Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT › Subchapter B - MEDICAL FEES AND FEE REVIEW › MEDICAL FEE UPDATES › Section 127.154 - Medical fee updates on and after January 1, 1995-inpatient acute care providers subject to DRGs plus add-on payments

Current through Register Vol. 54, No. 28, July 13, 2024
(a) On and after January 1, 1995, inpatient
					 acute care providers, whose payments under the act are based on DRGs plus
					 add-ons under §§
											127.110-127.116 shall be paid as follows:
					 the amount of payment authorized and based on the DRG shall be frozen on
					 December 31, 1994, and updated annually by the percentage change in the
					 Statewide average weekly wage.
(b)
					 The DRG grouper in effect for Medicare DRG payments as of December 31, 1994,
					 shall remain in effect and be frozen for purposes of determining payments under
					 the act. Additions, deletions or modifications to the ICD-9 codes used to
					 determine the DRG shall be mapped to the appropriate DRG within the frozen
					 grouper.
(c) The relative values of
					 DRGs in effect on December 31, 1994, shall be frozen for purposes of
					 calculating payments under the act. The introduction of modified or new DRGs,
					 on and after January 1, 1995, may not be utilized for purposes of calculating
					 payments under the act.
(d) On and
					 after January 1, 1995, add-on payments based on capital-related costs as set
					 forth in §
											127.112 (relating to inpatient
					 acute care providers-capital-related costs) shall be frozen at the rates in
					 effect on December 31, 1994, and updated annually by the percentage change in
					 the Statewide average weekly wage.
(e) On and after January 1, 1995, add-on
					 payments based on medical education costs as set forth in §
											127.113 (relating to inpatient
					 acute care providers-medical education costs) shall be frozen based on the
					 calculations made using the Medicare cost report and Medicare interim rate
					 notification in effect on December 31, 1994. These frozen rates shall be
					 applied to the updated DRG rates in subsection (a).
(1) Hospitals which lose the right to receive
					 add-on payments based on medical education costs under the Medicare Program on
					 and after January 1, 1995, shall also lose their right to receive these
					 payments under the act as set forth in § 127.113. Commencing with services
					 rendered on or after January 1 of the year succeeding the change in status, the
					 add-on payment that has been computed and included in the Medicare fee cap as
					 frozen on December 31, 1994, shall be eliminated from the calculation of the
					 reimbursement.
(2) Hospitals which
					 gain the right to receive add-on payments based on medical education costs
					 under the Medicare Program on and after January 1, 1995, shall receive payments
					 based on the rates calculated in §
												127.113(c). These
					 payments shall be frozen immediately, and thereafter shall be applied to the
					 updated DRG rates in subsection (a).