Medicaid Reimbursement
Page Updated: April 22, 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 impatient hospitals base rate methodology which will be effective July 1, 2023
- Hospital Provider Fee: In addition to base rates, hospitals receive supplemental payments through the Hospital Provider Fee, a program governed by the CHASE Board.
- Inpatient Base Rates: In February 2024, CMS approved HCPF revised impatient hospitals base rate methodology which will be effective July 1, 2023
- Background: CHA engages in significant advocacy related to HCPF’s reimbursement in coordination with member hospital CFOs.
- Inpatient Base Rates: Over the past two years, HCPF has introduced a new inpatient base rate methodology to determine how hospitals are reimbursed for Medicaid inpatient services. In October and November 2022, HCPF held hospital stakeholder engagement meetings to discuss the final proposed changes to the inpatient base rate methodology.
- Hospital Provider Fee: At the April 23, 2024 CHASE board meeting, HCPF will present the 2023-24 hospital provider fee calculation. CHA has expressed concerns with the current proposed hospital provider fee calculation, see CHA CHASE comments. The proposed CHASE model can be found here.
- 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:
Outstanding Items:
- Hospital Provider Fee: In April, HCPF will present the full CHASE model to the CHASE board including the detailed hospital reimbursement amounts.
- Inpatient Base Rates: HCPF will be updating APR-DRGs to version 40 proposed weights. The updated weights and hospital impacts, calculated by HCPF, are posted here. This payment change still needs to be approved by CMS.
- Outpatient Rates: HCPF plans to explore implementing a new outpatient base rate methodology (similar to the IP process). Timeline is not clear when this will be implemented. Additionally, HCPF is exploring options for changes to how hospitals are reimbursed for outpatient hospital drugs.
Resources:
- Hospital Provider Fee: HCPF CHASE Information for Providers
- Inpatient Base Rates
Meetings/Dates of Note:
- Tuesday, April 23 – CHASE board meeting
- Friday, May 3 – HCPF Hospital Stakeholder Meeting
CHA Staff Contact: Ryan Westrom, CHA senior director of finance, [email protected]