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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. 046-821

Revised Reimbursement Rates for Psychiatric Inpatient Exempt Units

Date: November 12, 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 revised rates of reimbursement for the periods July 1, 2014 through December 31, 2014 and January 1, 2015 through December 31, 2015 for inpatient psychiatric services. 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, 2014, and Inpatient and Outpatient Fee Schedules, 2015.

Please Note: The rates are based upon those rates previously certified for periods January 1, 2014 through December 31, 2014 and January 1, 2015 through December 31, 2015 but also take into consideration the following:

The Centers for Medicare & Medicaid Services (CMS) approved State Plan Amendment 14-0029, which changes the rural designation criteria for general hospitals with psychiatric exempt units. As a result, additional providers qualified for the rural adjustment factor of 1.2309, which is applied to the statewide base price for increased reimbursement. Additionally, those hospitals that meet the definition of serving in an “Upstate” region will receive a ten percent increase to the statewide base price component of the rate.


Robert E. Beloten