2016 APG Updates/Policy Changes
- Letter is also available in Portable Document Format (PDF, 95KB)
April 5, 2016
Dear Health Plans:
The purpose of this letter is to provide Health Plans with information regarding recent updates to the Medicaid outpatient capital rates for the period January 1, 2009 through December 31, 2015 for general clinics, school-based health center clinics, OASAS clinics and emergency departments.
These rates were calculated in accordance with Article 28 of the Public Health Law and Part 86 of the Commissioner of Health´s Administrative Rules and Regulations and continue the Ambulatory Patient Groups (APG) reimbursement methodology, as adopted in the 2009-2010 and 2010-2011 State Budgets and in accordance with Subdivision 2-a of Article 2807 of the Public Health Law.
The APG rates posted to the Department´s website include the rate components required to process Medicaid claims. Based on the above mentioned changes, plans are encouraged to process adjustments according to the terms of their provider contracts with hospitals. This includes any reprocessing that should occur consistent with those agreements. Please see Hospital APG Rates for the latest APG capital rates.
Rate Codes:
The table below references the Medicaid Fee-for-Service capital rate codes which were updated on the Department´s website, along with the corresponding base rate codes (which were not updated):
Base Rate Code | Base Rate Code Description | Capital Rate Code | Service dates affected by capital rate updates |
---|---|---|---|
1400 | Hospital Outpatient APG Clinic | 1403 | 1/1/2009 - present |
1432 | Hospital Outpatient APG Clinic-Episode | 1434 | 7/1/2009 – present |
1501 | Hospital Outpatient APG Clinic-MR/DD/TBI | 1503 | 7/1/2010 – present |
1489 | Hospital Outpatient APG Clinic-MR/DD/TBI-Episode | 1491 | 7/1/2010 – present |
1444 | Hospital Outpatient APG School-Based Health Clinic | 1446 | 4/1/2009 – present |
1450 | Hospital Outpatient APG School-Based Health Clinic- Episode | 1452 | 10/1/2009 - present |
1528 | OASAS – Hospital Article 32 Clinic | 1530 | 10/1/2010 - present |
1552 | OASAS – Hospital Article 32 Medical Visit | 1554 | 5/1/2015 – present |
1402 | Hospital Outpatient APG Emergency Room | 1405 | 1/1/2009 – present |
Should you have any questions regarding the above information, please submit your inquiry to the HospFFSunit@health.ny.gov email address and either Monique Grimm or Tami Berdi from the hospital fee-for-service rate unit will respond.
Sincerely,
Michael Ogborn
Deputy Director
Division of Finance and Rate Setting