Division Policy 8.16

SUBJECT

Hospital Per Diem

EFFECTIVE DATE

February 8, 1996

REVIEW DATE

January 18, 2013

EXPIRATION DATE

This policy will be reviewed and updated as needed.

PURPOSE

To provide guidelines regarding hospital or outpatient per diem.

AUTHORITY

FS 413; Rehabilitation Act of 1973, as Amended

POLICY

Division per diem rates are based on those established by the Office of Medicaid Cost Reimbursement Planning and Analyses. These are updated in AWARE.

When the Division authorizes payment for hospital or outpatient per diem, district administrators should ensure that rates and services comply with the following guidelines.

1. Hospital per diem is based on an all-inclusive per diem rate. The hospital per diem fee covers the following hospital services: a) a bed in a semi-private room (2-4 beds per room); b) a private room when available and ordered as a medical necessity by the attending physician; and c) other services and supplies including but not limited to laboratory, radiology, pharmacy, intensive care, recovery room electrocardiograms, electroencephalograms and other inpatient services, supplies. (Blood is not included in the per diem rate.)
2. Payment for these services will include the day of admission but not the day of discharge. However, a client who is admitted and discharged on the same day shall be charged for one day. All claims shall be paid on the basis of the rate in effect on the date of the client’s admission to the hospital.
3. Outpatient per diem may be paid for two days for cataract surgery. The number of days for other types of surgeries should be determined by the eye medical consultant.

Original signed by Joyce Hildreth, Director, October 14, 2009