December 16, 2014 Department of Health Letters to Workers' Compensation Board
December 16, 2014
Mr. Robert E. Beloten
Chairman
New York State Worker& Compensation Board
20 Park Street
Albany, NY 12207
Dear Mr. Beloten:
The Office of Health Insurance Programs has calculated rates of reimbursement for the period July 1, 2014 through December 31, 2014 for acute per case inpatient rates. These rates have been calculated for 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
Office of Health Insurance Programs
December 16, 2014
Mr. Robert E. Beloten
Chairman
New York State Worker& Compensation Board
20 Park Street
Albany, NY 12207
Dear Mr. Beloten:
Enclosed please find the certification letter and schedules of 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. These rates are for the period July 1, 2014 through December 31, 2014 for acute per case inpatient rates. Rates of payment for these services for these payers is to be based upon rates determined for state governmental agencies (Medicaid) in accordance with Article 2807-c (6-1) of the Public Health Law.
On December 9, 2013, in consensus with the NYS hospital associations, hospitals were notified of a delay of the rebasing of the 2014 acute per case inpatient rates. With this delay, the implementation of the 2014 APR-DRG Service Intensity Weights (SIWs) and 2014 v31 grouper were also delayed until the 2014 rebasing of acute rates was completed. These rates have since been completed and are retroactive for discharges on and after July 1, 2014. The 2014 APR-DRG SIWs and 2014 v31 grouper are to be used in conjunction with these rates.
The rates on the attached schedules are based upon those rates previously certified to you for the period April 1, 2014 through June 30, 2014, but also incorporate the following:
- 1) The rebased acute rates reflect an update from the 2005 Institutional Cost Report (ICR), which was utilized in the acute rates effective for discharges beginning on December 1, 2009, to the audited 2010 ICR for the operating components of the rates.
- 2) The provider specific wage equalization factor was calculated using a 3 year average (2008 through 2010) of provider specific Medicare occupational-mix adjusted wages and hours and 2010 audited ICR data to determine the labor share.
- 3) The alternate level of care (ALC) rates were updated to reflect the average upstate and downstate January 1, 2013 skilled nursing home rates, trended to 2014.
Should you have any questions or require further information, please contact Janet Baggetta at 518-473-8822 or via email at HospFFSunit@health.ny.gov.
Sincerely,
John E. Ulberg, Jr.
Medicaid Chief Financial Officer
Division of Finance and Rate Setting
Office of Health Insurance Programs
