APR-DRG and Exempt Rates for Medicaid Fee-for-Service and Managed Care

2018

Effective 11/01/2018 (Initial Rates)

• Medicaid Fee–for–Service
  • APR–DRG and Exempt Unit Rates effective 11/01/2018 (XLSX) Also available in PDF Format (PDF)
  • DOH Medicaid FFS and HMO Claims Payment Calculation (XLSX). Also available in PDF Format (PDF) – Updated 08/22/19
  • Chemical Dependency Detoxification Rates – 11/01/2018 (XLSX). Also available in PDF Format (PDF)
• Medicaid Managed Care
  • APR–DRG and Exempt Unit Rates effective 11/01/2018 (XLSX). Also available in PDF Format (PDF) – Updated – 08/22/19
  • DOH Medicaid FFS and HMO Claims Payment Calculation (XLSX). Also available in PDF Format (PDF) – Updated – 08/22/19
  • Chemical Dependency Detoxification Rates – 11/01/2018 (XLSX). Also available in PDF Format (PDF)
• Correspondence
  • Administrator Letter – August 22, 2019
  • Administrator Letter – June 14, 2019
  • Health Plan Letter – August 22, 2019
  • Health Plan Letter – June 14, 2019
  • Health Plan Letter – December 21, 2018

Effective 07/01/2018 (Psych only)

• Medicaid Fee–for–Service
  • Exempt Unit Rates effective 07/01/2018 (XLSX) Also available in PDF Format (PDF)
  • DOH Medicaid FFS and HMO Claims Payment Calculation (XLSX). Also available in PDF Format (PDF)
• Medicaid Managed Care
  • Exempt Unit Rates effective 07/01/2018 (XLSX). Also available in PDF Format (PDF)
  • DOH Medicaid FFS and HMO Claims Payment Calculation (XLSX). Also available in PDF Format (PDF)
• Correspondence
  • Administrator Letter – August 22, 2019
  • Health Plan Letter – August 22, 2019

Effective 07/01/2018 (Initial Rates)

• Medicaid Fee–for–Service
  • APR–DRG and Exempt Unit Rates effective 07/01/2018 (XLSX) Also available in PDF Format (PDF)
  • DOH Medicaid FFS and HMO Claims Payment Calculation (XLSX). Also available in PDF Format (PDF)
• Medicaid Managed Care
  • APR–DRG and Exempt Unit Rates effective 07/01/2018 (XLSX). Also available in PDF Format (PDF)
  • DOH Medicaid FFS and HMO Claims Payment Calculation (XLSX). Also available in PDF Format (PDF)
• Correspondence
  • Health Plan Letter – November 28, 2018

Effective 04/01/2018 (Initial Rates – MMC Only)

• Medicaid Managed Care
  • APR–DRG and Exempt Unit Rates effective 04/01/2018 (XLSX) Also available in PDF Format (PDF)
  • DOH Medicaid FFS and HMO Claims Payment Calculation (XLSX). Also available in PDF Format (PDF)
  • Chemical Dependency Detoxification Rates – 04/01/2018 (XLSX). Also available in PDF Format (PDF)
• Correspondence
  • Health Plan Letter – May 3, 2018

Effective 01/01/2018 (Initial Rates)

• Medicaid Fee–for–Service
  • APR–DRG and Exempt Unit Rates effective 01/01/2018 (XLSX) Also available in PDF Format (PDF)
  • DOH Medicaid FFS and HMO Claims Payment Calculation (XLSX). Also available in PDF Format (PDF)
  • Chemical Dependency Detoxification Rates – 01/01/2018 (XLSX). Also available in PDF Format (PDF)
• Medicaid Managed Care
  • APR–DRG and Exempt Unit Rates effective 01/01/2018 (XLSX). Also available in PDF Format (PDF) – Updated – 07/20/18
  • DOH Medicaid FFS and HMO Claims Payment Calculation (XLSX). Also available in PDF Format (PDF)
  • Chemical Dependency Detoxification Rates – 01/01/2018 (XLSX). Also available in PDF Format (PDF)
• Correspondence
  • Health Plan Letter – April 6, 2018

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