Inpatient Rate Processing Schedule
2013/2014 SFY
Updated 07/15/13
- Also available in Inpatient rate processing schedule (XLS, 33KB) and available in PDF format (PDF, 158KB, 4PG).
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 |