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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 3 Inpatient Hospital (Medical/Surgical Acute Care Inpatient Facility) : 3.7 Claims Filing and Reimbursement : 3.7.3 Inpatient Reimbursement : 3.7.3.5 Children’s Hospitals

3.7.3.5
Children’s hospitals are reimbursed using the prospective payment methodology based on APR-DRG methodology.
With the exception of designated children’s hospitals, hospitals that are reimbursed by APR-DRG payment methodology receive one SDA rate.
Designated children’s hospitals receive two SDA rates:
One rate for all other services rendered to clients who are 18 years of age and older and all services rendered to clients who are 17 years of age and younger, including obstetric delivery services.

Texas Medicaid & Healthcare Partnership
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