N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-8.4 - Capital cost reimbursement and rate add-ons

(a) A capital cost component shall be added to Medicaid payments made pursuant to this Subpart and computed in accordance with the following:

(1) the computation of the capital cost component for payments for general hospital outpatient and emergency services shall remain subject to otherwise applicable statutory provisions as set forth in subparagraphs (i) and (ii) of paragraph (g) of subdivision 2 of section 2807 of the Public Health Law;

(2) the computation of the capital cost component for payments for diagnostic and treatment center services shall remain subject to otherwise applicable statutory provisions as set forth in paragraph (b) of subdivision 2 of section 2807 of the Public Health Law;

(3) the computation of the capital cost component for payments for ambulatory surgery services provided by hospital-based and free-standing ambulatory surgery centers shall be the result of dividing the total amount of capital cost reimbursement paid to such facilities pursuant to section 86-4.40 of this Part for the 2005 calendar year for the upstate region and for the downstate region and then dividing each such regional total amount by the total number of claims paid pursuant to section 86-4.40 of this Part within each such region for the 2005 calendar year.

(b) For dates of service occurring on or after April 1, 2020 through December 31, 2020, and each calendar year thereafter, an upper payment limit (UPL) payment per visit shall be added to emergency department rates (hereinafter, add-ons). Such add-ons shall only apply to public general hospitals or public health systems, other than those operated by the state of New York or the state university of New York, located in a city having a population of 1,000,000 or more and shall be in lieu of any aggregate UPL payments. Such add-ons shall be calculated for each hospital by dividing the hospital"TMs latest approved UPL demonstration payment by its Medicaid fee-for-service emergency department visits, as reported in its most recently submitted institutional cost report. Each hospital"TMs add-ons shall be subject to and contingent upon the terms of a binding memorandum of understanding executed between the Department of Health and the public general hospital or public health system receiving an add-on, and shall be subject to termination or adjustment based on the terms of that agreement. The total amount paid for the add-on shall be included in the applicable annual UPL demonstration. If the annual UPL demonstration yields an amount that is more or less than the aggregate amount paid for the add-on, the add-on shall be adjusted to reflect the demonstration amount.

Notes

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-8.4