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

Subject No. 046-935

New Reimbursement Rates for Acute Per-Case Inpatient
Hospital Rates, Exempt Hospitals, Exempt Units and
Detoxification Inpatient Rates

Date: April 21, 2017

The Board is announcing new reimbursement rates for acute per-case inpatient hospital rates, exempt hospitals, exempt units and detoxification inpatient rates.

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. 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 January 1, 2017 through December 31, 2017. 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 Fee Schedules.

Please note, the APR-DRG Service Intensity Weights (SIWs) for 2017 will be updated later this year on a prospective basis. For inpatient discharges beginning on or after January 1, 2017, the SIWs, cost thresholds and average length of stay (ALOS) effective July 1, 2014 should be used for payment purposes with the APR-DRG grouper version 33. When the 2017 SIWs cost thresholds and ALOS are updated, the APR-DRG grouper should be updated to grouper version 34.


Kenneth J. Munnelly