APR-DRG Weights and ALOS for Acute Services

Note: The version (v#) displayed above pertains to the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) that will be utilized for the payment of the Medicaid, Workers Compensation and No-Fault rates.

January 1, 2013 Inpatient Rate Update

Effective for discharges on or after January 1, 2013, version 30 of the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) will be utilized for Medicaid, Workers Compensation and No-Fault. The Department of Health has completed the development of the applicable 2013 service intensity weights (SIWs), average length-of-stays and cost outlier thresholds, which are also effective January 1, 2013. The Department implemented the new SIWs effective for all 2013 acute discharges that were processed beginning on November 22, 2013. Further, all previously paid 2013 claims were reprocessed with the January 1, 2013 and April 1, 2013 hospital inpatient rates that were approved by the Division of the Budget and loaded into the eMedNY system on November 28, 2013. This reprocessing also utilized the 2013 SIWs for the period January 1, 2013 through November 28, 2013.

January 1, 2012 Inpatient Rate Update

Effective for discharges on or after January 1, 2012, version 29 of the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) will be utilized for Medicaid, Workers Compensation and No-Fault. The Department of Health has completed the development of the applicable 2012 service intensity weights (SIWs), average length-of-stays and cost outlier thresholds, which are also effective January 1, 2012. The Department implemented the new SIWs effective for all 2012 acute discharges that were processed beginning on March 1, 2012. Further, all previously paid 2012 claims were reprocessed with the January 1, 2012 hospital inpatient rates that were recently approved by the Division of the Budget and loaded into the eMedNY system on October 4, 2012. This reprocessing also utilized the 2012 SIWs for the period January 1, 2012 thru February 29, 2012.

APR-DRG Weights and Comorbidities for Psychiatric Services

Psychiatric Inpatient Rate Update for Rates effective beginning October 20, 2010

The Centers for Medicare and Medicaid approved State Plan Amendment 10-03 which establishes a new psychiatric inpatient reimbursement method effective October 20, 2010 for general hospitals and replaces a per diem payment method based on 1981 costs trended. This new method was established in order to pay more appropriately for inpatient psychiatric admissions and address length of stay variances. The formula on which these new psychiatric exempt unit rates are promulgated is in accordance with Article 28 of the Public Health Law set forth in Part 86-1.39 of the Commissioner of Health´s Rules and Regulations.

The components of the new psychiatric methodology will include the use of psychiatric APR-DRGs, a statewide price (adjusted for wage differences), capital costs and direct medical education costs. The new methodology will also include payment factors based on rural hospital status, patient age, presence of mental retardation, co-morbidities, length of stay and a separate payment for electroconvulsive (ECT) treatment.

Presentation to hospitals on September 13, 2010, regarding Psychiatric Reform rates.

July 1, 2013 Medicaid Update: New Inpatient Psychiatric Reimbursement Methodology