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Workers’ Compensation Board

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

Subject No. 046-773

New Reimbursement Rates for Inpatient Hospital Care Updated

Date: July 9, 2015

Pursuant to Article 2807-c (6-1) of the Public Health Law, 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. The DOH recently provided the Workers' Compensation Board (Board) with reimbursement rates for acute per case inpatient rates, exempt hospitals, exempt units and detoxification inpatient rates with discharge dates of January 1, 2015 through December 31, 2015. 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 located under Health Care Information, Medical Care Fee Schedules, Medical Fee Schedules, Inpatient and Outpatient Fee Schedules, 2015.

The new rates for medically managed detoxification (MMD) and medically supervised inpatient withdrawal (MSIW) reimbursement rates with discharge dates of January 1, 2015 through December 31, 2015 are also available on the Board’s website under Inpatient and Outpatient Fee Schedules, 2015. These rates reflect the detox rate reform provisions of Section 2807-c(4)(1) enacted under Chapter 58 of the Laws of 2008, and as subsequently revised under the Laws of 2009.

Please Note: The APR-DRG weights effective January 1, 2015 will not be updated. For discharges beginning on or after January 1, 2015, the SIWs, cost thresholds and average length of stay (ALOS) effective July 1, 2014 should be used for payment purposes with the updated APR-DRG grouper version 32.


Robert E. Beloten