CHAPTER 67:16:03

HOSPITAL SERVICES

Section

67:16:03:01                                       Definitions.

67:16:03:01.01 and 67:16:03:01.02  Repealed.

67:16:03:01.03                                  Determination of emergency hospital care.

67:16:03:02                                       Inpatient hospital services covered.

67:16:03:02.01                                  Inpatient hospital services requiring prior authorization.

67:16:03:03                                       Outpatient hospital services covered.

67:16:03:04                                       Inpatient hospital services not covered.

67:16:03:05                                       Repealed.

67:16:03:06                                       Basis of reimbursement -- Inpatient services -- Hospitals with more than 30 Medicaid discharges.

67:16:03:06.01                                  Basis of reimbursement -- Outpatient services other than outpatient laboratory and outpatient surgical procedures.

67:16:03:06.02                                  Certain in-state hospitals, hospital units, and procedures exempt from DRG basis of reimbursement.

67:16:03:06.03                                  Basis of reimbursement -- Inpatient services -- Hospitals with less than 30 Medicaid discharges.

67:16:03:06.04                                  Basis of reimbursement -- Inpatient services -- Out-of-state hospitals.

67:16:03:06.05                                  Repealed.

67:16:03:06.06                                  Reimbursement for in-state DRG-exempt hospitals and units.

67:16:03:06.07                                  Reimbursement of outpatient laboratory services.

67:16:03:06.08                                  Payment for above-average, access-critical and above-average, at-risk hospitals.

67:16:03:06.09                                  Disproportionate share hospitals.

67:16:03:06.10                                  Classification of hospitals providing certain outpatient surgical procedures.

67:16:03:06.11                                  Basis of reimbursement -- Outpatient surgical procedures covered under subdivision 67:16:03:03(10).

67:16:03:06.12                                  Services included in reimbursement rate for outpatient surgical procedures covered under chapter 67:16:28.

67:16:03:06.13                                  Items and services not included in reimbursement rate for outpatient surgical services covered under chapter 67:16:28 and paid under the provisions of chapter 67:16:03.

67:16:03:06.14                                  Payment groups for outpatient hospital surgical procedures covered under chapter 67:16:28.

67:16:03:06.15                                  Rate of payment -- Medicare crossover claims for certain inpatient hospital services.

67:16:03:06.16                                  Rate of reimbursement if individual subject to care management remains in psychiatric unit beyond established discharge date.

67:16:03:06.17                                  Basis of reimbursement – Inpatient services – Claims containing revenue code 275 or 278.

67:16:03:07                                       Payment of hospital services.

67:16:03:07.01                                  Maximum rate of payment -- Transfers between DRG‑reimbursed hospital unit and DRG-exempt intensive care nursery unit in same hospital.

67:16:03:07.02                                  Maximum rate of payment -- Patient transfer not medically necessary.

67:16:03:08 and 67:16:03:09            Repealed.

67:16:03:10                                       Utilization review.

67:16:03:11                                       Inpatient psychiatric hospital services.

67:16:03:12                                       Transferred.

67:16:03:13                                       Cost sharing.

67:16:03:14                                       Claim requirements.

67:16:03:14.01                                  Billing requirements.

67:16:03:14.02                                  Claim requirements for individuals subject to managed care who remain in psychiatric unit beyond established discharge date.

67:16:03:15                                       Application of other chapters.

Appendix A  List of Diagnosis-Related Groups (DRGs), repealed, 30 SDR 26, effective September 3, 2003.

Appendix B  List of Outpatient Laboratory Services, repealed, 30 SDR 26, effective September 3, 2003.

Appendix C  List of Inpatient Services Requiring Prior Authorization.