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


Subject No. 046-1163

Updated 2018 Reimbursement Rates for
Acute Per Case Inpatient Hospital Rates

Date: May 1, 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 July 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. Please see 2018 Medical Care Fee Schedules.

For discharges beginning on and after July 1, 2018, the APR-DRG Service Intensity Weights (SIWs) cost thresholds and average length of stay (ALOS) effective July 1, 2018, should 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 June 30, 2018, but also take into consideration the following:

  1. The service intensity weights (SIWs) were updated using 2012, 2013 and 2014 SPARCS data and 2013 ration of cost to charges as reported in the hospitalís audited 2013 Institutional Cost Report (ICR).
  2. The rebased acute rates reflect an update from the audited 2010 ICR, which was utilized for the operating components of the acute rates effective for discharges on and after July 1, 2014, to the audited 2015 ICR for the operating components of the acute rates for discharges on and after July 1, 2018.
  3. Total acute costs were used in the calculation of Direct Medical Education add-ons, as well as the non-comparable add-ons (School of Nursing, Ambulance and Teaching Election Amendment), divided by the total acute discharges, as reported in the audited 2015 ICRs.
  4. The Indirect Medical Education (IME) percentages were based on the acute resident counts provided to the Department on Exhibit 3 of the audited 2015 ICRs.
  5. The hospital-specific wage equalization factor was calculated using a three-year average (2012 through 2014) of hospital-specific Medicare occupational-mix adjusted wages and hours in addition to the 2015 hospital audited ICR data to determine labor share.
  6. No changes were made to the capital component of the rates of the Alternate Level of Care (ALC) rates.

 

Clarissa M. Rodriguez
Chair