Monday, August 7, 2017

UPDATE: AHCCCS has extended the comment period for the proposed APR-DRG rule to 5:00 p.m. August 14, 2017.

In order to provide hospitals with additional information about the proposed APR-DRG rebase and its projected fiscal impact, AHCCCS has published two exhibits with fiscal impact projections produced by Navigant Consulting. Please find the exhibits along with the proposed APR-DRG rule.

As a result of this additional data, AHCCCS has extended the public comment period for the proposed DRG rulemaking from 5 PM August 8 to 5 PM August 14. Although the public hearing will still be held at 1 PM on August 8, public comments will now be accepted through 5 PM Monday August 14, 2017.

On October 1st, 2014, AHCCCS launched a new inpatient hospital reimbursement methodology utilizing All Patient Refined, Diagnosis-Related Groups or APR-DRGs. The APR-DRG payment methodology is better aligned with the agency’s focus on improved patient care and health outcomes for its members, and incentivizes quality of care.

More than three years have elapsed since initial implementation of APR-DRG. The original DRG reimbursement methodology was developed using Fiscal Year 2011 data from the agency’s tiered per diem system. To assure that DRG reimbursement is based upon timely and relevant information, the rebase will utilize updated claims and encounter data, and rely on data from the DRG system rather than from an alternative and unrelated payment methodology.

AHCCCS has contracted with Navigant Consulting to provide assistance with the rebase. Some tasks associated with this project include:

  • Comparison of actual APR-DRG payments to prior forecasted payments
  • Analyze potential updates to all AHCCCS DRG reimbursement values
  • Recommend an updated version of the APR-DRG grouper
  • Review various reimbursement polices and claims submission guidelines
  • Suggest approaches to value-based reimbursement adjustments

Tentative Timeline

DRG analysis 02/10/2017-04/14/2017
Public meeting late February or early March
Tribal Consultation 04/20/2017
Rulemaking 04/03/2017-06/09/2017
Notice of Proposed Rulemaking 06/12/2017
Comment Period 06/12/2017-07/11/2017
Notice of Final Rulemaking 07/24/2017
Implement new version APR-DRG 01/01/2018
Implement APR-DRG rebase 01/01/2018

Public Presentations

Comments about the APR-DRG Rebase may be submitted to FFSRates@azahcccs.gov