Cal. Code Regs. tit. 22 § 51543

Current through Register 2024 Notice Reg. No. 17, April 26, 2024

Section 51543 - Out-of-State Hospital Inpatient Services Reimbursement

Out-of-state hospital inpatient services which have been certified for payment at the acute level and which are either of an emergency nature or for which prior Medi-Cal authorization has been obtained, shall be reimbursed the current statewide per diem average of contract rates for acute inpatient hospital services provided by California hospitals with at least 300 beds or the out-of-state hospital's actual billed charges, whichever is less. The term, "current," as used in this paragraph means the most recent per diem average as of December 1 of the prior calendar year of the contract rates for California hospitals with at least 300 beds that the California Medical Assistance Commission has reported to the Legislature pursuant to Welfare and Institutions Code Section 14165.9. Therefore, the average per diem contract rate in effect on December 1 in a particular calendar year for California contract hospitals with at least 300 beds shall be the maximum rate paid to out-of-state hospitals for dates of service beginning January 1 of the following calendar year.

Cal. Code Regs. Tit. 22, § 51543

1. New section filed 9-11-87; operative 10-11-87 (Register 87, No. 37).
2. Amendment filed 10-1-92 with Secretary of State by Department of Health Services; operative 10-1-92. Submitted to OAL for printing only pursuant to section 147(c), SB 485, (Chapter 722, Statutes of 1992) (Register 92, No. 40).
3. Certificate of Compliance as to 10-1-92 order transmitted to OAL 1-2-93 and filed 3-12-93 (Register 93, No. 11).
4. Amendment filed 4-21-2009; operative 5-21-2009 pursuant to Government Code section 11343.4 (Register 2009, No. 17).

Note: Authority cited: Section 20, Health and Safety Code; and Sections 14105, 14105.15 and 14124.5, Welfare and Institutions Code. Reference: Sections 14086, 14105 and 14105.15, Welfare and Institutions Code; Chandler Regional Medical Center, et al., v. California Department of Health Services; Diana M. BontÃ¡, et al. and Arizona Burn Center, et al., v. California Department of Health Services; Diana M. BontÃ¡, et al. City and County of San Francisco, Case Nos. CGC-01-324400 and CGS-02-408260.