reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.20 - Add-ons to the case payment rate per discharge

Current through Register Vol. 46, No. 28, July 10, 2024
Rates of payment computed pursuant to this Subpart shall
						be further adjusted in accordance with the following:
(a) A direct graduate medical education (GME)
					 payment per discharge shall be added to the case payment rates of teaching
					 general hospitals after the application of SIW and WEF adjustments to the
					 statewide base price and shall be calculated for each hospital by dividing the
					 facility's total reported Medicaid direct GME costs by its total reported
					 Medicaid discharges pursuant to section
					 86-1.16(b)(2) 
					 of this Subpart. Direct GME costs shall be those costs defined in section
					 86-1.15(f)(1) 
					 of this Subpart, derived from the same base period used to calculate the
					 statewide base price for the applicable rate period and trended forward to such
					 rate period in accordance with applicable provisions of section 2807-c (10)  of the Public
					 Health Law, and shall be excluded from the cost included in the statewide base
					 price.
(b)
(1) An indirect GME payment per discharge
					 shall be added to the case payment rates of teaching general hospitals after
					 the application of SIW and WEF adjustments to the statewide base price and
					 shall be calculated by multiplying such rates by the indirect teaching cost
					 percentage determined by the following formula:
where "r" equals the ratio of residents and fellows to
						beds based on the medical education statistics for the hospital for the period
						ended June 30, 2005 as contained in the survey document submitted by the
						hospital to the department as of June 30, 2009 and the staffed beds for the
						general hospital reported in the 2005 institutional cost report and submitted
						to the department no later than June 30,2009, but excluding exempt unit beds
						and nursery bassinettes.
(2)
					 Indirect GME costs are those costs defined in section
					 86-1.15(f)(2) 
					 of this Subpart, derived from the same base period used to calculate the
					 statewide base price for the applicable rate period and trended forward to such
					 rate period in accordance with applicable provisions of section 2807-c (10)  of the Public
					 Health Law, and shall be excluded from computation of the statewide base price.
					 The amount of such exclusion shall be determined by multiplying the total
					 reported Medicaid costs less reported direct GME costs by the following
					 formula:
1.03(((1 + r) [CIRCUMFLEX ACCENT]0.0405) -1)
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.21 - Outlier and transfer cases rates of payment

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1)
					 High cost out lierrates of payment shall be calculated by reducing total billed
					 patient charges, as approved by IPRO, to cost, as determined based on the
					 hospital's ratio of cost to charges. Such calculation shall use the most recent
					 data available as subsequently updated to reflect the data from the year in
					 which the discharge occurred, and shall equal 100 percent of the excess costs
					 above the high cost outlier threshold. High cost outlier thresholds shall be
					 developed for each individual DRG and adjusted by hospital-specific wage
					 equalization factors (WEF) and increased by the Consumer Price Index from the
					 base period used to determine the statewide base price and the rate
					 period.
(2) A non-public,
					 not-for-profit general hospital which has not established an ancillary and
					 routine charges schedule shall be eligible to receive high-cost outlier
					 payments equal to the average of high-cost outlier payments received by
					 comparable hospitals, as determined using the following criteria:
(i) downstate hospitals;
(ii) hospitals with a Medicaid fee for
					 service case mix greater than 1.75;
(iii) hospitals with Medicaid fee for service
					 revenue greater than $30 million of total revenue; and
(iv) hospitals with a proportion of Medicaid
					 fee for service outlier to inlier cases greater than 3.0 percent.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.22 - Alternate level of care payments

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Hospitals shall be reimbursed for ALC
					 days at the appropriate 1987 group average operating cost component of rates of
					 payment for hospital-based residential health care facilities established
					 pursuant to Subpart 86-2 of this Part trended to the rate year. The
					 determination of the group average operating rate for hospital-based
					 residential health care facilities shall be based on the combination of
					 residential health care facilities as follows:
(1) the downstate group consisting of
					 residential health care facilities located in the five boroughs of New York
					 City and Nassau, Suffolk, Westchester and Rockland Counties;
(2) the upstate group consisting of all other
					 residential health care facilities in the State.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.23 - Exempt units and hospitals

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Physical medical rehabilitation inpatient services shall qualify for
					 reimbursement pursuant to section 2807-c(4)(e-2) of the Public Health Law for
					 periods on and after December 1, 2009, only if such services are provided in a
					 hospital specializing in such services or in a distinct unit within a general
					 hospital designated for such services and only if:
(1) such hospital or such unit qualified for
					 exempt unit status for purposes of reimbursement under the Federal Medicare
					 prospective payment system as of December 31, 2001; or
(2) on or before July 1, 2009, the hospital
					 submitted a written request to the department for exempt status providing
					 assurances acceptable to the department that the hospital or unit within the
					 hospital meets the exempt status criteria set forth in section 2807-c (4)(e)  of the
					 Public Health Law for 2009 for periods prior to December 1, 2009.
(i) For periods on and after January 1, 2010,
					 a hospital seeking exempt status for a hospital or a distinct unit within the
					 hospital not previously recognized by the department as exempt for
					 reimbursement purposes shall submit a written request to the department for
					 such exempt status and shall provide assurances and supporting documentation
					 acceptable to the department that the hospital or unit meets qualifying exempt
					 status criteria in effect at the time such written request is submitted.
					 Approval by the department of such exempt status shall, for reimbursement
					 purposes, be effective on the January 1st following such approval, provided
					 that the request for such exempt unit status was received at least 120 days
					 prior to such date.
(ii) For days
					 of service occurring on and after December 1, 2009, the operating component of
					 rates of payment for inpatient services, other than physician services, for
					 facilities subject to this subdivision shall be a per diem amount reflecting
					 the facility's reported 2005 operating costs, excluding physician costs, as
					 submitted to the department prior to July 1, 2009, not including reported
					 direct medical education costs and physician costs, and held to a ceiling of
					 110 percent of the average of such costs in the region in which the facility is
					 located, as described in subdivision (i) of this section. Such rates shall
					 reflect trend adjustments in accordance with the applicable provisions of
					 section 2807-c (10)  of the Public
					 Health Law.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.24 - Trend factor

Current through Register Vol. 46, No. 28, July 10, 2024
The commissioner shall establish trend factors for
						hospitals to project the effects of price movements on historical operating
						costs. Rates of payment excluding capital, as calculated pursuant to the
						provisions of this Subpart, shall be trended to the applicable rate year by the
						trend factors developed in accordance with the provisions of subdivision 10 of
						section 2807-c  of the Public Health
						Law.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.25 - Capital expense reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The allowable costs of fixed capital
					 (including but not limited to depreciation, rentals and interest on capital
					 debt), and major movable equipment shall be reimbursed based on budgeted data
					 and shall be reconciled to total actual expense for the rate year and shall be
					 determined and computed in accordance with the provisions of subdivisions (f),
					 (g) and (h) of this section.
(b)
					 General hospitals shall submit a schedule of anticipated inpatient
					 capital-related expenses for the forthcoming year to the commissioner at least
					 120 days prior to the beginning of the rate year.
(c) The following principles shall apply to
					 budgets for inpatient capital-related expenses:
(1) The basis for determining capital-related
					 inpatient expenses shall be the lesser of actual cost or the final amount
					 specifically approved for construction of the capital asset.
(2) Any capital-related inpatient expense
					 generated by a capital expenditure which requires or required approval pursuant
					 to article 28 of the Public Health Law, must have received such approval for
					 the capital-related expense to be included in the rate calculation.
(3) The submitted budget may include the
					 capital-related inpatient expense of all existing capital assets, as well as
					 estimates of capital-related inpatient expenses for capital assets to be
					 acquired or placed in use prior to the commencement of the rate year.
(4) Any capital-related expense generated by
					 a capital expenditure acquired or placed in use during a rate year shall be
					 carried forward to the subsequent rate year, provided all required approvals
					 have been obtained. In instances where such approvals have been obtained or
					 where approval is not required and such assets are acquired or placed in use
					 during a rate year, the budget may include estimates for capital-related
					 expenses relating to these assets.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.26 - Statewide Planning and Research Cooperative System (SPARCS)

Current through Register Vol. 46, No. 28, July 10, 2024
Each general hospital shall be assessed an annual fee
						calculated on the basis of the hospital's proportionate share of the sum of
						total costs reported by all general hospitals in the most recent calendar year
						for which certified data are available. Such amount shall not exceed one tenth
						of one percent of the total certified cost of the hospital. The commissioner
						shall inform each such hospital of its actual fee to support the statewide
						planning and research cooperative system and each hospital shall submit such
						fee on a quarterly basis to be received by the commissioner not later than the
						15th of February, May, August and November of each year. Failure to submit such
						fees in accordance with this schedule may result in a two-percent reduction in
						the affected hospital's rate beginning on the first day following the due date
						and continuing until the last day of the calendar month in which said fees are
						submitted. These funds shall be pooled on a statewide basis and will be
						restricted and used to support the costs of the statewide planning and research
						cooperative systems.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.27 - Federal upper limit compliance

Current through Register Vol. 46, No. 28, July 10, 2024
In the event the State cannot provide assurances
						satisfactory to the secretary of the Department of Health and Human Services
						related to a comparison of rates of payment for general hospital inpatient
						services to beneficiaries of the title XIX program determined in accordance
						with this Subpart in the aggregate to maximum reimbursement payments provided
						in Federal law and regulation which are substantially the same as such
						assurances in effect on October 26, 1987 for purposes of securing Federal
						financial participation in such payments, such rates of payments shall be
						adjusted proportionally as necessary to meet Federal requirements for securing
						Federal financial participation.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.28 - Adding or deleting hospital services or units

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Notification of the elimination of a
					 general hospital inpatient service or identifiable unit of such a service in
					 instances in which the costs of such service are reflected in the rate
					 calculated pursuant to this Subpart shall be submitted in writing by the
					 facility to the department within 60 days of the elimination of such service or
					 unit. If a rate is modified by the department as a result of such service or
					 unit elimination, such rate shall be effective as of the date of the
					 elimination of the service or unit.
(b) Notification of the establishment of a
					 new hospital or of a new exempt unit of an existing hospital shall be submitted
					 in writing by the facility to the department within 60 days of the
					 establishment of such new hospital or such new unit. Thereafter the department
					 shall establish inpatient rates for such new hospital or such new exempt unit
					 in accordance with section
					 86-1.29 
					 of this Subpart. Such rates shall be effective the first day of the month
					 following 30 days after such notification or the date of the approved
					 certificate of need (CON) certification, whichever is later.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.29 - New hospitals and hospitals on budgeted rates

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
New hospitals.
Payments to new hospitals without adequate cost
						experience for inpatient acute care services that are not exempt from DRG
						case-based rates of payment shall be computed in accordance with this Subpart
						except as follows:
(1) Rates of
					 payment shall be computed on the basis of 100 percent of the statewide base
					 price determined pursuant to section
					 86-1.16  of
					 this Subpart multiplied by the service intensity weight for each DRG set forth
					 in section
					 86-1.18 
					 of this Subpart.
(2) The WEF used
					 to adjust the statewide base price shall be equal to 1.0 until adequate data
					 becomes available.
(3) The indirect
					 teaching adjustment shall be determined pursuant to the provisions of section
					 86-1.20 
					 of this Subpart.
(4) The
					 noncomparable operating costs of new facilities as defined in section
					 86-1.15  of
					 this Subpart and direct graduate medical education costs shall consist of the
					 hospital's budgeted operating costs for these services.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.30 - Swing bed reimbursement

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Definitions.
(1) For purposes of
					 this section,
eligible hospitals
shall mean those hospitals
					 fined as rural hospitals and meeting the swing bed program requirements in Part
					 406 of this Title.
(2)
Rate
shall mean the aggregate governmental payment made to
					 eligible facilities per patient day as defined in section
					 86-2.8  of
					 this Title for the care of patients receiving care pursuant to title XIX of the
					 Federal Social Security Act (Medicaid).
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.31 - Mergers, acquisitions and consolidations

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Rates of payment.
As used in this section, the terms
merger,
						acquisition
and
consolidation
shall mean the
						combining of two or more general hospitals licensed under article 28 of the
						Public Health Law, where such combination is consistent with the public need,
						would create a new, more economical entity, reduce the costs of operation,
						result in the reduction of beds and/or improve service delivery. In order to be
						eligible for reimbursement pursuant to this section, the applicant facility
						must have previously received a certificate of need (CON) approval by the
						commissioner and/or Public Health Council approval for the merger, acquisition,
						or consolidation pursuant to the Public Health Law. Payments for hospitals
						subject to a merger, acquisition or consolidation for inpatient acute care
						services that are not otherwise exempt from DRG case-based rates of payment
						will be effective on the date the transaction is effected and shall be computed
						in accordance with this Subpart except as follows:
(1) The WEF used to adjust the statewide base
					 price shall be calculated by combining all components used in the calculation
					 pursuant to section
					 86-1.19 
					 of this Subpart for all hospitals subject to the merger, acquisition or
					 consolidation.
(2) The direct GME
					 payment per discharge added to the case payment rates of teaching hospitals
					 shall be calculated by dividing the total reported Medicaid direct GME costs
					 for all teaching hospitals subject to the merger, acquisition, or consolidation
					 by the total reported Medicaid discharges reported by such hospitals in the
					 applicable base period.
(3) The
					 indirect GME payment per discharge added to the case payment rates of teaching
					 hospitals shall be calculated in accordance with section
					 86-1.20 
					 of this Subpart, except the ratio of residents to beds used in the calculation
					 shall be based on the total residents and beds of all such hospitals subject to
					 the merger, acquisition, or consolidation.
(4) The non-comparable payment per discharge
					 added to the case payment rates shall be calculated by dividing the total
					 reported Medicaid costs for qualifying non-comparable cost categories for all
					 hospitals subject to the merger, acquisition, or consolidation by the total
					 reported Medicaid discharges reported by such hospitals in the applicable base
					 period.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.33 - Out-of-state providers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For
					 discharges occurring on and after December 1, 2009, rates of payment for
					 inpatient hospital services provided by out-of-state providers in accordance
					 with the prior approval requirements set forth in section 365-a (4)(d)  of the Social
					 Services Law shall be as follows:
(1)
(i) the weighted average of inpatient rates,
					 including a teaching adjustment where applicable, in effect for similar
					 services for hospitals located in the downstate region of New York State shall
					 apply with regard to services provided by out-of-state providers located in the
					 New Jersey Counties of Sussex, Passaic, Bergin, Hudson, Essex, Union, Middlesex
					 and Monmouth, in the Pennsylvania County of Pike, and in the Connecticut
					 counties of Fairfield and Litchfield;
(ii) for rates effective beginning January 1,
					 2014, the weighted average of inpatient rates, including a teaching adjustment
					 where applicable, in effect for similar services for hospitals located in the
					 downstate region of New York State shall also apply with regard to services
					 provided by out-of-state providers located in cities where the city's
					 population census is 500,000 or greater based on the U.S. Department of
					 Commerce United States Census Bureau; and
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.36 - Hospital physician billing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) With the exception of hospitals
					 designated under the Medicare program as meeting the criteria set forth in
					 section 1861(b)(7) of the Federal Social Security Act, for discharges occurring
					 on and after February 1, 2010, hospitals may bill for physician services in
					 accordance with the applicable Medicaid physician fee schedule in addition to
					 billing the applicable DRG.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.37 - Readmissions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For discharges
					 occurring on and after July 1, 2010, Medicaid rates of payment to hospitals
					 that have an excess number of readmissions as defined in accordance with the
					 criteria set forth in subdivision (c) of this section, as determined by a risk
					 adjusted comparison of the actual and expected number of readmissions in a
					 hospital as described by subdivision (d) of this section, shall be reduced in
					 accordance with subdivision (e) of this section.
(b)
Definitions.
For purposes applicable to this section the following
						terms shall be defined as follows:
(1)
Potentially preventable readmission (PPR)
shall mean a
					 readmission to a hospital that follows a prior discharge from a hospital within
					 14 days, and that is clinically-related to the prior hospital
					 admission.
(2)
Hospital
shall mean a general hospital as defined pursuant to
					 section 2801  of the Public Health Law.
(3)
Observed rate of
					 readmission
shall mean the number of admissions in each hospital that
					 were actually followed by at least one PPR divided by the total number of
					 admissions.
(4)
Expected
					 rate of readmission
shall mean a risk adjusted rate for each hospital
					 that accounts for the severity of illness, APR-DRG, and age of patients at the
					 time of discharge preceding the readmission.
(5)
Excess rate of
					 readmission
shall mean the difference between the observed rates of
					 potentially preventable readmissions and the expected rate of potentially
					 preventable readmissions for each hospital.
(6)
Behavioral health
shall
					 mean an admission that includes a primary or secondary diagnosis of a major
					 mental health related condition, including, but not limited to, chemical
					 dependency and substance abuse.
(7)
Managed care encounter data
shall mean claims-like data that
					 describes services provided by managed care plans to their enrollees.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.38 - Transition pool for 2010-2013 period

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Subject to the availability of Federal
					 financial participation, the commissioner may, for rate periods effective on
					 and after October 20, 2010, increase inpatient Medicaid fee-for-service rates
					 subject to this Subpart for the following periods and in the following amounts:
(1) for the period October 20, 2010 through
					 March 31, 2011, up to $37,500,000;
(2) for the period April 1, 2011 through
					 March 31, 2012, up to $75,000,000;
(3) for the period April 1, 2012 through
					 March 31, 2013, up to $50,000,000;
(4) for the period April 1, 2013 through
					 March 31, 2014, up to $25,000,000.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.40 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.41 - Hospital quality contribution

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the period July 1, 2011 through March
					 31, 2012 a quality contribution shall be imposed on the inpatient revenue of
					 each general hospital that is received for the provision of inpatient
					 obstetrical patient care services in an amount equal to 2.4 percent of such
					 revenue, as defined in section 2807-d (3)(a)  of the
					 Public Health Law.
(b) For the
					 period on and after April 1, 2012, a quality contribution shall be imposed on
					 the inpatient revenue of each general hospital that is received for the
					 provision of inpatient obstetrical patient care services in an amount equal to
					 1.6 percent of such revenue, as defined in section 2807-d (3)(a)  of the
					 Public Health Law.
(c) For the
					 purposes of computing revenue subject to this section, inpatient obstetrical
					 patient care services shall also include services related to the care of
					 newborns, but shall exclude neonatal intensive care services.
(d) The funds collected pursuant to this
					 section shall be subject to and administered in accordance with the provisions
					 of section 2807-d-1  of the Public Health
					 Law.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.42 - Potentially preventable negative outcomes

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Effective for discharges occurring on or
					 after July 1, 2011, payments pursuant to this Subpart shall be denied with
					 regard to the following potentially preventable negative outcomes if they are
					 acquired during a patient's inpatient stay at the hospital seeking such
					 payments:
(1) A foreign object retained
					 within a patient's body after surgery.
(2) The development of an air embolism within
					 a patient's body.
(3) A patient
					 blood transfusion with incompatible blood.
(4) A patient's development of stage III or
					 stage IV pressure ulcers.
(5)
					 Patient injuries resulting from accidental falls and other trauma, including,
					 but not limited to:
(i) fractures;
(ii) dislocations;
(iii) intracranial injuries;
(iv) crushing injuries;
(v) burns;
(vi) electric shock.
(6) A patient's manifestations of poor
					 glycemic control, including, but not limited to:
(i) diabetic ketoacidosis;
(ii) nonketotic hyperosmolarcoma;
(iii) hypoglycemiccoma;
(iv) secondary diabetes with
					 ketoacidosis;
(v) secondary
					 diabetes with hyperosmolarity.
(7) A patient's development of a
					 catheter-associated urinary tract infection.
(8) A patient's development of a vascular
					 catheter-associated infection.
(9)
					 A patient's development of a surgical site infection following:
(i) a coronary artery bypass
					 graft""mediastinitis;
(ii)
					 bariatric surgery, including, but not limited to, laparoscopic gastric bypass,
					 gastroenterostomy, and laparoscopic gastric restrictive surgery; or
(iii) orthopedic procedures, including, but
					 not limited to, such procedures performed on the spine, neck, shoulder and
					 elbow.
(10) A patient's
					 development of deep vein thrombosis or a pulmonary embolism in connection with
					 a total knee replacement or a hip replacement, excluding pediatric patients,
					 defined as patients under 18 years of age, and also excluding obstetric
					 patients, defined as patients with at least one primary or secondary diagnosis
					 code that includes an indication of pregnancy.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.43 - Certified home health care agency ceilings

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Effective for services provided on and
					 after April 1, 2011 through March 31, 2012, Medicaid payments for certified
					 home health care agencies (agencies), except for such services provided to
					 children under 18 years of age, shall reflect ceiling limitations determined in
					 accordance with this section. Ceilings for each agency shall be based on a
					 blend of:
(1) the agency's 2009 average per
					 patient Medicaid claim, weighted at 51 percent; and
(2) the 2009 statewide average per patient
					 Medicaid claim for all agencies, as adjusted by the regional wage index factor
					 and by each agency's patient case mix index, and weighted at 49
					 percent.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.44 - Episodic payments for certified home health agency services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Effective for
					 services provided on and after May 2, 2012, Medicaid payments for certified
					 home health care agencies (CHHA), except for such services provided to children
					 under 18 years of age and except for services provided to a special needs
					 population of medically complex and fragile children, adolescents and young
					 disabled adults by a CHHA operating under a pilot program approved by the
					 department, shall be based on payment amounts calculated for 60-day episodes of
					 care.
(b) An initial statewide
					 episodic base price, to be effective May 2, 2012, will be calculated based on
					 paid Medicaid claims, as determined by the department, for services provided by
					 all certified home health agencies in New York State during the base period of
					 January 1, 2009 through December 31,2009.
(1)
					 Such base price shall be calculated by grouping all Medicaid paid CHHA claims
					 for dates of services in 2009 into 60 day episodes of care. All such 2009
					 episodes which include dates of service beginning in November or December of
					 2008 or ending in January or February of 2010 shall be included in such base
					 price calculation. Low utilization episodes of care, as defined in subdivision
					 (d) of this section, shall be excluded from such calculation. With regard to
					 high utilization episodes of care, costs in excess of outlier thresholds, as
					 determined in accordance with subdivision (e) of this section, shall be
					 excluded from such calculation. The resulting base price shall be subject to
					 such further adjustment as is required to comply with the aggregate savings
					 mandated by paragraph (b) of subdivision (13) of section 3614  of the Public Health Law
					 (PHL).
(2) The episodic base price
					 for periods beginning on or after April 1, 2013, may be based on paid Medicaid
					 claims for services provided by all certified home health agencies during a
					 base year period subsequent to 2009, as determined by the department.
(3) The applicable base year for determining
					 the base price shall be updated not less frequently than every three
					 years.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.45 - Reimbursement for language assistance services in hospital inpatient settings

Current through Register Vol. 46, No. 28, July 10, 2024
For hospital inpatient services, in addition to the
						inpatient rates of payment computed in accordance with this Subpart, a
						separately billable rate of payment shall be available for providing language
						assistance services, if applicable, in accordance with the following:
(a) A discrete rate of payment for language
					 interpretation services provided to patients with limited English proficiency
					 (LEP) and communication services provided for patients who are deaf and hard of
					 hearing will be established as follows:
(1)
					 Payment will be established on a per unit basis with the unit of payment
					 determined based on the number of minutes of language assistance service
					 provided.
(2) A maximum of two
					 billable units of language assistance services will be allowable per patient
					 per day with the billable units defined as follows:
i) 1st billable unit - for encounters
					 providing up to and including the first 22 minutes of language assistance
					 service.
ii) 2nd billable unit -
					 for encounters providing additional minutes (23+) beyond the initial 22 minutes
					 of language assistance services during the given patient
					 day.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.47 - Hospital indigent care pool payments

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Effective for periods on and after
					 January 1, 2013, payments pursuant to subdivision 5-d of section 2807-k  of the Public Health Law shall be
					 made in accordance with the provisions of this section.
(1) Funds reserved in the Financial
					 Assistance Compliance Pool ("FACP") pursuant to § 2807-k(5-d)(b)(iv) of the
					 Public Health Law for the calendar years 2014 through 2022 shall be distributed
					 to hospitals which demonstrate substantial compliance, as determined by the
					 Commissioner, with the provisions of § 2807-k(9-a) of the Public Health Law
					 (the "financial assistance law" or "FAL").
(2) Hospitals which are determined to be in
					 substantial FAL compliance by the end of each calendar year shall receive the
					 following year's FACP funds as soon as practical in such year, in accordance
					 with subdivision (b) of this section.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.50 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.51 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.52 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.53 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.54 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.55 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.56 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.57 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.58 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.59 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.60 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.61 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.62 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.63 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.64 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.65 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.66 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.67 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.68 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.70 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.71 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.72 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.73 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.74 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.75 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.80 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.81 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.82 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.83 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.84 - Repealed

Current through Register Vol. 46, No. 28, July 10, 2024