OAR 410-125-0090: Inpatient Rate Calculations — Type A, Type B, and Critical Access Oregon Hospitals

(1) The Office of Rural Health designates Type A, Type B, and Critical Access Oregon Hospitals. (2) Reimbursement to Type A, Type B, and Critical Access Oregon Hospitals for covered inpatient services is as follows: (a) Interim reimbursement for inpatient covered services is the hospital specific cost to charge percentage from the last finalized cost settlement, except laboratory and radiology services are based on the Division of Medical Assistance Program’s (Division) fee schedule; (b) Retrospective cost-based reimbursement is made during the annual cost settlement period for all covered inpatient services, except for the hospitals that have payment contracts with managed care plans; (c) Cost-based reimbursement; is derived from the most recent audited Medicare Cost Report and adjusted to reflect the Medicaid mix of services. (3) Type A, Type B, and Critical Access Hospitals are: (a) Eligible for disproportionate share reimbursements, but must meet the same criteria as other hospitals. See OAR 410-125-0150 for eligibility criteria and reimbursement calculation; (b) Type A, Type B, and Critical Access Hospitals do not receive cost outlier, capital, or medical education payments. (4) Notwithstanding subsection (2) of this rule, this subsection becomes effective for dates of service on and after January 1, 2006, but will not be operative as the basis for payments until Division determines all necessary federal approvals have been obtained. Reimbursement to Type A, Type B, and Critical Access Oregon Hospitals for covered inpatient services is as follows: (a) Interim reimbursement for inpatient-covered services is the hospital specific cost to charge percentage from the last finalized cost settlement, except clinical laboratory services which are based on the Division fee schedule; (b) Retrospective cost-based reimbursement is made for all fee-for-service covered inpatient services during the annual cost settlement period; (c) Cost-based reimbursement is derived from the most recent audited Medicare Cost Report and adjusted to reflect the Medicaid mix of services.