Reimbursement

Covered outpatient department services provided by REHs will receive an additional 5% payment for each service. Beneficiaries will not be charged coinsurance on the additional 5% payment. Additionally, REHs will receive a monthly additional facility payment set by the Centers for Medicare and Medicaid Services.

The Michigan Department of Health and Human Services (MDHHS) recently released a final policy to establish Medicaid reimbursement for rural emergency hospitals (REHs) effective Jan. 1, 2023. The MDHHS reimburses REHs based on the existing outpatient prospective payment system (OPPS) methodology. Critical access hospitals (CAHs) that convert will continue to be paid using the enhanced OPPS reduction factor, while non-CAHs will continue to be paid using their existing OPPS reduction factor. REHs must update their enrollment and subspecialty with the MDHHS through the Community Health Automated Medicaid Processing System (CHAMPS) provider enrollment system within 35 days of any change. Hospitals that convert to REHs must end date their inpatient specialty.

• CY 2026 Medicare Hospital OPPS Final Rule

Questions? Contact

Amanda Saint Martin

Hospital Programs Manager

amanda.saintmartin@affiliate.msu.edu