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296-23A-0195  <<  296-23A-0200 >>   296-23A-0210

WAC 296-23A-0200

Agency filings affecting this section

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
[Statutory Authority: RCW 51.04.030 and 51.12.330. WSR 06-12-073, § 296-23A-0200, filed 6/6/06, effective 7/7/06. Statutory Authority: RCW 51.04.020, 51.04.030, 51.36.080. WSR 00-06-027, § 296-23A-0200, filed 2/24/00, effective 3/26/00; WSR 97-06-066, § 296-23A-0200, filed 2/28/97, effective 4/1/97.]