N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-8.6

Current through Register Vol. 46, No. 51, December 18, 2024

Section 86-8.6 - Rates for new facilities during the transition period

(a) General hospital outpatient clinics which commence operation after December 31, 2007 and prior to January 1, 2012, and for which rates computed pursuant to Public Health Law section 2807(2) are not available shall have the capital cost component of their rates based on a budget as submitted by the facility and as approved by the department and shall have the operating component of their rates computed in accordance with the following:

(1) for the period December 1, 2008 through November 30, 2009, 75 percent of such rates shall reflect the historical 2007 average payment per visit as calculated by the department, and 25 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(2) for the period December 1, 2009 through December 31, 2010, 50 percent of such rates shall reflect the historical 2007 average payment per visit as calculated by the department, and 50 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(3) for the period January 1, 2011 through December 31, 2011, 25 percent of such rates shall reflect the historical 2007 average payment per visit as calculated by the department, and 75 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(4) for periods on and after January 1, 2012, 100 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(5) for the purposes of this subdivision, the historical 2007 regional average payment per visit shall mean the result of dividing the total facility specific Medicaid reimbursement paid for general hospital outpatient clinic claims paid in the 2007 calendar year in the applicable upstate or downstate region for all rate codes reflected in the APG rate-setting methodology except those specifically excluded pursuant to section 86-8.10 of this Subpart, divided by the total visits on claims paid under such rate codes.

(b) Diagnostic and treatment centers which commence operation after December 31, 2007 and prior to January 1, 2012, and for which rates computed pursuant to Public Health Law section 2807(2) are not available shall have the capital cost component of their rates based on a budget as submitted by the facility and as approved by the department and shall have the operating cost component of their rates computed in accordance with the following:

(1) for the period September 1, 2009 through November 30, 2009, 75 percent of such rates shall reflect the historical 2007 regional average peer group payment per visit as calculated by the department, and 25 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(2) for the period December 1, 2009 through December 31, 2010, 50 percent of such rates shall reflect the historical 2007 regional average peer group payment per visit as calculated by the department, and 50 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(3) for the period January 1, 2011 through December 31, 2011, 25 percent of such rates shall reflect the historical 2007 regional average peer group payment per visit as calculated by the department, and 75 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(4) for periods on and after January 1, 2012, 100% of such rates shall reflect APG rates as computed in accordance with this Subpart;

(5) for the purposes of this subdivision, the historical 2007 regional average peer group payment per visit shall mean the result of dividing the total facility specific Medicaid reimbursement paid for diagnostic and treatment center claims for each peer group, as defined in section 86-4.13 of this Part, paid in the 2007 calendar year in the applicable upstate or downstate region for all rate codes reflected in the APG rate-setting methodology except those specifically excluded pursuant to section 86-8.10 of this Subpart, divided by the total visits on claims paid under such rate codes.

(c) Free-standing ambulatory surgery centers which commence operation after December 31, 2007 and prior to January 1, 2012, and for which rates computed pursuant to Public Health Law section 2807(2) are not available shall have the capital cost component of their rates computed in accordance with section 86-8.4(c) of this Subpart and shall have the operating cost component of their rates computed in accordance with the following:

(1) for the period September 1, 2009 through November 30, 2009, 75 percent of such rates shall reflect the historical 2007 regional average payment per visit as calculated by the department, and 25 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(2) for the period December 1, 2009 through December 31, 2010, 50 percent of such rates shall reflect the historical 2007 regional average payment per visit as calculated by the department, and 50 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(3) for the period January 1, 2011 through December 31, 2011, 25 percent of such rates shall reflect the historical 2007 regional average payment per visit as calculated by the department, and 75 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(4) for periods on and after January 1, 2012, 100 percent of such rates shall reflect APG rates as computed in accordance with this Subpart;

(5) for the purposes of this subdivision, the historical 2007 regional average payment per visit shall mean the result of dividing the total facility specific Medicaid reimbursement paid for free-standing ambulatory surgery centers claims paid in the 2007 calendar year in the applicable upstate or downstate region for all rate codes reflected in the APG rate-setting methodology except those specifically excluded pursuant to section 86-8.10 of this Subpart, divided by the total visits on claims paid under such rate codes.

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-8.6