INPATIENT EXEMPT UNIT RATES EFFECTIVE 7/1/2014 - 12/31/2014 (MA HMO ONLY)

MEDICAID MANAGED CARE PUB
(1) (2) (3) (4) (5)
PSYCHIATRIC
PSYCHIATRIC OPERATING BILLING RATE PSYCHIATRIC NON-OPERATING BILLING RATE
w/out DME
*Informational Only* PSYCHIATRIC
DME Add-on
PSYCHIATRIC ECT PAYMENT PSYCHIATRIC ALC PER DIEM
OPCERT HOSPITAL NAME
1623001 ADIRONDACK MEDICAL CENTER $716.31 $60.03 $0.00 $231.32 $171.74
0101000 ALBANY MEDICAL CTR HOSP $614.25 $177.20 $29.80 $244.16 $171.74
0501000 AUBURN COMMUNITY HOSPITAL $750.25 $41.05 $0.00 $242.28 $171.74
7002001 BELLEVUE HOSPITAL CENTER $657.63 $47.76 $129.33 $287.55 $261.20
7002002 BETH ISRAEL MEDICAL CENTER $726.46 $115.28 $180.18 $317.64 $261.20
3535001 BON SECOURS COMMUNITY HOSP $589.64 $31.23 $0.00 $257.82 $171.74
7000001 BRONX-LEBANON HOSPITAL CTR $684.30 $67.87 $187.61 $299.21 $261.20
7001002 BROOKDALE HOSPITAL MED CTR $673.25 $33.38 $86.84 $294.38 $261.20
5123000 BROOKHAVEN MEMORIAL HOSP $654.42 $39.38 $0.00 $286.14 $261.20
5263000 CATSKILL REGIONAL MED CTR $796.11 $31.12 $0.00 $257.09 $171.74
5401001 CAYUGA MEDICAL CENTER $766.78 $43.59 $0.00 $247.62 $171.74
0901001 CHAMPLAIN VALLEY PHYS $731.19 $58.01 $0.00 $236.12 $171.74
4401000 CLAXTON-HEPBURN MED CTR $669.32 $36.57 $0.00 $216.15 $171.74
3421000 CLIFTON SPRINGS HOSPITAL $604.58 $26.25 $0.00 $195.24 $171.74
1001000 COLUMBIA MEMORIAL HOSPITAL $713.96 $30.03 $0.00 $230.56 $171.74
7001009 CONEY ISLAND HOSPITAL $649.73 $59.04 $116.79 $284.09 $261.20
1101000 CORTLAND REGIONAL MED CTR $698.73 $78.20 $0.00 $225.64 $171.74
5127000 EASTERN LONG ISLAND HOSPITAL $636.49 $63.69 $0.00 $278.30 $261.20
3101000 EASTERN NIAGARA HOSPITAL $571.41 $15.04 $0.00 $227.13 $171.74
4601001 ELLIS HOSPITAL $593.89 $33.72 $0.81 $236.07 $171.74
7003000 ELMHURST HOSPITAL CTR $691.69 $64.73 $257.88 $302.44 $261.20
1401005 ERIE COUNTY MEDICAL CENTER $651.64 $25.02 $35.05 $259.03 $171.74
3202003 FAXTON-ST LUKES HEALTHCARE $722.92 $63.11 $0.03 $233.45 $171.74
7003001 FLUSHING HOSPITAL $664.00 $44.60 $108.17 $290.33 $261.20
2910000 FRANKLIN HOSPITAL $631.67 $37.81 $0.08 $276.19 $261.20
2901000 GLEN COVE HOSPITAL $725.43 $40.21 $0.51 $317.19 $261.20
5601000 GLENS FALLS HOSPITAL $709.00 $54.46 $0.00 $228.96 $171.74
7002009 HARLEM HOSPITAL CENTER $675.37 $55.59 $212.95 $295.30 $261.20
5501000 HEALTHALLIANCE HOSP MARYS AVE CAMPUS $759.30 $22.48 $0.00 $245.20 $171.74
5153000 HUNTINGTON HOSPITAL $679.93 $42.13 $0.05 $297.30 $261.20
7001046 INTERFAITH MEDICAL CENTER $677.24 $37.26 $0.73 $296.12 $261.20
7000002 JACOBI MEDICAL CENTER $712.90 $150.86 $98.71 $311.71 $261.20
7003003 JAMAICA HOSPITAL $722.41 $20.12 $215.50 $315.87 $261.20
5149000 JOHN T MATHER MEMORIAL HOSP $661.04 $68.87 $0.00 $289.04 $261.20
7001016 KINGS COUNTY HOSPITAL CENTER $651.98 $166.86 $159.72 $285.07 $261.20
7001033 KINGSBROOK JEWISH MED CTR $737.90 $27.16 $23.66 $322.64 $261.20
7002017 LENOX HILL HOSPITAL $668.82 $102.19 $88.11 $292.44 $261.20
7000008 LINCOLN MEDICAL $663.29 $56.17 $236.99 $290.02 $261.20
7003004 LONG ISLAND JEWISH $699.34 $70.36 $73.43 $305.78 $261.20
7001019 LUTHERAN MEDICAL CENTER $653.71 $34.61 $65.98 $285.83 $261.20
7001020 MAIMONIDES MEDICAL CENTER $765.02 $63.47 $39.56 $334.50 $261.20
3824000 MARY IMOGENE BASSETT HOSP $655.92 $30.48 $6.41 $211.82 $171.74
2909000 MERCY MEDICAL CENTER $653.39 $43.49 $2.31 $285.69 $261.20
7002021 METROPOLITAN HOSPITAL CENTER $656.22 $23.49 $267.98 $286.93 $261.20
7000006 MONTEFIORE MEDICAL CENTER $721.64 $55.48 $538.26 $315.53 $261.20
5903001 MONTEFIORE MOUNT VERNON HOSP $678.01 $18.32 $0.06 $296.46 $261.20
7002024 MOUNT SINAI HOSPITAL $720.16 $78.81 $78.95 $314.89 $261.20
2950002 NASSAU UNIV MED CTR $727.75 $32.80 $22.76 $318.20 $261.20
3102000 NIAGARA FALLS MEMORIAL $549.14 $26.12 $1.83 $218.28 $171.74
7000024 NORTH CENTRAL BRONX HOSPITAL $733.15 $32.17 $111.34 $320.56 $261.20
2951001 NORTH SHORE UNIVERSITY HOSP $746.58 $50.63 $469.17 $326.44 $261.20
5920000 NORTHERN WESTCHESTER HOSP $650.11 $110.92 $0.00 $284.26 $261.20
4324000 NYACK HOSPITAL $626.59 $21.36 $0.00 $273.98 $261.20
7001021 NY METHODIST HOSP / BROOKLYN $686.55 $67.10 $81.23 $300.19 $261.20
7002054 NY PRESBYTERIAN HOSPITAL $718.75 $89.99 $66.56 $314.27 $261.20
7002053 NYU HOSPITALS CENTER $687.71 $234.66 $391.91 $300.70 $261.20
0401001 OLEAN GENERAL HOSPITAL $668.37 $54.48 $0.00 $215.84 $171.74
3523000 ORANGE REGIONAL MED CTR $639.96 $127.94 $0.00 $279.82 $171.74
3702000 OSWEGO HOSPITAL $716.05 $56.12 $0.00 $231.23 $171.74
5932000 PHELPS MEMORIAL HOSP $642.66 $72.40 $0.00 $281.00 $261.20
3950000 PUTNAM COMMUNITY HOSPITAL $659.18 $32.44 $0.00 $288.22 $171.74
7003007 QUEENS HOSPITAL CENTER $732.50 $75.51 $215.88 $320.28 $261.20
7004010 RICHMOND UNIV MED CTR $642.53 $31.40 $8.99 $280.94 $261.20
2701003 ROCHESTER GENERAL HOSPITAL $600.25 $69.53 $1.17 $238.60 $171.74
3201002 ROME MEMORIAL HOSPITAL $670.63 $23.95 $0.00 $216.57 $171.74
4102002 SAMARITAN HOSPITAL OF TROY $562.08 $22.28 $0.00 $223.42 $171.74
2201000 SAMARITAN MEDICAL CENTER $734.76 $43.64 $0.29 $237.28 $171.74
4501000 SARATOGA HOSPITAL $588.30 $38.64 $0.00 $233.85 $171.74
6120700 SOLDIERS AND SAILORS MEM HOSP $583.35 $61.39 $0.00 $188.38 $171.74
2950001 SOUTH NASSAU COMMUNITIES $619.01 $85.77 $0.66 $270.66 $261.20
5154000 SOUTHSIDE HOSPITAL $672.74 $60.94 $0.07 $294.15 $261.20
7000014 ST BARNABAS HOSPITAL $659.82 $85.52 $23.69 $288.50 $261.20
5157003 ST CATHERINE OF SIENA $679.87 $60.29 $0.00 $297.27 $261.20
3202002 ST ELIZABETH MEDICAL CENTER $730.15 $26.97 $0.15 $235.79 $171.74
1302000 ST FRANCIS HOSP / POUGH $555.26 $70.16 $0.00 $242.78 $171.74
7001024 ST JOHNS EPISCOPAL SO SHORE $767.14 $38.36 $85.53 $335.43 $261.20
0701001 ST JOSEPHS HOSP / ELMIRA $646.44 $14.69 $0.00 $208.75 $171.74
3301003 ST JOSEPHS HOSP HLTH CTR $624.64 $52.47 $0.23 $248.29 $171.74
5907002 ST JOSEPHS MEDICAL CENTER $658.41 $15.22 $29.74 $287.88 $261.20
7002032 ST LUKES / ROOSEVELT HOSP $782.82 $88.33 $44.74 $342.29 $261.20
2801001 ST MARYS HOSP / AMSTERDAM $657.49 $22.66 $0.00 $212.32 $171.74
7001037 STATE UNIV HOSP / DOWNSTATE $701.08 $53.48 $165.42 $306.54 $261.20
7004003 STATEN ISLAND UNIV HOSP $654.10 $46.11 $61.53 $286.00 $261.20
2701005 STRONG MEMORIAL HOSPITAL $635.95 $71.22 $34.21 $252.79 $171.74
2754001 THE UNITY HOSP OF ROCHESTER $548.01 $48.80 $1.01 $217.83 $171.74
0427000 TLC HEALTH NETWORK $593.79 $35.63 $0.00 $191.75 $171.74
0303001 UNITED HEALTH SERVICES INC $599.76 $37.94 $0.76 $238.40 $171.74
5151001 UNIV HOSP AT STONY BROOK $659.18 $75.01 $112.48 $288.22 $261.20
3301007 UNIV HOSP SUNY HLTH SCI CTR $649.24 $33.99 $121.77 $258.07 $171.74
3301003 UPSTATE UNIV HOSP/COMM GEN $654.90 $33.99 $0.00 $260.32 $171.74
5820000 WAYNE HEALTH CARE $672.98 $48.62 $0.00 $217.33 $171.74
5957001 WESTCHESTER MEDICAL CENTER $732.18 $63.40 $99.94 $320.14 $261.20
0602001 WOMANS CHRISTIAN ASSOC $645.31 $32.27 $0.00 $208.39 $171.74
7001045 WOODHULL MEDICAL $653.91 $37.47 $72.58 $285.92 $261.20
6027000 WYOMING CO COMMUNITY HOSP $675.15 $52.43 $0.00 $218.03 $171.74