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CHAPTER 67:16:03

 

HOSPITAL SERVICES

Section

67:16:03:01       Definitions.

67:16:03:01.01  Repealed.

67:16:03:01.02  Repealed.

67:16:03:01.03  Determination of emergency hospital care.

67:16:03:02       Inpatient hospital services covered.

67:16:03:02.01  Inpatient hospital services requiring prior authorization.

67:16:03:03       Outpatient hospital services covered.

67:16:03:04       Inpatient hospital services not covered.

67:16:03:05       Repealed.

67:16:03:06       Basis of reimbursement -- Inpatient services -- Hospitals with more than 30 Medicaid discharges.

67:16:03:06.01  Basis of reimbursement -- Outpatient services other than outpatient laboratory and outpatient surgical procedures.

67:16:03:06.02  Certain in-state hospitals, hospital units, and procedures exempt from DRG basis of reimbursement.

67:16:03:06.03  Basis of reimbursement -- Inpatient services -- Hospitals with less than 30 Medicaid discharges.

67:16:03:06.04  Basis of reimbursement -- Inpatient services -- Out-of-state hospitals.

67:16:03:06.05  Repealed.

67:16:03:06.06  Reimbursement for in-state DRG-exempt hospitals and units.

67:16:03:06.07  Reimbursement of outpatient laboratory services.

67:16:03:06.08  Payment for above-average, access-critical and above-average, at-risk hospitals.

67:16:03:06.09  Disproportionate share hospitals.

67:16:03:06.10  Classification of hospitals providing certain outpatient surgical procedures.

67:16:03:06.11  Basis of reimbursement -- Outpatient surgical procedures covered under subdivision 67:16:03:03(10).

67:16:03:06.12  Services included in reimbursement rate for outpatient surgical procedures covered under chapter 67:16:28.

67:16:03:06.13  Items and services not included in reimbursement rate for outpatient surgical services covered under chapter 67:16:28 and paid under the provisions of chapter 67:16:03.

67:16:03:06.14  Payment groups for outpatient hospital surgical procedures covered under chapter 67:16:28.

67:16:03:06.15  Rate of payment -- Medicare crossover claims for certain inpatient hospital services.

67:16:03:06.16  Rate of reimbursement if individual subject to care management remains in psychiatric unit beyond established discharge date.

67:16:03:06.17  Basis of reimbursement – Inpatient services – Claims containing revenue code 275 or 278.

67:16:03:06.18  Basis of reimbursement -- OPPS.

67:16:03:07       Payment of hospital services.

67:16:03:07.01  Maximum rate of payment -- Transfers between DRGreimbursed hospital unit and DRG-exempt intensive care nursery unit in same hospital.

67:16:03:07.02  Maximum rate of payment -- Patient transfer not medically necessary.

67:16:03:08       Repealed.

67:16:03:09       Repealed.

67:16:03:10       Utilization review.

67:16:03:11       Inpatient psychiatric hospital services.

67:16:03:12       Transferred.

67:16:03:13       Repealed.

67:16:03:14       Claim requirements.

67:16:03:14.01  Billing requirements.

67:16:03:14.02  Claim requirements for individuals subject to managed care who remain in psychiatric unit beyond established discharge date.

67:16:03:15       Application of other chapters.

Appendix A  List of Diagnosis-Related Groups (DRGs), repealed, 30 SDR 26, effective September 3, 2003.

Appendix B  List of Outpatient Laboratory Services, repealed, 30 SDR 26, effective September 3, 2003.

Appendix C  List of Inpatient Services Requiring Prior Authorization, repealed, 42 SDR 51,

                           effective October 13, 2015.


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