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WAC 296-23A-0480

Which hospitals does the department exclude from diagnosis-related-group (DRG) payments?

The following hospitals are excluded from DRG payments:
Military, Veterans Administration, state psychiatric facilities, health maintenance organizations (HMO), and children's hospitals will be paid their allowed charges.
Department-approved chronic pain management programs will be paid according to department agreement or contract.
Hospitals located outside of Washington will be paid a percent of allowed charges (POAC).
Other hospitals, as determined by the department, may be excluded from DRG reimbursement rates due to concerns about access, case volume or other considerations. These facilities will be paid using the applicable POAC factor and per diem rates.
[Statutory Authority: RCW 51.04.030 and 51.12.330. WSR 06-12-073, § 296-23A-0480, filed 6/6/06, effective 7/7/06. Statutory Authority: RCW 51.04.020, 51.04.030 and 51.36.080. WSR 97-06-066, § 296-23A-0480, filed 2/28/97, effective 4/1/97.]
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