AHCCCS pays hospitals for inpatient and outpatient services to AHCCCS members. Additionally, AHCCCS pays supplemental payments to hospitals for different purposes and activities. A summary of all hospital payments (claims as well as supplemental payments) is available.
Effective with dates of discharge on and after October 1, 2014, AHCCCS reimburses inpatient hospital services using the APR-DRG payment methodology. Read more about the AHCCCS Transition to DRG-based Payment.
Information on the individual supplemental payment programs is provided below:
Critical Access Hospitals (CAHs) are rural community hospitals that meet defined criteria outlined in the Conditions of Participation, 432CFR-485 and subsequent legislative refinements to the program through the BBA, BIPA, and Medicare Modernization Act. The Arizona State Legislature has directed AHCCCS to allocate additional funds appropriated in the annual state budget.
More information about Critical Access payments.
The Rural Hospital Inpatient Fund was established by the Legislature in 2005 in response to a 2002 hospital inpatient study that showed rural hospital inpatient cost structures are higher than urban hospital cost structures for inpatient services. This fund was designed to supplement rural hospital inpatient payments.
More information about Rural Hospital Inpatient Fund payments.
In November 2002, Arizona voters approved Proposition 202, the Indian Gaming and Self-Reliance Act. Among other things, the initiative established the Arizona Benefits Fund, consisting of tribal gaming revenues paid to the State on a quarterly basis. The Benefits Fund is administered by the Department of Gaming. To help offset the readiness and costs of Level I Trauma Centers and the increasing volume in Emergency Departments, a portion of these funds are transferred to AHCCCS for distribution.
More information about Proposition 202 payments.
Deadlines:
Graduate Medical Education (GME) funds are distributed to hospitals that provide training and education for medical school graduates. This training includes internships, residencies and fellowships. GME funds are either designated to cover direct medical education expenses or indirect medical education expenses.
More information about Graduate Medical Education payments.
Deadlines:
Disproportionate Share Hospital (DSH) payments provide financial assistance to hospitals that serve a large number of low-income patients such as people on Medicaid and the uninsured. Medicaid DSH payments are the largest source of federal funding for uncompensated care.
More information about Disproportionate Share Hospital payments.
Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives.
More information about EHR Incentive payments.
