Medicaid News

WSHA Forms Rebasing Task Force

The Washington Health Care Authority plans to significantly change the way it pays for inpatient and outpatient Medicaid hospital services.  WSHA has convened a task force of representatives from high-volume Medicaid and specialty hospitals to provide technical assistance and communication to the state and to Navigant, the state’s consultant for the rebasing project.  The task force met January 16 and February 26, 2013 and will next meet April 10.

Task Force Member Roster 

Other Rebasing Materials and Presentations:

Preliminary draft baseline model summaries for the Washington Medicaid inpatient APR-DRG and outpatient EAPG payment systems.  These baseline models use standardized payment rates adjusted by wage indices, and do not contain additional provider adjustments or service policy adjusters, nor do they include payment adjustments related to medical education.  These baseline models should be considered only as a starting point for discussions related to establishing appropriate funding levels (within budget neutrality parameters) by provider, provider type, service line or other relevant factors.  These baseline models should not be considered HCA’s or Navigant’s recommended approach.

EAPG Definitions Manual Order Agreement Form

The manual is provided by 3M Corporation free of charge to Washington prospective payment hospitals upon receipt of the signed order form. Please ignore the payment information section of the form. The signed form can be scanned and submitted to 3M at

October 2 Navigant presentation

Model components and design decisions

July 15 Navigant presentation

June 12 Navigant presentation

May 30 Navigant presentation

Handout 1: Preliminary APR-DRG Inpatient Baseline Model

Handout 2: Preliminary EAPG Outpatient Baseline Model

Handout 3: APR-DRG Inpatient Baseline Model with Medicare Outlier Factors

April 10 Navigant presentation

February 26 Navigant presentation

February 26 3M Presentation

Draft WSHA Summary of February 26 Meeting

Presentation Slides for January 16 Meeting

WSHA Summary of January 16 Meeting

Standard Outpatient Enhanced Ambulatory Payment Group (EAPGs) Weights

Standard Inpatient All Payer Refined Diagnosis Related Groups (APR-DRG)

December 19, 2012 Webcast 

Disproportionate Share Hospital Audits Web Conference April 17

Intended Audience:  Hospital staff responsible for completing DSH applications and related reports.

On April 17 the Health Care Authority hosted a webinar with representatives of Myers and Stauffer (formerly PHBV Partners and Clifton Gunderson) about the upcoming 2010 Disproportionate Share Hospital (DSH) audits required under federal law. The web conference included findings from previous audits, and discussion of proposed changes to the definition of uninsured used for DSH calculations.

Link to recording

Webinar slides

Medicaid Recovery Audit Contractor

The Health Care Authority has contracted with CGI Federal to be the Medicaid RAC.  The audits are beginning with medical necessity reviews of services by critical access hospitals.  See our webcast  for more information.


ER for Emergencies

Hospitals and physicians across Washington State are working together to implement seven best practices to reduce unnecessary emergency room visits. The goal of the program is to help patients get care in appropriate settings and save health care dollars. Initial results show the campaign is making progress.  See our webpage for more information.


Managed Care Procurement

Effective for services on or after July 1, 2012, the state contracted with five managed care plans to provide coverage for Medicaid, Basic Health, and non-dual blind and disabled enrollees.

WSHA is very concerned that enrollees are being assigned to plans in areas where they do not yet have adequate contracted provider networks.  See WSHA Bulletin.


Link to HCA’s health plan service area and assignment information.


Andrew Busz