HLT-09-10-00007-A Ambulatory Patient Groups (APGs) Methodology
6/2/10 N.Y. St. Reg. HLT-09-10-00007-A
NEW YORK STATE REGISTER
VOLUME XXXII, ISSUE 22
June 02, 2010
RULE MAKING ACTIVITIES
DEPARTMENT OF HEALTH
NOTICE OF ADOPTION
I.D No. HLT-09-10-00007-A
Filing No. 539
Filing Date. May. 18, 2010
Effective Date. Jun. 02, 2010
Ambulatory Patient Groups (APGs) Methodology
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:
Ambulatory Patient Groups (APGs) Methodology.
Purpose:
Modifies existing APG transition provisions for new providers and the listing of APG reimbursable & non-reimbursable services.
Text or summary was published
in the March 3, 2010 issue of the Register, I.D. No. HLT-09-10-00007-P.
Final rule as compared with last published rule:
No changes.
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.us
Revised Regulatory Impact Statement
Statutory Authority:
Authority for the promulgation of these regulations is contained in section 2807(2-a)(e) of the Public Health Law, section 79(u) of part C of chapter 58 of the laws of 2008 and section 129(l) of part C of chapter 58 of the laws of 2009, which authorizes the Commissioner of Health to adopt and amend rules and regulations, subject to the approval of the State Director of the Budget, establishing an Ambulatory Patient Groups methodology for determining Medicaid rates of payment for diagnostic and treatment center services, free-standing ambulatory surgery services and general hospital outpatient clinics, emergency departments and ambulatory surgery services.
Further, part C of Chapter 58 of the laws of 2009, amended Public Health Law section 2807(2-a). Amendments pertinent to these proposed regulations include: (1) section 14 of part C of chapter 58 of the laws of 2009 alters the schedule under which providers' reimbursement transitions fully to APG reimbursement (2) section 15 of part C of chapter 58 of the laws of 2009 provides authority for the commissioner of health to promulgate regulations establishing alternative payment methodologies, or utilize existing payment methodologies, when the APG methodology is not, or is not yet, appropriate or practical for specified services; and (3) sections 27 and 16-a of part C of chapter 58 of the laws of 2009 provides authority for APG reimbursement of cardiac rehabilitation services and for the commissioner of health to promulgate regulations establishing alternative payment methodologies for certain psychotherapy services.
Legislative Objective:
The Legislature's mandate is to convert, where appropriate, Medicaid reimbursement of ambulatory care services to a system that pays differential amounts based on the resources required for each patient visit, as determined through APGs.
Needs and Benefits:
The proposed regulations are in conformance with statutory amendments to provisions of Public Health Law section 2807(2-a), which mandated implementation of a new ambulatory care reimbursement methodology based on APGs. This reimbursement methodology provides greater reimbursement for high intensity services and relatively less reimbursement for low intensity services. It also allows for greater payment homogeneity for comparable services across all ambulatory care settings (i.e., Outpatient Department, Ambulatory Surgery, Emergency Department, and Diagnostic and Treatment Centers). By linking payments to the specific array of services rendered, APGs will make Medicaid reimbursement more transparent. APGs provide strong fiscal incentives for health care providers to improve the quality of, and access to, preventive and primary care services.
COSTS
Costs for the Implementation of, and Continuing Compliance with this Regulation to the Regulated Entity:
There will be no additional costs to providers as a result of these amendments.
Costs to Local Governments:
There will be no additional costs to local governments as a result of these amendments.
Costs to State Governments:
There will be no additional costs to NYS as a result of these amendments. All expenditures under this regulation are fully budgeted in the SFY 09/10 enacted budget.
Costs to the Department of Health:
There will be no additional costs to the Department of Health as a result of these amendments.
Local Government Mandates:
There are no local government mandates.
Paperwork:
There is no additional paperwork required of providers as a result of these amendments.
Duplication:
This regulation does not duplicate other state or federal regulations.
Alternatives:
These regulations are in conformance with Public Health Law section 2807(2-a). Alternatives would require statutory amendments.
Federal Standards:
This amendment does not exceed any minimum standards of the federal government for the same or similar subject areas.
Compliance Schedule:
The proposed amendment will become effective upon publication of a Notice of Adoption in the New York State Register.
