APR-DRG and Exempt Rates for Workers' Compensation/No-Fault
New York State Department of Health
October 13, 2015
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 Worker´s Compensation Board
20 Park Street
Albany, New York 12207
Dear Mr. Beloten:
Enclosed please find the schedule of revised rates of reimbursement for the periods July 1, 2014 through December 31, 2014 and January 1, 2015 through December 31, 2015 for inpatient psychiatric services. These rates have been calculated in accordance with Article 2807-c (b-1) of the Public Health Law and shall apply 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.
The rates on the attached schedules are based upon those rates previously certified to you for the periods January 1, 2014 through December 31, 2014 and January 1, 2015 through December 31, 2015 but also takes into consideration the following:
- The Centers for Medicare and Medicaid (CMS) approved State Plan Amendment 14-0029, which changes the rural designation criteria for general hospitals with psychiatric exempt units. As a result, additional providers qualified for the rural adjustment factor of 1.2309 which is applied to the statewide base price for increased reimbursement. Additionally, those hospitals that meet the definition of serving in an "Upstate" region will receive a ten percent increase to the statewide base price component of the rate.
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 Title 10 (Health) of the Codes, Rules, and Regulations of the State of New York.
Should you have any questions or require further information, please email your inquiry to the Bureau of Acute and Managed Care Rate-Setting at HospFFSunit@health.ny.gov and either Monique Grimm or Tami Berdi from the hospital fee-for-service unit will respond.
Sincerely,
Jason A. Helgerson
Medicaid Director
Office of Health Insurance Programs
Enclosure(s)
