Subpart
1.
Adjusted base year operating cost per admission for
Minnesota and local trade area hospitals.
The department will determine the adjusted base year
operating cost per admission by program and the rehabilitation distinct part
specialty group for each Minnesota and local trade area hospital according to
items A to D.
A. Determine and
classify the operating cost for each admission according to part
9500.1110, subpart
1, items A to E.
B. Determine the operating costs for day
outliers for each admission in item A that is recognized in outlier payments.
For each base year admission that is a day outlier, cut the
operating cost of that admission at the trim point by multiplying the operating
cost of that admission by the ratio of the admission's days of inpatient
hospital services in excess of the trim point, divided by the admission's
length of stay, and then multiply the cut operating cost by each hospital's
elected outlier percentage or 70 percent if an election is not made. When
neonate or burn diagnostic categories are used, the department shall substitute
90 percent for the 70 percent or elected percentage.
C. For each admission, subtract item B from
item A, and for each hospital, add the results within each program and the
rehabilitation distinct part specialty group, and divide this amount by the
number of admissions within each program and the rehabilitation distinct part
specialty group.
D. Adjust item C
for case mix according to subitems (1) to (4).
(1) Multiply the hospital's number of
admissions by program and the rehabilitation distinct part specialty group
within each diagnostic category by the relative value of that diagnostic
category.
(2) Add together each of
the products determined in subitem (1).
(3) Divide the total from subitem (2) by the
number of admissions and round that quotient to five decimal places.
(4) Divide the cost per admission as
determined in item C by the quotient calculated in subitem (3) and round that
amount to whole dollars.
Subp. 2.
Adjusted base year operating
cost per day outlier for Minnesota and local trade area hospitals.
The department will determine the adjusted base year
operating cost per day outlier by program and the rehabilitation distinct part
specialty group for each Minnesota and local trade area hospital according to
items A and B.
A. To determine the
allowable operating cost per day that is recognized in outlier payments, add
the amounts calculated in subpart
1, item B and divide the
total by the total number of days of inpatient hospital services in excess of
the trim point.
B. Adjust item A
for case mix according to subitems (1) to (4).
(1) Multiply the hospital's number of outlier
days by program and the rehabilitation distinct part specialty group within
each diagnostic category by the relative value of that diagnostic
category.
(2) Add the products
determined in subitem (1).
(3)
Divide the total from subitem (2) by the number of hospital outlier
days.
(4) Divide the cost per day
outlier as determined in item A by the quotient calculated in subitem (3) and
round that amount to whole dollars.
Subp. 3.
Out-of-area hospitals.
The department will determine the adjusted base year
operating cost per admission and per day outlier by program for out-of-area
hospitals according to items A to C.
A. Multiply each adjusted base year operating
cost per admission and per day outlier for each Minnesota and local trade area
hospital determined in subparts
1 and
2 by the number of
corresponding admissions or outlier days in that hospital's base
year.
B. Add the products
calculated in item A.
C. Divide the
total from item B by the total admissions or outlier days for all the hospitals
and round that amount to whole dollars.
Subp. 4.
Minnesota metropolitan
statistical area and local trade area hospitals that do not have five or more
medical assistance admissions or five or more day outlier medical assistance
admissions in the base year and low volume local trade area hospitals.
The department will determine the adjusted base year
operating cost per admission or per day outlier by program according to items A
to C.
A. Multiply each adjusted base
year cost per admission and per day outlier for each Minnesota metropolitan
statistical area and local trade area hospital determined in subparts
1 and
2 by the number of
corresponding admissions or outlier days in that hospital's base
year.
B. Add the products
calculated in item A.
C. Divide the
total from item B by the total admissions or outlier days for all Minnesota
metropolitan statistical area and local trade area hospitals and round that
amount to whole dollars.
Subp.
5.
Nonmetropolitan statistical area hospitals that do not
have five or more medical assistance admissions or five or more day outlier
medical assistance admissions in the base year.
The department will determine the adjusted base year
operating cost per admission or per day outlier by program for nonmetropolitan
statistical area hospitals by substituting nonmetropolitan statistical area
hospitals terms and data for the metropolitan statistical area hospitals terms
and data under subpart
4.
Subp. 5a.
Minnesota and local trade
area hospitals that do not have five or more medical assistance rehabilitation
distinct part specialty group admissions or five or more day outlier medical
assistance rehabilitation distinct part specialty group admissions in the base
year.
The department will determine the adjusted base year
operating cost per admission or per day outlier for the rehabilitation distinct
part specialty group for Minnesota and local trade area hospitals by
substituting Minnesota and local trade area hospital terms and data for the
metropolitan statistical area hospital terms and data under subpart
4.
Subp. 6.
Limitation on separate
payment.
Out-of-area hospitals that have a rate established under
subpart
3 may not have certified
registered nurse anesthetists services paid separately from parts
9500.1090 to
9500.1155.