Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 46 - RATES FOR HOSPITAL SERVICES › Section 471-46-003 - PAYMENT FOR PEER GROUPS 1, 2, AND 3 METRO ACUTE, OTHER URBAN ACUTE, AND RURAL ACUTE

Current through June 17, 2024
Payments for acute care services are made on a prospective per
	 discharge basis, except hospitals certified as a critical access hospital. For
	 inpatient services that are classified into a diagnosis related group, the
	 total per discharge payment is the sum of the operating cost payment amount;
	 the capital-related cost payment; and when applicable direct medical education
	 cost payment; indirect medical education cost payment; and a cost outlier
	 payment. For inpatient services that are classified into a transplant diagnosis
	 related group, the total per discharge payment is the sum of the cost-to-charge
	 ratio payment amount; and when applicable direct medical education cost
	 payment.
003.01
DETERMINATION OF OPERATING COST PAYMENT AMOUNT.
The
  hospital diagnosis related group operating cost payment amount for discharges
  that are classified into a diagnosis related group is calculated by multiplying
  the peer group base payment amount by the applicable national relative weight.
003.01(A)
CALCULATION OF THE
  APR-DIAGNOSIS RELATED GROUP WEIGHTS.
For dates of service on or
  after July 1, 2014, the Department will use the All-Patient Refined Diagnosis
  Related Groups classifications. The National Weights published by 3M will be
  applied to the all patient refined-diagnosis related groups. The National
  Weights are calculated using the nationwide inpatient sample released by the
  healthcare cost and utilization project. The Department will annually update
  the all patient refined-diagnosis related group grouper and national relative
  weights with the most current available version.
003.01(B)
CALCULATION OF NEBRASKA
  PEER GROUP BASE PAYMENT AMOUNTS.
Peer group base payment amounts
  are used to calculate payments for discharges with a diagnosis related group.
  Peer group base payment amounts effective July 1, 2016, are calculated for peer
  group 1, 2 and 3 hospitals based on the peer group base payment amounts
  effective during state fiscal year 2011, adjusted for budget neutrality,
  calculated as follows: peer group 1 base payment amounts, excluding children's
  hospitals: multiply the state fiscal year 2011 peer group 1 base payment amount
  of $4, 397.00 by the diagnosis related group budget neutrality factor.
  Children's hospital peer group 1 base payment amounts: multiply the state
  fiscal year 2011 children's hospital peer group 1 base payment amount of $5,
  278.00 by the diagnosis related group budget neutrality factor. Peer group 2
  base payment amounts: multiply the state fiscal year 2011 peer group 2 base
  payment amount of $4, 270.00 by the diagnosis related group budget neutrality
  factor. Peer group 3 base payment amounts: multiply the state fiscal year 2011
  peer group 3 base payment amount of $4, 044.00 by the diagnosis related group
  budget neutrality factor. State fiscal year 2007 Nebraska peer group base
  payment amounts are described in this chapter. Peer group base payment amounts
  excluding the 0.5% increase for the rate period beginning October 1, 2009 and
  ending June 30, 2010, will be increased by.5% for the rate period beginning
  July 1, 2010. The peer group base payment amount is subject to annual
  adjustment as specified by the Department.