Medicaid Hospital Reimbursement--Fees

Medicaid Hospital Reimbursement

Fees/Payment

Outpatient Hospital Rates

January 1, 2024
Outpatient Rate Letter
Rate Calculations
Out-of-State and Border Hospital Reimbursement

January 1, 2023
Outpatient Rate Letter
Rate Calculations
Out-of-State and Border Hospital Reimbursement

January 1, 2022
Outpatient Rate Letter
Rate Calculations
Out-of-State and Border Hospital Reimbursement

January 1, 2021
Outpatient Rate Letter
Rate Calculations
Out-of-State and Border Hospital Reimbursement

January 1, 2020
In-State Hospital APC Rate Letter
Out-of-State Hospital Rate Letter
Rate Calculations

January 1, 2019
In-State Hospital APC Rate Letter
Out-of-State Hospital APC Rate Letter
Rate Calculations

January 1, 2018
In-State Hospital APC Rate Letter
Out-of-State Hospital APC Rate Letter
Rate Calculations

January 1, 2017
In-State Hospital APC Rate Letter
Out-of-State Hospital APC Rate Letter
Rate Calculations

July 1, 2016 - DSS issued outpatient rates effective for dates of service on and after July 1, 2016 using the Ambulatory Payment Classification (APC).
In-State Hospital APC Rate Letters
Out-of-State Hospital APC Rate Letter

July 1, 2015 - DSS issued outpatient rates for FY16.
Hospital Outpatient Rate Letters
General Hospital Outpatient Rates
RCC 901 - Outpatient Fee Change

Inpatient Hospital Rates

January 1, 2024
Inpatient Rate Letter
Rate Calculations
Annual Update to Adjustment Factor and APR-DRG Weights
DRG Adjustment Factor by Peer Group CY2024

January 1, 2023
Inpatient Rate Letter
Rate Calculations
Inpatient Adjustment Factor Update
DRG Adjustment Factor by Peer Group
Out-of-State and Border Hospital Reimbursement

January 1, 2022
Inpatient Rate Letter
Rate Calculations
Inpatient Adjustment Factor Update
DRG Adjustment Factor by Peer Group
Out-of-State and Border Hospital Reimbursement

January 1, 2021
Inpatient Rate Letter
Rate Calculations
Inpatient Adjustment Factor Update
DRG Adjustment Factor by Peer Group
Out-of-State and Border Hospital Reimbursement

January 1, 2020
In-State Hospital DRG Rate Letter
Out-of-State Hospital Rate Letter
Rate Calculations

Inpatient Adjustment Factor Update
DRG Adjustment Factor by Peer Group

January 1, 2019
In-State Hospital DRG Rate Letter
Out-of-State Hospital DRG Rate Letter
Rate Calculations

January 1, 2018
In-State Hospital DRG Rate Letter
Out-of-State Hospital DRG Rate Letter
Rate Calculations

January 1, 2017
In-State Hospital DRG Rate Letter
Out-of-State Hospital DRG Rate Letter
Weights and Outlier Thresholds Under APR-DRG V33 and V34 System
Rate Calculations

January 1, 2015 - DSS issued inpatient rates on December 8, 2014 for admissions on or after January 1, 2015. The letters list the APR-DRG base rates as well as per diem rates for behavioral health and rehabilitation.
In-State Inpatient Hospital Rate Letters
Out-of State and Border Psychiatric Hospital Rate Letter
Out-of-State General Acute Care Hospital Rate Letter
Rate Calculations

DRG Payment Calculator All general acute care hospitals, including border and out-of-state, are now reimbursed using the All Patient Refined Diagnosis Related Groups (APR-DRG) methodology. A hospital can estimate its payment for a claim using the DRG payment calculator. The calculator contains detailed instructions regarding the data to be entered, including a link to 3M's site that must be used to calculate the DRG assignment to be entered in the calculator.

Disproportionate Share Hospital (DSH), Supplemental, and Direct Graduate Medical Education (GME) Payments

Organ Acquisition Reimbursement
Rates are for both in- and out-of-state hospitals. Organ acquisition rates are effective for all inpatient claims. Acquisition of the heart, liver, and kidneys will be manually priced based on the submission of RCC 81X. For lung and pancreas acquisition, hospitals must submit most recent Medicare cost reports submitted to CMS. Additional information can be found on Provider Bulletin 2014-79.

	SFY15	SFY16	SFY17	SFY18	SFY19	SFY20	SFY21	SFY22	SFY23	SFY24	SFY25
Kidney	$71,715	$64,324	$70,192	$79,732	$82,289	$91,504	$79,300	$83,588	$83,846	$87,107	$88,129
Heart	$81,352	$96,667	$81,102	$100,487	$87,194	$120,727	$113,634	$109,318	$115,095	$162,517	$208,804
Liver	$86,032	$93,691	$119,107	$115,680	$164,760	$168,347	$135,022	$174,966	$125,730	$139,351	$141,723
Pancreas*	$174,121	$50,913	$7,121	$134,209	TBD	TBD	TBD	TBD	TBD	TBD	TBD
Lung*	TBD	TBD	TBD	TBD	TBD	TBD	TBD	TBD	TBD	TBD	TBD

Payment will be the lower of charges or state-wide average.
*For lung or pancreas acquisition, hospitals must submit most recent Medicare cost report submitted to CMS.