October 26, 2010 Health Plan Letter
October 26, 2010
Dear Health Plans:
The purpose of this letter is to provide Health Plans with the revised Medicaid inpatient reform rates for the period April 1, 2010 through September 30, 2010 and October 1, 2010 through December 31, 2010.
The rates for the periods as noted above are the same basis as those rates provided for the period January 1, 2010 through March 31, 2010 with the following modifications as noted below:
April 1, 2010-September 30, 3010
1. Corrections to several facilities rates and costs to reflect the implementation of appeals that were inadvertently left out of the prior rates. There corrections include the following:
- Update to base year Medicaid costs as previously developed due to revised data submitted by several facilities.
- Correction of the WEF used for several hospitals, due to oversight of timely appeals.
- Removal of physicians costs from several hospitals' Direct Medicaid Education costs as the hospitals do not have interns and these costs are not teaching costs
October 1, 2010 through December 31, 2010:
1. These rates reflect the update of the statewide base price to incorporate both Statewide Medicaid fee for service and Medicaid managed care projected inpatient expenditures and the new reform variables (GME, WEF, Case Mix, etc.). The gross Medicaid savings across both fee for service and managed care sectors is unchanged as it relates to the previous $225 million annualized Medicaid savings as set forth in Section 35 of Article 2807-c of the Public Health Law.
2. Inclusion of adjustments where applicable that reduce hospital's statewide base price, DME and non-comparables to reflect implementation of Potentially Preventable Readmissions (PPR's) as included in the 2010 state budget for discharges beginning July 1, 2010 implemented effective October 1, 2010. The adjustment is based upon an annual gross savings of $37.1 million for fee for service and $9.9 million for Managed Care. The annual amount is prorated for the month 9 period July 1, 2010 through March 31, 2010.
The enclosed rates schedules include the rate components required to process Medicaid claims. We have also included schedules that show how each of the components from the schedule are used in the payment of Medicaid claim, where applicable. The APR-DRGs, Service Intensity Weights and cost outlier thresholds can be found on the Department of Health's website at the following address: www.nyhealth.gov/facilities/hospital/reimbursement/apr-drg
Should you have any questions, please do not hesitate to contact John W. Gahan Jr. at (518) 474-3267.
Sincerely,
John E. Ulberg, Jr.
Director
Division of Health Care Financing
