Section 86-8.8 - Base rates

Section 86-8.8 Base rates

Base rates shall be developed by the Department for each category of providers set forth in subdivision (a) of section 86-8.1 of this Subpart, in accordance with the following:

(a) Separate base rates for each category of provider shall be established based on the location of such providers in the Upstate Region or the Downstate Region and such base rates shall reflect differing regional cost factors as determined by the Department.

(b) Additional discrete base rates may be developed by the Department for such peer groups as may be established by regulation in this Subpart. Such base rates shall include a MR/DD/TBI peer group for hospital clinics for periods commencing on and after July 1, 2010 and a MR/DD/TBI peer group for free-standing clinics which may be established for rate periods commencing on or after January 1, 2011.

(c) Such base rates shall be established based on estimated historical per visit payment amounts, as adjusted to reflect the level of State appropriations made available for such purposes. Such adjustments shall be calculated on a per visit basis, utilizing the same historical visit volume used to calculate the estimated per visit payment amounts.

(d) Such base rates shall be peer group specific and shall reflect the estimated case mix index for each peer group and any projected changes in provider coding patterns for each peer group.

(e) Such base rates may be periodically adjusted to reflect changes in provider coding patterns and case mix.

(f) For hospital clinics operating under a mental hygiene law license and instituting utilization of the APG reimbursement methodology, the applicable blend rate calculation shall be determined on a licensure-specific and provider-specific basis and shall be based on the most recent 12 month period for which accurate and complete billing information exists, as determined by the commissioner of the mental hygiene law agency having jurisdiction over that class of provider. Such clinics shall have the blend rate otherwise computed and applied on the same schedule as applies to public health law article 28 licensed hospital clinics pursuant to paragraph (a) of subdivision 2-a of section 2807 of the public health law.

Effective Date: 
Wednesday, January 5, 2011
Doc Status: 
Complete