Office of Rate Review (ORR)
Strengthen care access through effective rate setting
Who we are
We help make sure Alaskans can get high-quality medical care by setting fair Medicaid payment rates and supporting smart health care planning across the state.
Our vision: All Alaskans should be able to access quality health care.
What we do
Through our programs and initiatives, we provide Medicaid rate setting services that:
- Help people access care
- Support health programs across Alaska
- Encourage smart and fair development of health care services and facilities
Programs
Certificate of Need (CON)
Certificate of Need (CON)
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.
Supplemental Emergency Medical Transport (SEMT)
Supplemental Emergency Medical Transport (SEMT)
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.
Initiatives
Diagnosis Related Groups (DRG)
Diagnosis Related Groups (DRG)
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.
Skilled Nursing Facility (SNF) Payment
Skilled Nursing Facility (SNF) Payment
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 Review
Medicaid Rate Review
The Alaska Department of Health is reviewing how Medicaid pays for behavioral health services. This project looks at provider costs, gathers input from experts and community members, and uses data to recommend fair and clear payment rates. The goal is to improve access to care, support providers, and ensure Medicaid payments work well for Alaska.
The project began in August 2024 and includes surveys, meetings, and listening sessions through summer 2025. Providers and others who want to get involved can email AKRateStudy_BH@guidehouse.com for more information.