ARM 37.86.2905. INPATIENT HOSPITAL SERVICES, GENERAL REIMBURSEMENT

(1) Except as provided in (2), which is applicable to exempt hospitals, preferred out-of-state hospitals, critical access hospitals (CAH), and inpatient hospital service providers, including inpatient rehabilitation services and services in a setting that is identified by the department as a distinct rehabilitation unit, will be reimbursed under the DRG prospective payment system described in ARM 37.86.2907, 37.86.2912, 37.86.2914, 37.86.2916, 37.86.2918, 37.86.2920, and 37.86.2924. (2) Exempt hospital, preferred out-of-state hospitals, and CAH interim reimbursement is based on a hospital specific Medicaid inpatient cost to charge ratio, not to exceed 100%. Exempt hospitals, preferred out-of-state hospitals, and CAHs will be reimbursed their allowable costs as determined according to ARM 37.86.2803. (3) Preferred out-of-state hospitals must sign individual agreements with the department agreeing to reimbursement requirements under ARM 37.86.2947 and prior authorization requirements under ARM 37.86.2801. (a) Preferred out-of-state hospitals must agree to all department rules applicable to inpatient hospital providers. (4) Except as otherwise specified in these rules, facilities reimbursed under the DRG prospective payment system may be reimbursed, in addition to the prospective DRG rate, for the following: (a) capital-related costs as set forth in ARM 37.86.2912; (b) medical education costs as set forth in ARM 37.86.2914; (c) cost outliers as set forth in ARM 37.86.2916; (d) readmissions and transfers, as set forth in ARM 37.86.2918; (e) hospital residents, as set forth in ARM 37.86.2920; (f) disproportionate share hospital payments as provided in ARM 37.86.2925; (g) certified registered nurse anesthetist costs as provided in ARM 37.86.2924; (h) qualified rate adjustor payments, as set forth in ARM 37.86.2910; and (i) hospital reimbursement adjustor payments as provided in ARM 37.86.2928.