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SPA 19-0020 All Patient Refined-Diagnosis Related Groups (APR-DRG) Reimbursement has been approved by CMS

State Plan Amendment (SPA) 19-0020 All Patient Refined-Diagnosis Related Groups (APR-DRG) Reimbursement has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid to make the following changes, effective July 1, 2019:  1) The following APR-DRG parameters will be updated for discharges on and after July 1, 2019: The base price will change from $6,585 in State Fiscal Year (SFY) 2019 to $6,574 in SFY 2020, which represents a 2.5% increase over the SFY 2018 base price, and the DRG cost outlier threshold will change from $45,000 to $47,000. 2) Clarify language regarding the issuance of public notices, and 3) Update transplant case rates and post the transplant case rates on the Division of Medicaid’s Fee Schedule webpage.

For more information view the approved SPA pages.