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PA Bulletin, Doc. No. 16-1363



Changes to the All Patient Refined-Diagnosis Related Groups Classification System

[46 Pa.B. 4896]
[Saturday, August 6, 2016]

 The Department of Human Services (Department) is providing final notice of its change in the relative values used for the fee-for-service payment methodology for inpatient acute care services. Effective for dates of discharge on or after October 1, 2015, the Department now uses National relative values for the All Patient Refined-Diagnosis Related Groups (APR-DRG) instead of the New York Medicaid APR-DRG relative values. When the Department initially adopted the APR-DRG patient classification system, the National relative values were not being used by any payer. Since that time, the National relative values have been upgraded and better represent a broader approach to health care delivery.

 The Department published notice of its intent to change the relative values at 45 Pa.B. 5883 (September 26, 2015) and received one comment during the 30-day public comment period. The commenter requested the Department adjust the base payment rates for facilities that serve the highest volumes of Medical Assistance (MA) covered beneficiaries to ensure no loss in reimbursement. Base rates are determined by specific facility costs and characteristics, which include consideration of a facility's MA volume. In addition, any change to base rates is outside the scope of the change to relative rates announced in the notice of intent and would need to be separately announced. Additionally, this adjustment in relative weights affects all acute care general hospitals and is not targeted towards particular facilities. Therefore, the Department is not considering the revision of acute care hospital specific base rates at this time.

Fiscal Impact

 There is no fiscal impact as a result of the change to the APR-DRG classification system.


Fiscal Note: 14-NOT-1052. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 16-1363. Filed for public inspection August 5, 2016, 9:00 a.m.]

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