Administrator Letter

  • Letter is also available in Portable Document Format

June 21, 2023

Dear Administrator:

We are transmitting for your review the calculation of your hospital's revised inpatient acute and exempt hospital rates for Medicaid Managed Care (MMC), which are effective April 1, 2022 - December 31, 2022. Please note that the Medicaid Fee-for-Service and Workers' Compensation/No-Fault (WCNF) rates have not changed. These rates have been promulgated in accordance with Article 2807-c and, for the acute rates, Article 2807-c (35)(c).

These rates are based upon the same information and methodology as the previous acute and exempt hospital rates effective April 1, 2022, but take into consideration the following updates:

Acute Rates:

  • NYC Upper Payment Limit (UPL) Conversion per discharge add-ons to the acute rates based on the 2021 UPL demonstration. These add-ons are effective April 1, 2022 - March 31, 2023 and will also be included in the January 1, 2023 MMC rates.

Exempt Specialty Hospital Rates:

  • NYC Upper Payment Limit (UPL) Conversion per diem add-on to the exempt specialty hospital rate based on the 2021 UPL demonstration (Henry J Carter Specialty Hospital only). These add-ons are effective April 1, 2022 - March 31, 2023 and will also be included in the January 1, 2023 MMC rates.

Appeals:

With the exception of the April 1, 2022 UPL rate add-ons, all data associated with these rates was previously subjected to the appeal process. Therefore, only appeals related to the UPL add-ons for this rate period will be allowed.

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 October 19, 2023. Due to bureau staff 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 mailed.

Where possible, original appeal copies may be mailed to:

Ms. Monique Grimm
Director
Bureau of Hospital and Clinic Rate Setting
One Commerce Plaza, Room 1430
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 Tami Berdi or John Neuberger from the rate unit will respond.

Sincerely,

Monique Grimm
Director
Bureau of Hospital and Clinic Rate Setting