2020 Institutional Cost Report (ICR)

NYS Department of Health
Division of Finance & Rate Setting
Bureau of Hospital & Clinic Rate Setting

June 10, 2021

Agenda

Software, Support & Filing Procedures

  • ➣ Obtaining Software and Support
    • Software will be available for download from the Health Financial Systems (HFS) website.
      Note: The Department will provide hospitals with the URL, Username and Password using the Health Commerce System (HCS).
  • ICR problem resolution and questions:
    • Hospital.ICR@health.ny.gov
      Note: please do not send via secure email – DOH security prohibits these emails
    • For problem resolution, send your "four-pack" files (CR, IC, B_, T_) to this address. The files will then be forwarded to KPMG, if necessary.
  • ➣ Electronic Filing Procedures
    • DH file (HCS electronic submission):
      • Due date: Monday, August 2, 2021
    • Electronic submission of documents within 5 Business days of electronic DH file submission:
      • Signed CFO/CEO certification
      • Edit Report (Initialed with explanations)
      • Final Audited Financial Statements
        • ✓ "Draft" statements cannot be used for audit purposes
    • Email files to: AFS@health.ny.gov
      Note: please do not send via secure email – DOH security prohibits these emails
    • Signed CFO/CEO Certification:
      • File named with 7-digit operating certificate number and "_CFO"
        • Example: 1234567_CFO
    • Edit Report (initialed with explanations):
      • File named with 7-digit operating certificate number and "_Edits"
        • Example: 1234567_Edits
    • Audited Financial Statements:
      • File named with 7-digit operating certificate number and "_AFS"
        • Example: 1234567_AFS
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2020 ICR Audit Fees

  • ➣ Due at time of filing
  • ➣ Same fee schedule as previous years
  • ➣ Same payment process as previous years
  • ➣ Email notification to be released for facility-specific fees
  • ➣ Fee schedule
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Health Commerce System (HCS)

  • ➣ Website
  • ➣ Communication Tool
    • Secure network for posting provider information
    • Keep email address current
      • ✤ Facility´s responsibility
      • ✤ Email blast separate from public website electronic mailing list
  • ➣ HCS Help Contact
    • Commerce Accounts Management Unit (CAMU) Help Desk: 1-866-529-1890 or camu@its.ny.gov
      • ✤ HCS accounts
      • ✤ Password resets
      • ✤ Removal of employee
  • ➣ HCS Access Contact
    • Hospital Fee-for-Service Rate Unit: HospFFSunit@health.ny.gov
      • ✤ Receiving access to the ICR (or other hospital applications)
      • ✤ Rate related questions
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Department of Health Public Website

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2020 ICR Updates

  • ➣ Psychiatric Services
  • Inpatient Dual-Diagnosis Psychiatric (NEW for 2020)
    • Cost Center 378 (Medicare line 40.01)
    • Exhibit 32/52 – Medicaid Service Code (MSC) 204
    • Exhibit 46 – report revenue for new service
  • Comprehensive Psychiatric Emergency Program (CPEP) Observation
    • Effective 4/1/2020 – OMH Fee-for-Service outpatient rate code 4049
    • 2020 ICR – accommodates based on effective billing periods
    • Exhibit 32 – MSC 202 prior to 4/1/2020
    • Exhibit 33/52 – MSC 293 effective 4/1/2020
    • Exhibit 46 – NEW Line 015, routine charges
  • ➣ Clinic Services
    • Federally Qualified Health Center / Rural Health Center
      • Exhibit 1 – "Are any hospital FQHC / RHC sites paid by APGs? Y/N"
        • FQHC rate – all inclusive federal rate
        • APG rate – physicians are carved out (billed separately)
      • FQHC / RHC cost centers are excluded from Medicaid only automated ICR physician´s adjustment (Line 633)
        • FQHC´s / RHC´s that opt into APG´s may require Medicaid only physician´s adjustment on Exhibit 14 if carve out was not automatically done
    • Chemical Dependency Clinic/Rehab
      • Cost Center 291 – Header updated
      • Exhibit 33 – only hospital-based visits should be reported
      • Use Medicaid Service Code (MSC) 248 "Other OASAS Programs"
      • ICR Schedules – distinctly reported (no longer reported under MSC 235 General Clinic)
  • ➣ Out-of-State Sites
    • Services provided outside New York State
      • Out-of-State sites are not certified or monitored by New York State
      • Exhibit 1 – "Does this hospital provide services at any site outside New York State?" Y/N
        • List of services – check box
        • "Other" provide short description
      • Distinct cost center
      • Medicaid Service Code 959 for associated costs or adjust on Exhibit 14 – MA only
      • No utilization should be reported on Exhibits 32, 33 or 34
      • Out-of-state payments are based on upstate and downstate average rates from NYS hospitals
  • ➣ Exhibits
    • Exhibit 14 - Adjustments
      • Article 31 Hospitals – excluded from automated Medicaid only physician´s adjustment
        • No longer requires manual add-back of physician´s expenses
    • Exhibit 30 – Inpatient & Swing Bed Statistics
      • Non-fatal edit when dual-eligible days/discharges are left blank or have 0´s
      • Combined Medicaid Primary & Dual-eligible (excludes service areas not part of inpatient hospital definition, such as Transitional Care Units)
    • Exhibit 31A – Transfer Statistics
      • Prior Year - Charge-based statistic
        • Will not allow change to visits (1) if charges (0) are already being used
        • Service column closed to data entry
    • Exhibit 32 – Inpatient Days & Discharges
      • New – Dual-Diagnosis Psychiatric
      • Will display as "N/A" for hospitals not certified
    • Exhibit 33 – Outpatient Visits
      • CPEP Observation Beds (NEW)
        • Report days versus visits (rate code 4049)
        • MSC 293
      • Chemical Dependency Clinic/Rehab
        • See slide 11 for MSC change
      • Header changes
        • PROS to PROS Monthly (Personalized Recovery Oriented Services)
        • CPEP to CPEP Emergency
        • Alcohol/Chemical Dependency Clinic to Chemical Dependency Clinic/Rehab
    • Exhibit 40 – Detail of Capital Expenses
      • Modified non-projectable capital
        • Line 004, Real Estate Taxes – Buildings and Fixtures
        • Line 088, Real Estate Taxes – Movable Equipment*
        • Line 005, Property Insurance – Buildings and Fixtures
        • Line 089, Property Insurance – Movable Equipment
        *Note: it is not anticipated that this line will be commonly used
    • Exhibit 40 – Detail of Capital Expenses
      DETAILS RE: CAPITAL RELATED COST BUILDINGS & FIXTURES LINE # RECLASSIFIED BUILDINGS & FIXTURES RECLASSIFIED MOVABLE EQUIPMENT RECLASSIFIED TRIAL BALANCE ALL PAYOR AND MEDICAID ADJUSTMENTS DIRECT CHARGE CAPITAL TOTAL CAPITAL RELATED COSTS
      1 2 3 4 5 6 7 8
      21045 21046 0140 0335 0404 0405 0401 0402
      DEPRECIATION - NON 28B 001            
      AMORTIZATION OF LEASEHOLD IMPROVEMENTS 002            
      PROPERTY RENTAL 003            
      REAL ESTATE TAXES - BUILDINGS AND FIXTURES 004            
      REAL ESTATE TAXES - MOVEABLE EQUIPMENT 088            
      PROPERTY INSURANCE - BUILDINGS AND FIXTURES 005            
      PROPERTY INSURANCE - MOVEABLE EQUIPMENT 089            
      INTEREST EXPENSE - CAPITAL DEBT - NON 28B 006            
      OPERATING LEASES 007            
      CAPITALIZED LEASES 008            
    • Real Estate Taxes & Property Insurance
      • Each line designated as Buildings and Fixtures or Movable Equipment
      • Non-related column - closed to data entry
    • Other than Real Estate Taxes or Property Insurance
      • Continue to report expenses under appropriate column
    • Purpose of Change
      • Discrete reporting of All-Payor / Medicaid only Adjustments
      • Discrete reporting of Direct Charge Capital
    Note: If exhibit has been completed prior to software update, necessary changes will be required
  • Exhibit 46 – Hospital Service Revenue
    • NEW Line 015, routine charges
      • Used for transfer cost calculation associated with CPEP Observation
  • ➣ ICR Schedules
    • ICR Schedule 1B – Transfers by Service
      • Based On Visits
        • Will not display when Exhibit 31A Transfer Basis = Charges
      • CPEP–Observation Beds (NEW)
        • Transfers based on charges – Exhibit 46, line 015
    • ICR Schedule 2A – Uncompensated Care Utilization & Collections (NEW)
      • New for 2020
      • Used in the Indigent Care Pool calculation
      • Data is driven by proper MSC coding on Exhibits 32 & 33
    • ICR Schedule 3 Part 1 – Allowable Capital Costs
      • Non-Projectable Capital - Property Tax & Insurance
        • From Exhibit 40 – Total Capital Related Costs (Col 0402)
    • ICR Schedule 3 Part 2 – Distribution of Allowable Capital
      • Carried forward Total Reported (63200/960) from Part 1
      • Rounding Differential = Total Reported Part 1 less the sum of all distributed capital from Part 2
      Refer to ICR instructions for ICR Schedule 3
    • ICR Schedules – All
      • New/Revised Medicaid Service Codes (MSCs)
        • 204 – Dual-Diagnosis Psychiatric
        • 293 – CPEP Observation Beds
        • 248 – Other OASAS (Chemical Dependency Clinic/Rehab)
  • ➣ Edits & Instructions
    • Edits
      • Several non-fatal edits have been added or modified
      • List of edits will be available on the NYS ICR web page
      Note: The purpose of a non-fatal edit is to alert the provider of a potential anomaly in the data
    • Instructions
      • Instructions have been added or updated based on:
        • Changes / Additions implemented in 2020
        • Q&As incorporated from 2019
        • Additional Clarifications
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Future Updates

  • ➣ COVID Reporting – 2020 ICR
    • ICR and/or Instruction updates expected based on guidance from the Centers for Medicare and Medicaid (CMS)
  • ➣ CPEP Observation – 2021 ICR
    • Removal from Exhibit 32 (Exhibit 33 reporting only)
  • ➣ Essential Plan Reporting – 2022 ICR
    • Two new payer categories to be added to various exhibits & ICR Schedule 2
    • "Essential Plans 1 & 2" and "Essential Plans 3 & 4"
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Questions?

ICR Questions: Hospital.ICR@health.ny.gov

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