Inpatient Rate Processing Schedule

2013/2014 SFY

Updated 07/15/13

Changes from Prior Schedule Highlighted.in Yellow

Item Rates and Rate Period Rate Element Payers Affected by Rate Change Estimated Completion Date Comments/Issues
Medicaid FFS Medicaid MC WC/No Fault
1. Initial Acute Rates 1/1/2012 - 3/31/2012 & Initial Exempt Units Rates 1/1/2012 - 12/31/2012: Change to Statewide Price due to updating utilization/CMI X X X Rates processed in Cycle 1834. Updated 1/1/2012 weights
Trend 0% thru 3/31/13 X X N/A WC/NF delinked from cuts; Trend for WC is 1.5%
Budgeted 2012 Capital X X X Implement 2012 Budgeted Capital
Continue PPR % X X N/A Does not apply to WC/NF
Update Transition I X N/A N/A Pay remaining 4/1/11 - 3/31/12 pool. Using 2010 claims as the divisor.
Update Transition II X N/A N/A Pay remaining 4/1/11 - 3/31/12 pool. Using 2010 claims as the divisor.
ALC capital X X X Correction to calcuation - Removed ALC days from the capital per diem divisors for Acute & Specialty since we do not pay capital in ALC rate.
Facility Specific Corrections X X X Miscellaneous changes due to mergers, etc.
Sterilization Rate During Delivery N/A X N/A Weight changed 1/1/12
2. Psych Reform Rates effective 10/20/2010 - 12/31/2011 Statewide Price, DME & Transition X TBD X Rates sent to eMedNY w cycle 1834. Will be retro processed. New Rates paid with claims beginning 10/4/2012. Approved by CMS. DOH is exploring legislative authority to implement prospectively.
Psych Reform Rates effective 1/1/2012 - 12/31/2012 Statewide Price, DME & Transition X TBD X Transition Pool reduced to $17M. $8M added back to Statewide Price.
3. Initial 4/1/2012 - 12/31/2012 Acute & Exempt Units Change to Statewide Price for "Inappropriate Use of Services" X X X Rates processed in Cycle 1853. Reduction to Statewide Price of $19.2M ($24.2M less $5M [C-section proposal in the 2012/2013 enacted budget])
PPNO % X X N/A Pending CMS Approval. Will be implemented prospectively when approved by CMS and will not be implemented in the 4/1/12 rates. When approved, rates will be adjusted to implement a combined PPC/PPR % [PPNOs] .
Update Transition I X N/A N/A Pool decreases $25M. Final Transition I Pool. Divisor 2010 Paid Claims.
Update Transition II X N/A N/A Pool decreases $25M. Dollars originally to be added back to the Statewide Price but the 2012/2013 State Budget has allocated these dollars to the Safety Net/VAP Pool.
4. 12/1/2009 - 12/31/2009 Acute & Exempt Units 2009 Actual Capital X X X Will be processed with the 2010 Actual Capital (July/Aug 2013) Affects All Payers
Several Small Facility Appeals X X X Affects All Payers
Update Transition I X N/A N/A For hospitals who did not follow through with plan
5. 1/1/2010 - 3/31/2010 & 4/1/2010 - 9/30/2010 Acute & Exempt Units, 1/1/2010 - 10/19/2010 Pre-Reform Psych Rates 2010 Actual Capital X X X Waiting on audited 2010 data (July/Aug 2013) Affects All Payers
Update Transition I X N/A N/A For hospitals who did not follow through with plan
6. 10/1/2010 - 12/31/2010 Acute & Exempt Units 2010 Actual Capital X X X Waiting on audited 2010 data (July/Aug 2013) Affects All Payers
Update Transition I X N/A N/A For hospitals who did not follow through with plan
Update Transition II X N/A N/A For hospitals who did not follow through with plan
7. 1/1/2013 - 12/31/2013 NOTICE Rates [Rates not Paid, 60 Day Noticing of Rates Required] Change to Statewide Price due to updating utilization/CMI X X X November 2, 2012 - Rates Completed and posted the HCS Updated 1/1/2013 weights
2013 Budgeted Capital X X X Affects All Payers
Trend 0% thru 3/31/13 X X N/A WC/NF delinked from cuts
PPNO % X X N/A Pending CMS Approval. Will be implemented prospectively when approved by CMS and will not be implemented in the 1/1/13 Notice rates. When approved, rates will be adjusted to implement a combined PPC/PPR % [PPNOs] .
Update Transition I X N/A N/A Pay remaining 4/1/12 - 3/31/13 pool. Final Transition I Pool. Using 2011 claims as the divisor.
Update Transition II X N/A N/A Pay remaining 4/1/12 - 3/31/13 pool. Using 2011 claims as the divisor.
8. 1/1/2013 - 12/31/2013 Initial Rates & 4/1/2013 - 12/31/2013 Acute Initial Rates Rates based on Notice Rates posted November 2, 2012 X X X Waiting on 2013 SIWs (July 2013) All Payers rates are based on the Notice Rates
Facility Specific Rate Changes based on Notice Period X Possibly Possibly Payer affected dependent on rate change issue requested by Provider during Notice Period.
9. 1/1/2011 - 3/31/2011, 4/1/2011 - 9/30/2011 & 10/1/2011 - 12/31/2011 Acute & Exempt Units 2011 Actual Capital X X X Waiting on 2011 audited cost report data Affects All Payers
Update Transition I X N/A N/A For hospitals who did not follow through with plan
Update Transition II X N/A N/A For hospitals who did not follow through with plan