CHA News Article

New State Plan Amendment Proposed for Medi-Cal APR-DRG Program

The Department of Health Care Services (DHCS) has proposed to submit a state plan amendment updating the Medi-Cal reimbursement methodology for year 5 All Patient Refined-Diagnosis Related Group (APR-DRG) payments. The changes would apply to general acute inpatient hospital services provided by private and non-designated public hospitals, out-of-state border hospitals and Medicare-designated critical access hospitals.

The payment changes, detailed in the attached notice, would be effective July 1 and include increases to the high-cost outlier threshold one, non-remote rural base rates and policy adjustor for pediatric service. The proposed changes also include eliminating the high-cost outlier threshold two. Written comments about the proposal must be received by May 26 and should be mailed to John Mendoza, DHCS Safety Net Financing Division, MS 4518, P.O. Box 997436, Sacramento, CA 95899-7436.

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