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Workers' Compensation Board

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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. 046-709

New Reimbursement Rates for
Acute Inpatient Hospital Care

Date: August 6, 2014

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 promulgate the workers' compensation inpatient rates. These rates also apply to treatment provided under the Comprehensive Motor Vehicle Reparations Act, Volunteer Firefighters' Benefit Law, and Volunteer Ambulance Workers' Benefit Law.

Following approval by the New York State Division of the Budget (DOB), the DOH recently provided the Workers' Compensation Board (Board) with reimbursement rates for acute inpatient hospital care with discharge dates of April 1, 2014 through June 30, 2014. These rates are determined using the Medicaid inpatient methodology, All Patients Refined – Diagnostic Related Groups (APR-DRG).

Please note: Implementation of the 2014 APR-DRG Service Intensity Weights (SIWs) and 2014 v31 grouper were delayed pending completion of the 2014 rebasing of acute rates. Payments for discharges for the period April 1, 2014 through June 30, 2014 should be processed utilizing the 2013 SIWs, 2013 v30 grouper and the “Schedule of Workers' Compensation/No Fault (WCNF) Inpatient Case Payment Rates – Effective 4/1/14-6/30/14” posted on the Board’s website.

The new rates are located under Health Care Information, Medical Care Fee Schedules, Inpatient & Outpatient Fee Schedules, 2014. Questions related to this announcement can be directed to the Medical Directors' Office by email at: WCBMedicalDirectorsOffice@wcb.ny.gov.

 

Robert E. Beloten
Chair