October 1, 2014, cases falling into DRG 580 and 581 shall not be treated as transfer cases. Both the transferring hospital and the final discharging hospital shall receive the full DRG operating payment.\n\n2. Cases transferred to or from a psychiatric or rehabilitation DPU of a general acute care hospital, a freestanding psychiatric facility licensed as a hospital, or a rehabilitation hospital shall not be treated as transfer cases.","path":["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"],"source_url":"https://law.lis.virginia.gov/admincode/title12/agency30/chapter70/section251/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:50:58Z","sha256":"ae142af5ca62fd805e151d340170adf47f4e9900d546a0a989d9bd394a231c2d","source_id":"us-va-vac","stale":false,"prev":"us-va/12vac30-70-241","next":"us-va/12vac30-70-261"},"notice":"GroundRules: Original legal text. Not legal advice."}