DRG update for SoonerCare delayed

Posted on: 10/25/17


The Oklahoma Health Care Authority (OHCA) informed hospitals today that its annual update to Medicaid inpatient payment rates will be delayed.

Each year, OHCA analyzes SoonerCare claims classified by Diagnosis Related Groups (DRGs) along with Medicare cost report information to adjust the weight, and therefore the SoonerCare payment amount, assigned to each DRG. This process also updates the base rates to which DRG weights are applied.

SoonerCare Provider Reimbursement Notice 2017-08, issued Oct. 25, 2017, said OHCA intended these changes to be effective Oct. 1, 2017, but the implementation has been postponed for continued analysis. OHCA now plans to update their DRG weights and base rates effective Jan. 1, 2018. Until then, OHCA will continue to use the Medicare Grouper MS-DRG Version 34.

This delay is unrelated to any potential rate cuts the agency may be forced to make because of reductions in legislative appropriations. (Rick Snyder)

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