Specifications include, but are not limited to: a) Inpatient Prospective Payment System (IPPS) The Contractor will be responsible for payment modeling and rate setting related to the VT Medicaid IPPS. This includes, but is not limited to, collecting and analyzing claims information, modeling payment scenarios, and advising the State of any updates or changes resulting from Medicare’s IPPS Final Rule. The Contractor will assist the State in updating the hospital-specific cost-to-charge ratios (CCRs), inpatient fixed outlier threshold, outlier payment percentage, inpatient base rates, inpatient psych base rate and additive factors, as well as identifying DRG additions or deletions. All inpatient rates, updates, and related documents are due to the state 6 weeks prior to VT’s annual effective date of October 1st or on an alternative submission due date with prior written approval by the State. b) Outpatient Prospective Payment System (OPPS) The Contractor will be responsible for payment modeling and rate setting related to the VT Medicaid OPPS. This includes, but is not limited to, collecting and analyzing claims information, modeling payment scenarios, and advising the State of any updates or changes resulting from Medicare’s OPPS Final Rule. The Contractor will assist the State in updating the status indicators, APC’s, packaged revenue code list, composite pricing methodology, outpatient fixed outlier threshold, outpatient outlier payment percentages, and the hospital standard discount and adjusters. The Contractor will also supply the State with a memorandum summarizing all updates and changes made to the OPPS methodology. All OPPS rates, updates, and related documents are due to the state 6 weeks prior to VT’s annual effective date of July 1st or on an alternative submission due date with prior written approval by the State.
