Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-70 - Payment for transfers

Current through June, 2024
(a) A hospital
				  inpatient shall be considered "transferred" when the patient has been moved
				  from one acute inpatient facility to another acute inpatient
				  facility.
(b) A hospital which
				  receives a transfer and subsequently discharges that individual shall be
				  considered the discharging hospital. All other hospitals which admitted and
				  subsequently transferred the patient during a single spell of illness shall be
				  considered transferring hospitals.
(c) The service category into which the
				  patient falls at the time of transfer or discharge shall be considered the
				  appropriate service category for purposes of payment to that
				  facility.
(d) If a classification I
				  facility or the freestanding rehabilitation hospital transfers an inpatient to
				  another classification I facility or the freestanding rehabilitation hospital,
				  both facilities shall receive the per diem rates calculated in section
				  17-1739-66.
(e) If a classification
				  I facility or the freestanding rehabilitation hospital transfers an inpatient
				  to a classification II or III facility, the classification I facility shall
				  receive the per diem rate calculated in section 17-1739-66, and the
				  classification II or III facility shall receive the full per diem and ancillary
				  reimbursement rate to which it is entitled under section 17-1739-66.
(f) If a classification II or III facility
				  transfers an inpatient to another acute inpatient facility, payment shall be as
				  follows:
(1) In nonpsychiatric cases where
				  medical necessity requires that the patient remain in the transferring hospital
				  three or more days or that the patient be cared for in the intensive care or
				  coronary care units, the transferring classification II or III facility shall
				  receive the full per diem rate for routine care and the full ancillary
				  discharge rate for the appropriate service category, as calculated in
				  accordance with section 17-1739-66;
(2) For nonpsychiatric cases of less than
				  three days and not involving intensive care, payment to a transferring
				  classification II or III facility shall be the facility-specific per diem rate
				  for routine care and thirty per cent of the ancillary discharge rate for the
				  appropriate service category, as calculated in accordance with section
				  17-1739-66;
(3) For nonpsychiatric
				  services, payment to a discharging classification II or III facility shall be
				  the full prospective payment rates calculated in section 17-1739-66;
(4) For nonpsychiatric services, payment to a
				  discharging classification I facility or the freestanding rehabilitation
				  facility shall be determined by multiplying the number of days of stay in the
				  discharging facility by the per diem calculated in section 17-1739-66;
				  and
(5) For psychiatric services,
				  payment to any transferring or discharging facility shall be determined by
				  multiplying the number of days of stay by the per diem calculated in section
				  17-1739-66.