Proposed APR-DRG Grouper 38 Implementation for Reimbursement of Medicaid Hospital Inpatient Services

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Hearing. The Health and Human Services Commission (HHSC) conducted a public hearing to receive comments regarding the proposed APR-DRG Grouper 38 implementation on September 28, 2021, at 10:00 am. HHSC will consider all concerns expressed at the hearing prior to final approval. This public hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires a public hearing on proposed payment adjustments. Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted both in-person and as an online event. Background. HHSC uses the 3M Grouper software to assign DRGs and severity of illness (SOI) levels to claims. HHSC conducted an analysis on the 3M Grouper 38 logic changes by running the most current and complete claims and encounters dataset through Grouper versions 36 and 38. APR-DRG Grouper 38 statistical calculations were completed to determine relative weights, mean length of stay and day thresholds. Claims and encounters w

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