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Hospital reimbursement
This page provides information for hospitals serving Medicaid clients using the Washington State Medicaid Prospective Payment System (PPS fee-for-service).
Rates and program information
Disproportionate Share Hospital (DSH) application
- Application and instructions (updated May 12, 2021)
Medicaid cost report
- Cost report form (updated July 8, 2015)
- Cost report instructions (updated June 27, 2014)
Washington Administrative Code (WAC) information
Interim rates
- January 1, 2021 - present (updated January 26, 2021)
- January 1, 2020 - December 31, 2020 (updated February 21, 2020)
- January 1, 2019 - December 31, 2019 (updated February 4, 2019)
- January 1, 2018 - December 31, 2018 (updated March 5, 2018)
- January 1, 2017 - December 31, 2017 (published December 28, 2016)
- January 1, 2016 - December 31, 2016 (updated June 10, 2016)
- January 1, 2015 - December 31, 2015 (updated March 5, 2015)
Additional information
- HCA standard revenue code to cost center crosswalk (updated August 28, 2014)
- Department of Health - Critical Access Hospitals
Payments
- Low income DSH SFY2020 (updated May 11, 2020)
- Low income DSH SFY2014 (updated March 17, 2015)
- Low income DSH SFY2013 (updated April 9, 2013)
- Low income DSH SFY2012 (updated July 1, 2012)
- Small rural DSH SFY2020 (updated May 11, 2020
- Small rural DSH SFY2014 (updated May 22, 2014)
- Small rural DSH SFY2013 (updated July 14, 2012)
- Small rural DSH SFY2012 (updated July 1, 2012)
Calculations
- Low income DSH SFY2020 (updated May 11, 2020)
- Low income DSH SFY2014 (updated March 17, 2015)
- Low income DSH SFY2013 (updated April 9, 2013)
- Low income DSH SFY2012 (updated July 1, 2012)
- Small rural DSH SFY2020 (updated May 11, 2020)
- Small rural DSH SFY2014 (updated June 9, 2014)
- Small rural DSH SFY2013 (updated June 9, 2014)
- Small rural DSH SFY2012 (updated July 1, 2012)
Utilization rates
- Low income DSH SFY2020 (updated May 11, 2020)
- Low income DSH SFY2014 (updated May 22, 2014)
- Low income DSH SFY2013 (updated April 9, 2013)
- Low income DSH SFY2012 (updated July 1, 2012)
Application and instructions (non-CPE)
- DSH application (updated June 2, 2020)
- DSH application troubleshooting (published July 1, 2012)
Reporting data file (DRDF)
- DRDF filing schedule (published July 10, 2014)
- DRDF preparation instructions (published July 1, 2012)
- DRDF certification review process (updated June 11, 2015)
Fee-for-service (FFS) payments
- SFY2021 4th quarter (published June 8, 2021)
- SFY2021 3rd quarter (published March 18, 2021)
- SFY2021 2nd quarter (published December 14, 2020)
- SFY2021 1st quarter (published September 23, 2020)
- SFY2020 4th quarter (published June 12, 2020)
- SFY2020 3rd quarter (updated June 12, 2020)
- SFY2020 2nd quarter (published January 3, 2020)
- SFY2020 1st quarter (published September 23, 2019)
- View all Hospital Safety Net Assessment payments
Critical Access Hospital (CAH) grant payments
- SFY2021 (published April 19, 2021)
- SFY2020 (published March 26, 2020)
- SFY2019 (published February 26, 2019)
- SFY2018 (published March 26, 2018)
- SFY2017 (updated June 14, 2017)
- SFY2016 (published June 21, 2016)
Revised Code of Washington (RCW) information
Inpatient provider rates (includes outpatient ratio of cost to charges (RCC) rates)
- July 1, 2021 (proposed) - current (published June 15, 2021)
- May 1, 2021 - June 30, 2021 (updated April 29, 2021)
- February 1, 2021 - April 30, 2021 (published January 28, 2021)
- December 1, 2020 - January 31, 2021 (updated January 25, 2021)
- November 1, 2020 - November 30, 2020 (published June 9, 2021)
- October 1, 2020 -October 31, 2020 (updated June 9, 2021)
- September 1, 2020 - September 30, 2020 (updated November 5, 2020)
- August 1, 2020 - August 31, 2020 (updated June 9, 2021)
- July 1, 2020 - July 31, 2020 (updated June 9, 2021)
- May 1, 2020 - June 30, 2020 (updated November 5, 2020)
- View all Inpatient Prospective Payment System (IPPS) rates
Diagnosis-related group (DRG) grouper weights and utilization/length of stay information
- April 1, 2018 - current (updated May 15, 2018)
- July 1, 2014 - March 31, 2018 (updated July 16, 2014)
Outlier factors
- July 1, 2014 - current (published July 2, 2014)
Quality Incentive Payments (QIP) hospital scores
- July 1, 2021 - current (published June 14, 2021)
- July 1, 2020 - June 30, 2021 (published June 29, 2020)
- July 1, 2019 - June 30, 2020 (published June 26, 2019)
- July 1, 2018 - June 30, 2019 (published June 19, 2018)
- July 1, 2017 - June 30, 2018 (published June 12, 2017)
- July 1, 2016 - June 30, 2017 (published July 26, 2016)
- August 1, 2015 - June 30, 2016 (published July 20, 2015)
Additional information
Ratio of cost to charges (RCC) rates
Provider conversion factors
- April 1, 2021 - present (updated April 15, 2021)
- January 1, 2021 - March 31, 2021 (published February 18, 2021)
- October 1, 2020 — December 31, 2020 (updated October 16, 2020)
- July 1, 2020 — September 30, 2020 (updated September 28, 2020)
- April 1, 2020 — June 30, 2020 (updated April 3, 2020)
- View all OPPS provider conversion factors
Relative weights
- April 1, 2017 - current (updated March 17, 2017)
- July 1, 2014 - March 31, 2017 (updated June 26, 2014)
Additional information
Payments
- SFY2021 2nd distribution (published May 4, 2021)
- SFY2021 1st distribution (published February 2, 2021)
- SFY2020 5th distribution (published June 7, 2021)
- SFY2020 4th distribution (published November 4, 2020)
- SFY2020 3rd distribution (published August 5, 2020)
- SFY2020 2nd distribution (published May 7, 2020)
- SFY2020 1st distribution (published February 5, 2020)
- View all Trauma payments