1/4/12 N.Y. St. Reg. HLT-39-11-00019-A
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of Subpart 86-8 of Title 10 NYCRR.
Statutory authority:
Public Health Law, section 2807(2-a)(e)
Subject:
July 2011 Ambulatory Patient Groups (APGs) Payment Methodology.
Purpose:
To refine the APG payment methodology.
Substance of final rule:
The amendments to Part 86 of Title 10 (Health) NYCRR are required to update the Ambulatory Patient Groups (APGs) methodology, implemented on December 1, 2008, which governs reimbursement for certain ambulatory care fee-for-service (FFS) Medicaid services. APGs group procedures and medical visits that share similar characteristics and resource utilization patterns so as to pay for services based on relative intensity.
The proposed amendment to section 86-8.2 of Title 10 (Health) NYCRR removes subdivision (r), which defined ambulatory surgery permissible procedures.
86-8.7 – APGs and relative weights
The proposed revision to section 86-8.7 of Title 10 (Health) NYCRR repeals all of section 86-8.7 effective July 1, 2011 and replaces it with a new section 86-8.7 that includes revised APG weights, procedure-based weights, and APG fee schedule fees.
86-8.9 Diagnostic coding and rate computation
The proposed revisions to section 86-8.9 of Title 10 (Health) NYCRR removes subdivision (c), which references ambulatory surgery permissible procedures. Additionally, a new subdivision (c) is added to allow for a reduction of reimbursement for drugs purchased through the 340B drug benefit program. Subdivision (d) is amended to add APG 451 Smoking Cessation Treatment.
86-8.10 Exclusions from payment
The proposed revisions to section 86-8.10 of Title 10 (Health) NYCRR amends subdivision (h) to add APG 465 Class XIII Combined Chemotherapy and Pharmacotherapy and subdivision (i) to add APG 490 Incidental to Medical, Significant Procedure or Therapy Visit to the if stand alone do not pay list.
Final rule as compared with last published rule:
Nonsubstantial changes were made in section 86-8.10(i).
Text of rule and any required statements and analyses may be obtained from:
Katherine Ceroalo, DOH, Bureau of House Counsel, Regulatory Affairs Unit, Room 2438, ESP, Tower Building, Albany, NY 12237, (518) 473-7488, email:
regsqna@health.state.ny.usRevised Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement
Changes made to the last published rule do not necessitate revision to the previously published RIS, RFA, RAFA and JIS.
Assessment of Public Comment
We have reviewed the comments dated November 14, 2011 from the NYC DOHMH relative to the APG regulatory revision (HLT-39-11-00019-P) and we concur that the smoking cessation APG should be a payable stand alone APG. We will revise the regulation and the policy manual accordingly. Specifically, we will add to the policy manual a section that states that tobacco cessation is billable for all Medicaid enrollees. We thank NYC DOHMH for bringing this issue to our attention.
