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 86-1.39 - Inpatient psychiatric services

Current through Register Vol. 46, No. 28, July 10, 2024
Inpatient psychiatric services provided in general
						hospitals, or distinct units of general hospitals, specializing in such
						inpatient psychiatric services, with regard to patients admitted on and after
						October 20, 2010, shall be reimbursed on a per diem basis in accordance with
						the following, provided, however, that such rates applicable to inpatients
						otherwise subject to the provisions of Public Health Law section
						2807-c(1) (a-2)(i) shall
						be effective with regard to patients admitted on and after January 1,
						2011:
(a) Such reimbursement shall be
					 based on the All Patient Refined Diagnostic Related Group (APR-DRG) patient
					 classification system as defined in section
					 86-1.15(a) 
					 of this Subpart.
(b) The operating
					 component of the rate shall be based on a statewide price, utilizing 2005
					 Medicaid fee-for-service (FFS) inpatient costs adjusted for case mix and the
					 wage equalization factor (WEF) and excluding costs for direct GME,
					 electroconvulsive therapy, and capital costs.
(c) The capital cost components of rates
					 computed pursuant to this section shall be computed on the basis of budgeted
					 capital costs allocated to the hospital, or to the distinct unit of a hospital,
					 in accordance with the provisions of section
					 86-1.25 
					 of this Subpart divided by the hospital or distinct unit patient days and
					 reconciled to actual total expenses.
(d) The non-operating component of the rate
					 shall reflect 2005 Medicaid fee-for-service direct GME costs.
(e) The statewide price shall be adjusted for
					 each patient to reflect the following factors:
(1) a service intensity weight (SIW)
					 associated with the case based on the grouper assigned APR-DRG, as described in
					 subdivision (f) of this section, will be applied to the adjusted operating per
					 diem;
(2) a rural adjustment factor
					 of 1.2309 will be applied to the operating per diem for those hospitals
					 designated as rural hospitals. For dates of service beginning on or after July
					 1, 2014, rural designation shall apply to hospitals located in an upstate
					 region, as defined in subdivision (o) of this section, with population
					 densities of 225 persons or fewer per square mile, based on the New York State
					 2010 Vital Statistics table of estimated population, land area, and population
					 density;
(3) an age adjustment
					 payment factor of 1.0872 will be applied to the per diem operating component
					 for adolescents ages 17 and under;
(4) a payment adjustment factor of 1.0599
					 will be applied to the operating component for the presence of a mental
					 retardation diagnosis;
(5) the
					 payment methodology shall include one co-morbidity factor per stay and if more
					 than one co-morbidity is presented, the co-morbidity that reflects the highest
					 payment factor shall be used to adjust the per diem operating
					 component;
(6) a variable payment
					 factor will be applied to the operating per diem for each day of the stay, with
					 the factor for days 1 through 4 established at 1.2, the factor for days 5
					 through 11 established at 1.0, the factor for days 12 through 22 established at
					 0.96 and the factor for stays longer than 22 days established at 0.92;
					 and
(7) for dates of service
					 beginning on or after July 1, 2014, a ten percent increase will be applied for
					 hospitals located in an upstate region, as defined in subdivision (o) of this
					 section.