Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 7 - STANDARDS FOR PAYMENTS › Section R9-22-712.71 - Final DRG Payment

Current through Register Vol. 30, No. 28, July 12, 2024
A. The final
				DRG payment is the sum of the final DRG base payment, the final DRG outlier
				add-on payment, and the Differential Adjusted Payment.
B. The final DRG base payment is an amount
				equal to the product of the covered day adjusted DRG base payment and a
				hospital-specific factor established to limit the financial impact to
				individual hospitals of the transition from the tiered per diem payment
				methodology and to account for improvements in documentation and coding that
				are expected as a result of the transition.
C. The final DRG outlier add-on payment is an
				amount equal to the product of the covered day adjusted DRG outlier add-on
				payment and a hospital-specific factor established to limit the financial
				impact to individual hospitals of the transition from the tiered per diem
				payment methodology and to account for improvements in documentation and coding
				that are expected as a result of the transition.
D. The factor for each hospital and for each
				federal fiscal year is published as part of the AHCCCS capped fee schedule and
				is available on the AHCCCS administration's website and is on file for public
				inspection at the AHCCCS administration located at 801 E. Jefferson Street,
				Phoenix, Arizona.
E. For inpatient
				services with a date of discharge from October 1, 2022 through September 30,
				2023 (CYE 2023), the Inpatient Differential Adjusted Payment is the sum of the
				final DRG base payment and the final DRG outlier add-on payment multiplied by a
				percentage published on the Administration's public website as part of its fee
				schedule, subsequent to the public notice published no later than September 1,
				2022. A hospital will qualify for an increase if it meets the criteria
				specified below for the applicable hospital subtype.
1. A hospital designated by the Arizona
				Department of Health Services Division of Licensing Services as type: hospital,
				subtype: short-term or children's will qualify for an increase if it meets the
				criteria:
a. By April 1, 2022, a hospital the
				hospital must have submitted a Letter of Intent (LOI) to AHCCCS and the Health
				Information Exchange (HIE), in which it agrees to achieve the following
				milestones by the specified dates, or maintain its participation in the
				milestone activities if they have already been achieved.
i. No later than April 1, 2022, the hospital
				must have in place an active participation agreement with a qualifying HIE
				organization and submit a LOI to AHCCCS and the HIE, in which it agrees to
				achieve the following milestones by the specified dates or maintain its
				participation in the milestone activities if they have already been
				achieved.
ii. No later than May 1,
				2022, or by the hospital's go-live date for new data suppliers, or within 30
				days of initiating the respective COVID-19 related services for current data
				suppliers, the hospital must complete the following COVID-19 related
				milestones, if they are applicable:
(1)
				Related to COVID-19 testing services, submit all COVID-19 lab test codes and
				the associated LOINC codes to qualifying HIE organization to ensure proper
				processing of lab results within the HIE system.
(2) Related to COVID-19 antibody testing
				services, submit all COVID-19 antibody test codes and the associated LOINC
				codes to the qualifying HIE organization to ensure proper processing of lab
				results within the HIE system.
(3)
				Related to COVID-19 immunization services, submit all COVID-19 immunization
				codes and the associated CDC-recognized code sets to the qualifying HIE
				organization to ensure proper processing of immunizations within the HIE
				system.
iii. No later
				than May 1, 2022, hospitals that utilize external reference labs for any lab
				result processing must submit necessary provider authorization forms to the
				qualifying HIE organization, if required by the external reference lab, to have
				all outsourced lab test results flow to the qualifying HIE on their
				behalf.
iv. No later than May 1,
				2022, the hospital must electronically submit the following actual patient
				identifiable information to the production environment of a qualifying HIE
				organization: admission, discharge and transfer information (generally known as
				ADT information), including data from the hospital emergency department if the
				provider has an emergency department; laboratory and radiology information (if
				the provider has these services); transcription; medication information;
				immunization data; and discharge summaries that include, at a minimum,
				discharge orders, discharge instructions, active medications, new
				prescriptions, active problem lists (diagnosis), treatments and procedures
				conducted during the stay, active allergies, and discharge
				destination.
v. No later than
				November 1, 2022, the hospital must approve and authorize a formal statement of
				work (SOW) to initiate and complete a data quality improvement effort, as
				defined by the qualifying HIE organization.
vi. No later than November 1, 2022, the
				hospital must approve and authorize a formal SOW to initiate connectivity to
				and usage of the Arizona Healthcare Directives Registry (AzHDR) operated by the
				qualifying HIE organization.
vii.
				No later than November 1, 2022, the hospital must approve and authorize a
				formal statement of work (SOW) to initiate and complete a data quality
				improvement effort, as defined by the qualifying HIE organization.
viii. No later than January 1, 2023, the
				hospital must complete the data quality profile with a qualifying HIE
				organization, in alignment with the data quality improvement SOW.
ix. No later than May 1, 2023, the hospital
				must complete the final data quality profile with a qualifying HIE
				organization, in alignment with the data quality improvement SOW.
x. Quality Improvement Performance Criteria:
				Hospitals that meet each of the following HIE data quality performance criteria
				will be eligible to receive DAP increases described below.
(1) Demonstrate a 10% improvement from
				baseline measurements in the initial data quality profile, based on October
				2021 data, to the final data quality profile, based on March 2022
				data.
(2) Meet a minimum
				performance standard of at least 60% based on March 2022 data.
(3) If performance meets or exceeds an upper
				threshold of 90% based on March 2022 data, the hospital meets the criteria,
				regardless of the percentage improvement from the baseline
				measurements.
xi. DAP
				HIE Data Quality Standards CYE 2023 Measure Categories: Hospitals that meet the
				standards, as defined in Attachment A of this notice, qualify for a 0.5% DAP
				increase for each category of the five measure categories, for a total
				potential increase of 2.0% if criteria are met for all categories.
(1) Data source and data site information
				must be submitted on all ADT transactions. (0.5%)
(2) Event type must be properly coded on all
				ADT transactions. (0%)
(3) Patient
				class must be properly coded on all appropriate ADT transactions.
				(0%)
(4) Patient demographic
				information must be submitted on all ADT transactions. (0%)
(5) Race must be submitted on all ADT
				transactions. (0.5%)
(6) Ethnicity
				must be submitted on all ADT transactions. (0.5%)
(7) Diagnosis must be submitted on all ADT
				transactions. (0.5%)
(8) Overall
				completeness of the ADT message. (0%)