February 28, 2011 Department of Health Letter to Workers' Compensation Board
February 28, 2011
Mr. Robert E. Beloten
Chairman
New York State Worker´s Compensation Board
20 Park Street
Albany, NY 12207
Dear Mr. Beloten:
The Office of Health Insurance Programs has calculated initial rates of reimbursement for the period January 1, 2011 through March 31, 2011 for hospital inpatient 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,
Jason A. Helgerson
Medicaid Director
Deputy Commissioner
Office of Health Insurance Programs
February 8, 2011 Mr. Robert E. Beloten Dear Mr. Beloten: Enclosed please find the certification letter and schedules of initial 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 for the period January 1, 2011 through March 31, 2011. Rates of payment for inpatient services for these payors is to be based upon rates determined for state governmental agencies (Medicaid) in accordance with Article 2807-c(b-1) of the Public Health Law. The formula on which these rates are based was promulgated in accordance with Article 28 of the Public Health Law as recently amended. The rates for the period January 1, 2011 through March 31, 2011 are based on the same methodology and data as used in the rates for the period October 1, 2010 through December 31, 2010 but reflect an update to 2011 Budgeted Capital and incorporate a trend factor of 1% based upon the methodology as set forth in Article 2807-c(10). Also, as with the rates effective October 1, 2010 through December 31, 2010, the January 1, 2011 through March 31, 2011 rates reflect a statewide base price calculated to incorporate all Medicaid based expenditures for hospitals statewide for fee-for-service and managed care to develop a blended rate. This statewide price however does not reflect the base reductions as set forth in paragraph 35 of 2807-c of the Public Health Law, as this adjustment does not apply. In addition, the Acute statewide price calculation has been updated to reflect the 2011 average APR-DRG casemix index (CMI) based on the Service Intensity Weights (SIW) in effect beginning January 1, 2011 whereas the October 1, 2010 through December 31, 2010 used the average APR-DRG CMI based on the SIWs in effect for the period beginning December 1, 2009. The SIW update is in accordance with Part 86-1.18 of the Commissioner of Health´s Administrative Rules and Regulations. The schedules attached have been calculated in accordance with these provisions and the various schedules and components are described in detail below: These are the per diem rates that are applicable for exempt hospital and exempt units within a general hospital in accordance with Article 2807-c of the Public Health Law. Should you have any questions or require further information please do not hesitate to contact Mr. John W. Gahan Jr., Director, Bureau of Primary and Acute Care Reimbursement at (518) 474-3267. Sincerely, John E. Ulberg, Jr.
Chairman
New York State Worker´s Compensation Board
20 Park Street
Albany, NY 12207
Director
Division of Health Care Financing
