Dear Administrator Letter

  • Letter is also available in Portable Document Format

November 9, 2021

Dear Administrator:

We are transmitting for your review the calculation of your hospital's initial inpatient acute, exempt hospital and exempt unit reimbursement rates for Medicaid Fee-for-Service (FFS) and Medicaid Managed Care (MMC), which are effective October 1, 2021. Please note that the inpatient rates for Workers’ Compensation/No-Fault (WCNF) have not changed and remain the same as the rates effective January 1, 2021. These rates have been promulgated in accordance with Article 2807-c and, for the acute rates, Article 2807-c (35)(c).

The October 1, 2021 Medicaid FFS rates have been approved by the New York State Division of the Budget (Budget) and have been transmitted to eMedNY for payment and retroactive claims processing in cycle #2309.

These rates are based upon the same information and methodology as the inpatient rates effective January 1, 2021 but take into consideration the following update effective October 1, 2021, per the enacted State Fiscal Year (SFY) 2021-22 State Budget:

  • Increase in the reduction percentage to all hospital inpatient budgeted capital rate add-ons from 5% to 10%

Appeals:

All data associated with these rates was previously subjected to the appeal process. The capital reductions are not subject to appeal since they were implemented in accordance with the enacted SFY 2021-22 State Budget. Therefore, only appeals related to mathematical errors by the Department will be accepted for this rate period.

Part 86-1.32 of the New York Codes, Rules and Regulations sets forth the rules governing appeals, which does not include issues regarding methodology. In filing an appeal, a facility must provide the following:

  1. A cover letter signed by the Operator or Chief Executive Officer of the hospital containing a summary of the item(s) of appeal.
  2. Supporting schedules or any other pertinent data is to be included with the facility's appeal letter.
  3. All rate appeals and supporting documentation pertaining to items revised in this publication of inpatient rates for services for Title XIX (Medicaid) beneficiaries should be submitted to the Bureau of Hospital and Clinic Rate Setting and must be received by this office no later than January 10, 2021. Due to bureau staff still working on a partially remote basis, it is requested that providers submit a copy of their appeal request via email to HospFFSunit@health.ny.gov. Given that many hospital staff may also be working remotely, the Department is not requiring that the original signed appeal request letter be physically mailed.

Where possible, original appeal letters may be mailed to:

Ms. Janet Baggetta
Director
Bureau of Hospital and Clinic Rate Setting
One Commerce Plaza, Room 1432
99 Washington Ave
Albany, New York 12210

Should you have any questions regarding the above information, please send an email to the hospital rate-setting unit at HospFFSunit@health.ny.gov and either Monique Grimm or Tami Berdi will respond.

Sincerely,

Janet Baggetta
Director
Bureau of Hospital and Clinic Rate Setting