Wash. Admin. Code § 296-23A-0200
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 |
Wash. Admin. Code § 296-23A-0200
Statutory Authority: RCW 51.04.030 and 51.12.330. 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. 00-06-027, § 296-23A-0200, filed 2/24/00, effective 3/26/00; 97-06-066, § 296-23A-0200, filed 2/28/97, effective 4/1/97.