HCA to revise rules for inpatient and outpatient Medicaid payment

August 23, 2017

HCA recently announced a preliminary notice of rulemaking regarding changes to inpatient and outpatient Medicaid payment.  Specifically, WSHA requested HCA to update the Outpatient Prospective Payment System’s – Payment limitations language to correct a conflict with the current policy that has resulted in underpayment of outpatient hospital claims by some managed care plans.  WSHA is seeking additional information from HCA on the nature of the other proposed changes to determine whether they are changes to payment policy or corrections to rule language to conform to existing policy.

The Washington Administrative Code sections include:

182-550-3600 – Diagnosis-related group (DRG) payment – Hospital transfer
182-550-3700 – DRG high outliers
182-550-3800 – Rebasing
182-550-3830 – Adjustments to inpatient rates
182-550-7300 – OPPS –  Payment limitations

(Andrew Busz, andrewb@wsha.org)


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