State analysts outline APR DRG v42 weight update and May review, aiming for Oct. 1, 2026 rollout
March 09, 2026 | Health Care Policy & Financing, Governor's Cabinet, Organizations, Executive, Colorado
This article was created by AI summarizing key points discussed. AI makes mistakes, so for full details and context, please refer to the video of the full meeting. Please report any errors so we can fix them. Report an error »
Andrew Abalos, facility rate section manager at the Colorado Department of Health Care Policy & Financing, opened the March 2026 hospital stakeholder engagement meeting and turned the floor to Diana Lamb, the department’s inpatient hospital rates analyst.
"We're working on the analysis now that sets the new weights for version 42 to be budget neutral," Lamb said, describing the department's plan to derive new APR Diagnosis‑Related Group (APR DRG) weights using in‑state hospital claims for the 12‑month data set cited in the presentation. She said the department will present payment differentials by major diagnostic category and by hospital system for hospital review at the May 1, 2026 hospital engagement meeting.
The Department intends to post the new weight table on May 1 and open a 15‑day review window for hospitals to comment, Lamb said. "This year because of the timeline we've been — there's been a lot going on here. We're going to have a 15‑day hospital review in order for us to be able to make the October 1, 2026 effective date," she added, and stated the goal is to "turn it on" October 1 without reprocessing previously adjudicated claims.
Why it matters: APR DRG weight updates change relative payments across diagnostic categories and hospital systems; presenting the new tables for stakeholder review is a standard step before implementation. Lamb said the analysis will compare spending under version 40 and version 42, and the Department plans to continue the same policy adjustments carried forward from version 40.
What hospitals were told to do: Department staff asked hospitals to review the May 1 materials and send comments during the 15‑day review period so the Department can coordinate any needed edits and complete technical submission to its vendor for system testing.
Next steps: The Department will present the detailed weight table on May 1, accept hospital feedback during a 15‑day review, complete Gainwell testing, and, barring unforeseen issues, implement the new weights for an October 1, 2026 effective date.
"We're working on the analysis now that sets the new weights for version 42 to be budget neutral," Lamb said, describing the department's plan to derive new APR Diagnosis‑Related Group (APR DRG) weights using in‑state hospital claims for the 12‑month data set cited in the presentation. She said the department will present payment differentials by major diagnostic category and by hospital system for hospital review at the May 1, 2026 hospital engagement meeting.
The Department intends to post the new weight table on May 1 and open a 15‑day review window for hospitals to comment, Lamb said. "This year because of the timeline we've been — there's been a lot going on here. We're going to have a 15‑day hospital review in order for us to be able to make the October 1, 2026 effective date," she added, and stated the goal is to "turn it on" October 1 without reprocessing previously adjudicated claims.
Why it matters: APR DRG weight updates change relative payments across diagnostic categories and hospital systems; presenting the new tables for stakeholder review is a standard step before implementation. Lamb said the analysis will compare spending under version 40 and version 42, and the Department plans to continue the same policy adjustments carried forward from version 40.
What hospitals were told to do: Department staff asked hospitals to review the May 1 materials and send comments during the 15‑day review period so the Department can coordinate any needed edits and complete technical submission to its vendor for system testing.
Next steps: The Department will present the detailed weight table on May 1, accept hospital feedback during a 15‑day review, complete Gainwell testing, and, barring unforeseen issues, implement the new weights for an October 1, 2026 effective date.
View the Full Meeting & All Its Details
This article offers just a summary. Unlock complete video, transcripts, and insights as a Founder Member.
✓
Watch full, unedited meeting videos
✓
Search every word spoken in unlimited transcripts
✓
AI summaries & real-time alerts (all government levels)
✓
Permanent access to expanding government content
30-day money-back guarantee
