Comparing APG to 7 Tier

As of December 1, 2008 fee for service Medicaid reimbursement to Designated AIDS Centers will be based on Ambulatory Patient Groups (APG) rates. Except for Therapeutic Visits for case management, 7 Tier rates will no longer be available for fee for service Medicaid outpatient care.

In this first year of APGs the formula for reimbursement is 25% of the State regional (Downstate or Upstate) outpatient APG rate and 75% of the hospital blended clinic rate plus hospital capital. The  State published APG regional rates for outpatient care are: $276.38 Downstate and $219.69 Upstate. The rates are posted here on the State’s web site. I have posted a spreadsheet example of a 7 Tier Routine visit for an AIDS patient using APG rates for NewYork-Presbyterian Hospital.

Click here for the spreadsheet example >>>   7tier-example

Note that the blended rate and capital allowance are selected from the State published hospital rate list here.

I offer this document for illustrative purposes only. Please verify the financial assumptions with your fiscal advisors to ensure validity.

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