APR-DRG and Exempt Rates for Medicaid Fee-for-Service and Medicaid Managed Care
New York State Department of Health
April 12,2018
ANDREW M. CUOMO, Governor
HOWARD A. ZUCKER, M.D., J.D., Commissioner
SALLY DRESLIN, M.S., R.N., Executive Deputy Commissioner
Chair
New York State Workers´ Compensation Board
328 State Street, Suite 2
Schenectady, New York 12305
Dear Ms. Rodriguez:
The Office of Health Insurance Programs has calculated rates of reimbursement for the period January 1, 2018 through December 31, 2018 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,
Donna Frescatore
Medicaid Director
Office of Health Insurance Programs
Enclosure(s)
Ms. Clarissa M. Rodriguez
Chair
New York State Workers´ Compensation Board
328 State Street, Suite 2
Schenectady, New York 12305
Dear Ms. Rodriguez:
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 January 1, 2018 through December 31, 2018 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. Please note that revised rates are anticipated effective July 1, 2018 due to the rebasing of the acute per case, exempt hospitals, exempt units and detoxification inpatient rates.
The APR–DRG Service Intensity Weights (SIWs) for 2018 will not be updated until July 1, 2018, on a prospective basis. For discharges beginning on or after January 1, 2018, the SIWs, cost thresholds and average length of stay (ALOS) effective July 1, 2014 should be used for payment purposes with the APR–DRG grouper version 33. At the time that the 2018 SIWs, cost thresholds and ALOS are updated, anticipated for July 1, 2018, the APR–DRG grouper should be updated to grouper version 34.
The rates on the attached schedules are based upon the same methodology and data used in the rates effective January 1, 2017 through December 31, 2017, but also take into consideration the following:
- Inclusion of 2018 budgeted capital as reported by hospitals and calculated in accordance with Section 8 of Article 2807–c of the Public Health Law.
- Prospective rate adjustments associated with the capital component of each of the inpatient rates to reflect the reconciliation of budgeted to actual costs and utilization for the period January 1, 2014 – December 31, 2015.
- The inclusion of a 2018 trend factor of 2.2% based upon the initial CPI as published in the most recent Federal Register and as required by Section 10 of Article 2807–c of the Public Health Law.
- Adjustments to the acute services, critical access hospital and medical rehabilitation rates as a result of Article 19 of the NYS Labor Law that established new minimum wage increases beginning January 1, 2018.
- Rate appeals for Westchester Medical Center/St Francis of Poughkeepsie and University Hospital – Stony Brook/Southampton Hospital to reflect merged acute rates.
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,
Donna Cater
Deputy Director
Division of Finance and Rate Setting
Office of Health Insurance Programs
