Bermuda Hospitals Board (Hospital Fees) Regulations Laws/Bermuda Hospitals Board... · BERMUDA HOSPITALS…

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FA E RN

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BERMUDA

BERMUDA HOSPITALS BOARD (HOSPITAL FEES) REGULATIONS 2018

BR 110 / 2018

The Bermuda Hospitals Board, in exercise of the power conferred upon it bysection 13 of the Bermuda Hospitals Board Act 1970 and with the approval of the Ministerresponsible for health, makes the following Regulations:

CitationThese Regulations may be cited as the Bermuda Hospitals Board (Hospital Fees)

Regulations 2018.

Rates for in-patient treatment of residents in the general hospitalThe fees payable to the Board by a person who is taken to be ordinarily resident

in Bermuda for the purposes of the Health Insurance Act 1970 (in these Regulationsreferred to as a resident) for in-patient treatment at the general hospital are

in respect of any admission to the hospital with a length of stay of 15 daysor less, equal to the amount in Schedule 1 opposite the Diagnosis RelatedGroup to which the patient has been assigned by the attending physician;or

in respect of any admission to the hospital with a length of stay of greaterthan 15 days, equal to the amount referred to in subparagraph (a) plus theproduct obtained by multiplying the number of days of stay at the hospitalgreater than 15 days by the per diem rate listed in Part A of Schedule 2.

Notwithstanding paragraph (1), the fees payable for in-patient treatment at thegeneral hospital to the Board by residents who are long term care patients or patientsrequiring hospice care are equal to the product obtained by multiplying the number of daysof hospital stay by the applicable per diem rate listed in Part A of Schedule 2.

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2 (1)

(a)

(b)

(2)

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BERMUDA HOSPITALS BOARD (HOSPITAL FEES) REGULATIONS 2018

Rates for in-patient treatment of non-residents in the general hospitalIn the case of any person who is not ordinarily resident in Bermuda or who is

deemed not to be so resident for the purposes of the Health Insurance Act 1970 (in theseRegulations referred to as a non-resident), the fees payable to the Board for in-patienttreatment at the general hospital

in respect of any admission to the hospital with a length of stay of 15 daysor less, are equal to the amount in Schedule 1 opposite the DiagnosisRelated Group to which the patient has been assigned by the attendingphysician plus a 100% surcharge based on that amount; or

in respect of any admission to the hospital with a length of stay of greaterthan 15 days, are equal to the amount referred to in subparagraph (a) plusthe product obtained by multiplying the number of days of stay at thehospital greater than 15 days by the per diem rate listed in Part B ofSchedule 2.

Rates where patient readmitted with related diagnosisWhere a resident referred to in regulation 2 or a non-resident referred to in

regulation 3 is readmitted to the general hospital within three days after discharge and isassigned by the attending physician to a Diagnosis Related Group closely related to the oneto which he was assigned before discharge, the fees payable to the Board are calculated asprovided in regulation 2 or 3, whichever is applicable, as if

the length of stay at the hospital for the admission and readmission wereone continuous period, not counting the days between discharge andreadmission; and

the Diagnosis Related Group to which the patient is assigned were the onedetermined by the attending physician after readmission to be the mostappropriate to apply to the entire period referred to in subparagraph (a).

Rates for physician chargesThe fees payable to the Board for in-patient or out-patient treatment of a

resident in the general hospital by a physician provided by the Board are as set out inSchedule 3, which

in Part A, sets out the fees payable for treatment included in standardhealth benefit; and

in Part B, sets out the fees payable (if any) for treatment excluded fromstandard health benefit.

The fees payable to the Board for in-patient or out-patient treatment of a non-resident in the general hospital by a physician provided by the Board are as set out inSchedule 3 plus a 100% surcharge.

3

(a)

(b)

4

(a)

(b)

5 (1)

(a)

(b)

(2)

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BERMUDA HOSPITALS BOARD (HOSPITAL FEES) REGULATIONS 2018

Rates for treatment of residents in the Mid-Atlantic Wellness InstituteThe fees payable to the Board by residents for in-patient treatment at the Mid-

Atlantic Wellness Institute are equal to the product obtained by multiplying the number ofdays of stay at the Institute by the applicable per diem rate listed in Part A of Schedule 2.

The maximum number of days in any calendar year for which the per diem ratemay be charged under paragraph (1) is 40 days.

Rates for treatment of residents in hospicesThe fees payable to the Board for residential hospice care in an establishment under

the charge and management of the Board are equal to the product obtained by multiplyingthe number of days of stay at the hospice by the applicable per diem rate listed in Part A ofSchedule 2.

Rates for in-patient treatment of non-residents in the Mid-Atlantic Wellness InstituteThe fees payable to the Board by non-residents for in-patient treatment at the Mid-

Atlantic Wellness Institute are equal to the product obtained by multiplying the number ofdays of stay at the Institute by the applicable per diem rate listed in Part B of Schedule 2.

Rates for out-patient treatmentThe fees payable to the Board by residents for out-patient treatment at the

general hospital or in an establishment under the charge and management of the Board areas set out in Schedule 4, which

in Part A, sets out the fees payable for treatment included in standardhealth benefit; and

in Part B, sets out the fees payable for treatment excluded from standardhealth benefit.

The fees payable to the Board by non-residents for out-patient treatment at thegeneral hospital or in an establishment under the charge and management of the Board areas set out in Schedule 4 plus a 100% surcharge.

RevocationThe Bermuda Hospitals Board (Hospital Fees) Regulations 2015 are revoked.

6 (1)

(2)

7

8

9 (1)

(a)

(b)

(2)

10

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BERMUDA HOSPITALS BOARD (HOSPITAL FEES) REGULATIONS 2018

SCHEDULE 1

(Regulations 2, 3 and 4)

IN-PATIENT TREATMENT CHARGE BY DIAGNOSIS RELATED GROUP (DRG)

DRG CDM Code DRG Title $3 9500034 ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE,

MOUTH & NECK W MAJ O.R. 124,3414 9500042 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH &

NECK W/O MAJ O.R. 78,07311 9500117 TRACHEOSTOMY FOR FACE,MOUTH & NECK

DIAGNOSES W MCC 34,70412 9500125 TRACHEOSTOMY FOR FACE,MOUTH & NECK

DIAGNOSES W CC 24,85913 9500133 TRACHEOSTOMY FOR FACE,MOUTH & NECK

DIAGNOSES W/O CC/MCC 16,99420 9500208 INTRACRANIAL VASCULAR PROCEDURES W PDX

HEMORRHAGE W MCC 70,54421 9500216 INTRACRANIAL VASCULAR PROCEDURES W PDX

HEMORRHAGE W CC 53,16922 9500224 INTRACRANIAL VASCULAR PROCEDURES W PDX

HEMORRHAGE W/O CC/MCC 40,33423 9500232 CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE

CNS PDX W MCC OR CHEMOTHERAPY IMPLANT OREPILEPSY W NEUROSTIMULATOR 38,767

24 9500240 CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNSPDX W/O MCC 27,031

25 9500257 CRANIOTOMY & ENDOVASCULAR INTRACRANIALPROCEDURES W MCC 30,382

26 9500265 CRANIOTOMY & ENDOVASCULAR INTRACRANIALPROCEDURES W CC 21,145

27 9500273 CRANIOTOMY & ENDOVASCULAR INTRACRANIALPROCEDURES W/O CC/MCC 16,696

28 9500281 SPINAL PROCEDURES W MCC 39,21629 9500299 SPINAL PROCEDURES W CC OR SPINAL

NEUROSTIMULATORS 23,09630 9500307 SPINAL PROCEDURES W/O CC/MCC 15,05031 9500315 VENTRICULAR SHUNT PROCEDURES W MCC 28,74332 9500323 VENTRICULAR SHUNT PROCEDURES W CC 15,01033 9500331 VENTRICULAR SHUNT PROCEDURES W/O CC/MCC 11,98834 9500349 CAROTID ARTERY STENT PROCEDURE W MCC 28,16235 9500356 CAROTID ARTERY STENT PROCEDURE W CC 15,71736 9500364 CAROTID ARTERY STENT PROCEDURE W/O CC/MCC 12,44237 9500372 EXTRACRANIAL PROCEDURES W MCC 22,357

4

BERMUDA HOSPITALS BOARD (HOSPITAL FEES) REGULATIONS 2018

DRG CDM Code DRG Title $38 9500380 EXTRACRANIAL PROCEDURES W CC 11,06039 9500398 EXTRACRANIAL PROCEDURES W/O CC/MCC 7,85740 9500406 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W

MCC 26,86441 9500414 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W

CC OR PERIPH NEUROSTIM 16,44642 9500422 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/

O CC/MCC 13,47952 9500521 SPINAL DISORDERS & INJURIES W CC/MCC 10,64753 9500539 SPINAL DISORDERS & INJURIES W/O CC/MCC 6,58454 9500547 NERVOUS SYSTEM NEOPLASMS W MCC 9,27755 9500554 NERVOUS SYSTEM NEOPLASMS W/O MCC 7,05156 9500562 DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC 13,50057 9500570 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O

MCC 8,00858 9500588 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC 11,55859 9500596 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC 7,56660 9500604 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/

MCC 5,96061 9500612 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR

TRANSIENT ISCHEMIA W THROMBOLYTIC AGENT WMCC 19,739

62 9500620 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION ORTRANSIENT ISCHEMIA W THROMBOLYTIC AGENT W CC 13,631

63 9500638 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION ORTRANSIENT ISCHEMIA W THROMBOLYTIC AGENT W/OCC/MCC 11,407

64 9500646 INTRACRANIAL HEMORRHAGE OR CEREBRALINFARCTION W MCC 12,477

65 9500653 INTRACRANIAL HEMORRHAGE OR CEREBRALINFARCTION W CC OR TPA IN 24 HRS 7,274