WAC 296-23A-0200. How does the department pay for hospital inpatient services?

The department will pay for hospital inpatient services according to the following table: Hospital Type or Location Do Diagnosis Related Group (DRG) payment methods apply? Do per diem payment methods apply? Do percent of allowed charges (POAC) payment methods apply to hospital inpatient services? Children’s Hospitals No No Yes, paid 100% of allowed charges Chronic Pain Management Program Exempt, paid per department agreement. Exempt, paid per department agreement. Exempt, paid per department agreement. Health Maintenance Organizations No No Yes, paid 100% of allowed charges Military No No Yes, paid 100% of allowed charges Veterans Administration No No Yes, paid 100% of allowed charges State psychiatric facility No No Yes, paid 100% of allowed charges All other Washington hospitals Yes Yes, statewide average per diem rates apply for designated categories: Chemical dependency, psychiatric, rehabilitation, low volume medical, and low volume surgical DRGs Yes, applies to low cost outlier payments and high cost outlier payments above the high cost outlier threshold Hospital Type or Location Do Diagnosis Related Group (DRG) payment methods apply? Do per diem payment methods apply? Do percent of allowed charges (POAC) payment methods apply to hospital inpatient services? Children’s Hospitals No No Yes, paid 100% of allowed charges Chronic Pain Management Program Exempt, paid per department agreement. Exempt, paid per department agreement. Exempt, paid per department agreement. Health Maintenance Organizations No No Yes, paid 100% of allowed charges Military No No Yes, paid 100% of allowed charges Veterans Administration No No Yes, paid 100% of allowed charges State psychiatric facility No No Yes, paid 100% of allowed charges All other Washington hospitals Yes Yes, statewide average per diem rates apply for designated categories: Chemical dependency, psychiatric, rehabilitation, low volume medical, and low volume surgical DRGs Yes, applies to low cost outlier payments and high cost outlier payments above the high cost outlier threshold