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Subject Number 046-1233 New 2019 Reimbursement Rates for Acute Per Case Inpatient Hospital Rates, Exempt Hospitals, Exempt Units and Detoxification Inpatient Rates

Board Bulletins and Subject Numbers

November 29, 2019

The New York State Department of Health (DOH) recently provided the Workers' Compensation Board with updated reimbursement rates for acute per case inpatient rates for the period of January 1, 2019, through December 31, 2019. Rates of payments for these services are based upon rates determined for state governmental agencies (Medicaid) in accordance with Article 2807-c(6)(1). 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. Please see 2019 Medical Care Fee Schedules.

For discharges beginning on and after July 1, 2019, the APR-DRG Service Intensity Weights (SIWs) cost thresholds and average length of stay (ALOS) effective July 1, 2018, should continue to be used for payment purposes, in conjunction with the APR-DRG 3M grouper version 34.

Please note, that the rates on the attached schedules are based upon the same methodology used in the rates effective January 1, 2018, through December 31, 2018, but also take into consideration the following:

  1. The inclusion of 2019 budgeted capital as reported by hospitals and calculated in accordance with Section 8 of Article 2807-c of the Public Health Law.
  2. The removal of prospective rate adjustments, associated with the capital component of each of the inpatient rates, which had previously been included to reflect the reconciliation of budgeted to actual costs and utilization for the period of January 1, 2014 December 31, 2015.
  3. The inclusion of a 2019 trend factor of 2.2% based upon the initial Consumer Price Index (CPI) as published by the Congressional Budget Office and as required by Section 10 of Article 2807-c of the Public Health Law.
  4. Adjustments to the acute, specialty hospital and critical access hospital rates, where applicable, as a result of Article 19 of the NYS Labor Law that established new minimum wage increases beginning January 1, 2019.
  5. Rate appeal for Cobleskill Regional Hospital due to conversion from acute per discharge to Critical Access Hospital per diem reimbursement effective January 1, 2019.
  6. Rate appeal for Eastern Niagara Hospital due to change in teaching status and eligibility for Graduate Medical Education adjustments in their acute rates.

Clarissa M. Rodriguez