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 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.40 - Computation of case-based rates of payment for licensed free-standing ambulatory surgery centers and hospital-based ambulatory surgery services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Medicaid
					 reimbursement for ambulatory surgery services provided by licensed
					 free-standing ambulatory surgical centers and hospital-based ambulatory surgery
					 services shall be based upon a single payment schedule with a discrete price
					 for each of the separate groupings of surgical procedures set forth in this
					 section.
(b) Reimbursement for
					 ambulatory surgery services shall be based upon the Products of Ambulatory
					 Surgery (PAS) classification system as defined in subdivision (o) of this
					 section. A base price shall be established for each of the payment groups
					 defined in the PAS classification. All procedures within the same payment group
					 shall be reimbursed at a single discrete price.
(c) Each base price shall be adjusted by a
					 wage equalization factor and a space occupancy factor to reflect regional
					 differences in the price of labor and space. The wage equalization factor shall
					 be applied to the operating room and preoperative and postoperative nursing
					 personnel salary components of each base price.
(d) Prices established pursuant to
					 subdivision (b) of this section shall provide full reimbursement for
					 applicable:
(1) nursing services, technician
					 services, and other related professional expenses directly incurred by the
					 licensed facility;
(2) drugs,
					 biologicals, surgical dressings, supplies, splints, appliances and equipment
					 directly related to the provision of the surgical procedures;
(3) diagnostic or therapeutic items and
					 services directly related to the provision of surgical procedures;
(4) materials for anesthesia;
(5) prosthetic and orthotic appliances
					 provided during or integral to an ambulatory surgery procedure;
(6) administrative, personnel, business
					 office, data processing, recordkeeping, housekeeping and other related facility
					 overhead expenses; and
(7) space
					 occupancy and plant overhead costs.
(8) costs associated with graduate medical
					 education programs involved in the provision of ambulatory surgery services;
					 and
(9) costs associated with
					 hospital-based physicians, defined as salaried physicians excluding interns and
					 residents engaged in direct provision of ambulatory surgical services can be
					 included in a facility's payment rates upon appeal to the Department of Health.
					 Such adjustments will be limited to the current schedule of surgical fees, as
					 set forth in section
					 7.0 of the Medicaid Management
					 Information System Provider Manual, Physicians (revised January, 1985). Copies
					 of the Physicians Manual schedules may be obtained from the Department of
					 Social Services, and are available for inspection and copying at the Department
					 of Health Records Access Office, as indicated in subdivision (h) of this
					 section.