Medicaid Reimbursement

Page Updated: Oct. 10, 2024

CHA Advocacy Principle: Maximize reimbursement through the annual state budget process and Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) program.

What Has Been Completed:

• • Origin: Hospitals receive reimbursement from base rates based on services provided to Medicaid enrollees. Additionally, hospitals receive supplemental payments through the Hospital Provider Fee. Within those categories, there are two pertinent areas to watch for ongoing advocacy in 2023:
    • Inpatient Base Rates: In February 2024, CMS approved HCPF revised inpatient hospitals base rate methodology which went into effect July 1, 2024.
    • Hospital Provider Fee: In addition to base rates, hospitals receive supplemental payments through the Hospital Provider Fee, a program governed by the CHASE Board. 
  • Background: CHA engages in significant advocacy related to HCPF’s reimbursement in coordination with member hospital CFOs.
  • Hospital Provider Fee: At the June 23, 2024 CHASE board meeting, HCPF presented the 2023-24 hospital provider fee calculation. Following strong advocacy from CHA and our members, during the meeting, HCPF presented a recommendation to establish the Medicaid upper payment limit (UPL) at 99.25% for the 2023-24 CHASE model, apply 99.25% retroactively to the 2022-23 CHASE model, and indicate their intent to set the UPL at 99.25% in future years.  

Outstanding Items: 

• • Hospital Provider Fee: At the Oct. 22 CHASE board meeting, HCPF will present updated 2022-23 and 2023-24 CHASE models to establish the Medicaid upper payment limit (UPL) at 99.25% recommendation approved at the June CHASE board meeting.  
  • Inpatient Base Rates: HCPF has delayed the implementation of APR-DRG version 40 until 10/1/2024. The updated version 40 weights and hospital impacts, calculated by HCPF, are posted  here. This payment change still needs to be approved by CMS. This postponement will allow additional time to obtain SPA approval and reduce administrative burdens associated with reprocessing claims. Additionally, HCPF has received requests to make changes to the base rate add-on methodology for GME and payer mix. HCPF has scheduled an Oct. 11 stakeholder meeting to discuss feedback. Meeting details can be found here: Stakeholder Meeting.  
  • Outpatient Rates: HCPF plans to update to the most recent EAPG version effective July 1, 2025. This change and the implementation timelines will be discussed at future hospital stakeholder meetings. Meeting details can be found here: Stakeholder Meeting. 

Resources: 

• • Hospital Provider Fee: HCPF CHASE Information for Providers
  • Inpatient Base Rates
  • CHA UPL sign on letter
  • CHA HCPF response letter
  • CHA UPL recommendations
  • CHA comments on the proposed CHASE 2023-24 model email
  • CHA Polis Administration long form
  • CHA Polis proposals summary
  •  

Meetings/Dates of Note:

• • N/A

CHA Staff Contact: Ryan Westrom, CHA senior director of finance, [email protected]