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(ii) inpatient charges for ancillary services to Medicaid patients, as those charges are determined from the adjusted Medicare cost report;

(9) for purposes of this subsection, if the department determines that a provision in this chapter became effective after the last adjustment under 7 AAC 150.150 and the provision may change the per-day rate by a material amount, the department will apply the provision when the per-day rate is updated to the prospective year by the adjustment factors in 7 AAC 150.150. (c) The department will express outpatient general acute care hospital payment rates not subject to Diagnosis Related Groups (DRG) reimbursement under 7 AAC 150.250 as a percentage of charges calculated as follows:

(1) each outpatient cost-to-charge ratio by cost center from the adjusted Medicare cost report is multiplied by the corresponding Medicaid outpatient charges to calculate the Medicaid outpatient costs by cost center;

(2) the sum of Medicaid outpatient costs by cost center is divided by the sum of Medicaid outpatient charges by cost center to obtain the percentage rate;

(3) the applicable outpatient cost-to-charge percentage may not exceed 100 percent;

(4) under this subsection, the laboratory cost center is not included in the cost centers;

(5) for purposes of this subsection, if the department determines that a provision in this chapter became effective after the last adjustment under 7 AAC 150.150 and the provision may change the outpatient rate by a material amount, the department will apply the provision when the per-day rate established under (b) of this section is updated to the prospective year by the adjustment factors in 7 AAC 150.150. (d) The department will express outpatient general acute care hospital payment rates for hospitals providing inpatient and outpatient services only, and subject to Diagnosis Related Groups (DRG) reimbursement under 7 AAC 150.250, as a percentage of charges, where the outpatient cost-to-charge ratio is calculated in the same manner as set out in (c) of this section. (e) The department will express outpatient general acute care hospital payment rates for hospitals providing inpatient, outpatient, and long-term care services, and subject to Diagnosis Related Groups (DRG) reimbursement under 7 AAC 150.250, as a percentage of charges, where the outpatient cost-to-charge ratio is calculated in the same manner as set out in (c) of this section. (f) The department will determine a rate of payment for a hospital outpatient laboratory