Office of Rate Review (ORR)

The Certificate of Need (CON) program reviews health care projects to make sure they meet community needs, improve care quality, and keep costs under control. We check that new or expanding health facilities and services are necessary and won’t create extra, unneeded costs. Public input is an important part of the process, giving people a chance to share their thoughts before decisions are made.

Each review looks at project plans, data, and building designs for new construction, remodeling, or added services. Every review includes a public comment period, and if requested, a meeting is held for in-person feedback. This helps ensure projects are developed in a way that benefits the community.

SEMT is a voluntary program for publicly owned emergency medical services. It allows them to get extra Medicaid payments to help cover the full cost of transporting patients.

Each year, providers send a cost report to the state. The state uses this report to figure out how much it costs for each transport and compares it to what the provider has already been paid. SEMT covers part of the difference using federal Medicaid funds.

The DRG project is working to change how hospitals are paid for inpatient care. Instead of paying a set amount per day, hospitals will be paid based on the type and amount of care each patient needs.

This project looked at changing how nursing homes are paid. Instead of paying a set amount per day, the goal was to base payments on how much care each patient needs.

After working with partners and getting feedback, the project ended on November 17, 2020.

Medicaid Rate Study

The Alaska Department of Health (DOH) is reviewing how Medicaid pays for health services. This statewide effort looks at current payment methods, compares them to provider costs, and explores options to make the system clearer, more consistent, and better suited to Alaska’s needs. The study focuses on developing data-driven recommendations that DOH can use to plan future rate updates.

Our Goals

The Medicaid Rate Study aims to:

• Support access to quality health care and improve health outcomes while keeping Medicaid financing sustainable.
• Reflect the needs of Alaskans and the costs of delivering care across the state.
• Account for Alaska’s geography and Tribal partnerships.
• Support a stable health care workforce.
• Simplify administration and create a process for regular rate updates.

Phase 1

Phase 1 began in August 2024 and focuses on four key service areas:

1. Behavioral Health
2. Long-Term Services and Supports
3. Federally Qualified Health Centers
4. Medical Transportation

The project includes data analysis, provider cost surveys, and stakeholder engagement to inform recommendations on rate structures and methodologies. These recommendations will guide planning for future rate updates.

Behavioral Health

The Behavioral Health Rate Study Report will be posted here once finalized.

Appendix A: Rate Models will be posted at a later date.

Federally Qualified Health Centers (FQHCs)

The FQHC Rate Study Report will be posted here once finalized.

Long-Term Services and Supports (LTSS)

The LTSS Rate Study Report will be posted here once finalized.

Medical Transportation

The Medical Transportation Rate Study Report will be posted here once finalized.