APR-DRG and Exempt Rates for Medicaid Fee-for-Service and Medicaid Managed Care
New York State Department of Health
June 2, 2015
ANDREW M. CUOMO, Governor
HOWARD A. ZUCKER, M.D., J.D., Commissioner
SALLY DRESLIN, M.S., R.N., Executive Deputy Commissioner
Chairman
New York State Worker´s Compensation Board
20 Park Street
Albany, New York 12207
Dear Mr. Beloten:
Enclosed please find the certification letter and schedules of hospital reimbursement rates for services rendered to patients covered under the Workers' Compensation Benefit Law, the Volunteer Ambulance Workers' Benefit Law and the Comprehensive Motor Vehicle Reparation Act. These rates are for the period January 1, 2015 through December 31, 2015 for acute per case inpatient rates, exempt hospitals, exempt units and detoxification inpatient rates. Rates of payment for these services for these payers is to be based upon rates determined for state governmental agencies (Medicaid) in accordance with Article 2807-c (6-1) of the Public Health Law.
The APR-DRG weights effective January 1, 2015 will not be updated. For discharges beginning on or after January 1, 2015, the SIWs, cost thresholds and average length of stay (ALOS) effective July 1, 2014 should be used for payment purposes with the updated APR-DRG grouper version 32.
The rates on the attached schedules are based upon the same methodology and data used in the rates effective January 1, 2014 through December 31, 2014 (July 1, 2014 through December 31, 2014 for acute per case), but also take into consideration the following:
- Inclusion of 2015 budgeted capital as reported by hospitals and calculated in accordance with Section 8 of Article 2807-c of the Public Health Law.
- The inclusion of a 2015 trend factor of 1.1% based upon the initial CPI as published in the most recent Federal Register and as required by Section 10 of Article 2807-c of the Public Health Law. A final trend factor for 2014 of 1.6% has also been incorporated into the necessary roll factors applied to the Workers' Compensation rates.
Should you have any questions or require further information, please contact Janet Baggetta at 518-473-8822 or via email at HospFFSunit@health.ny.gov.
Sincerely,
John E. Ulberg, Jr.
Medicaid Chief Financial Officer
Division of Finance and Rate Setting
Office of Health Insurance Programs
New York State Department of Health
ANDREW M. CUOMO, Governor
HOWARD A. ZUCKER, M.D., J.D., Commissioner
SALLY DRESLIN, M.S., R.N., Executive Deputy Commissioner
Chairman
New York State Worker´s Compensation Board
20 Park Street
Albany, New York 12207
Dear Mr. Beloten:
The Office of Health Insurance Programs has calculated rates of reimbursement for the period January 1, 2015 through December 31, 2015 for acute per case inpatient rates, exempt hospitals, exempt units and detoxification inpatient rates. These rates have been calculated for services rendered to patients covered under the Workers' Compensation Law, the Volunteer Firefighters' Benefit Law, the Volunteer Ambulance Workers' Benefit, and the Comprehensive Motor Vehicle Insurance Reparations Act.
Pursuant to section 2807(4) of the Public Health Law, I hereby certify to you that the rates appearing on the enclosed schedules have been developed in accordance with section 2807-c of the Public Health Law, as amended by the Health Care Reform Act, and Part 86-1 of the Title 10 (Health) of the Codes, Rules and Regulations of the State of New York.
Sincerely,
Jason A. Helgerson
Medicaid Director
Office of Health Insurance Programs
Enclosure(s)
