1.0 APPLICABILITY
This policy is mandatory for
reimbursement of services provided by either network or non-network
providers. However, alternative network reimbursement methodologies
are permitted when approved by the Defense Health Agency (DHA) and
specifically included in the network provider agreement.
3.0 POLICY
Payment Rate.
3.1 When it is determined that
a hospital may be paid for care provided to a beneficiary who requires
only SNF care, payment is to be at the SNF Prospective Payment System
(PPS) rate.
3.2 The contractor shall use either
the rate for the SNF which most likely would be used by the beneficiary,
or it may use an average of the rates of comparable, equally accessible
SNF, in order to determine the payment for a beneficiary who is
exempt from the SNF PPS.