Acute Inpatient Facility Reimbursement Changes
Changes in Reimbursement Rates and/or Methodology for HealthChoice and Department of Corrections Contracts
On February 12, 2014, the Employees Group Insurance Division (EGID) of the Office of Management and Enterprises Services held a public hearing regarding changes in reimbursement rates and/or methodology for short-term acute inpatient facilities in accordance with Oklahoma State Statutes, Title 74, Chapter 37, Section 1325 which requires EGID to schedule a hearing 30 days prior to adopting major changes to reimbursement rates or methodologies. The hearing was an open forum where providers had an opportunity to comment on the proposed changes presented by EGID. In addition, providers were given the opportunity to provide written comments by February 21, 2014. Facilities with high utilization participated on a task force prior to the public hearing to provide input into EGID’s proposed reimbursement recommendations. Public comments are included in the transcript of the hearing. Written comments can be obtained by requesting a copy from Network Management at 405-717-8790 / toll-free 1-800-543-6044, by fax to 405-717-8977, by email to EGID.NetworkManagement@omes.ok.gov, or by mail to:
EGID – Network Management
3545 N.W. 58th, Suite 110
Oklahoma City, Ok. 73112
The reimbursement changes will become effective on June 1, 2014.
- Establish a four tier system for short-term acute facilities:
- Tier 1 – Network urban facilities with greater than 300 beds
- Tier 2 – All other urban and non-network facilities
- Tier 3 – Critical access hospitals (CAH), sole community hospitals (SCH), Indian, military and VA facilities
- Tier 4 – All other network rural facilities
- Base rate increase:
- Tier 1 – 13% increase
- Tier 2 – 5% increase
- Annual updates to the base rate:
- Tier 1 and Tier 2 – 100% of Medicare’s full market basket percentage
- Tier 3 – 50% of Medicare’s full market basket percentage
- Tier 4 – Remain frozen
- Base rates will be reevaluated annually
- MS-DRGs 789-794 will be reimbursed at 70% of billed charges for all tiers
- MS-DRG 795 (normal newborn) will receive the allowable fee for each tier
- Tier 1 - $78,228
- Tier 2 - $61,090
- Tier 3 - $48,542
- Tier 4 - $50,586
- Marginal Factor
|Initial phase-in (06/01/14 to 09/30/15)
|Estimated full phase-in (10/01/15)
To access a transcript of the hearing, click here.
To access the presentation made at the hearing, click here.
To access the fee schedule effective 06/01/14, click here.