Rate Appeal Process

Please refer to Part 86-1.32 of the New York Codes, Rules and Regulations (NYCRR) for appealable issues that would pertain to inpatient rates as well as applicable deadlines. In filing an appeal, a facility must provide the information listed below.

To be considered for an inpatient rate-appeal request rate appeals, and the responses to requests for additional information, must be postmarked within the timeframes specified in New York Codes Rules and Regulations (NYCRR) Section 86-1.32 These timeframes start to run on the date the notification is sent to the facility that a new rate posting, or request for additional information, has been uploaded to the Health Commerce System (HCS). Notifications will be sent using the email address maintained by the facility for the HCS. Facilities are responsible for keeping this email address current and checking it for notifications from the Department. The date the notification is sent to the facility is also evidenced in the “Dear Administrator Letter” document that is posted on the HCS and describes the rate update. Please refer to the Rate Notification Process for further information.

  1. A cover letter, signed by the Operator or Chief Executive Officer of the hospital, containing a summary of the item(s) of appeal.

    Appeals must be submitted to:
    Monique Grimm
    Bureau of Hospital and Clinic Rate Setting
    One Commerce Plaza - Room 1430
    99 Washington Avenue
    Albany, New York 12210
  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, must be submitted to the Bureau of Hospital & Clinic Rate Setting by the applicable deadline to be deemed timely.
  4. Appeals for New Teaching Hospitals / Displaced Residents due to closure of a teaching facility. A completed template must accompany your appeal. Please refer to the New Teaching / Displaced Residents policy document.
  5. Providers will be notified by email that the resolution of the appeal request has been posted on the Health Commerce System (HCS). The email will be sent to the facility contacts that have access to the Hospital Program Applications on the HCS. Please refer to the Rate Notification Process for further information.

For further questions regarding hospital inpatient administrative rate appeals, please email your question to: HospFFSunit@health.ny.gov