34 Pa. Code § 127.110 - Inpatient acute care providers-generally
(a) Payments to providers of inpatient acute
care hospital services shall be based on the sum of the following:
(1) One hundred thirteen percent of the DRG
payment.
(2) One hundred percent of
payments that are reimbursed on the prospective payment system, as listed in
subsection (b).
(3) One hundred
percent of pass-through costs.
(4)
One hundred percent of applicable cost outliers or 100% of applicable day
outliers.
(b) In
calculating the payment due, the following payments, which are reimbursed on a
prospective payment basis by the Medicare Program, shall be multiplied by 100%:
(1) The prospective portions of
capital-related costs relating to payments to the following:
(i) Fully-prospective hospitals.
(ii) Hold-harmless hospitals reimbursed at
100% of the Federal rate (100% hold harmless).
(iii) Blended hold-harmless
hospitals.
(2) Direct
medical education costs.
(3)
Indirect medical education costs.
(c) In calculating the payment due, the
following costs, which are reimbursed on a cost basis by the Medicare Program,
shall be multiplied by 100%:
(1) The cost
portions of capital-related costs relating to the following:
(i) Blended hold-harmless
hospitals.
(ii) Capital-exceptional
hospitals.
(2)
Paramedical education costs.
(3)
Cost outliers or day outliers.
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