<html> <head> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <style> <!-- --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div> <p align=center><b>CHAPTER 67:16:03</b></p> <p align=center><b>&nbsp;</b></p> <p align=center><b>HOSPITAL SERVICES</b></p> <p>Section</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:01">67:16:03:01</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Definitions.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:01.01">67:16:03:01.01</a>&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:01.02">67:16:03:01.02</a>&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:01.03">67:16:03:01.03</a>&nbsp; Determination of emergency hospital care.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:02">67:16:03:02</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Inpatient hospital services covered.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:02.01">67:16:03:02.01</a>&nbsp; Inpatient hospital services requiring prior authorization.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:03">67:16:03:03</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Outpatient hospital services covered.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:04">67:16:03:04</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Inpatient hospital services not covered.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:05">67:16:03:05</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06">67:16:03:06</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Basis of reimbursement -- Inpatient services -- Hospitals with more than 30 Medicaid discharges.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.01">67:16:03:06.01</a>&nbsp; Basis of reimbursement -- Outpatient services other than outpatient laboratory and outpatient surgical procedures.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.02">67:16:03:06.02</a>&nbsp; Certain in-state hospitals, hospital units, and procedures exempt from DRG basis of reimbursement.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.03">67:16:03:06.03</a>&nbsp; Basis of reimbursement -- Inpatient services -- Hospitals with less than 30 Medicaid discharges.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.04">67:16:03:06.04</a>&nbsp; Basis of reimbursement -- Inpatient services -- Out-of-state hospitals.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.05">67:16:03:06.05</a>&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.06">67:16:03:06.06</a>&nbsp; Reimbursement for in-state DRG-exempt hospitals and units.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.07">67:16:03:06.07</a>&nbsp; Reimbursement of outpatient laboratory services.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.08">67:16:03:06.08</a>&nbsp; Payment for above-average, access-critical and above-average, at-risk hospitals.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.09">67:16:03:06.09</a>&nbsp; Disproportionate share hospitals.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.10">67:16:03:06.10</a>&nbsp; Classification of hospitals providing certain outpatient surgical procedures.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.11">67:16:03:06.11</a>&nbsp; Basis of reimbursement -- Outpatient surgical procedures covered under subdivision <a href="DisplayRule.aspx?Rule=67:16:03:03">67:16:03:03</a>(10).</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.12">67:16:03:06.12</a>&nbsp; Services included in reimbursement rate for outpatient surgical procedures covered under chapter 67:16:28.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.13">67:16:03:06.13</a>&nbsp; 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 <a href="DisplayRule.aspx?Rule=67:16:03">67:16:03</a>.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.14">67:16:03:06.14</a>&nbsp; Payment groups for outpatient hospital surgical procedures covered under chapter 67:16:28.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.15">67:16:03:06.15</a>&nbsp; Rate of payment -- Medicare crossover claims for certain inpatient hospital services.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.16">67:16:03:06.16</a>&nbsp; Rate of reimbursement if individual subject to care management remains in psychiatric unit beyond established discharge date.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.17">67:16:03:06.17</a>&nbsp; Basis of reimbursement  Inpatient services  Claims containing revenue code 275 or 278.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:06.18">67:16:03:06.18</a>&nbsp; Basis of reimbursement -- OPPS.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:07">67:16:03:07</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Payment of hospital services.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:07.01">67:16:03:07.01</a>&nbsp; Maximum rate of payment -- Transfers between DRGreimbursed hospital unit and DRG-exempt intensive care nursery unit in same hospital.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:07.02">67:16:03:07.02</a>&nbsp; Maximum rate of payment -- Patient transfer not medically necessary.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:08">67:16:03:08</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:09">67:16:03:09</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:10">67:16:03:10</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Utilization review.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:11">67:16:03:11</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Inpatient psychiatric hospital services.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:12">67:16:03:12</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Transferred.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:13">67:16:03:13</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:14">67:16:03:14</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Claim requirements.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:14.01">67:16:03:14.01</a>&nbsp; Billing requirements.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:14.02">67:16:03:14.02</a>&nbsp; Claim requirements for individuals subject to managed care who remain in psychiatric unit beyond established discharge date.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:15">67:16:03:15</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Application of other chapters.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:0A">Appendix A</a>&nbsp; List of Diagnosis-Related Groups (DRGs), repealed, 30 SDR 26, effective September 3, 2003.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:0B">Appendix B</a>&nbsp; List of Outpatient Laboratory Services, repealed, 30 SDR 26, effective September 3, 2003.</p> <p><a href="DisplayRule.aspx?Rule=67:16:03:0C">Appendix C</a>&nbsp; List of Inpatient Services Requiring Prior Authorization, repealed, 42 SDR 51,</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;effective October 13, 2015.</p> </div> </body> </html>