Feestanding Providers - APG Phase-In Capital Rates
Updated May 31, 2013
The September 1, 2009 through December 31, 2011 rates were transmitted to eMedNY and activated on May 31, 2013 in cycle 1868. These rates will retro process and providers will not need to amend their claims based on this revision.
The provisions of Public Health Law section 2807(2-a)(b) require that the "existing payment for blend" used for the clinic payment during the phase-in of APG rates be based on the "average Medicaid payments per claim... for services provided by that facility in the [2007] calendar year." Therefore, this "existing payment for blend" rate must also include the capital average Medicaid payment per claim that was in place in 2007. For the capital component of the APG portion of the rate, Section 2807(2-a)(h)(ii) requires the use of the capital component methodology described in Section 2807(2)(b), which involves the use of a "rolling base" that is updated annually. This means that for the phase-in period, capital reimbursement will reflect a combination of pre-APG capital reimbursement as in effect in 2007 and another portion based on a two-year lagged base year methodology subject to annual updating. The recalculation was based on the following method:
- Rates effective 9/1/2009 thru 11/30/2009 will reflect 75% of the pre-existing payment capital rate and 25% of the 2 year base capital rate.
- Rates effective 12/1/2009 thru 12/31/2010 will reflect 50% of the pre-existing payment capital rate and 50% of the 2 year base capital rate.
- Rates effective 1/1/2011 thru 12/31/2011 will reflect 25% of the pre-existing payment capital rate and 75% of the 2 year base capital rate.
- Rates effective 1/1/2012 thru 12/31/2012 will reflect 0% of the pre-existing payment capital rate and 100% of the 2 year base rate as the phase-in period ended 12/31/2011.
