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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

Certified Public Expenditures (CPE)

Disproportionate Share Hospital (DSH) application

Application and instructions (updated June 2, 2020)

Medicaid cost report

Cost report form (updated July 8, 2015)
Cost report instructions (updated June 27, 2014)

Washington Administrative Code (WAC) information

Critical Access Hospitals (CAH)

Interim rates

January 1, 2020 - present (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

Disproportionate Share Hospital (DSH)

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)

Washington Administrative Code (WAC) information

Hospital Safety Net Assessment (HSNA)

Fee-for-service (FFS) payments

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)
SFY2019 4th quarter(published May 29, 2019)
SFY2019 3rd quarter (published February 26, 2019)
SFY2019 2nd quarter (published December 14, 2018)
SFY2019 1st quarter (published September 19, 2018)
SFY2018 4th quarter (published June 20, 2018)
SFY2018 3rd quarter (published March 26, 2018)
SFY2018 2nd quarter (published December 18, 2017)
SFY2018 1st quarter (published October 2, 2017)
SFY2017 4th quarter (published June 13, 2017)
SFY2017 3rd quarter (published March 28, 2017)
SFY2017 2nd quarter (published December 30, 2016)
SFY2017 1st quarter (published September 30, 2016)
SFY2016 4th quarter (published June 21, 2016)
SFY2016 3rd quarter (published April 25, 2016)
SFY2016 2nd quarter (published December 18, 2015)
SFY2016 1st quarter (updated December 18, 2015)

Critical Access Hospital (CAH) grant payments

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

Chapter 74.60 - Hospital Safety Net Assessment

Inpatient Prospective Payment System (IPPS)

Inpatient provider rates (includes outpatient ratio of cost to charges (RCC) rates)

October 1, 2020 - current (published September 30, 2020)
September 1, 2020 - September 30, 2020 (updated September 18, 2020)
August 1, 2020 - August 31, 2020 (updated September 9, 2020)
July 1, 2020 - July 31, 2020 (updated September 9, 2020)
May 1, 2020 - June 30, 2020 (updated September 9, 2020)
March 1, 2020 - April 30, 2020 (updated September 9, 2020)
February 1, 2020 - February 29, 2020 (updated September 9, 2020)
January 1, 2020 - January 31, 2020 (updated September 9, 2020)
November 1, 2019 - January 31, 2020 (updated September 9, 2020)
October 1, 2019 - October 31, 2019 (updated September 9, 2020)
August 1, 2019 - September 30, 2019 (updated September 9, 2020)
July 1, 2019 - July 31, 2019 (updated September 9, 2020)
May 1, 2019 - June 30, 2019 (updated May 6, 2020)
April 1, 2019 - April 30, 2019 (updated May 6, 2020)
February 1, 2019 - March 31, 2019 (updated May 6, 2019)
January 1, 2019 - January 31, 2019 (published May 6, 2019)
November 1, 2018 - December 31, 2018 (updated May 6, 2019)
October 1, 2018 - October 31, 2018 (updated May 6, 2019)
August 1, 2018 - September 30, 2018 (updated November 1, 2018)
July 1, 2018 - July 31, 2018 (updated August 13, 2018)
May 1, 2018 - June 30, 2018 (updated August 13, 2018)
February 1, 2018 - April 30, 2018 (updated August 13, 2018)
January 1, 2018 - January 31, 2018 (updated March 6, 2018)
November 1, 2017 - December 31, 2017 (updated March 6, 2018)
October 1, 2017 - October 31, 2017 (updated March 6, 2018)
August 1, 2017 - September 30, 2017 (updated August 25, 2017)
July 1, 2017 - July 31, 2017 (updated August 3, 2017)
May 1, 2017 - June 30, 2017 (updated August 3, 2017)
February 1, 2017 - April 30, 2017 (updated August 3, 2017)
January 1, 2017 - January 31, 2017 (updated August 3, 2017)
November 1, 2016 - December 31, 2016 (updated March 31, 2017)
August 1, 2016 - October 31, 2016 (updated March 31, 2017)
July 1, 2016 - July 31, 2016 (updated March 31, 2017)
June 1, 2016 - June 30, 2016 (updated March 31, 2017)
February 1, 2016 - May 31, 2016 (updated March 31, 2017)
January 1, 2016 - January 31, 2016 (updated March 31, 2017)
November 1, 2015 - December 31, 2015 (published October 30, 2015)
August 1, 2015 - October 31, 2015 (updated September 8, 2015)
May 1, 2015 - July 31, 2015 (updated September 16, 2015)
February 1, 2015 - April 30, 2015 (updated July 22, 2015)
January 1, 2015 - January 31, 2015 (published December 31, 2014)

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, 2020 - current (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

Outpatient Prospective Payment System (OPPS)

Ratio of cost to charges (RCC) rates

Inpatient rates (includes outpatient RCC)

Provider conversion factors

October 1, 2020 — present (published September 30, 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

Trauma Program

Payments

SFY2020 3rd distribution (published August 5, 2020)
SFY2020 2nd distribution (published May 7, 2020)
SFY2020 1st distribution (published February 5, 2020)
SFY2019 4th distribution (published November 1, 2019)
SFY2019 3rd distribution (published August 1, 2019)
SFY2019 2nd distribution (published May 6, 2019)
SFY2019 1st distribution (published February 4, 2019)
SFY2018 final distribution (published August 17, 2020)
SFY2018 4th distribution (published November 7, 2018)
SFY2018 3rd distribution (published September 6, 2018)
SFY2018 2nd distribution (published May 1, 2018)
SFY2018 1st distribution (published February 1, 2018)
SFY2017 final distribution (published June 10, 2019)
SFY2017 4th distribution (published November 2, 2017)
SFY2017 3rd distribution (published August 3, 2017)
SFY2017 2nd distribution (published May 3, 2017)
SFY2017 1st distribution (published February 1, 2017)
SFY2016 final distribution (published June 21, 2018)
SFY2016 4th distribution (published November 2, 2016)
SFY2016 3rd distribution (published August 11, 2016)
SFY2016 2nd distribution (published May 2, 2016)
SFY2016 1st distribution (published February 1, 2016)
SFY2015 final distribution (published January 4, 2018)
SFY2015 4th distribution (published November 3, 2015)
SFY2015 3rd distribution (published August 3, 2015)
SFY2015 2nd distribution (published May 4, 2015)
SFY2015 1st distribution (published February 2, 2015)

Additional information

Department of Health - Trauma System

Contact

Office of Hospital Finance