July 6, 2011 Health Plan Letter

July 6, 2011

Dear Health Plans:

The purpose of this letter is to provide Health Plans with the initial 2011 Medicaid inpatient chemical dependency detox rates for medically managed detoxification (MMD) and medically supervised inpatient withdrawal (MSIW) services for the period January 1, 2011 through March 31, 2011. Health Plans should determine if these rates apply based upon their contract with hospital providers.

The formula on which these rates are based was promulgated in accordance with Article 28 of the Public Health Law (PHL) and reflect the detoxification rate reform provisions of Section 2807-c (4)(l) enacted under Chapter 58 of the Laws of 2008, and as subsequently revised under the Laws of 2009. The statute established a regional price based per diem rate methodology for chemical dependency detox services provided by general hospitals certified by the Office of Alcoholism and Substance Abuse Services (OASAS) effective December 1, 2008 forward, and included a 16-month phase-in to full regional pricing. Implementation of 100% regional price based rates became effective April 1, 2010.

The revised OASAS certified provider chemical dependency detox per diem rates for the periods January 1, 2011 through March 31, 2011, provided herein, take into consideration the following:

  1. Implementation of a 2011 trend factor of 1% based upon methodology as set forth in Article 2807-c (10).
  2. Capital cost reimbursement is included based on the current reimbursement methodology for determining allowable capital for exempt unit per diem rates. The budgeted rate year 2011 capital included in the initial 2011 rates will be revised to reflect actual 2011 capital as these costs become available to the Department.

Plans are reminded that observation days (up to 2 days of care) are to be recognized for payment at the MMD rate. Additionally, length-of-stay reductions in payment apply to both MMD and MSIW service rates (inclusive of capital) as follows:

  • Days 0 - 5 are to be reimbursed at 100% of the applicable rate,
  • Days 6 -10 are to be reimbursed at 50% of the applicable rate,
  • Days 11 and greater are not reimbursable (i.e. 0%).

The enclosed Billing Instructions For Part 816 OASAS Certified Chemical Dependency Detox provides the corresponding Medicaid Fee-For-Service rate code descriptions and necessary details for accurately calculating payment for inpatient chemical dependency detoxification services provides at OASAS certified general hospitals.

The rates on the enclosed schedule have been computed by the Bureau of Primary and Acute Care Reimbursement. Should you have any questions regarding these schedules, please contact my office at (518) 474-3267.

Sincerely,

John W. Gahan, Jr.
Director
Bureau of Primary and Acute Care Reimbursement

Enclosures