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Inpatient Hospital Payment Method for Mississippi Medicaid

Hospital Inpatient APR-DRG Alert: July 1, 2017 updates

The Division of Medicaid (DOM) previously notified all hospitals that effective for last dates of service on or after July 1, 2017, the following hospital inpatient APR-DRG updates would be implemented:

  • Adopt V.34 of the 3M Health Information Systems Hospital Inpatient APR-DRG Grouper
  • Adopt V.34 of the Health Care Acquired Conditions (HCAC) utility
  • Implement a Low-side Outlier payment reduction policy for low cost non-psychiatric cases
  • Implement a Charge Cap policy
  • Change the neonate policy adjustor from 1.45 to 1.40

DOM will not implement the above-mentioned changes effective July 1, 2017.  Hospitals will be notified of any future updates to the hospital inpatient payment methodology.

Finance Archive

Outpatient Hospital Payment Method for Mississippi Medicaid

Hospital Outpatient Prospective Payment System (OPPS) Date Bundling Update

Hospital Outpatient Prospective Payment Fiscal Year 2016 Update Alert
The Mississippi Division of Medicaid Outpatient Prospective Payment System (OPPS) fee schedule will be updated July 1, 2015 for Medicare Outpatient Addendum B or C changes effective April 1, 2014, as required by the State Plan.

The Mississippi Division of Medicaid will implement is expecting to move forward with OPPS Phase 2 in the near future.

Hospitals will be notified of all information related to these changes and training session dates via e-mail, the DOM website, Late Breaking News, and RA Banner Messages.

Federal Medical Assistance Percentage

Each state runs their own Medicaid program within federal guidelines, jointly funded by state and federal dollars. For Medicaid, the Federal Medical Assistance Percentage (FMAP) is used to calculate the amount of federal matching funds for state medical services expenditures. The Social Security Act requires the Secretary of Health and Human Services to calculate and publish the FMAP annually.

For fiscal year 2018, the FMAP applicable to medical service claims for the Mississippi Medicaid program is 75.65 percent.