PDFWAC 296-23A-0240

How does the department define and pay a new hospital?

New hospitals are those open for less than one year prior to the implementation of the department's most recent hospital payment rates. The department will pay new hospitals according to the following table:
Hospital Type or Location
What Diagnosis Related Group (DRG) base price applies?
What Per Diem Payment Rates Apply?
What percent of allowed charges (POAC) factor applies?
Military, Veterans Administration, State Psychiatric, Health Maintenance Organization, Children’s,
Exempt
Exempt
Paid 100% of allowed charges
Chronic Pain Management Program
Exempt, paid per department agreement
Exempt, paid per department agreement
Exempt, Paid per department agreement
Other Washington Hospital
Weighted median case-mix adjusted average cost per case for Washington DRG hospitals, except major teaching hospitals
Washington statewide average per diem rates
Washington statewide average POAC
A new hospital will be paid using its hospital-specific POAC within three years of receiving a provider account number(s) from the department.
[Statutory Authority: RCW 51.04.030 and 51.12.330. WSR 06-12-073, § 296-23A-0240, filed 6/6/06, effective 7/7/06. Statutory Authority: RCW 51.04.020, 51.04.030, 51.36.080. WSR 00-06-027, § 296-23A-0240, filed 2/24/00, effective 3/26/00; WSR 97-06-066, § 296-23A-0240, filed 2/28/97, effective 4/1/97.]