APR-DRG and Exempt Rates for Medicaid Fee-for-Service and Medicaid Managed Care
September 21, 2015
Dear Health Plans:
The purpose of this letter is to provide Health Plans with revised Medicaid inpatient psychiatric rates for the periods July 1, 2014 through December 31, 2014 and January 1, 2015 through December 31, 2015.
The rates for the above periods are based upon the same methodology and data used in the rates effective January 1, 2014 through December 31, 2014 and January 1, 2015 through December 31, 2015,but also takes into consideration the following:
- The Centers for Medicare and Medicaid (CMS) approved State Plan Amendment 14-0029,which changes the rural designation criteria for general hospitals with psychiatric exempt units. As a result, additional providers qualified for the rural adjustment factor of 1.2309 which is applied to the statewide base price for increased reimbursement. Additionally, those hospitals that meet the definition of serving in an "Upstate" region will receive a ten percent increase to the statewide base price component of the rate.
The enclosed rate schedules include the rate components required to process Medicaid claims. Based on these changes, plans are encouraged to process adjustments according to the terms of their provider contracts with hospitals. This includes any reprocessing that should occur consistent with those agreements.
Should you have any questions regarding the above data, please submit your inquiry to the Bureau of Acute and Managed Care Rate-Setting at HospFFSunit@health.ny.gov and either Monique Grimm or Tami Berdi from the hospital fee-for-service unit will respond.
Sincerely,
Michael Ogborn
Deputy Director
Division of Finance and Rate Setting
