N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-1.17

Current through Register Vol. 46, No. 50, December 11, 2024

Section 86-1.17 - Exclusion of outlier and transfer costs

(a) In calculating rates pursuant to this Subpart, high-cost outlier costs from hospitals with ancillary and routine charges schedules shall be excluded from the statewide base price and shall equal 100 percent of the excess costs above the high cost outlier threshold which shall be developed using acute Medicaid operating costs derived from the base period used to calculate the statewide base price. The Medicaid discharges to be applied to the high-cost outlier thresholds shall be those that occurred in the base period used to calculate the statewide base price.

(b) In calculating rates pursuant to this Subpart, transfer case costs shall be excluded from the statewide base price by excluding the transfer discharges that occurred in the base period used to calculate the statewide base price, except for those transfer cases that are assigned to a DRG specifically identified as a DRG for transferred patients only.

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-1.17

Amended, New York State Register, Volume XXXVI, Issue 27, effective 7/9/2014

Audit of state rates of payment to providers of health care services, Social Services Law § 368-c.