Department details EAPG changes, 340B reimbursement cut and pending CMS reviews
March 09, 2026 | Health Care Policy & Financing, Governor's Cabinet, Organizations, Executive, Colorado
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Sean Basqui, outpatient rates analyst at the Colorado Department of Health Care Policy & Financing, reviewed recent outpatient and coding changes and what hospitals should expect.
Basqui said the department implemented EAPG changes effective July 1, 2025 (including EAPG version 3.18) and noted a 1.6% base rate increase that was later rolled back per an executive order on Oct. 1, 2025. He told stakeholders the department reduced the 340B drug rate reimbursement "from 80% down to 65%." He asked hospitals that find claims not pricing correctly under EAPG 3.18 to send the ICNs of affected claims for department review.
Basqui also reported system change requests completed Dec. 17, 2025 and said 749,355 claims were reprocessed and included in the Jan. 23, 2026 financial cycle. "If some of those claims are not pricing as they should under EAPG 318 or any other issues you may come across, please email us the ICNs of those claims so that we may review them," he said.
Andrew Abalos and other staff then described several state plan amendments that remain under CMS review, including the 340B reduction and the SPA related to the 1.6% rate change and its rollback; Abalos said CMS has requested additional information and the department is working with the agency to provide it. Abalos added that inpatient rebasing effective July 1, 2025 is also in a SPA "request for additional information" status and that the Department is completing compliance steps to resolve outstanding items.
Basqui summarized recent technical updates to the EAPG module: 3M Solventum released service pack 2026.0.2 (installed Jan. 15, 2026) to apply CPT updates, and a general availability release (2026.1.0) was slated for March 26, 2026 with installation and interchange testing planned that week.
Why it matters: Changes to EAPG rules and 340B reimbursement affect outpatient payment levels and pharmacy reimbursement for hospitals serving Medicaid patients. Large‑scale reprocessing (749,355 claims reported) can affect hospital revenue recognition and reconciliation timelines.
Next steps: Hospitals should review the Dec. 31, 2025 email with details, send ICNs for any mispriced claims, and monitor the Department's communications while the Department and CMS resolve outstanding SPA questions.
Basqui said the department implemented EAPG changes effective July 1, 2025 (including EAPG version 3.18) and noted a 1.6% base rate increase that was later rolled back per an executive order on Oct. 1, 2025. He told stakeholders the department reduced the 340B drug rate reimbursement "from 80% down to 65%." He asked hospitals that find claims not pricing correctly under EAPG 3.18 to send the ICNs of affected claims for department review.
Basqui also reported system change requests completed Dec. 17, 2025 and said 749,355 claims were reprocessed and included in the Jan. 23, 2026 financial cycle. "If some of those claims are not pricing as they should under EAPG 318 or any other issues you may come across, please email us the ICNs of those claims so that we may review them," he said.
Andrew Abalos and other staff then described several state plan amendments that remain under CMS review, including the 340B reduction and the SPA related to the 1.6% rate change and its rollback; Abalos said CMS has requested additional information and the department is working with the agency to provide it. Abalos added that inpatient rebasing effective July 1, 2025 is also in a SPA "request for additional information" status and that the Department is completing compliance steps to resolve outstanding items.
Basqui summarized recent technical updates to the EAPG module: 3M Solventum released service pack 2026.0.2 (installed Jan. 15, 2026) to apply CPT updates, and a general availability release (2026.1.0) was slated for March 26, 2026 with installation and interchange testing planned that week.
Why it matters: Changes to EAPG rules and 340B reimbursement affect outpatient payment levels and pharmacy reimbursement for hospitals serving Medicaid patients. Large‑scale reprocessing (749,355 claims reported) can affect hospital revenue recognition and reconciliation timelines.
Next steps: Hospitals should review the Dec. 31, 2025 email with details, send ICNs for any mispriced claims, and monitor the Department's communications while the Department and CMS resolve outstanding SPA questions.
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