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Workers’ Compensation Board

New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo


Subject No. 046-1083

Updated 2017 and New 2018 Reimbursement Rates for Acute
Per Case Inpatient Hospital Rates, Exempt Hospitals, Exempt
Units and Detoxification Inpatient Rates

Date: July 24, 2018

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 (DOH) is required by statute to announce the workers' compensation inpatient rates. The DOH recently provided the Workers' Compensation Board (Board) with updated reimbursement rates for acute per case inpatient rates, exempt hospitals, exempt units and detoxification inpatient rates for the period of April 1, 2017 through December 31, 2017, and new reimbursement rates for January 1, 2018 through December 31, 2018. 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, are posted on the Board's website. Please see 2017 Medical Care Fee Schedules and 2018 Medical Care Fee Schedules.

For the updated 2017 rates, please note that the rates on the attached schedules are based upon the same methodology and data used in the rates effective January 1, 2017 through March 31, 2017, but also take into consideration the following updates related to rate appeals:

  • Westchester Medical Center and St. Francis of Poughkeepsie (Mid-Hudson Valley Division of Westchester Medical Center) combined acute rates due to the merger of these facilities.
  • University Hospital Stony Brook and Southampton Hospital combined acute rates due to the merger of these facilities.
  • St. Johns Riverside Hospital updated acute rates to reflect graduate medical education adjustments due to the facility becoming a new teaching hospital.
  • Medina Memorial Hospital has new critical access hospital rates due to the facility converting from an acute care to a critical access hospital.

For the new 2018 rates, please note that the rates on the attached schedules are based upon the same methodology and data used in the rates effective January 1, 2017 through December 31, 2017, but also take into consideration the following:

  • Inclusion of 2018 budgeted capital as reported by hospitals and calculated in accordance with Section 8 of Article 2807-c of the Public Health Law.
  • Prospective rate adjustments associated with the capital component of each of the inpatient rates to reflect reconciliation of budgeted to actual costs and utilization for the period January 1, 2014 December 31, 2015.
  • The inclusion of a 2018 trend factor of 2.2% based upon the initial CPI as published in the most recent Federal Register and as required by Section 10 of Article 2807-c of the Public Health Law.
  • Adjustments to the acute services, critical access hospital and medical rehabilitation rates, as a result of Article 19 of the NYS Labor Law that established new minimum wage increases beginning January 1, 2018.
  • Rate appeals for Westchester Medical Center/St. Francis of Poughkeepsie and University Hospital Stony Brook/Southampton Hospital to reflect merged acute rates.

 

Clarissa M. Rodriguez
Chair