New Medicaid hospital payment rates and grouper weights effective July 1, 2022

June 13, 2022

New Medicaid inpatient and outpatient hospital payment rates will be in effect July 1, 2022, due to the Washington State Health Care Authority’s (HCA) rebasing of its prospective payment methodologies. The changes apply to hospitals that receive Medicaid payment from the Health Care Authority or managed care organizations (MCOs) for inpatient and outpatient services paid under the inpatient All-payer Refined Diagnosis Related Group (APRDRG) and Enhanced Ambulatory Payment Group (EAPG) methodologies, as well as certain services paid on a per diem basis. The rebasing does not impact existing inpatient psychiatric per diem rates. HCA and Milliman, its consultant, met with a hospital workgroup put together by WSHA representing each impacted hospital or system throughout the process. WSHA consultants also reviewed information to ensure the rebasing was done in a budget neutral manner.

HCA has posted the new APRDRG and EAPG weights and provided this information to the Medicaid Managed Care organizations (MCOs).  The new hospital-specific payment rates will be finalized and posted by June 15 and will reflect adjustments for area wage level, medical education costs, and Medicaid Quality Incentive.

The rebasing was necessary as the current grouper versions were no longer going to be supported by 3M. The updated national weights are expected to better reflect current relative differences in costs of providing specific services. The rebasing is designed to be budget neutral, meaning aggregate payments going forward under the new grouper versions, weights and hospital-specific rates are expected to be about the same as they would have been under the existing rates and grouper versions. Individual hospitals may experience differences in overall payment, depending on the hospital’s mix of services and changes to the weights for specific services.  WSHA is preparing a bulletin for hospital finance staff with more information. (Andrew Busz,


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