PPS changes to state Medicaid programs

A number of states recently made changes to their Medicaid prospective payment systems, according to an Industry Insight published by Ingenix. These states include:

• Georgia – Switching to the Version 24 CHAMPUS Grouper from Version 16 CHAMPUS DRGs
• Michigan – Effective Jan. 1, 2008, Michigan Medicaid implemented Version 25 of the Medicare DRG Grouper, and applies Michigan-specfic DRG weights.
• New York – Effective Jan. 1, 2008, the New York Department of Health transitioned to using a prospective payment system based on Version 25 of the All-Patient DRGs (AP-DRGs).
• North Carolina – At the start of its fiscal year (Oct. 1, 2007), the North Carolina Division of Medical Assistance (NC DMA) implemented the Medicare Version 24.0 DRG assignment rules. Also, NC DMA will continue to replace MDC 15 with 10 North Carolina-specific neonatal DRGs.
• Ohio – The state added new high trim points and cost outlier thresholds, effective Jan. 1, 2008.

Additional details about these changes can be found in the Industry Insight document link above. If you have questions regarding the prospective payment programs described above, or if you need software to assign appropriate casemix measures and calculate state-specific reimbursement, please contact Ingenix at 1-866-222-1298 or msdrg@ingenix.com.