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Subject Number 046-1232 Change in Reimbursement Rates for Inpatient Psychiatric Exempt Unit Services

Board Bulletins and Subject Numbers

November 29, 2019

Pursuant to New York Public Health Law § 2807-c(6-1), the workers' compensation fee schedule for inpatient hospital care tracks New York Medicaid rates, with limited statutory modifications. The New York State Department of Health is required by statute to announce the workers' compensation inpatient rates. These rates, which also apply to treatment provided under the Comprehensive Motor Vehicle Reparations Act, Volunteer Firefighters' Benefit Law, and Volunteer Ambulance Workers' Benefit Law, are posted on the Board's website. Please see 2018 Medical Care Fee Schedules.

The Centers for Medicare and Medicaid Services recently approved State Plan Amendment 18-0059, which increased the payment adjustment factor for psychiatric inpatient services provided to individuals that are 17 years of age or under from 1.0872 to 1.3597, effective July 1, 2018. This age adjustment payment factor is applied to the psychiatric operating per diem rate component.

Please note that the attached rate schedule remains unchanged from the psychiatric rates previously certified effective July 1, 2018. Only the calculation file has been updated since the payment adjustment factor used to calculate the payment of a claim for individuals 17 years of age and under has changed.

Clarissa M. Rodriguez