HealthChoice considers inpatient payment changes

Posted On: 10/16/2013


The Employees Group Insurance Division (EGID) of Oklahoma’s Office of Management and Enterprise Services (OMES) met Tuesday, Oct. 15, with a task force of urban and rural hospitals and the OHA. The hospital task force was asked for comments on several changes proposed for HealthChoice inpatient hospital payment rates and methods.

EGID’s short-term objectives are to adjust HealthChoice reimbursement to be within a close range of other Oklahoma commercial payers. Longer term objectives include consideration of quality measurements, medical homes, accountable care organizations, and other innovative approaches to hospital payment.

EGID proposes to:
  • Freeze the base rate paid to rural hospitals, which is higher than the urban rate, eventually ending the rural/urban distinction.
  • Create a two-tiered base rate for urban hospitals, using a higher base rate for certain high-intensity diagnosis related groups (DRGs).
  • For DRGs 793 (full term neonate w/major problems) and 794 (neonate w/other significant problems), reimburse a percentage of billed charges rather than a flat amount: 60 percent for urban hospitals, and 70 percent for rural hospitals.
  • Decrease the marginal cost factor and increase the outlier threshold, significantly reducing outlier payments.
EGID has asked the task force to submit written comments on these proposals, and plans to hold a public hearing on the changes, probably in December. 

EGID’s presentation to the hospital task force on inpatient facility reimbursement is available on OHA’s website (Inpatient Task Force - Oct. 15, 2013.pdf).  Hospitals with questions about the proposals, or an interest in learning how the proposals may affect their facility’s payment, should contact Teresa South, director of network management/provider relations at EGID. OHA will be commenting on the proposals and welcomes input from members.  
(Rick Snyder)

Save the dates for OHA 2022 events

Posted on: 2/18/22


It’s a new year and a new lineup of important events for you and your staff. Don’t miss out on these opportunities to engage in advocacy, education and networking all year long. Mark your calendar now!

OHA Advocacy Day - Tuesday, April 5, Oklahoma History Center. Join us for our annual legislative day. We will begin with a member briefing at 3 p.m., followed by a legislative reception at 5 p.m. Watch for registration materials soon.

OHA-PAC Golf Tournament - Tuesday, June 21, Jimmie Austin Golf Club at OU, Norman. Time and details TBA.

OHA Health Care Leaders Forum - Tuesday, July 19 - Thursday, July 21, Shangri-La Resort, Grand Lake. Watch for registration soon!

OHA Connect 22 - Wednesday, Nov. 9 - Friday, Nov. 11, Oklahoma City Convention Center and Omni Hotel, downtown Oklahoma City. Plan now to attend OHA’s annual conference and exhibit hall. More details to come.

Details on these events and other upcoming education opportunities will be available on the OHA website.