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)

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