Freestanding Providers - Additional 37.5M Investment approved by CMS

APG base and capital rates updated February 15, 2013

The Centers for Medicare and Medicaid Services has approved the additional $37.5M annual investment in APGs beginning effective December 1, 2009. In addition, the revised base rates have been approved by the Division of the Budget and transmitted to eMedNY for payment. The rates were activated on February 15, 2013 and retroactive rate processing automatically occurred in cycle #1853 with a check date of February 25, 2013 and a check release date of March 13, 2013. In addition, in cycle 1854 and 1855, a correction to the retro processing was implemented.

The initial investment of $12.5M was effective September 1, 2009, however, the additional investment of $37.5M is effective December 1, 2009. In addition, the base rates for both freestanding clinics and ambulatory surgery centers were reduced, effective April 1, 2011, to implement the 2% across-the-board payment as agreed upon with the provider industry to be incorporated at the time the additional investment was implemented in the rates. However, since the Ambulatory Surgery Centers (ASC) do not receive a portion of the additional investment, their rates do not reflect an increase for the investment and reflect a reduction of 2% to implement the 2% payment reduction effective April 1, 2011.

Further, the APG clinic capital rates were also revised to update to the 2 year base capital as required in regulations (Part 86-8.4(b)) beginning effective September 1, 2009. However, regulations (Part 86-8.4(c)) do not require ASC capital rates be updated and were not updated to the 2 year base capital. The 2007 thru 2010 base year AHCF cost report data was used in the 2009 thru 2012 APG capital rate calculations, respectively.

Please be aware that for providers that did not submit an AHCF Cost Report for these years, the capital APG rate was set to $0.00 as the Department did not have any data to calculate a payment rate.

As of cycle 1861, the Department has placed a hold on the 15% collections for the liabilities resulting from the capital rate updates that occurred in cycle 1853. This hold has been placed while the Department is reviewing the capital rate calculation.

2010 AHCF Cost Report referencing Capital Update (PPT, 4.99MB, 46pgs.)

12/1/09:

Rate change was due to the blend payment changing from 25/75 to 50/50. Additional investment was included beginning as of this date.

1/1/10:

Rate change was due to a reweighting.
Case mix decreased causing the rate to increase to stay budget neutral.

7/1/10:

Rate change was due to a reweighting.
Case mix increased causing the rate to decrease to stay budget neutral.

1/1/11:

Rate change was due to the blend payment changing from 50/50 to 75/25.

4/1/11:

Rate change was due to the 2% Across-the-Board reduction in the investment.

7/1/11:

Rate change was due to a reweighting.
Case mix decreased causing the rate to increase to stay budget neutral.

1/1/12:

The rate decreased due to the blend payment changing from 75/25 to 0/100.

7/1/12:

Rate change was due to a reweighting.
Case mix decreased causing the rate to increase to be budget neutral.