Statutes, codes, and regulations
District Of Columbia Administrative Code
Title 29 - PUBLIC WELFARE
Chapter 29-48 - MEDICAID REIMBURSEMENT FOR INPATIENT HOSPITAL SERVICES
Rule 29-4804 - INPATIENT SERVICES: INDIRECT MEDICAL EDUCATION (IME)

D.C. Mun. Regs. tit. 29, r. 29-4804

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Current through Register Vol. 71, No. 49, December 6, 2024
Rule 29-4804 - INPATIENT SERVICES: INDIRECT MEDICAL EDUCATION (IME)
4804.1

For Medicaid reimbursement of inpatient hospital discharges, the amount of the hospital-specific cost per discharge adjusted for IME shall be added to the District-wide base rate for each in-District general hospital to determine the hospital-specific base rate.

4804.2

The hospital-specific cost per discharge of IME shall be calculated annually as follows:

(a) The hospital-specific cost per discharge adjusted for casemix shall be divided by the IME factor.
(b) For discharges occurring on or after October 1, 2014, the amount calculated in Subsection 4804.2(a) shall be multiplied by a factor of 0.75 to determine the IME payment per discharge for each hospital.
(c) For discharges occurring on or after October 1, 2015, and annually thereafter, the amount calculated in Subsection 4804.2(a) is multiplied by a factor of 0.50 to determine the IME payment per discharge for each hospital.
(d) The amount established pursuant to Subsections 4804.2(b) or (c) shall be subtracted from the average cost per discharge for each hospital before determining the District-wide base rate.

D.C. Mun. Regs. tit. 29, r. 29-4804

Final Rulemaking published at 45 DCR 4141, 4146 (June 26, 1998); as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 2691 (March 26, 2010) [EXPIRED]; as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 6837 (July 10, 2010) [EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 4323, 4327 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012); amended by Final Rulemaking published at 63 DCR 5234 (4/8/2016)
29 DCMR § 4804 is formerly entitled SAdjustment for Outlier Payments".
Authority: The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2001; Supp. 2008)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2001; Supp. 2008)).