APR-DRG and Exempt Rates for Medicaid Fee-for-Service and Medicaid Managed Care
New York State Department of Health
May 26,2017
ANDREW M. CUOMO, Governor
HOWARD A. ZUCKER, M.D., J.D., Commissioner
SALLY DRESLIN, M.S., R.N., Executive Deputy Commissioner
Chairman
New York State Workers´ Compensation Board
328 State Street, Suite 2
Schenectady, New York 12305
Dear Mr. Munnelly:
Enclosed please find the certification letter and schedules of hospital reimbursement rates for services rendered to patients covered under the Workers’ Compensation Benefit Law, the Volunteer Ambulance Workers’ Benefit Law and the Comprehensive Motor Vehicle Reparation Act. These rates are for the period April 1, 2015 through December 31, 2015 for acute per case inpatient rates, exempt hospitals, exempt units and detoxification inpatient rates. Rates of payment for these services for these payers is to be based upon rates determined for state governmental agencies (Medicaid) in accordance with Article 2807-c (6-1) of the Public Health Law.
The July 1, 2014 APR-DRG Service Intensity Weights (SIWs) continued to be in effect for discharges on and after April 1, 2015 through December 31, 2015. The July 1, 2014 Average Length of Stay (ALOS) and Cost Outlier Thresholds also continued to be used for transfer and cost outlier payments for 2015 discharges. As previously notified, the 3M APR-DRG v.32 grouper was implemented for discharges on and after January 1, 2015. However, due to ICD-10 implementation, the 3M APR-DRG v.33 grouper was implemented for discharges on and after October 1, 2015.
The rates on the attached schedules are based upon the same methodology and data used in the rates effective January 1, 2015 through March 31, 2015, but also take into consideration the following:
- Hospital specific rate updates due to approved appeals for the following hospitals:
- Mount Sinai Beth Israel (Acute)
- Mount Sinai Beth Israel Kings Highway (Acute)
- Mount Sinai Hospital (Acute)
- Mount Sinai Hospital of Queens (Acute)
- New York Eye and Ear Infirmary of Mount Sinai (Acute)
- Peconic Bay Medical Center (Acute)
- Lewis County General Hospital (Critical Access Hospital)
Should you have any questions or require further information, please contact Janet Baggetta at 518-486-7164 or via email at HospFFSunit@health.ny.gov.
Sincerely,
John E. Ulberg, Jr.
Medicaid Chief Financial Officer
Division of Finance and Rate Setting
Office of Health Insurance Programs
New York State Department of Health
May 26, 2017
ANDREW M. CUOMO, Governor
HOWARD A. ZUCKER, M.D., J.D., Commissioner
SALLY DRESLIN, M.S., R.N., Executive Deputy Commissioner
Chairman
New York State Workers´ Compensation Board
328 State Street, Suite 2
Schenectady, New York 12305
Dear Mr. Munnelly:
The Office of Health Insurance Programs has calculated rates of reimbursement for the period April 1, 2015 through December 31, 2015 for acute per case inpatient rates, exempt hospitals, exempt units and detoxification inpatient rates. These rates have been calculated for services rendered to patients covered under the Workers’ Compensation Law, the Volunteer Firefighters’ Benefit Law, the Volunteer Ambulance Workers’ Benefit, and the Comprehensive Motor Vehicle Insurance Reparations Act..
Pursuant to section 2807(4) of the Public Health Law, I hereby certify to you that the rates appearing on the enclosed schedules have been developed in accordance with section 2807-c of the Public Health Law, as amended by the Health Care Reform Act, and Part 86-1 of the Title 10 (Health) of the Codes, Rules and Regulations of the State of New York.
Sincerely,
Jason A. Helgerson
Medicaid Director
Office of Health Insurance Programs
Enclosure(s)
