471 NAC 46-013. OUT-OF-STATE HOSPITAL RATES

013. OUT-OF-STATE HOSPITAL RATES. Out-of-state hospitals are paid for hospital inpatient services using the same methods described in this chapter for in-state hospitals, except that out-of-state hospitals do not receive direct medical education (DME) cost payments, indirect medical education (IME) cost payments or graduate medical education payments. Payments for services are determined by assigning out-of-state hospitals to the appropriate Peer Group. (A) Peer Group 1: Metro Acute Care Hospitals, Peer Group 2: Urban Acute Care & Regional Rural Referral Hospitals, Peer Group 3: Rural Acute Care Hospitals, and Peer Group 10: Children’s Hospitals; (i) Operating costs payment amounts are calculated based on the appropriate Peer Group base payment amount; (ii) Capital-related cost payment are made based on the appropriate Peer Group capital per diem rate; (iii) Outpatient rates will be the average of the in-state Peer Group; (iv) Cost-to-charge ratio (CCR) outlier will be the average in-state by Peer Group; and (v) Cost-to-charge ratio (CCR) transplant will be the average in-state by Peer Group; (B) Peer Group 5: Mental Health or Psychiatric Hospitals: tiered rates per diem will be used for all psychiatric services and are the same of the in-state hospitals; (C) Peer Group 6: Physical Rehabilitation Hospitals: payments are made on a prospective per diem for rehabilitation hospitals are based on average of the in-state rehabilitation hospitals per diem rates; (D) Peer Group 7: Critical Access Hospitals (CAH); (i) Acute per diem payment will be the average of in-state hospitals; (ii) Bassinet or nursery per diem will be the average of in-state hospitals; and (iii) Outpatient rates will be the average of in-state critical access hospitals (CAH); (E) Peer Group 8: Rural Emergency Hospitals: outpatient rates will be the average of in-state rural emergency hospitals; and (F) Peer Group 9: Long-Term Acute Care Hospitals (LTACH): payments are made on a prospective per diem for long term acute care hospitals are based on average of the in-state rehabilitation hospitals per diem rates. .